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Discussion about multiple myeloma treatments, stem cell transplants, clinical trials, alternative medicines, supplements, and their benefits and side effects.

Re: K_Shash's RVD induction therapy experience

by mikeb on Fri Feb 13, 2015 11:30 am

Hi K_Shash,

Congratulations on your Monday lab results. They might not have been exactly what you wanted, but they are clearly heading in the right direction. Keep up the good work!

Mike

mikeb
Name: mikeb
Who do you know with myeloma?: self
When were you/they diagnosed?: 2009 (MGUS at that time)
Age at diagnosis: 55

Re: K_Shash's RVD induction therapy experience

by K_Shash on Wed Feb 18, 2015 12:51 pm

Thanks, MikeB. My oncologist concurred with that, too, as you can see in my weekly update below.

Week 9:

Another uneventful week after re-starting Revlimid (it was an "off" week last week and my oncologist had asked me to skip the last 2 days in the prior week, a net total of 9 days off). No rash or any new side effect. It did seem like it is taking longer to get back to my near-normal endurance. The feeling of the heaviness in the chest seems to last for 4 days after the Velcade / dex day. The soreness and occasional pain in the lower left ribs has greatly diminished and was quite likely caused by a pulled muscle.

I have to avoid any walks near trees and bushes. It took me almost 10 days to get over an allergic reaction I suffer after such walks. I often get nose bleeds and swelling inside of my nostrils after a round of golf at a specific golf course and after a walk on specific paths. The next few days would also show if the Benadryl I take on the two nights after the dex / Velcade is to blame.

I kept myself busy with some autos-related activities this week.

The main event of the week was the discussion with my oncologist in the monthly (every 4 weeks, to be exact) visit. He was not for reducing the dex dose and assured me that even though my main marker, the Kappa LCF's, came down by about 60% in the past 4 weeks compared to the near-90% drop in the prior cycle, my response to the treatment remains 'excellent' to 'very good'.

I briefly discussed my understanding of my specific case per the mSMART chart, wherein it is recommended that the "trisomies only" standard-risk myeloma patient (transplant eligible) should get the stem cells harvested for a future use. I am not quite sure now but the oncologist told me that harvesting stem cells and storing them was not an option at my HMO!! At this point, I am not in favor of a stem cell harvest after my induction and consolidation Therapy, IF I get a complete remission (CR) and may even get a near-stringent CR, I may not even opt for the stem cell harvest, based on my age and based on my personal preference. However, I was surprised at not having the option. Also, my oncologist said that there would be no need to harvest and store the stem cells since the stem cells can be harvested later, just before a transplant (ASCT) at a later date! That was news to me since I have been under the impression that one's stem cells would not be as 'healthy' at a later date; mainly due to the effects of years' of chemo (maintenance levels). I plan to raise this concern in a new topic, unless I find discussion on this subject elsewhere.

My oncologist did confirm that nothing is going to be 'quick' in my treatment and there would be a few more 4-week cycles of this induction and consolidation therapies before I can get on the maintenance therapy.

The latest blood test showed a slight improvement in my RBC's and in the HgB and HCT levels. This may be due to the 9 days off from Revlimid. Overall, I think I am managing this induction chemotherapy with the usual side effects by limiting the strenuous activities for a few days of the week and also by limiting the sugar and coffee on those days. The Revlimid rash was minor and already responding to Benadryl and my oncologist advised me to use Benadryl if the rash should reappear. Benadryl certainly has been helping me sleep on the first two nights after the dex / Velcade, too. Thanks, TracyJ.

K_Shash

K_Shash
Name: K_Shash
Who do you know with myeloma?: Self
When were you/they diagnosed?: November 2014
Age at diagnosis: 67

Re: K_Shash's RVD induction therapy experience

by Cmouli on Thu Feb 19, 2015 1:30 am

Hi,

For RBC; my dad and I believe that 1 pomegranate fruit per day has immensely helped him. These are easily available in Costco and Indian grocery stores.

Anu

Cmouli
Name: Cmouli
Who do you know with myeloma?: My father
When were you/they diagnosed?: Nov 4, 2014
Age at diagnosis: 78

Re: K_Shash's RVD induction therapy experience

by MiaM on Fri Feb 20, 2015 2:31 am

Congratulations with the results, K_Shash! Wishing you to complete your treatment soon and to be in complete remission.

I haven't been commenting on the forum since I joined after my husband's diagnosis but was reading quite a bit. Decided to comment since we are in the same area as you and have to make a decision whether to proceed with BMT or just harvest for now.

My husband completed his induction therapy this December. His bone marrow biopsy results came in couple of weeks ago stating no clear indication of myeloma cells being present! His doctor is strongly encouraging to proceed with auto BMT, or at least harvest stem cells. We've been referred to Stanford. Stanford harvests and stores the stem cells, but we are yet to figure out whether our HMO covers.

Wishing you the best of luck!

MiaM
Name: MiaM
Who do you know with myeloma?: husband
When were you/they diagnosed?: September, 2014
Age at diagnosis: 41

Re: K_Shash's RVD induction therapy experience

by K_Shash on Wed Feb 25, 2015 12:29 pm

Thanks, Cmouli. I will certainly get some pomegranates.

All the best wishes to your husband, MiaM.

I hope your HMO allows / pays for the stem cell harvest and storage. As stated in my post of a week ago, my oncologist said my HMO won't allow it. I am still trying to find out whether a later stem cell harvest is viable for a late transplant, IF and when needed. I will be 68 in April and I have a standard-risk (trisomies only) multiple myeloma. The Mayo Clinic's mSMART guidelines indicate only harvesting my stem cells for future use, even though I am transplant eligible. I have not been to enthusiastic about the stem cell harvesting procedure and I may not push my HMO to reconsider.

Update, Week 10:

Fairly uneventful week, again. I am getting anxious to get this induction therapy done and over with! I have had no major side effects, except the 'hyper' feeling for a couple of days on the day of and the day after the dex / Velcade, and the mild rash (all evidence pointing to the Revlimid) toward the end of the second 3-week 'on' cycle of Revlimid.

However, I seem to be very susceptible to allergies and develop watering eyes and a runny nose in a slight breeze. After a couple of allergy attacks that can be attributed to playing golf and walking on the sidewalks lined by trees and bushes, I am avoiding outdoor walks. An out­doors lover like me feels all 'grounded'. The grandsons have runny noses, one after the other! That has taken the weekend thrill away. Seriously though, I should stay away from them when they are sick, even if I were not on this therapy.

I have had mild itching for the last couple of days but have no rash; yet!

All the weekly blood tests were 'in line' with the re-starting Revlimid after the week 'off', the hemoglobin (HGB), hematocrit (HCT) and red blood cell counts (RBCs) all just below the "normal" range.

I am not quite sure what the drug regimen is going to be for the maintenance therapy. I sure hope I do not have to place myself under 'house arrest' for two days a week during that long-term therapy.

K_Shash

K_Shash
Name: K_Shash
Who do you know with myeloma?: Self
When were you/they diagnosed?: November 2014
Age at diagnosis: 67

Re: K_Shash's RVD induction therapy experience

by K_Shash on Thu Mar 05, 2015 9:26 am

Week 11:

Just completed the '3-weeks on' of the 3rd 4-week cycle of Revlimid. No rash this time.

Grandsons are healthy, and we spent a good amount of time with them on Friday, Saturday and watched the older one at his soccer practice. Feels like "normal" life has begun again, letting us forget all about the myeloma for while, till I have to take the chemo drugs at night.

I was out and about in our garage area and, with the slight wind last week, I picked up a nasty eyelid swelling (cyst that did not become a stye), thanks to all the trees in full bloom. Some antibiotic and warm compress finally got it to shrink after 5 days. I wonder how I am going to manage a 1-hour yard work on a riding mower. I will be using a heavy duty mask, but I may have to keep myself covered head to toe and be outdoors only if it's not windy. In the meantime, my only outdoor activity would be driving my few old cars in a 5-mile loop near the home and keeping them in a good working order. Somebody has to do it.

I have been putting it off, but I have to start using my wife's treadmill for a 20 minute 'power walk', just on Mondays and Tuesdays, and start using the exercise machine, too. Walking in the city doesn't seem to bother me, and I get long walks on Friday, Saturday, and Sunday. I cannot do any rigorous exercise on Wednesday and Thursday because of the dex on Wednesday morning, anyway.

The 'end of 3rd cycle' blood test will be on Monday and the kappa FLC's will be reported on Wednesday. I have an appointment to see my oncologist next Wednesday, and I am looking forward to a low 'normal range' reading of the kappa and hoping for no more than one more cycle of this induction treatment with the 'consolidation' cycle. I do not have a clear under­standing of what my maintenance drug regimen is going to be.

K_Shash

K_Shash
Name: K_Shash
Who do you know with myeloma?: Self
When were you/they diagnosed?: November 2014
Age at diagnosis: 67

Re: K_Shash's RVD induction therapy experience

by Betsy50 on Thu Mar 05, 2015 2:25 pm

Hello KShash,

I just like to say thank you for your active participation on the forum, because all the information that you provide for sure will help others. I’m so sorry to hear about your allergies. I can relate, because I suffered of allergies all my life so I know how it feels. I hope the doctor can help you to get a good solution because I know that it could be very aggravated, to say the least.

My best wishes for good results on your next appointment. :)

Betsy

Betsy50

Re: K_Shash's RVD induction therapy experience

by MiaM on Fri Mar 06, 2015 1:54 am

Thank you K_Shash.

We put the stem cell transplant conversation on hold. My husband is off drugs and thank G-d is doing well. He does not want to even go through harvesting at this time; wants to enjoy the normalcy of life. Doctor stated that he's a good candidate for transplant, however it's his body and his decision. He is turning 42 in April too. So all I can do is to support it.

Thank you for sharing in detail your experiences. Closer to the end of his treatment, my husband also developed a cyst on his eyelid. It went away as soon as chemo was completed. I hope yours is different case.

All the very best!
Mia

MiaM
Name: MiaM
Who do you know with myeloma?: husband
When were you/they diagnosed?: September, 2014
Age at diagnosis: 41

Re: K_Shash's RVD induction therapy experience

by K_Shash on Tue Mar 10, 2015 12:06 am

Thanks for your support and encouragement, Betsy and Mia.

My cyst is all but gone and I am not sure whether it was the 'off'' week of Revlimid, or just the passing of time or the antibiotic I applied to the cyst that caused it to shrink and disappear.

I really feel for both of you and your families (and for all the other young patients of this disease) for having to deal with multiple myeloma at a much younger age. As I have mentioned here and in other threads, I will be 68 in a couple of months and at least I do not have any dependents to provide for. Also, much as I considered myself to be a very vibrant and active person at a 'young' age of 67 while I must have had a smoldering but absolutely asymptomatic multiple myeloma, these (soon to be completed) four cycles of induction chemo have certainly made a big difference for me. Also my choices regarding any stem cell transplant and stem cell harvest have to factor in the years I want to enjoy (at my age) with a high quality of life vs. the long ordeal and the probable lasting side effects of the transplant.

Current 'chemo effect':

  1. I walked the 2-mile round trip with my wife to go fetch our grandson while in San Francisco on the last two Fridays. I had to slow down often, when I felt I was getting out of breath. I seem to manage the walk quite well at a steady and moderate pace. However, I was far more tired the rest of the day and part of Saturdays in comparison with the same time of the week when we did not take these walks during this induction chemo.
  2. I played a round of golf in almost perfect weather on Saturday, the third day after my dex and Velcade. In spite of this being an 'off' week for Revlimid, I had the feeling of heaviness in the chest and I had to stop and take deep breaths quite often. I was very tired for all of the rest of Saturday and most of Sunday, which is unusual even during this chemo. Finally today, I seem to have about average energy for a Monday in this induction chemo phase. My son and I took a cart and I hardly ever take any practice swings. This is very frustrating for someone who could play almost a round every day, walking and carrying his bag; until this chemo started. I am awed by so many active people posting how they kept up with the rigorous exercise even during the induction chemo.
Allergies:

I am also very concerned about the allergies and infections. I wear a patient's mask whenever I go to the chemo clinic for my shots or for the oncologist's appointments or for the blood tests. Every so often there is someone sick in the waiting areas. Also, I avoid going out in the yard when there is a slightest breeze. Our bushes and plum trees are in full bloom and there is pollen everywhere in the neighborhood. I do not want to take walks with a face mask on and I have been putting off some major yard work till we have a few hours of calm and warm weather. I think we will have that in the next day or two and I will certainly wear the heavy duty masks when I am doing any yard work.

Little things that help:

Following is a recap of what I have learned from others here at the Myeloma Beacon and some precautions that seem to work for me (thanks to Multibilly, MikeB, Dan from Arizona, Tracy, Dr. Santiago and many others):

  1. Insist on the air bubble in the Velcade shot. A couple of nurses in our chemo clinic did not seem to be too convinced and may have just sucked a very tiny amount of air. Now I have to make it a point to ask for 0.2 or 0.25 cc of air bubble. It sure avoided any itch or burning after the first Velcade shot without any air bubble.
  2. I have to take a full 40 mg dose of Benadryl to help me sleep for 4 or 5 hours on the night of the dex. I do not seem to need any Benadryl after that first night, unless I am suffering from any allergies.
  3. Avoid sugar and coffee on the day of and the day after dex.
  4. Take the dex with a heavy breakfast. I still feel the effects within an hour but the onset seems a lot less abrupt.
  5. Expect cramps in the fingers of your hands if you work with any hand tools (clutching them with tight grips) during the first few days of dex. I get cramps in my calves and in the toes, too. My physician wife recommended that I drink Ensure to help get more potassium.
  6. One must keep physically active (without overdoing it) just to keep the blood circulation going. I found the advice "stay with a rhythm that your body can tolerate" very helpful. Fortunately, the breathlessness I feel is very short lived. Slowing down during a walk and taking a few deep breaths seems to help.
  7. Avoid strenuous exercise on the day and on the day after dex. Your "normal" endurance level will return on the 5th -7th day of the weekly dex. Plan your physical activities accordingly.

Blood Tests:

I had my 'dnd of the 4-week cycle blood test" yesterday and all the usual HgB, RBC and CBC readings were just below 'normal'. It seems to take a couple of days before the kappa and lambda LCF's are reported. I am quite hopeful that these tests would indicate that I am in or near a complete remission (as per that indicator only, but the kappa was my main marker). And that makes all this worthwhile!

All in all these side effects are minor and though I am tired of them, I am managing a 'normal life', for all practical purposes. Considering the kind of disease we are battling, it is truly a miracle of modern medicine. I certainly want to thank the Myeloma Beacon community, once again, for all the advice and moral support that has made my life a lot easier during this treatment. One just cannot get this kind of information that makes a myeloma patient's life easier, from oncologists or from renowned myeloma experts! For example, those that my physician wife and I consulted had never even heard of the air bubble technique!!

K_Shash

K_Shash
Name: K_Shash
Who do you know with myeloma?: Self
When were you/they diagnosed?: November 2014
Age at diagnosis: 67

Re: K_Shash's RVD induction therapy experience

by mikeb on Tue Mar 10, 2015 5:20 pm

Hi again K_Shash,

Glad to hear that you're continuing to do well overall!

I've had problems with muscle cramps too. They may be related to the Revlimid you're taking, as well as – or instead of – the dex. I'm on Revlimid maintenance and still sometimes have problems with muscle cramps in my hands or legs.

There are a couple of Beacon threads related to muscle cramps that were helpful to me:

"Muscle Cramps," forum disc. started Mar 12, 2012
"Revlimid and cramps," forum disc. started Jan 20, 2013


In particular, when I have a "lock up" situation, drinking a mixture of equal parts vinegar and water unlocks things for me. It tastes horrible, but works almost instantly.

A few months ago my doctor added 500 mg magnesium xxide one time per day to my sup­ple­ments, and I think that has been a big help.

Also keeping hydrated helps a lot too.

Best wishes to you for good test results in the next few days!

Mike

mikeb
Name: mikeb
Who do you know with myeloma?: self
When were you/they diagnosed?: 2009 (MGUS at that time)
Age at diagnosis: 55

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