A journey in life - musings of a doctor, husband, dad, grandad, brother, and friend

Sorry for late entry.  The chemotherapy last week was just a 'grind' -- I saw patients all last week but just tired and the injections in the abdomen... well, it's getting old.  But, again, a lot to be thankful for!  On Monday last week (April 24) my ANC (absolute white count) was 480.  For those who know, this means my white count to fight infection was very low.  Our great staff reminded me to "mask up" (with my glasses) on for those folks who have respiratory infections. A disappointment last week was the fact that (Jan and) I had to bail on going this past weekend (4/28-30) to Las Vegas for the research meeting with PPRNet (Primary care Practice Research Network)*.  Was hoping to catch a meal and a show with Jan on Saturday night before heading back on Sunday.  Sometimes, you gotta listen to that quiet voice of wisdom (a.k.a the Holy Spirit) when loved ones expressed concern over the travel.  Well, after prayer, I listed.  T...

Just like when a snowstorm is impending, I find myself trying to prepare.  This time for a week of chemotherapy.  Trying to make sure the office 'stuff' is taken care of (finishing up charts, signing off other charts, reviewing results, etc.).  I had a GI bug over the weekend (not as bad a Jan got it) but this has taken the 'wind out my sails' a little bit.  I have an almost full schedule (except the early start time since I will be in Winchester).  My prayer is that I will do as well as last time... Our church (Riverton UMC) is starting a series, "The Case for Christ" by Lee Strobel.  This is a somewhat autobiographical story of a journalist, Lee Strobel, who when he started, was a atheist. Now as a Christian, he has laid out his investigation and the credible evidence that Jesus, is the Son of God.  Jan and I have taught from his student edition before but it will be interesting to see how the entire church responds to the book and the teachings....

Sorry for the late entry for April 7. Today was a check in with the oncologist, Nick Gemma, to see how I was doing and repeat the CBC. He was encouraged that the counts actually were up with the CBC and suggested this 'could be' a good prognostic sign indicating a response to the azacitidine! PRAISE GOD.  Jan was there.  All of this is encouraging and good to hear since we had planned on leaving to go the HH, SC for a few days with 2 of our grandkids and Aaron our son.  Still tired so I plan on not doing too much but probably will be cruising on the bikes with the kids and lounging on the beach.  Still have the bruised abdomen from the chemo shots but I figure anyone who looks will just have to deal with it! Had an opportunity to share with Nick Gemma about witnessing to patients and praying with them. It was a productive time of sharing...

Fatigue has hit new lows -- I tell folks that my 'tires are deflated' but that is probably an understatement.  I received my last dose of chemo and what follows is some information for those who want to know... I have decided that the areas left after my chemo shots is more like an itchy, red, painful swollen wasp sting.  As Jan says, it looks like my arms and abdomen were part of a paint ball fight! I inquired about the cost of the AZACITIDINE (I get 150mg in two shots) ... Each two shot day is $2100 or $10500 per cycle...Insurance will pick up some of this - we'll have to see :-( ===========Here is some info on how azacitidine works for those interested========= Azacitidine is a member of a new class of drugs known as DNA "demethylating" agents.  Methylation of DNA is a major mechanism that regulates gene expression in cells.  When there is an increase in DNA methylation this can result in the blockage of the activity of "suppressor genes" ...

The first course of azacitidine is almost done.  One more day left (Friday) and then a month's break! Getting 2 shots (150mg total) in the subcutaneous tissue each day.  They've been pretty accommodating at the cancer center.  I realize that they don't mix up the chemo beforehand since if the patient doesn't show, they're out a lot of money since this therapy is expensive.  But... wouldn't it be nice to just come in, get the injection and go?   The first set of injections were in my arms and that last 3 were in my abdomen.  It's, I guess, a blessing that I have not been active and exercising (from the fatigue).  As a result, I have a little more 'insulation' over my abdomen! I looked at my abdomen after the shower and you would've thought I was getting vaccinated for rabies with the old vaccine (equine serum) which were delivered to the abdomen in a series which was not very pleasant at all!  However, the injections take about 3 min...

Jan and I are (pleasantly) overcome with the blessings and prayers all of you have bestowed on me and my family.  Thanks so much. I now have patients praying with me FOR ME!  A friend and patient gave me a book of bible quotes today and prayed with me!  An internal medicine physician (and a friend) - called from southern Virginia to offer prayers and mentioned he would bring my name up to his prayer group and still uses the bible I gave to him when he entered medical school! Given all  you all  have done for us, the chemo is a breeze.  The injections are subcutaneous with local reactions and some nausea but all controllable.  I told my chemo nurse as she was getting ready for today's abdominal subQ injections (in front of my fellow POD chemo patients) that she was going to ruin my belly dancing gig I had this PM.  She laughed.  Laughter is the best medicine sometimes!

Checked into the cancer center this AM for my chemo with the prerequisite lab work.  Counts are about the same and platelets holding steady at 94,000.  We'll see when the nadir (expected lowest counts) comes in about 2 weeks. All the staff are very nice.  I believe I threw the nurse a 'curve ball' by telling her I remember Dr Gemma telling use the azacitidine was to be IV.  She gave it subcutaneously - in each arm.   All of this took about 1 hour and 20 minutes which I count as being the NKOB (new kid on the block). Very tired today and just slightly nauseated (predosed with Ondansetron - aka Zofran) but not enough to slap on the transdermal patch they gave me (Sancuso - granisetron).  I came to the office late, but had, thankfully, a relatively light day. Can't wait to get home a kick my feet up. Had occasion to see the friends and family responses on FaceBook and this site.  What a blessing my family and I have to have such folks looking ...

[This is a little longer so I encourage to you to click on the "Read More"] Today, after prayer, and thanks to those who've prayed before this day, I revealed my diagnosis at church when my pastor, Marc, at Riverton UMC asked me to speak after I went forward for prayer. What follows is paraphrased: "... First I speak through the grace of GOD and Jesus Christ, my savior.  I want to thank all of those who've privately prayed for my family and I to this point.  I am coming 'out of the closet' (in a good way) regarding the diagnosis of... MYELODYSPLASIA*, a low grade cancer of the bone marrow [which I found out I had on Thursday]... I beseech that you pray for my family and I as I enter into this trial before me.  I also ask you pray for those may come to know our Lord, Jesus Christ, as a result of this trial...Thank you." *Read March 23 for more details on Myelodysplasia I realize now the release of not having to keep this among my family...

Sat down with (Dr) Nick Gemma with Jan this afternoon.  The results show: Myelodysplasia - this beats a lot of other possibilities -  More info on Myelodysplasia So... this is a low grade cancer of the bone marrow.  It isn't multiple myeloma, leukemia or lymphoma. Fortunately, the genetic markers done (during the bone marrow) are all without deletions, monosomies, trisomies and so I have a favorable prognosis.  I do have the following genetic marker: IDH2 p.Arg172Lys Course of treatment - initially chemotherapy -  Azacitidine  IV (for now) - 5 days in a row for one week of each month - we will see how this works. After a time, we'll get another bone marrow biopsy to see how it has helped (or not).  Nick Gemma thinks it may help my fatigue (and decreased exercise performance!) by allowing the normal cell lines to make a come back (red cells [primarily], white cells, platelets.  I start this coming Monday, March 27!  Pray...

Actually not too different which is good: WBC 2,300 - absolute neutrophil count 780 H/H - 11.5/33.2 (which is a little improved) Platelets at 87,000 (a little less but not critical) Still tired but have tried to give my normal bone marrow cell lines adequate building blocks (while not eating as much 'junk food') - iron, B12, folate and MVTs This may have helped to maintain my H/H (hemoglobin/hematocrit).  Still have the macrocytic indices with an MCV of 109 and MCH of 37.8 with moderate ovalocytes (this is on the red cell line - they are very large compared to most people). Got the stationary bike - over 300 lbs in the box - so I will break down the contents and move the pieces from my medical office to my home and try to put together over the weekend.  In the meantime, will try to enjoy March Madness and hope the Duke Blue Devils will continue 'peaking' in their performance.