Recently, I finished my first course of chemotherapy with Dexamethasone (Decadron) and Velcade. Overall it went well, as I have mentioned, but as expected, 3 days of the week fatigue prevented me from accomplishing much. I kept wondering if this would need to go on in perpetuity. Should one trade occasional days of discomfort for a month of really feeling sick with the stem-cell transplant. And yet, I have always felt that the stem-cell transplant was inevitable, so why delay it. One reason for delay would be to give Velcade chance to lower my kappa light chain levels; yet none could tell me for how long I would need to be on these drugs. Forever?? Much of the treatment is not based on strong data from the literature, but rather, results based, such as is it working or how bad are the side-effects. Therefore, it is difficult to know when to abandon one therapy and change to another.
Tuesday I had my routine heart biopsy (it is sad when a heart biopsy is seen as routine). Which showed a good result with minimal rejection present. I also saw Dr Schrier and Witteles at Stanford and he was concerned that my kappa light chains significantly increased, despite the Velcade. Since my six month anniversary from my heart transplant will be next month, he suggested that I go ahead and schedule the stem-cell transplant. That was actually what I wanted to hear. I would like to move forward with this. However, I had asked Dr Weisshaar, my cardiologist if I could return to work in February thinking that the stem-cell transplant would be far in the future. She reluctantly agreed, but wanted me to take a gradual approach, with Barbie as the judge that I wouldn't overexert myself. But now I realize that I may have to delay my return until after the stem-cell transplant. I am a little sad about this, not just because I still feel a sense of responsibility to my patients and my colleagues, but in addition, psychologically I need to work to add some normality back to my life. However, my priorities are well placed and I will follow the counsel of my doctors. It is better to sacrifice now for something better in the future.
Barbie is going to start classes next week at Sierra College. She is taking organic chemistry and nutrition as prerequisites of dental hygiene school. So we will have a busy Winter and Spring this year. We remain constant in our hope.