Good Blood, Bad Blood

In the mountains, in the heart of winter, an antiseptic stillness penetrates the landscape. Many of my solitary walks in December and January were steeped in silence, the crunch of my shoes on road grit the only sound.

By mid-February though, a clatter of orchard ladders mixed with the beat of mariachi music breaks the monotony. Pruning crews strip the orchards of debris. On my strolls I now observe the rowdy awakening of spring. Robins conduct mid-air courtships erupting spontaneously in a frenzy of squawks and lost feathers, coupling and darting through a tangle of trimmed pear branches.

Meanwhile, I’m practicing letting go of expectations. My yoga teacher reminds me about this at each session. She’s referring to the postures, of course, but the advice colors other facets of my life. I try to look at it like I do the weather: just take what comes.

Oregon weather tutors me well in that regard. Last Wednesday, I noticed a green tinge to the dormant grasses in the pasture. Thursday morning, four inches of white velvet snow draped the shoulders of Bald Butte and the lap of the valley.

Accordingly, I drove our Subaru to town for my doctor appointment. This was to be a 60,000-mile check-up following the stem cell transplant. It’s been exactly six months since we flushed out my radiator, so to speak. The consult could easily have been anticipated out of proportion to its significance, a challenge to my “no expectations” discipline. So, on the drive into town, I held close the advice of a favorite blogger, Nancy. She says, “one of the great things about having cancer is you don’t have to worry about getting cancer.”

Thursday marked the fifth visit with Dr. M. He’s easy to like, especially since he keeps delivering good news. We’ll see if my thinking changes when the myeloma begins leaking out of the marrow.

Seriously, though, his style appeals to me. He operates from the theory that “less is more.” Some docs recommend aggressive treatment post-transplant, regardless of the outcome. Dr. M. keeps it simple. He charts the general characteristics of my blood, along with a couple of specific markers. But, rather than track down and kill every last bit of the malignancy, he recommends waiting.

For my myeloma friends, here are the facts.

My complete blood count (CBC) and General Chemistry labs show no problems.

My Serum Free Light Chain ratio (Kappa/Lambda) is 2.25 mg/dl, up from 2.07 in January, but still making the doc smile. Beta 2 Microglobulin is 1.6 mg/L. That, paired with albumin at 4.2 g/dl, translates to a Stage 1 diagnosis.

Dr. M. is not a big fan of biopsies to further scrutinize the marrow population. Nor does he bother with additional M-Spike measurements. He believes the light chain ratio has more sensitivity and, therefore, validity. In all my research, I’ve never heard this opinion so ardently promoted. Given that, along with the minor up tick in the light chain number, we can now watch the action. In mid-April, at my next appointment, we’ll look for a drop to offset this movement.

Overall, this confirms a great response to the transplant. The myeloma still sticks out like a tiny wart on the serum free light chain assay. Yet, given my numbers are much improved from fourteen months ago, I’d say the picture is prettier. Stage 1 is associated with a median survival of 62 months, the same old five-year prognosis I heard back in December of 07. Theoretically, the malignant cells evolve and become resistant to treatment and remission periods decrease with attempts to eliminate them. These clever little suckers evidently adapt in response to each initiative.

Dr. M. and I both accept the myeloma will return but he’s so cheery about its current state, not to mention options for future treatment, I can’t help but get caught up in his enthusiasm. He’s obviously not attached to any expectations. This frees him (and me) to enjoy the moment.