Last week I wrote a pair of posts about the good news I received from my myeloma specialist, Dr. Melissa Alsina, at my quarterly appointment. She described my myeloma as “stable disease.” Velcade and dexamethasone alone are–thus far–able to keep my myeloma in check without adding Revlimid. But living with myeloma is a lot more than M-spikes and chemistry. What about my bone and hip pain?
My PET scan results from the previous week were good. The only concern was a potential hot-spot above my painful right hip. But there had been so much previous damage there, the radiologist and Dr. Alsina felt that could be what’s causing the area to light-up.
Here is what the supervising radiologist and nuclear medicine specialist, Dr. Claudia Berman, had to say:
A destructive occipital skull lesion is slightly improved. Lesions involving the right iliac (anterior/superior iliac spine) and right T6 costovertebral angle have resolved.
There is less uptake in lesions involving right inferior pubic ramus, right posterior lateral 10th rib and C5. There is increased uptake in the left iliac bone. There is stable uptake in the right hip which could be related to degenerative changes.
Nonhypermetobolic subcentimeter right lung nodules are smaller or stable.
Impression: There are no new bone lesions, overall, improvement.
I’m glad Dr. Berman added that last interpretive statement. Without it, one might get the impression that I’m pretty messed-up!
Kidding aside, this is why I make the hour+ drive each way to Moffitt Cancer Center, instead of using a diagnostic center a few minutes from home. I want an experienced cancer expert looking at my films. It’s the same reason I want any orthopedic surgery (hip and/or back) done there, too.
These people specialize in cancer-related issues. No surprises; no panic if they run-into unexpected complications.
At this point, let me back up and give a play-by-play of our 30 minute visit. I think it may be instructive.
I’ve always been a “deferred gratification” kind of guy. I live for the future. I’m a planner. I like to play the odds. That’s one reason I’ve had so much trouble adapting to my diagnosis–it’s the uncertainty of it all.
But now that I’ve adjusted, I think my intellectual curiosity and willingness to work toward future goals is a good thing. This is part of what drives me to learn as much as I can about multiple myeloma and myeloma therapies. So when I discuss therapy options with my doctors, we often “talk shop.” I learn a lot. I believe it causes them to pause and possibly consider my case more carefully. That’s exactly what took place late last Thursday afternoon.
I was Dr. Alsina’s last patient. She walked into the exam room with several of her staff and collapsed into the chair across the conference table from me. I could tell Dr. Alsina was tired and it had been a tough day.
Trying to lighten the mood, I immediately began kidding around. As Dr. Herman’s report vividly pointed-out, my lesion riddled, now arthritic right hip has been getting progressively worse. Pattie and I had discussed how, if my numbers were stable, maybe it was time to consider a hip replacement. So of course I led-off my monologue with, “Good myeloma news; maybe I should celebrate by getting some elective surgery!” No reaction. So I continued undeterred. “What do you think, doc? Time for a hip replacement? Or maybe a fun kyphoplasty?”
She didn’t even crack-a-smile. “Tough room!” I mocked. Still nothing. So I focused-in on a possible hip replacement. Dr. Alsina methodically clicked a few keystrokes on the desk top computer sitting on the far edge of the small conference table. She quickly pulled-up a report from a previous MRI from a few years back. The orthopedic oncologist I saw to help evaluate some concerning new activity that had showed-up following my last PET scan, Dr. David Cheong, had made extensive notes about new and existing lesions. “No risk of fracture.” He wrote, noting the advanced stage of arthritis in my hip joint.
I remember reviewing the films with him. My hip joint looks like a moonscape; rough and scraggly. “Gnarly” as my friends out in California might say. Dr. Cheong even joked, “I’m free next Tuesday if you would like me to replace that hip.” Hmm. You don’t forget a suggestion like that…
Back to the present, I could feel Dr. Alsina engaging. “Now would be a good time to do this.” She said. “Your myeloma is stable. I would do it now.”
Don’t you just love the way that sounds! There is was again; “Your myeloma is stable.” Music to my ears!
For the moment, our conversation drifted away from my hip and moved on to the the theoretical. I will share Dr. Alsina’s thoughts about possible future therapy options–and what we decided to do about my ailing hip–tomorrow.
Until then, feel good and keep smiling! Pat