Wow Squared

Finally I have figured out the elusive equation that defines personal happiness (at least for this week).
It follows that happiness equals:

Weekly Happiness = Children's Happiness (N^7) x (7-[n2+n3])days/week x WOW^2

WOW^2: Wow squared represents what I uttered out-loud today as I clicked on that final result from my electronic medical record (being an MD has its percs) and seeing the number 38 staring back at me. (20 is normal.) This is the lowest that my Kappa light chains have been in recorded history, Wow................Wow!
For those interested in the treatment of amyloidsosis this resulted from the conversation I had last month with Dr. Schrier. Revlimid had stopped making a noticeable difference, therefore Velcade (or Bortezomib) was added (not replaced.) The Kaiser Cancer Clinic now gives the weekly Velcade dose subcutaneously as opposed to intravenous. This is reported to decrease the side effect of neuropathy. This may be true as my neuropathy has only slightly worsened, (above my usual baseline of tingling toes,) after 4 doses. Unfortunately, it also causes skin reactions at the injection site. The first was the worst, however since then I have asked the nurse to inject with the full needle perpendicular to the skin to bury the dose as deep as possible. The last three have had much less of a reaction. I got very sick from Velcade two years ago, but haven't had that reaction this time. I am now off my Revlimid for a month, but will continue weekly Velcade and dexamethasone. I will repeat the Kappa level in 4 weeks. If it remains low, bye bye, Revlimid. Does a lower kappa chain level indicate I will live longer and prosper? Fascinating question; no answer. Hopefully.

All of our children are happy this week. 2 daughters-in-law both got great jobs this week to support their twin husbands as they begin graduate school (deja vu all over again). Son-in-law loving school supported by my daughter as she starts her career in her dream job. (As seen on TV) Youngest daughter voraciously attacking her first semester of college with aplomb, while being wooed by a very nice and overly eligible young man. I once heard a wise man say that a parent is only as happy as their saddest child. In this case the inverse remains true while the contra positive paradoxically is not. (at least not relevant). Furthermore, the increase does not occur linearly, rather exponentially. Children's happiness N (number of children)^7.

Some days the drugs steal my joy for a little while; usually 2 days after the dexamethasone for 2 days. Hence the (7-[n2+n3]) giving 5 goods days a week.

All in all this represents a whole boatload of happiness. I am going to bottle up some of it and share it with others. This is clearly too much to keep for myself.

Kevin

P.S. I just noticed that it is 12:01 A.M., Happy Birthday, Rebecca.

Random Thoughts

A view from our front porch


I love my job, no, really, I do! I have been known to employ sarcasm on occasion; and limited only to verbal communication bereft of vocal intonation; I do love my job. Mostly I enjoy sitting down with patients and helping them through their problems. To answer the question that I was asked so often, I am a better doctor after being a patient. But I wouldn't recommend that other physicians employ this self-improvement method for themselves. I listen better. I always give hope and occasionally I share my own experience with them, but only when I feel that it will help my patient to be more at ease. I don't compare. I don't want to become the 'Me Monster'. The day goes by so fast and it is already 5:00 P.M. and time to ride my scooter home.

I think that riding a scooter is just as cool as riding a Harley. My helmet goes oh so well with my Oxford shirt, tie and Sperry Topsiders.

The sunset was amazing tonight. I rode past my neighbors, Jennifer and Frank, and decided to stop to have her come out and watch. A minute later a very wet and very naked 18 month old boy runs out, escaping his evening shower. She was embarrassed but I reassured her that, as a urologist, I am professionally trained to deal with these situations. I didn't charge her, however, for the exam. I continued to ride to the top of the hill where there is a 360 degree view for 100 miles both East and West. As the sun set over the Coastal Range on the west side of the San Joaquin Valley the cloud colors became vibrant and illuminated. To the East the rising moon was surrounded by clouds of orange, pink and magenta. (if I knew girly names of colors, I would use them too.) The warm dry air served to invite the local fauna as this happy traveler arrived home with bugs in his teeth.

Barbie started school on Monday and is very stressed. She, through divine providence, was able to add Microbiology only to have her professor's stern warning not to take anatomy concurrently. Asi es la vida, que va hacer. I have complete faith in her that she will succeed; veni vidi vici.

My low white count last week was quite effectively treated by Dr Sardar as he gave me Neupogen, which I self-injected for three days, to bring my count back up to 6,200 from 800.

Another bit of good news, my light chain level this cycle came back at 124 mg/l (or 12.4 mg/dl). It is now at 33% of what I started at prior to the Revlimid, Cytoxan abd Decadron. All in all, it has been a good day.

Tomorrow we discuss Web 2.0

Kevin

Ups and downs

Sometimes health updates, albeit not very absorbing reading, can be helpful to some who just might experience the same outcome from a specific treatment. I imagine the number of people in the world that have primary amyloidosis, then a heart transplant, then a bone marrow transplant and then Revlimid are very few. However, that is the major impetus for me to write. Where else can they find this information?
One of the side effects of Revlimid is that it can decrease your white blood cell count and your platelets. Paradoxically, it actually raises my red cell count. My white cell count on Monday was 0.8 K or 800 cells; that is really low (Normal 3.4 K to 11.8K) My percentage neutrophils dropped to 49% so my total neutrophil count is now 400. During my bone marrow transplant they wouldn't let me leave my room even with a mask until I was above 500. I went to work the last two days. I did, however, every once in a while where a paper mask and I washed my hands frequently. Even before this drop I was quite concerned with swine flu. I still am. Ironically, concurrently with this severe immunosuppression I caught a cold. My oncologist, Dr Sardar added Zithromax, a potent antibiotic, to my antiviral medications. I am well covered.
Last week in San Diego, if I were to have given myself a health score I would have been 94 on Tuesday morning (even with a broken rib) and then dropped to 62 for 45 minute on Tuesday afternoon. By Wednesday because of steroids and being at Disneyland on my birthday, I was back up to 91. I haven't been this high in two years. It may seem like a roller-coaster ride and it was; Space Mountain, Splash Mountain, Thunder Mountain, California Screamin' and Indiana Jones. I had my ups and downs and loved every one of them.

Kevin