Farber, Knee, and LLS

After several weeks of relative quietude on the blogging front, I have more topics to cover today.  This morning I had my monthly Farber appointment.  I hadn't bothered to look at the schedule in detail--I just knew I had to be there at 10:15.  When I got there and finally checked the appointments, I found there was good news and bad news.  The good news was that I was scheduled to meet with Dr. Richardson!  The bad news was that I was scheduled to meet with Dr. Richardson!  The good part was that I haven't seen him since May, and I was delighted to have the opportunity to talk to him again directly about my situation.  The bad part was that I knew it was going to be a long day.

While I was waiting, I met with Muriel.  My numbers this month were great!  The pathology results from last month confirmed no monoclonal gammopathy again, meaning I'm still in remission.  The bilirubin, which I was concerned about last month, dropped from 1.7 to 1.0, back in the normal range.  Muriel said that a number of patients on Rev maintenance have had similar random jumps in bilirubin with no apparent cause.  While a high bilirubin can be indicative of liver problems, none of my other liver indicators are out of line, so it may just be a spurious side effect of the Revlimid.  (Phew!  I'll drink to that.)  My neutrophil count continues to be great at 2.45, well into the normal range, despite the fact that I am taking Rev every day.  Almost everything else was in the normal range.  The only negatives were my HCT and Hgb counts, which have both dropped somewhat, which means my anemia is not getting any better.  That may explain why I still need 9-10 hours of sleep every night, and I still often nap during the day.  You know what?  It's a small price to pay for how good I've been feeling.

By the way, my knee still feels great!  I totally forgot to bring in the CDs with my Xrays and MRIs.  Damn!  Anyway, Muriel said that it was no big deal, because it won't affect any of my treatments at the Farber.  They just want them for complete records, so hopefully, I'll remember to bring them next time.  (Siri, remind me!)  However, she did strongly suggest that I take advantage of the PT prescription I got from the ortho doc.  It can only help, and after the cortisone wears off, it would be good to have built up some of the surrounding muscle.  I can't say I disagree, so maybe I'll try it out for a session or two, and maybe I can continue to do the appropriate exercises at the gym on my own. 

I'm glad I brought my computer and Kindle, so I was able to surf the Net and read while waiting for Dr. Richardson.  He finally arrived at 1:50, two hours and 50 minutes behind schedule.  I was thinking that might have set a new record for promptness, but not so.  I checked my records, but in May he was only two hours and 40 minutes behind.  It was definitely worth the wait though, as it always is. 

After his examination, Dr. Richardson's overall assessment is that I am doing great!  He also thinks that I am looking really good.  It's nice to hear these words from him, because in the past he has been very blunt when he thinks otherwise.  I left the meeting with him feeling super!  Have I ever mentioned that I am really grateful that he is my doctor?

While waiting for Richardson, I perused the DFCI internal publication, "Inside the Institute", which had an interesting article about a $6 million grant from the Leukemia and Lymphoma Society (LLS) to Dr. Irene Ghobrial, one of Richardson's colleagues, to study the biology of clonal evolution of MM to help develop drugs to prevent the progress of the malignancies.  The objective is to help find ways to prevent the progression of precursor conditions (such as MGUS and Smoldering Myeloma) to full blown MM, by finding why MM cells attack the bone marrow and what factors instigate the clonal mutations causing the malignancies.  If such an approach could successfully stymie progression from precursor MM to active MM, perhaps the same approach could also help prevent those in remission from relapsing.  I don't know, but it occurs to me that it would be a reasonable possibility.  I'm excited by this research direction, and from all I have read so far about this, I feel that in addition to the powerful new drugs becoming available, treating clonal mutation abnormalities at the molecular level will eventually lead to individualized treatment regimens and potentially a cure for MM.

I brought this subject up with Dr. Richardson, and he acknowledged that the entire Farber team is involved in this research, and it is a very promising endeavor.  Let's just hope!