Let me get this out of the way right at the outset: I am a for­tu­nate person.

It is true that I have an incurable cancer. At the time of my initial diag­nosis, I was suffering from pretty significant bone pain, especially in my ribs. And during the six months of my induction treat­ment, I dealt with some un­pleas­ant side effects, especially the crazi­ness and sleep­less­ness caused by dexamethasone ^[1] (Dec­a­dron).

I went through a stem cell transplant, which was taxing, brought on severe fa­tigue, and caused painful gastrointestinal side effects. Recovery from the transplant was slow and it was many months before I felt “normal” again.

Maintenance on Revlimid ^[2] (lenalidomide) has provided some challenges as well. Diarrhea was difficult until I happened onto the “colestipol cure ^[3],” and tiredness is always there.

There is also my ongoing war against osteonecrosis of the jaw (ONJ), which I discussed in a previous col­umn ^[4]. Although several of my friends are convinced that I really don’t have ONJ, my oral surgeon is pretty sure that I do. So I treat it with antibiotics and anti-bacterial mouth rinse.

On the other side of the ledger, though, is the important fact that I have been able to achieve stringent com­plete remission (assuming my remaining M-spike really is secondary MGUS, as my oncologist and I believe). And, despite some lingering effects from the Revlimid – primarily less-than-normal blood counts, which have a limiting effect on my already limited athletic abilities – I am really doing pretty well.

I am able to do just about whatever I want to do with only minor limitations. I still cannot lift heavy objects or weights, but I do go beyond what my ever cautious doctor thinks I should. I ride my bike long distances, slow­er than in the past, but at least I can get out there. I can play with my grandsons, work around the house and garden, and generally enjoy my still new semi-retirement.

But that does not mean that the road is always smooth.

Two months ago, my urine immunofixation tests showed measurable monoclonal proteins for the first time since my diagnosis. The proteins, however, are kappa and, at initial diagnosis, my M-spike was due to a lambda clone. So we think that this is just further evidence of secondary MGUS. Still, the doctor has ordered a 24-hour urine test to take a closer look at the situation.

I hate to complain, but the 24-hour urine test is a pain. As many of you know, not only do you have to collect an entire day’s worth of urine in a container, it also must be refrigerated. Needless to say, this is incredibly inconvenient, especially if you are not at home. There are worse things in the world, to be sure, but I am not looking forward to it.

Does this seemingly sudden decision to order a 24-hour urine test betray some doubt on the part of my doc­tor regarding the secondary MGUS diagnosis? Did I hear him correctly when he seemed to suggest that the clone can change? More to think about.

More concerning, though, is whether I may have a liver issue. A little over a year ago I noticed that my AST (aspartate aminotransferase) and ALT (alanine aminotransferase) liver enzyme levels were elevated above the normal range. When I raised this with my oncologist, he recommended that I consult with a liver expert who also worked at the teaching hospital where I was being treated for my myeloma.

The liver doctor reviewed my results and ordered some additional tests, including an ultrasound of the liver. None of these tests revealed any cause for worry. The liver function tests were all normal. So his conclusion at the time was that this was one of those things that really could not be explained, but that I should not be concerned.

A year went by and the liver enzyme levels continued to be elevated – in at least one instance very much so. When I went to the liver doctor for a follow-up appointment in mid-July, he was more concerned since there had been no reduction in the AST and ALT levels. At this point, he said that it would be prudent to do a liver biopsy. I agreed.

I am now scheduled for what is called a “transjugular liver biopsy.” As the name suggests, entry is gained through the jugular vein in the neck. A catheter is threaded down through the jugular vein and eventually into the hepatic vein in the liver. It is not entirely clear to me how this tube gets from the jugular vein to the hepatic vein, although the doctor seemed to suggest that it goes through the heart. That sounds a bit scary.

As the doctor explained to me, once the catheter reaches the liver, they then perform a series of maneuvers.

First, a balloon in inflated and deflated. This allows the doctor to check the pressure in the liver.

Next, dye is injected so that they can view the blood flow through the liver.

Finally, several tissue samples are extracted for pathological testing.

Local anesthetic and conscious sedation is used during the procedure. The entire process, including re­covery, takes between five and seven hours.

Not exactly a walk in the park.

Although it seems like it must be easier to access the liver more directly – say from the side – the doctor explained that, while the transjugular access is more invasive, it is safer. There is less chance of bleeding, and any bleeding will be back into the venous system. And there is no need to puncture the liver capsule.

Sounds comforting, but I would just as soon skip it if I could.

My point is that, despite all of the good results, there are still issues to deal with.  As Roseanne Roseannadanna said: “It’s always something – if it’s not one thing, it’s another …”

I have made a conscious choice since my diagnosis to concentrate on the positive. This from someone who, when tasked in a college creative writing class to pen an essay on my personal philosophy, wrote an epistle entitled “A Cynic’s Eye View.”

Whenever I find myself getting overly concerned, I begin singing in my head (with apologies to Lennon and McCartney): “It’s getting better all the time, better, better, better …”