Marker: Year Two

June 26, 2008.

I was ready early today. At 7:26 AM, I turned on the ignition of my minivan –it had served me well this past two years. Today is the last day that I will be receiving Rituxan, a monoclonal antibody that my doctors prescribed for me. This is a 4-hour intravenous infusion, and I am taking it at Johns Hopkins’ Outpatient Oncology unit as I had for the past year.

I memorized my 28-mile route to Baltimore by heart: Interstate 95 North, Exit 53, right at Conway, left at Light Street, right at Pratt, left at Broadway. Go straight on Broadway, crossing Lombard, E Baltimore, Fairmount, Fayette and Orleans streets, turn right into Weiberg Building main entrance and into the basement parking lot. The building houses the Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Hospital.

I had been into this for a long time I can also memorize the preliminary procedures: Take the elevator to first floor, scan orange ID card, take computer printout of schedule. Go to phlebotomy, scan orange ID again (computer says, “Thank You, Ana F. Please be seated.”). Read magazines, listen to Ipod, stare at people or twiddle fingers while waiting for name to be called. Enter Phlebotomy room once name is called, weight is taken, sit in one of the chairs. ID verification (“Please tell me your name and date of birth…”), give computer printout of schedule to phlebotomist. Vital signs taken, noted down on printout. Phlebotomist double checks the orders, prepares the tubes, prepares the labels and needles. “Roll up your sleeves,” or “Take off your jacket,” phlebotomist says. He or she ties tourniquet, finds a good vein, slap arm lightly (will the vein really come out when it is hit this way, I wonder?). He/she alcohol swabs the selected site, sticks the needle (Ouch!) (double Ouch! If he/she cannot get the vein at first shot), withdraws blood specimen then labels the tubes in my presence.

Ah, well…. I had agreed to participate in this phase 2 clinical trial to join in the search for the elusive cure for multiple myeloma. The protocol consist of infusion of a high dose chemotherapy (Cytoxan) infused 4 days in a row, and Rituxan given once a week for 4 weeks, every three months for one year. Today is the last day, so a quick look back is needed. It would be a pity if this whitewater experience is not recorded – no one else will be able to help me recall them when I am old and forgetful!

So, every three months, before I was given Rituxan infusions, I was evaluated on three areas: hematology & blood chemistries, 24-hour urine, and bone marrow aspiration for biopsy. The lab results will determine whether I will receive Rituxan. There is always a little bit of drama whenever I am due to submit those three specimen: around twenty tubes of blood each between 5-10 cc each, 3 liters of urine to be collected for 24 hours, and (sigh!) bone marrow aspiration.

On this last month’s evaluation and before I started this last series, my oncologist told me that my counts were “stable,” and had not increased, yet had not been completely rid of, either. The hematology and blood chemistries were normal, the 24 hr urine does not show any protein in them, the free light chain assay shows a 13.78 kappa/lambda ratio (the normal should be .26 to 1.65) and the bone marrow examination shows “5-10% plasma cells.” The diagnosis from my bone marrow biopsy was: Residual Plasma Cell Myeloma.

The pathological fracture on my right femur is still not healed, though. As I have mentioned in a previous post, the IM (intramedullary) rod they placed last July 2006 broke (as X-ray of April 2007 indicated.) Therefore, the fracture had twisted, causing pain and swelling on the surrounding tissues, and length discrepancy (one and a half inches) on my right leg. The diagnosis: Pathological Fracture Non-Union, Right Femur, Subtrochanteric, secondary (due) to Multiple Myeloma.

I feel fine, though. Like my colleague diagnosed with prostate cancer but feels fine said, “I am only sick on paper.”

And what is next? No, I am not done with my trips to Hopkins in Baltimore yet. I will still have periodic evaluations, and then decisions will be made according to the results. I guess hospital trips like this has become a part of my life. Right now there are several clinical trials being done in different centers in the US and Europe for multiple myeloma, and researchers say that there are drugs and combinations that hold promise.

Maybe I shall take a different route just to mark off another phase in my treatments. For the meantime, the journey had been runs and rapids for me. Right now I am on a ‘run,’ gliding in calm, peaceful, slow current. However, I have learned that on this journey there is no place for whining nor complacency. Up ahead and around the next bend could be whitewater, yet I need not be scared. The same Power that had been my Guide through the storms will still be with me.

Meanwhile, I will glide along and enjoy this ride.

“What lies behind us and what lies before us are tiny matters compared to what lies within us.” -Ralph Waldo Emerson (1803-1882)