Category Archives: Life and death

The end of an era

I am sitting tentatively in front of my lap top opened at my blog not knowing quite where to start with a new post.   Much has happened since my last post that if I don’t make a start, my blog will be as adrift as I am!  So as in the lyrics of Do Re Mi from the Sound of Music:-

“Let’s start at the very beginning
A very good place to start”

The beginning for me is my last post, The Party’s Over.  To recap, I had just started a new more intensive treatment regime called PAD to try and reduce my light chains before having a second autologous stem cell transplant. That treatment finished on 31 August and a stem cell transplant was scheduled for 10th September.  I had pre transplant tests such as a blood tests, swabs for infection, ECG, lung function test and 24 hour urine collection (my favourite!) on 26 August and signed the consent forms. A bone marrow biopsy was arranged for the 2nd September. A couple of days after the tests, the hospital rang to say I had an infection, Parainfluenza 3 virus which had started to manifest itself that day with a sore throat and runny nose which I thought was probably just a cold.  A drug to prevent the virus from multiplying (Ritavarin) and preventative antibiotics were prescribed and for the first week I really was quite poorly.

This coincided with my last day at work on 27 August 2014.  I made the huge decision to stop working a couple of months prior having been considering it for some time. I have been fortunate to be well enough to work since my diagnosis, with a couple of months off initially and some further time off to recover from my first transplant.  My employer has been supportive enough to accommodate my time off for treatment and allow me to work flexible hours. Working has given me a decent income as well as a routine and structure to my life which is outside of the world of cancer. A connection to the “normal world”.  What it hasn’t given me, especially since relapse, is much job satisfaction, as I couldn’t manage a case load anymore for operational reasons and was assisting other colleagues with their work. There was an understanding with my employer that when I was in remission again I would have my own caseload.  However I came to realise that wouldn’t be possible because there would always be uncertainty about how long I would be in remission.  There would be periods of remission and periods of treatment or even periods of remission whilst on treatment and/or periods of no treatment or remission. It’s complicated!  I would always be struggling about whether to drag myself into work when feeling lousy, not to mention being exposed in the open plan air conditioned offices to infections. Not being a productive employee was also affecting my self esteem.

I always had in mind that I would give up work after my second transplant to spend my time doing other things or even nothing, but as that transplant has been shelved for so long whilst in remission from low dose Velcade, it dawned on me that I didn’t know if and when I would get to that point and the time was now, Carpe Diem, as they say!

“Happiness, not in another place but this place…not for another hour, but this hour.”
― Walt Whitman

I want to do things that I enjoy even though I am not sure what those things might be! Some cautioned me that I shouldn’t shut doors that didn’t need to be shut and that work gave a purpose to life other than living with myeloma. Others were concerned about whether I would be able to afford to stop working. The former rather than the latter concerned me more but I decided that working to give purpose to life was a rather conventional view of what may constitute a purpose and there were other things I could do to give meaning to my life.  Although I don’t discount the value of work as a link to the normal world, it has become increasingly difficult to be part of that. As for purpose, what does that mean? I love the quote below:-

“Cat: Where are you going?
Alice: Which way should I go?
Cat: That depends on where you are going.
Alice: I don’t know.
Cat: Then it doesn’t matter which way you go.”
― Lewis Carroll, Alice in Wonderland

I had a break from writing this post to do some work in the garden. Sometimes I go into the garden purposively to do a specific job whether it be pruning a bush, weeding a border etc. Sometimes I go as on this occasion not knowing what I will do until I do it. I cut down some dead flower stems and tidied up a border so was this my purpose without me consciously realising it? Does there have to be a purpose or as Cat says “then it doesn’t matter which way you go”.  There you are, philosophy in action!

My last day at work was quite emotional, marking the end of over 20 years of being a solicitor, and the end of that part of my life and connection with that world.  Now I just want to be! I didn’t particularly want to celebrate what was being called my  “retirement on ill health grounds”. I would not have been able to chose to give up work at the age of 53 if I didn’t have myeloma as I would like everyone else be waiting until my pension pot was big enough for me to retire. Now I don’t care about that! The next day I started feeling poorly with para influenza virus and was quite concerned as to whether I would be able to go on the trip to Verona that was planned for 4 September. I had my bone marrow biopsy on 2 September and discussed whether I was fit enough to go, coincidentally with an Italian doctor from Turin. He said I should see how I felt and that hopefully the drugs would work to contain the virus. I did turn a bit of a corner and so went with the intention of taking it easy but this is more or less impossible when in a beautiful town like Verona where there is so much to see and do. I was stressed and anxious about flying back on the 9th September and my stem cell transplant being on 10th September. I felt I had little time to prepare or pack for a possible three week spell in hospital or to recover from the virus.

Anyway I went and was glad I did despite coughing and spluttering my way round Verona and Bologna. I even went to see Aida at the famous outdoor arena which was fantastic.

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Prior to going away I had asked the transplant co-ordinator if my transplant might be put off until the 17th September to allow me more time to recover from the virus. She said they were already full for that week but that might change. When I got back on Tuesday, I went straight from the airport to the hospital for more swabs and was told that they had decided to put it off the transplant until the following week as I had tested positive for the virus before I went to Verona and they did not want me to be admitted with an infection. I was much relieved to have a little more time to recover and prepare. The next day I had my PICC line fitted and a pre arranged appointment with the transplant lead consultant to discuss the possibility of having a donor transplant after my auto transplant. What was discussed at that appointment has altered the plan once again!  I will deal with this in my next post but to give you a clue, I still haven’t had my transplant!

 

 

 

 

 

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Filed under Cancer, chemotherapy treatment, Health, Life and death, Multiple Myeloma, Myeloma, Relapse, Remission, Stem cell transplant, Travel

The Party’s Over

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At my clinic appointment on the 1st August, I found out that my kappa light chains had risen quite considerably from 54 to 195mg/litre (up to 19 is normal). So it seems that the increased dose of  Velcade that I referred to in my last post Upping the Ante had no effect.

The new,  young and pleasant doctor I saw who has replaced the lead myeloma specialist, Dr Gibbs, who sadly (probably not for him!) went back to Australia wasn’t quite sure what to do next although it was clear that I would coming off trial. He asked me to attend clinic the following Wednesday to allow him time to speak with his colleagues about the best way forward. I appreciated the fact that he did not try to hide his inexperience.

I spent a rather wet weekend staying near Penrith in Cumbria with some friends. I was pretty anxious and gloomy about what is effectively a second relapse, my anxiety and fears exacerbated by steroid withdrawal. However the gentle beauty of the Eden Valley, the moody majestic peaks of the Lakes, even in the pouring rain,  combined with the company of good friends helped take my mind off my situation.

On Wednesday I saw the same Doctor again. He suggested that I had one cycle of PAD which is a more intensive treatment regime and lasts 21 days, the aim of which would be to knock the light chains down to closer to normal range. After completion of the cycle I will have a bone marrow biopsy to assess the percentage of abnormal plasma cells in my bone marrow and if less than 10%, I will be having my second autologous stem cell transplant probably around mid to late September. The party is over!

I have had the PAD regime before, two cycles in fact during my induction treatment prior to my first transplant. It includes Velcade, a very high pulse of Dexamethasone each week and a standard chemotherapy agent called Doxurubicin.   There is the possibility that my disease has already become resistant to Velcade but it is at a much higher dose on the PAD regime and works synergistically with Doxurubicin so fingers crossed, it is a tough regime but bearable if only for one cycle.

I am now on Day 15 of the cycle and have finished the treatments in the day unit but what is left this last week is the worst for me, the dreaded steroids.   I’ve already described in my post Dexamathasone just how awful I find them.  I have been on a very low dose over the last 6 months (just 16mg a week) and found the effects minimal . The first week of this new regime I was on 160mg!!  Not so bad the days on, apart from sleepless nights, but the crash from Friday to Sunday is unbearable.

It’s not going to be a pleasant or easy next few months but at least it is a plan, the absence of which I have struggled with over the last 6 months or so.  I knew that Velcade wouldn’t last forever and that I would be having a second stem cell transplant, it was just a question of when.  I would have liked more control over the timing and to have avoided the need for further chemotherapy but it is virtually impossible to have any control over the course of this disease. I suppose I could have chosen to have had the transplant when I had reached complete remission after 5 cycles at the end of November but I decided with my consultant to continue on the trial on a lower dose and extend the cycle to a five weekly one. I guess this was a bit of an experiment for him as velcade as maintenance therapy is quite new and untested. My quality of life was pretty good and as I have learnt there is no rush to proceed to the next treatment/procedure as none of them are curative. If something is working with minimal side effects then why stop it?  The downside is living with a very stressful level of uncertainty, having to waiting for results at end of each cycle to determine if I should start another cycle but I was learning to live with it.

I started this new regime exactly 12 months to the day after starting treatment following relapse when my light chains were 6000mg/litre and I  was becoming quite ill with myeloma again. I’m in a different place now, both mentally and physically. It will also be just over three years since my first transplant on 1 September 2011. There seem to be numerous coincidences date wise in my journey with myeloma, I think they exist for all of us but perhaps they are more firmly implanted in my memory. There are significant ones that I will probably never forget such as the date of diagnosis, date of transplant, date of starting a new treatment, date of relapse as well as anniversaries of the same. And of course I have had to become fanatical about writing down on my calendar, dates and appointments for clinic and treatment, having attended hospital over 100 times this past 12 months for treatment!

I thought when I started treatment a year ago that my life would be curtailed by the effects of the treatment but after a tough first few cycles I have enjoyed pretty good quality of life. I’ve been able to carry on working, play tennis, take part in a triathlon, go on hikes and of course holidays of which there have been many!  In essence I’ve had the outward veneer of a “normal” life but beneath the surface is my cancer world, with its endless hospital appointments, tests, fatigue, stress and infections. I find it hard to integrate the two worlds, part of me doesn’t want to (and hasn’t really had to) but as I move closer towards a second transplant I don’t think I will have much choice.

I went for a lovely walk yesterday below Kinder in the Peak District, the heather on the moors was abundant and beautiful with a fragrant aroma of honey, the leaves have started to fall and the sun was mellow and low. The school holidays are coming to an end and autumn is almost here. Approaching my transplant and the next stage of my journey feels like going back to school after the summer holidays.  New uniform, new classes, teachers, a little more grown up, apprehension mingled with curiosity about what lies ahead.

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Filed under Cancer, chemotherapy treatment, Health, Life and death, Multiple Myeloma, Myeloma, Remission, Travel

Fighting Talk

This is the second post exploring “cancer cliches”, the first one being keep your chin up.  More to follow on looking well, being positive, being brave and well I could go on and no doubt will!

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When the British tennis player, Elena Baltacha died from liver cancer recently, I posted on Facebook that it was sad news but that I wished the press wouldn’t say she had lost her battle with cancer.  It seemed to strike a chord as I got quite a few comments agreeing with me. This may be controversial but I really dislike fighting talk in relation to cancer and particularly dislike hearing of people in the public eye losing their fight or battle with cancer or even beating cancer. though for some reason there is less of  the latter!  It demeans our lives if all it comes down in the end is that we lost our battle with cancer. Cancer is not like a game of tennis which you can win or lose and have some influence over depending on how well you play. I am sure that Elena Baltacha showed true grit in dealing with her diagnosis and illness but she was never going to win her battle. If I lose my battle with cancer does that mean that I’ve not fought it hard enough or that somehow I haven’t done enough to beat it, come up with the right strategy, lived the right way, had the right diet, had the right attitude etc etc ? Have I somehow failed?

Does the fact that I only got 15 months remission from my first stem cell transplant whereas some get 5 years plus mean I am not fighting it hard enough or just unlucky that my disease is more aggressive.

James Steinberg

Is cancer something I can fight against or is it just a disease following its pathological course in my body which will hopefully be abated temporarily by chemotherapy or some other treatment.  Cancer is random, recovery is random, it is not a battle, it is a disease. Does someone who has heart disease or diabetes lose their battle with it or does this just apply to cancer?   It just seems to apply to cancer maybe because it is the disease that we are all frightened of getting and probably know someone that has been affected by cancer as more than 1 in 3 people will get some form of cancer in the UK.

I appreciate that for some people fighting talk and imagery may help them deal better with their cancer but I am not at war with my body.  There have been times when feeling rotten on chemotherapy,  I have tried to console myself with the thought that at least the horrible treatment is killing off my cancer cells, imagining that I have one less bad cell to deal with.  Please note I am not talking about VISUALISATION here or invading armies!  I can’t stand that either. I also see why cancer charities use words like fight, beat, stand up to cancer etc to raise awareness and funds. They have more impact and imply that there is something we can do to beat cancer but it places too much responsibility on us which is unrealistic. Cancer will only be beaten through advancements in medical science, earlier diagnosis and awareness but not by individuals fighting their own battles. Of course the idea that somehow you can personally beat cancer leads to a whole industry of alternative remedies, therapies and diets etc etc which in my view cynically exploit desperate cancer patients.  I just looked online and here is a few examples below. There are many more.

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So I may be gritty, I may be strong, I may even be resolute at times but I am not battling or fighting my cancer and if anyone writes in my obituary that I lost my battle to myeloma, I will come back from my grave and kill them. Now that is fighting talk!

 

 

 

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Filed under Cancer, chemotherapy treatment, Health, Life and death, Multiple Myeloma, Myeloma

Not Good Not Bad

Since my last post The Best Laid Plans I had a further light chain test, the results of which were pretty similar to the previous ones.  So not good not bad, just the same. Strangely, the last few hospital lab test results are in normal range but the trial test results are slightly out of normal range and in both sets of tests there has been little movement which my consultant finds reassuring. Perhaps the blood samples don’t travel well to where they are tested in France for the trial!

So the plan now is that there isn’t one! The situation remains the same. I have started my 12th cycle of treatment today and if my test results show any further rises the chances are I will have my second stem cell transplant sooner rather than later. If not I’ll continue with treatment hopefully until around August and then I will have a transplant. I feel much calmer about this now than I did when I wrote my last post. Right now I don’t have the energy to spend on being disappointed about not being able to plan etc because I have flu and am feeling pretty drained. It is not the way I would have liked to have come to terms with my situation but there it is (ideally I would have liked to come to accept the uncertainty of my situation through the path of spiritual enlightenment but we can’t have everything we want!).

I woke up in the early hours of Tuesday morning feeling shivery and with a temperature of 38.5. Oh dear, time to read the Haematology card I carry with me. it operates as a sort of get out of jail free card if I need to go to A&E. It means I should be seen sooner as someone with a compromised immune system and preferably in a isolation room.  Even so being in A&E is a hellish experience to be avoided.

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Although I am meant to contact the 24 hour haematology helpline with a temp of 37.5 and over, I knew they would tell me to go to A&E and I couldn’t face that so I piled on the duvets until I felt warmer and slept intermittently. Having survived the night, I then rang the trial nurse, Pippa at 9am. She arranged for me to go to the Haematology day unit and said I would be reviewed by a doctor.  Five hours later I was sent home with antibiotics after being tested, swabbed, examined and X rayed. My temperature had at least gone down but I felt exhausted. Nothing conclusive but the next day, the Italian doctor I saw rang me and said I had influenza and that he would arrange for me to be prescribed Tamiflu.  Flu?  Now I felt seriously ill!  So I have been resting but not bed resting, I am not very good at that, coughing a lot and producing copious amounts of snot. The worst thing though has been the combined effect of self pity, a lot of time spent alone and severe tiredness resulting in very negative flights of fancy about flu becoming pneumonia, treatment stopping, myeloma returning with a vengeance etc etc,  you know where this is going! I must admit too feeling a little like the cat below at times!

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As I am recovering, fortunately I am regaining my sense of perspective.  I hope that as my energy returns I don’t start getting frustrated and anxious about my situation and can retain that feeling of detachment that having the flu has given me.

Ps in case you are wondering, I have had the flu jab!

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Filed under Cancer, Health, Life and death, Multiple Myeloma, Myeloma, Relapse, Remission, Stem cell transplant, Uncategorized

Why I won’t be getting run over by a bus any time soon!

How many times have I heard that I could get run over by a bus any time or other such platitudes about how none of us know when our number is up when I talk about my life shortening diagnosis.  I know it is partly because people don’t know what to say and yes it is true there is a very remote chance I could get run over by a bus…………..

About 2 in 1000000000 to be precise

I think it is far far more likely that I will die of a Myeloma related cause, in fact I would gamble my life on it!

I love this video, I don’t know why it makes me laugh so much, Jesus is being so positive and upbeat singing I will survive and then what happens…I won’t spoil the ending!

I know of 5 people between the age of 35 and 60 with Myeloma who have died recently. Three through the online myeloma community and two others in the public eye, Felix Dexter who was on the comedy show, The Real McCoy a while back and a biochemist, Professor Michael Neuberger who ironically was involved in life saving work on the immune system.

Over time I have become less affected by hearing of deaths of people I know of caused by Myeloma than I used to be.  In an oldish post In a Clod  I expressed how I felt about the death of “Outdoor Paul”. Such untimely deaths always serve to remind me that this is likely to be my fate too at some point sooner than most people of my age and whilst some will say in an attempt to blunt this fact that any of us could get run over by a bus any time, I find that cliche very annoying. I know it is meant to convey the point that although death is a certainty none of us know when it is going to happen or how but saying that takes away from the most profound effect that the knowledge of my likely early death has on my life. It degrades my experience.

Having a life shortening illness is something I have to deal with but for those don’t have their awareness of their demise in quite as much focus as I do, it is hard to talk about.  I nearly got caught out myself when I was having lunch with a myeloma mate recently and he referred to an event that would happen when he was 58 (6 years time) and then remarked that he would probably be dead by then so he wouldn’t see it happen.  I was initially shocked and the words “oh you won’t be” were nearly out of my mouth before I shut it and changed it to something like I hope you won’t be.

And I hope I won’t be too but I’ve had to adjust and accept that this might be the case. In some ways there is a liberating element to having a life shortening illness.  For example, I have

– cancelled payments into the pathetic personal pension I had

– ceased caring about how I am going to support myself financially in old age

– stopped fearing death and that I might be extremely old, out of my mind, lonely and a burden on others

– stopped shelving plans and dreams of what I am going to do when I retire, and am DOING THEM NOW, as far as possible.

Oh yes, I am living the dream (said with more than a touch of irony and a little bitterness if I am honest)!

I am pretty sure of what I am going to die of and roughly how long I have got but for those that don’t, here is another classic song from the old maestro Leonard Cohen to give you some food for thought. This post is really just an excuse to play another song by him. I am a just a little obsessed at the moment!

And who by fire, who by water,
Who in the sunshine, who in the night time,
Who by high ordeal, who by common trial,
Who in your merry merry month of may,
Who by very slow decay,
And who shall I say is calling?And who in her lonely slip, who by barbiturate,
Who in these realms of love, who by something blunt,
And who by avalanche, who by powder,
Who for his greed, who for his hunger,
And who shall I say is calling?And who by brave assent, who by accident,
Who in solitude, who in this mirror,
Who by his lady’s command, who by his own hand,
Who in mortal chains, who in power,
And who shall I say is calling?

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Filed under Cancer, Health, Life and death, Multiple Myeloma, Myeloma, Uncategorized

And on the sixth cycle …..

Velcade gave me complete remission!

I’m half way through my seventh cycle of Velcade and Dexamathasone and the time from the start of treatment in August seems to have whizzed by. In some ways I am surprised by how normal life has been. I have had an excellent response to treatment, my kappa light chains are now in normal range and I am in complete remission.  The plan is to strengthen that response with another couple of cycles followed by a stem cell transplant (from my own stem cells) and then possibly a donor stem cell transplant a few months later. I try not to think too far ahead to these procedures, as the latter especially is not without considerable risks.

I am fortunate that apart from the awful dex, (see my post, Dexamethasone, the good the bad and the ugly) the side effects of the treatment have been fairly minimal and I’ve tolerated it well without all the numerous infections and issues I had on my initial chemotherapy. Managing to work, rest and play including trips to Palma, Cornwall, London to see the ATP world tour mens tennis finals. I also went to Barcelona and Girona a couple of weeks ago where I took these photos of the sparkly Christmas decorations and the stunning Sagrada Familia by Gaudi. I was disappointed to see that it still hasn’t been finished though!  I’ve also started playing tennis again after recovering from a painful  and debilitating nerve compression problem in my neck (which I am pleased to say turned out to be nothing to do with myeloma). Oh and I’ve also started running again mostly on dex days! In fact the outward appearance of my life is so “normal” that I think people forget I am on chemotherapy!

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For the past few years this time of year has been associated with bad things happening in my life.  It was just before Christmas in December 2010 that I was diagnosed with myeloma, I described how that was in my post The Nightmare before Christmas.  And this time last year I found out that my light chains had risen out of normal range which turned out to be the start of an upward trend signifying relapse and a turbulent and stressful 2013 at times. I’m hoping this Christmas on my 7th cycle will be completely uneventful, with the only thing hanging over me caused by over indulgence!

It is three years today since I was diagnosed with myeloma  so today is a milestone of sorts. According to the most recent UK stats for survival  from Cancer Research UK  (http://www.cancerresearch.uk.org/cancer-info/cancerstats/types/myeloma/survival/multiple-myeloma-survival-statistics)

I am one of the 72.3% of women with myeloma that have survived more than a year. Will I be one of the 37.1% who survive 5 years (the five-year relative survival rates for myeloma are among the lowest of the 21 most common cancers in England) or the 14.9% that survive 10 years? Who knows?  I hope so and I know there have been further improvements in overall survival rates since this study due to the newer and better treatments but realistically there is a very strong possibility that I won’t make my 60th birthday or even my 55th.  Of course I feel sad about that but on the upside, at least I won’t have the stress of planning how to celebrate it!  However there will be the pressure of trying to make the most of the birthdays I am around for as as well as the dilemma of how to live a significantly shortened life.

The milestones like birthdays, number of years post diagnosis, stem cell transplant anniversaries etc are great but counting the milestones as simply the passage of time is meaningless. It is about how we spend the time between each milestone that matters.  I can’t very well live every day as if it is my last but want to make sure that I spend as much of my precious time as possible doing things I enjoy, being with people I love and care about and having fun.  So no pressure then! The counter balance to this is accepting the times when I am  feeling down, fatigued, ill, horrible, anti social etc etc are not a waste of my precious time and that I don’t have to do anything for the sake of “making the most of whatever life I have left”.

I love the lyrics to this song by Leonard Cohen, (A Thousand Kisses Deep). I don’t know what they mean to him but to me they sum up my experience of living with myeloma, the periods of remission, relapse and dealing with a reduced like expectancy.

The ponies run, the girls are young,
The odds are there to beat.
You win a while, and then it’s done –
Your little winning streak.
And summoned now to deal
With your invincible defeat,
You live your life as if it’s real,
A Thousand Kisses Deep.

I’m turning tricks, I’m getting fixed,
I’m back on Boogie Street.
You lose your grip, and then you slip
Into the Masterpiece.
And maybe I had miles to drive,
And promises to keep:
You ditch it all to stay alive,
A Thousand Kisses Deep.

Felices fiestas

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Filed under Cancer, chemotherapy treatment, Life and death, Multiple Myeloma, Myeloma, Relapse, Remission, Stem cell transplant, Uncategorized

A Room With A View

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“Though life is very glorious, it is difficult.”
―     E.M. Forster,     A Room with a View / Howards End

 

 

 

 

 

 

Another of my favourite books by one of my favourite authors.

The title being apt because I have had my own room with a view of sorts recently.  I took an unplanned short break for a couple of nights in the Manchester Royal Infirmary, not quite the same as Italy!  During this recent glorious spell of hot dry weather I had been feeling a little cold and shivery and was wearing warm winter clothing in the office with the window closed, very unlike me. When I came back from work on Wednesday I was exhausted and was intending to take some paracetamol and lie down but something made me take my temperature with the old velcade thermometer I had been given when I first started chemotherapy and it was 39.1, quite high then. The advice when I was on chemotherapy and after my transplant was to contact the haematology department if your temperature was over 37.5 but did that apply when not on treatment?

I wasn’t sure so I thought I would ring the out of hours haematology line at my hospital. I explained I had relapsing myeloma and my temperature was 39.1 and the person I spoke to advised me that I should go to A&E as I may need antibiotics. I anticipated that they would say that, from past experiences, having attended several times whilst on treatment.

I rang a friend who kindly gave me a lift. I wondered about packing an overnight bag but decided that I would probably be home later and it wasn’t necessary. I duly arrived and showed my haematology alert card which means that I shouldn’t be left in the main waiting area too long and within a short space of time I saw the triage nurse. My temperature had dropped to 37.9 by then and I was beginning to wonder whether I should just go home!

I was then taken to a side room in the amber area. About 3 hours later I saw a doctor who said he didn’t want to give me antibiotics yet but wanted to admit me for observation as a high temperature and fever was a sign of infection. That was about 9pm and I was left there until about 3.30am with a break for a chest xray, after which I was eventually moved to a bay on the acute medical unit. It was a truly awful experience trying to sleep on a trolley with bright lights and continual noise! When they took my temperature again at 4am it had gone back up to 38.4.

From there I was later moved again to a haematology ward after I saw my haematology consultant who said he wanted to keep me in another night for observation and give me some intravenous antibiotics.  It was a different ward to where I had my stem cell transplant but a similar set up with haematology nurses who reassuringly knew what they were doing and with what they were dealing. I was sharing a large room with another patient undergoing a stem cell transplant who was very poorly and the room had ceiling to floor windows with a view of the a car park with some grassy areas beyond it and a modern section of the hospital on the far side of the road. Certainly one of the best views to be had from a hospital bed in the MRI!

Well before I got the intravenous antibiotics, my temperature had stabilised and I felt ok but exhausted through lack of sleep for more than 24 hours. My consultant told me I couldn’t possibly start treatment with an infection in my body as it could end up being much much worse and I expressed my frustration that treatment had been delayed to the point where I had got an infection and now couldn’t start treatment. He tried to explain in a rather abrasive manner that it wasn’t vital that I started treatment straight away as my kidney function was fine and my blood counts were normal but I didn’t really take it in and just felt that my myeloma would spiral out of control untreated. After he had gone I am afraid that I just broke down and cried and cried and cried!  I felt alone and as out of control as I perceived my myeloma to be.

I calmed down a little later on in part due to a chance encounter with my former lovely consultant in the coffee bar who reassured me with far more empathy than my consultant showed, that it would be ok to delay treatment and it wouldn’t affect the outcome although I didn’t ask her what damage if any, was being caused by my rising kappa light chains now at 1032 mg/litre.

So with all the endless waiting around for tests, doctors, nurses and medication over the next 24 hours and in the absence of a working TV or a decent mobile signal, wifi or even a book I had no distractions in my room with a view.

hospital room

I watched from the chair by the window, people sitting on the grass basking in lovely sunshine, smiling, drinking, eating, being happy and going about their business, in contrast to my sterile prison like environment. I gloomily realised a view of my future, of admissions to hospital, treatments, clinic appointments, transplants, a life over which I had no control but which was shaped and determined by medics, numbers and endless blood tests. This would be the life ahead for me and I would never experience that careless abandonment of those people outside sitting on the grass. It would be a life that set me apart from my friends and peers whom I am already conscious of boring with the latest tales of my relapse and kappa light chain figures. It can only get worse in the future and I don’t want to burden my friends with that but neither can I pretend to be unaffected by it. I don’t want talk about it but I do want to talk about it. I am in danger of becoming alienated from the world my friends and peers inhabit, of planning for their future retirement, booking holidays, downsizing, celebrating their 60th birthdays and making assumptions about their futures which I cant make.

And I know my future will be about more than that and there will be good times ahead but right now I am feeling a little bleak and don’t want to or cant feel positive or “keep my chin up”. I try to live from day to day but my two days away didn’t help to keep my spirits up.

“I never think of the future – it comes soon enough.”
―     Albert Einstein

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Filed under Cancer, chemotherapy treatment, Health, Life and death, Multiple Myeloma, Myeloma, Relapse, Stem cell transplant

The test that was right that was wrong that was right

“Let everything happen to you
Beauty and terror
Just keep going
No feeling is final”
―     Rainer Maria Rilke

monet garden

When I got back from Paris a week last Friday on the Eurostar trip with my parents to see Monet’s garden, amongst my post was an odd letter from the Haematology department saying my appointment with the consultant had been cancelled and that an appointment had been arranged for Friday 17th May instead at 12pm. By the time I got the letter it was too late to ring them to say I had only just got back so it had to wait until Monday. I didn’t really worry about it but rang on Monday and spoke to the appointment secretary and explained that I had been away and unable to attend. I asked why it had been brought forward and was told something like the doctor was trying to clear down his list for 31 May when my appointment had been scheduled for.  It was rearranged for 24 May.

I duly attended, expecting to discuss the erroneous test result (see my last posts, falling off the plateau  and back on the plateau ) and perhaps to have another discussion about what treatment I might have when I do relapse bearing in mind that my kappa light chains were only 117 mg/litre, there was no immediate concerns.  I had the last appointment and when I arrived clinic was extremely busy but as I was having Zometa  (a bone strengthening treatment) as well, I went to the day unit for my bloods to be taken and my kidney function tested as usual. I had Zometa at about 3pm and still hadn’t seen my consultant but as I was leaving the day unit I bumped into him and the haematology specialist nurse as they were coming to find me. Seeing the nurse there as well made me feel slightly anxious as she doesn’t normally sit in on my appointments. We went into his consulting room and he then told me that unfortunately the first test showing the massive rise in my light chains to 617 mg/litre was in fact correct and it was the retest that was wrong. I was completely stunned. He said that both tests had been retested several times and that it was confirmed. The lab were unable to give any explanation as to how they got the retest result so wrong.

My consultant said on that basis I was now relapsing and we needed to sort out a treatment plan pretty quickly. We discussed different options but my head was in a complete spin and I couldn’t really concentrate on what he was saying. I am to ring up in a few days time to find out the result of the light chain test taken on Friday and if my kappa light chains are over 1000, I have to make an urgent appointment to see my consultant and have my kidney function tested which is a big concern and possibly start treatment straight away. If they are less than 1000 I will see him on 14 June by which time a trial may be available which might be a good option for me. So unless by some bizarre chance my light chain test this time shows a massive reduction in my light chains, I will be starting treatment very soon and all my plans of doing the triathlon in August and a couple of holidays in September will be out of the window.

After the appointment, I was in shock and disbelief.  It felt a little surreal. I debated whether to go to a friend’s 60th birthday meal that evening but I did and it was fine but that night I couldn’t sleep and the following morning I was low and tearful and was thinking of putting off my friends visit to me for the weekend that thinking that my mood would be so low I wouldn’t want to see them.  I went to my outdoor fitness session in the local park hoping that it would raise my serotonin levels but it didn’t really have that effect, instead I was worrying about whether too much exercise would be stressing my body!

My friends arrived, it was a lovely day, I told them the bad news and by the afternoon my mood had completely lifted and I was dancing to salsa music round the kitchen and the garden whilst making dinner. I am still feeling okay, after all I am in no worse position than I was when I found out that my light chains had risen to 617 on 19 April. I adjusted to that after the initial shock and disappointment, then had the elation of finding out that test was supposedly wrong, had cocktails on my birthday with friends, went to London and then Paris in a celebratory mood ( I probably wouldn’t have gone if I had known my light chains were over 600). Monet’s garden was truly beautiful (aside from the drama of my mother falling over and breaking her wrist) and Paris was well Paris, the city of light!

It is a cliché, but life at the moment is truly like being on a roller coaster!

coaster

In fact dealing with the emotional effects of having myeloma is far more challenging than the physical effects at least for me so far. It has truly been a mind blowing experience. How I can go from feeling so desperately low and alone on Saturday morning to happy and elated by late afternoon is just as strange as the recent sequence of test results.

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Filed under Cancer, chemotherapy treatment, Health, Life and death, Multiple Myeloma, Myeloma, Relapse, Remission

Falling off the plateau

It seems that I have fallen off the plateau that I had made my temporary home for the last few months before the descent into relapse.   Just as I was settling in and adjusting to my new territory,  I have yet again been reined in by my rising kappa light chains which have jumped rather dramatically from 77 mg/litre to 617 mg/litre in the space of a month.

Plateau

I didn’t stay at plateau point very long but it was great whilst it lasted!

Needless to say I was as disappointed and surprised as my consultant who arranged for me to have a retest last week to see if the jump is for real or some kind of freaky fluke.  There is an outside chance at most that there could have been a massive error in the lab testing but I am not holding my breath and I am not praying for a miracle or some such thing.

I mentioned in a previous post (Hello Relapse Goodbye Remission Part 2 The Calm after the Storm) that my consultant said as long as my light chains weren’t above 600mg/litre I could go to India. I feel so fortunate that I was able to go before the steep rise to 617 this last month.

So the plateau was short, January to April, to be precise, but I had adapted to the new phase of my disease and the fact that I was no longer in remission fairly quickly, once over the initial shock of relapse.  I was hoping that this phase might last until September, which would be two years post stem cell transplant, a respectable period of time.  I became comfortable with the new normal for me and was off again planning and booking trips, playing matches for the ladies team at my tennis club and starting a 16 week training plan for the Salford Triathlon in August.  This was on the premise that I would not be on treatment and my light chains would remain in the bracket of around 70 to 90.

And now I am back to not knowing what I can do when.  I feel like I get slapped down by my disease whenever I start taking things for granted.  Logically I know that my myeloma isn’t capable of such vindictive behaviour, it doesn’t have a personality, being just some cancer cells doing their thing, so if I get into slapping them back we are entering into battleground territory and you will see from a previous post (Hello Relapse Goodbye Remission) that I am not battling my disease.  However I do feel a little like Humpty Dumpty at the moment, getting to the top of the wall, balancing there a while, happy, and then falling off except that hopefully as I am not an egg, I can be put back together again!

Humpty_falls

I expect to be starting chemotherapy treatment soon after 20 months of being drug free since my stem cell transplant, apart from the monthly infusion of Zometa, a bone strengthening treatment. I am dreading it and my head is spinning with the various options that are on the cards. It is good that there are options, but options mean choices and I really don’t know how I am going to decide between them… but more of that another time!

This is likely to be my last post for some time with the blog subtitle “living in remission”.  Of course I am hoping to achieve remission or stable disease at some point in the future but I am conscious that the remission I have enjoyed may not be as long again. Unfortunately the law of diminishing returns usually applies to a second stem cell transplant if that is what I decide to have so that I may only get one half to two thirds of my first remission.

Whilst the past 20 months have not been easy, they have generally been good. I have been able to live life well with no health issues and no pain unlike some with Myeloma. I want to appreciate and celebrate what I have done whilst being at the top of the mountain so to speak since from my stem cell transplant on 1 September 2011 and then latterly on the plateau.  In more or less chronological order some of the highlights are:-

  • cycling along the Monsal trail in the Peak District one fine autumnal day
  • long weekends in London, Dublin and Alicante
  •  starting my blog
  • a holiday to Tenerife
  • seeing the Northern Lights and going dog sledding in Sweden
  • playing the piano again
  • a stay in Palma, Majorca
  • running the Manchester 10k
  •  a holiday to Lake Maggiore and Switzerland
  • a trip to Oxfordshire and Somerset
  • joining an outdoor fitness class
  • giving a patient experience talk at Myeloma UK info day
  • a tennis holiday in Corfu
  • a trip to Tromso, Norway to see the northern lights and go dog sledding (P)
  • seeing a wild tiger whilst on holiday in India (P)
  • playing (albeit badly )in a tennis tournament (P)
  • training for a triathlon (P) (R)
  • finally and hopefully going to Paris on Eurostar, to see Monet’s garden at Givernay (R)

Those marked P indicate done whilst plateauing

Those marked R indicate doing whilst relapsed!

Thanks to everyone that I shared some of these things with and those that supported me and encouraged me to do them.

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Filed under Cancer, Health, Life and death, Multiple Myeloma, Myeloma, Relapse, Remission, Stem cell transplant, Travel, Uncategorized

Hello Relapse Goodbye Remission Part 2 The calm after the storm

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Since I last posted a month ago with the dramatic news of my relapse in a rather angry and stormy moment, I feel so much calmer about relapsing. The storm has passed, and in its wake is a sense of rebuilding and adaptation to my new situation. I have seemingly made the transition to my impending relapse with resigned acceptance pretty much as I said I would do in my last post.  I don’t feel angry with anyone or anything anymore. In fact I have bounced back fairly quickly. Having recovered from a lingering cold and cough, I feel very fit and well and even happy.  After the initial shock and despair I have felt a strange mixture of apprehension and excitement about this new phase of my disease. I can only liken the feeling to starting school or a job or something new for the first time.

I may have been slightly distracted by my lovely holiday in Tromso, Norway, I managed to see the northern lights, went dog sledding and packed in a whole host of other winter activities too in spite of feeling below par with my cold!  The photos on this post were taken on my holiday for no particular reason other than they are lovely! I find the landscape and its muted colours very calming. I think I look calm and happy too!

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This holiday was also good for my confidence in terms of it being ok for me to go to India even though I am relapsing.  I feel reassured by my haematology consultant that nothing untoward will happen to me in India apart from a probable dose of the “squits” (his words), in which case I should drink plenty of water! In fact the couple of meetings I have had with my consultant have been very reassuring in terms of timescale and now being more regularly monitored.

The term used by my haematology specialist nurse to describe my situation is “relapsing” meaning I am no longer in remission as my kappa light chains aren’t in normal range but neither have I relapsed as I don’t need any treatment because my myeloma is not active or going to do any damage at the current levels and can go quite a lot higher before they do.

My kappa light chains have gone from 19.4mg/litre in October 2012 (just inside normal range which is 3.3 to 19.4) to 39 mg/litre in December, to 77. 5 on 9 January 2013 to 69.2 on 25 January to 89 on 15 February, my last test. My consultant has set a ceiling of 600 mg/litre for me to go to India and when they reach that level or I start feeling unwell such as anaemic, tired or bone pain I will need to start treatment. To put it in perspective, my kappa light chains were probably around 10,000 when I was first diagnosed and the amount of free light chains circulating in my body were being deposited in my kidney which couldn’t process them and caused my acute kidney failure which eventually led to the diagnosis of multiple myeloma.

The best case scenario is that I plateau around the level that they are now which whilst not normal is not causing any harm to me and so doesn’t need treatment, akin to those with smouldering myeloma or MGUS. It is a watch and wait scenario which could go on for months or even years but I think months is more realistic and years more hopeful as I have full blown myeloma.

The worse case scenario hasn’t actually happened but would have been continued steep rises in my kappa light chains from one test to the next so requiring treatment almost straightaway. I have discussed possible treatment options with my consultant for when the time comes as we need to start having those conversations sooner rather than later to be prepared. He has talked about having a further autologous stem cell transplant followed within 6 months by a “mini allo” (when the stem cells come from a donor).  This procedure was recommended to me after my transplant but I couldn’t have it because there was no suitably matched donor. Well the search has been reactivated and there is a potential 9/10 match available this time but further tests would be need to be carried out to determine the donor’s suitably. It was scary enough contemplating it last time so I don’t want to think too far ahead about that right now.  I am not ready to step back on the rollercoaster yet.  It is and always has been one day at a time since diagnosis and that is the way it has to be, but this mantra doesn’t mean I live each day as if it is my last or I feel under pressure to make the most of each day and party like there is no tomorrow.  However I am aware that this period of relapsing however long it lasts is precious whilst my health is good and I am not treatment.

So here is what I am not doing or being:-

  1. I am not being positive but I’m not being negative
  2. I am not praying as I am not religious
  3. I am not doing any affirmations or visualisations
  4. I am not going into battle with my cancer cells
  5. I am not going to worry
  6. I am not going to get my affairs in order yet
  7. I am not giving up cake!

And so I don’t sound too negative, here is what I am doing or being

  1. I am training and hoping to enter a triathlon in June/July whilst I am fit and able to (that involves 2 x swim,run and bike each week)
  2. I am getting on with my life and having fun
  3. I am going to India in one week’s time for what will be hopefully an amazing holiday
  4. Through some great online resources and contacts, I am learning as much as I can about my disease and what chemical and/or natural agents may be able to control it so I can do as much as I can to facilitate my survival and quality of life (nb this is not battling!)
  5.  I am as always trying to live in the present

नमस्ते

namastē or ha det bra!

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Filed under Cancer, Health, Life and death, Multiple Myeloma, Myeloma, Relapse, Remission, Stem cell transplant