The cancer continues to sleep. My oncologist, Dr. M., ordered blood labs of CBC, CMP, SFLCA, and SPEP. Nothing stood out, just a bunch of numbers. The myeloma is stable 17 months post transplant. I am not on any maintenance therapy. I take a multi-vitamin, 1000 mg of calcium, and a low dose aspirin each day. That’s all. I work fulltime. Simply put, I feel good… well, pretty good.
For several nights, a head cold accompanied by a scratchy throat disturbed my sleep. A low-grade fever accentuated all my age related muscular pains. The peripheral neuropathy in my feet throbbed. I thrashed about. My mind churned irrationally with anxiety about the bogeyman of multiple myeloma living in my marrow. The cancer awakened in spirit, if not in my body. What to do? Motion is my antidote for worry, so first some stretching, and then yoga, before heading out for one of my six-mile walks.
On Sunday, heavy wet snow fell most of the day. My maple trees drooped under the weight. I stayed home, rested and finished reading The Indian Clerk, a work of historical fiction about the Indian mathematical genius, Srinivasa Ramanujan. The book, by David Leavitt, culminates with the prodigy’s death. At one point during his illness, Ramanujan’s mentor, a renowned English mathematician, says, “Oh, what a sloppy science is medicine!” I laughed out loud with respect for those I know who suffer from the clumsy treatment of their blood cancer.
Monday morning the dirty residue of December’s storms lay covered in a fluffy meringue of snow. The footprints of a solitary fox pocked my driveway. Birds twittered when I appeared outdoors. I scraped clear a feeding station on the gravel and scattered their morning meal. Quail arrived from a distant thicket to inspect the offering. Juncos alighted in their midst, flicking their tail feathers as they dodged the bobble-headed game birds.
My virus had run its short course and work beckoned. I have not missed a day since returning last April. My immune system seems to have fully recovered from the stem cell transplant. As I review my treatment history, I admit the SCT was a shot in the dark that, due to nothing more exacting than luck, hit its mark. Even if I were to relapse sometime this year, the drug-free period I’ve enjoyed has been worth it.
Such is the confounding nature of myeloma. The glut of clinical trials cause as much confusion as they do clarity. Every imaginable combination of velcade, melphalan, thalidomide, revlimid, doxil, bisphosphanates, and steroids has gone to trial with positive outcomes. Arguably these drugs, which cost us four to eight grand per month, are geese laying the golden eggs for their respective pharmaceutical companies. You don’t need to be a math whiz to realize somebody is making a lot of money off of multiple myeloma. Now, if only there were a consensus of opinion as to how to treat this disease.
Instead, debates about cure vs. control and the pros and cons of transplants exist in the myeloma community. There are MM specialists on each side. All have compelling arguments, beautiful résumés, and statistics to back up their ideas. The trend, regardless of which protocol a patient chooses, leans toward myeloma evolving from an incurable cancer with a relatively short prognostic trajectory to one that may be managed for years and years. That’s good, but the choices continue to be difficult. The side effects of the chemo’s toxicity, along with the economics of insurance, add problems to the solutions.
Yes, medicine is a sloppy science, cluttered with guesswork, ego, and the taint of money. Nevertheless, it is our science. We’d like our care to be as neat as a mathematical theorem. Unfortunately, the complexity of human biology defies easy answers. Its best practitioners must be artists as well as clinicians. Alas, if only Ramanujan were alive he might write the equation for a cure: C = x + whatever. But he’s not. For now, I’ll commit only to staying active. After all, bodies in motion tend to …