When most people see the phrase “The Three R's,” they automatically think of Reading, 'Riting (writing), and 'Rithmetic (arithmetic), the foun­da­tions of a basic skills-oriented education. Or, for those who are envi­ron­men­tally con­scious, the association might be Reduce, Reuse, and Recycle.

At this stage in my life, my Three R's consist of Retirement, Remission, and Revlimid.

One might ask, what does retirement have to do with living with multiple myeloma?

For me, everything.

It was multiple myeloma that led me to retire at the end of last year at the young age of 59. I did so despite the fact that I still enjoyed my job as a school super­intendent. I had recovered completely from my autol­o­gous stem cell transplant in June of 2014. Apart from suffering the usual side effects (neuropathy, fatigue, diar­rhea) of my Revlimid ^[1] (lenalidomide) maintenance regimen, which have been made manageable by medi­ca­tion, I felt as good physically as I had felt since my diagnosis in April 2012.

What couldn't be managed by prescription was the sense that I was slipping cognitively. The fog of chemo­therapy was real, and I had little faith things would improve given that, for years to come, I would be on the very drug that had caused this decline.

I also was approaching the midpoint of the eight-year prognosis for living with this disease, which I was given at the time of my diagnosis. Simply put, if that survival estimate was accurate, I didn't want to spend the last four years of the time I had left working in one of the most demanding and stressful jobs in education.

That concern seemed to gain credibility recently when I learned of the unfortunate passing ^[2] of fellow Beacon columnist Pat Killingsworth ^[3]. Pat is the third columnist who has succumbed to multiple myeloma since I first began sharing my experiences with Beacon readers two years ago. The fact that the three of them survived on average just over seven years after diagnosis makes me wonder if I should add a fourth R – Resignation – to my Three R's.

Adding that fourth R would not mean that I have given up, or that I have a fatalistic sense of my future with multiple myeloma. Rather, it would indicate a recognition of the harsh reality that relapse is inevitable, regardless of how successful previous procedures and treatment regimens may have been.

I have been retired from my job as a school superintendent for more than a month now. While I greatly enjoy doing what I want to do when I want to do it, there are some challenges that I was unaware of.

The challenge of staying occupied has been offset by taking on part-time employment. I am now working with an organization committed to developing education and economic partnerships within our county.

Changing health insurance coverage has been more challenging. It took several phone calls and con­versa­tions to determine that Revlimid is covered by my new carrier. Revlimid is only dispensed through specialty pharmacies, and my new carrier did not work with the specialty pharmacy that I have been dealing with for the last three years. Fortunately, this too was resolved after numerous phone calls, and I was able to refill my Revlimid prescription without disrupting my treatment regimen.

The relief of being able to continue my maintenance regimen without disruption was quickly offset by the fact that the deductible for my new insurance plan is double than that of my previous plan.

It is generally accepted that stress can have a negative impact on one's health, either magnifying current symptoms or accelerating a condition. If such is the case, then I can be optimistic that my state of remission will continue. The day I walked out of my office for the last time, I felt the proverbial weight lifted off my shoulders. Family and friends all comment that I look better, appear more relaxed, and – from my family's standpoint – am far more enjoyable to be with. My new part-time position is stress free and allows me to continue working with many of the people I enjoyed working with for the last 20 years.

As many on Revlimid can attest, one of the most common side effects of the drug is diarrhea. Before retire­ment, I barely avoided numerous embarrassing incidents related to diarrhea at work. While the drug Welchol (colesevelam) has for the most part eliminated this condition, it has not done so completely. However, the fact that I now have complete control of where I need to be eliminates the stress that this con­di­tion caused.

During my time on Revlimid, I have found that the side effect of fatigue is not constant, but rather that it comes in a sudden, unexpected wave. Now I am able to walk away from whatever I am doing, rest in any manner I choose, and return to what I was doing when I feel up to it.

Like fatigue, neuropathy, another side effect of Revlimid, has not been a constant condition that I have ex­peri­enced. It comes and goes, varying from barely noticeable to moderately uncomfortable. I was pre­scribed Cymbalta (duloxetine) to treat this, but found that it was slow acting and affected me emotionally in ways I was not com­fortable with. Long, hot whirlpool baths have been my best remedy to deal with neuropathy, and being on a retirement schedule (really a non-schedule) enables me to soak the neuropathy away when needed.

In short, retirement has made the disease more manageable for me. Whether it has had any impact on my condition may be too early to determine. A good indicator may come at my next three-month checkup in early March. The results of those blood tests will determine if the faint-to-moderate sign of a monoclonal protein in my last blood test is no cause for concern, as my doctor indicated, or if I'll have to add yet another R to my Three R's – Relapse.