Sunday, April 21, 2013

Rethinking the Battle Plan

Bortezomib is not living up to its fierce and aggressive sounding name.  I began low dose Velcade (Bortezomib) treatments in January, receiving injections every other week.  During that time my lambda light chain numbers kept going up, the kappa/lambda ratio kept going down and  the Beta 2 Micro-globulin serum continued to trend up.  

                                 01/3/13    01/31/13    03/06/13    04/10/13
Kappa Light Chain          7.83         8.25           6.09           6.71  
Lambda Light Chain      51.37        62.64          83.81       100.86
Kappa/Lambda Ratio      0.15          0.13           0.07           0.07

                                  07/05/12   10/26/12   01/31/13   04/10/13
Beta 2 Micro-globulin      2.60          2.81          3.03          3.97

The kappa light chain is staying well within the normal range of 3.3 - 19.4 mg/L.  However, the lambda light chain has moved out of the  normal range of 5.7 - 26.3 mg/L.  It crossed that threshold back in October and just keeps  moving up.  The ratio between the kappa and lambda light chains is below the normal range of 0.26-1.65 and that is not a good thing. The rise in the Beta 2 Micro-globulin is an indicator that low dose Velcade treatments are not working.  The normal range for this component is <OR=2.51 mg/L.

These latest numbers have made it necessary to begin a more aggressive treatment plan.  Beginning on April 23, I will be having Velcade injections twice a week for two weeks in a row and then have one week off. After six weeks of this regimen, we will assess where I am and if we are not making progress in reversing this upward trend,  my doctor will probably add other drugs from the multiple myeloma arsenal.  

I spent about 18 months in remission after my stem cell transplant and even though I knew the myeloma would come back some day, it seemed like that day would be a long way off.   It felt good to be living an almost normal life and I could easily tell myself that the myeloma probably wasn't coming back in the next week or the next month, so I would think, "I don't have to worry about that right now."  I felt like Scarlett O'Hara......"I'll think about it tomorrow."   Multiple myeloma returned sooner than I had hoped or imagined.

Now, I am back thinking about it a lot.  I won't say I dwell on it because I don't, but it has wormed its way back to a more prominent place in my consciousness.  It is always there ready to worry me if I let it.  Some days are harder than others to keep it at bay.  It is difficult to be back in the battle against this disease and I am having a bit of a hard time accepting it.  I know I will overcome that and be able to gather the strength of mind and body to wage this war successfully.  I'm just not quite there yet.

I would like to end on a more uplifting note and share a picture I took last week in the beautiful Skagit Valley of western Washington.   Each spring Skagit Valley hosts a Tulip Festival and tens of thousands of visitors from all over  make the trek to see the acres and acres of glorious tulips.  I am fortunate that this spectacle is just about a 30 minute drive from my home.
Skagit Valley Tulips