At the 16th Pole

The title for today's essay comes from the world of horse racing. In a one-mile race (typically once around the track), there are poles placed every 1/16th of a mile (every half furlong) which are visual indications to jockeys of how far along they are from the finish line. The last pole before the finish is the 16th pole.

In less than two weeks I'll be traveling back to Mayo Clinic to have my Day 60 check-up. Sept 27 marks 60 days since my stem-cell transplant, and Dr Buadi wants to see me then to figure out what success we've achieved in placing my cancer into remission. It's an important assessment, the results of which will go a long way in determining how best to manage my health going forward.

While the cancer was surely knocked back July 27 when I took melphalan (the poison that killed everything in my bone marrow, good cells as well as bad), the question is how far and for how long. As I have a relatively aggressive form of multiple myeloma the doctors need to keep a close eye on my markers, to be alert for its return. Both Dr Buadi (the hematologist who oversaw the transplant treatment in Rochester) and Dr Alkaied (the oncologist who oversees my treatment in Duluth) are anticipating that I'll be placed on a maintenance level of chemotherapy—because of the aggressive nature of my myeloma, how well chemo worked over the winter and spring, and how well I tolerated it. 

The tests coming up Sept 27 will determine which treatment will be selected. It might be pills; it might be infusions. While the latter is more awkward (infusions will need to be administered in a hospital or clinic on an outpatient basis, probably once every two weeks) pills can be taken anywhere. That said, I'll do whatever the doctors recommend.

Fortunately, I've been assured by Alkaied (I met with him this past Monday for the first time since June, before my trip to Mayo's) that there can be flexibility about dates. This is important to me as someone who hopes to resume his consulting/teaching career on a modified basis, and thus needs some latitude with respect to travel.

Meanwhile, the tests done Monday looked good. (I can hardly tell you how reassuring it is to watch your doctor scan the computer screen looking at your test results and saying, sotto voce, "Good" and even "Excellent." What you don't want to hear is, "Uh oh" or "Yikes!") Unfortunately, my Monday appointment with Alkaied did not allow enough time to return the most important test result: the amount of light chains in my blood and urine. In the kind of myeloma I have I was producing way too many light chain plasma cells and thus, in my case, this has been the most important indicator of the strength of the cancer. 

When I was first hospitalized in late January my light chain count was around 1600 (where 100 is considered acceptable). By the time I went to Mayo for the stem-cell transplant in July, the chemotherapy had driven that number down to under 50—proof that the chemo was working. So it was good news when Alkaied's nurse called Tuesday (I had left for Oregon by train Monday night) and told Susan that my light chain count was practically nonexistent. Whoopee!

Essentially, the test results at this stage (Day 48) could not be better. (Can you see me smiling?) Yes, it's early days and there will be more challenges ahead, but right now I'm enjoying the sun shining on my face, with the wind at my back. Today, life is pretty damn good.