Waiting, Back-to-Back Biopisies, and More fun with the Central Line

Yesterday was a looong day.

I had to track down the PA in the morning to find out if they really wanted me to do the vertebroplasty or not. He said they did so I hurried over to my fine needle aspiration appointment (where they were supposed to do both procedures) and signed in. Over an hour and a half later a nurse came out and brought me to a room and said the doctor wanted to talk to me. The doctor it turns out really did not see the urgency in doing the vertebroplasty. He reviewed the previous scans and said I am at risk for a compression fracture, but there was no urgency to do a procedure that would require conscious sedation and recovery. Fine by me since I had two other appointments that afternoon.

After that it still took another hour and half for them to get me on the CT table for the fine needle aspiration. I arrived at 12 for my 12:30 appointment and they weren't ready for me until 3pm. So by the time they got started on the fine needle aspiration I was already 45 minutes late for the bone marrow biopsy. Luckily they were waiting for me by the time I got there at about 4.

After that I headed over to the infusion clinic (an hour and a half late) for my first dose of melphalan . Melphalan is a chemo drug that is a derivative of mustard gas. It attaches itself to DNA and prevents DNA replication in rapidly dividing cells (like cancer cells). It was to be just a "baby dose" so not many side effects were expected.

After the uneventful infusion the nurse was to change the dressing on my central line. The line was thankfully feeling a bit better and the weird sensation subsided, but the adhesive from the dressing was really irritating my skin. The new one felt a little better at first, then it started to get really irritated too.

Later before bed I noticed that the stitches were poking through the film covering it. This wasn't good because it's really important to keep this thing clean and dry and a break like that could let bacteria in. So I covered the whole thing with a sheath they had given me (in lieu of Press'n Seal, which actually works pretty well!) to protect it overnight. I headed in this morning for my daily blood draw and asked them to change it again. She noticed how irritated my skin was and used a different type of cover, but this one is super itchy now too. So I guess I'll have to see if they have any other ones to try.

After that we were free for the day. We checked out the house and it seems like a good deal. It's nothing fancy but well kept and in a nice quiet neighborhood. It's much better than the current place. It has two bedrooms, which will be important when other caretakers are here with me. The owner is really nice and flexible so I think we will go for it at least through the transplants.

Tomorrow will be another long day, I'll get two more biopsies and start SIX new drugs. Altogether they are referred to as DT-PACE, Dexamethasone, Thalidomide, cis-Platin, Adriamycin, Cyclophosamide, and Etoposide.

Dexamethasone is a steroid that targets myleoma cells. Thalidomide has various anticancer properties related to modulating the immune system, but the mechanisms aren't really understood. Interestingly thalidomide was first used to treat morning sickness in woman in the late 50's and was responsible for causing thousands of cases of severe and devastating birth defects. Since that time several other legitimate uses have been found including myeloma treatment. It's very highly regulated. Somehow though the pharmacy still managed to give me another patients prescription for it today...different dosage and dosing instructions! I didn't notice until I was unpacking it when we got home. OOPS! It had a sticker price of over $3K. I hope the poor guy didn't need it today. I have a feeling someone at the pharmacy is going to be in BIG trouble when I bring this to their attention. The Dex and Thal are oral meds, they the other 4 ( cis-platin, adriamycin, cyclophosphamide, and etoposide) are given as an infusion over 4 days so I get the pleasure of getting my "chemo bag" tomorrow. I'm not holding out much hope it will be a stylish accessory. ;p This lovely 4 drug combo consists of more traditional chemo drugs that target the DNA replication process (like melphalan) to prevent replication of cancer cells.

Altogether these drugs aren't expected to make me feel too great, so the next week will probably be a bit rough. We're pretty well settled in now so I think we're ready to bring out the big guns for 4 days. Wish us luck!