“Calibration” is a good engineering word. It means “to check, adjust, or determine by comparison with a standard; to make corrections in.” We use the word quite a lot in both technical and general contexts. It also seems to me to have many applications when dealing with multiple myeloma.

Let me start out with some examples of the use of the word in my work at NASA.

The mission that I am working on is flying four spacecraft in a tight for­ma­tion in order to carry out detailed scientific measurements of the magnetic field of the earth. Formation flying in space is very different from what the Blue Angels do, since spacecraft must use their fuel sparingly. It is not possible to refuel sat­el­lites, so once they use up the fuel they were launched with, their mission is over.

What we do for our mission is to fire thrusters briefly, about every month, to put the sat­el­lites on orbits that coast around each other in a good formation. These have to be very precise ma­neu­vers, and it is important for us to know how accurate they actually turn out to be. Con­sequently, after each ma­neu­ver we use tracking data to measure how far the orbits are from where we expected them to be, and produce a “Maneuver Calibration Report” that describes these results.

At NASA, we also talk about becoming calibrated to a new problem or mission. For instance, someone who is used to working on Moon lander missions, where landing can be a violent event that is difficult for a space­craft to survive, would have to make a big adjustment if they started work on a comet lander. The gravity of a comet is so low that the entire spacecraft can weigh as much as a paperclip would on Earth. The problem then is not to survive the landing, but rather not to bounce off afterwards and float away into space. The engineer has to become recalibrated to this new problem.

In a less technical application, inter-personal relationships (even engineers have to deal with these) can require careful calibration too. For instance, if Person A tells you “We have a real problem,” it would be natural to give more weight to this warning than to Person B’s “I’m slightly concerned.” However, a listener who is calibrated to the two speakers may know that the statement from Person B indicates a severe problem, while Person A's statement probably is due to a minor glitch.

In similar vein, I once talked with the person at NASA Johnson Space Center in Houston who was in charge of astronaut selection. He told me how British understatement could cause problems when interpreting reference letters for candidates who had attended the Empire Test Pilots’ School in England. He had to calibrate himself enough to realize that “He is an adequate pilot” in British-speak actually meant “He is outstanding.”

There are many types of calibration required for the myeloma patient, starting of course with the significant recalibration that comes with diagnosis as well as new expectations concerning life expectancy. The patient also has to become calibrated to the idea of undergoing intense medical treatments where not only the potential benefits, but also the possible side effects, go beyond what a lifetime of “normal” experiences prepares you for.

I am very aware that I have been lucky, in that my myeloma experiences so far have been better than those of many others. For instance, I did not require treatment for seven years after my stem cell transplant in 2007.

Even so, I have sometimes faced difficult recalibrations. One such time came in late 2013, when my IgA reading increased enough that my oncologist decided to finally put me back on treatment. (My kappa light chains had been creeping up since late 2011, indicating that something was afoot. However, that increase was not by itself enough to merit treatment.) Somehow, going from a person who did not require treatment to one who again did was quite a mental recalibration.

Another form of calibration involved deciding on my exact treatment. In January 2014, I started taking 15 mg of Revlimid ^[1] (lenalidomide) at the usual 21 out of every 28 day schedule. However, this schedule produced various side effects, notably neuropathy in my feet, which added to the irreversible neuropathy produced by my thalidomide ^[2] (Thalomid) induction therapy. It also did not do a good job of controlling my IgA and kappa light chain numbers.

After a few months, we therefore reduced the Revlimid to 10 mg (to reduce the side effects) and added my favorite drug (sarcasm!) dexamethasone ^[3] (Decadron) to better control the myeloma. At first, I took the dex in 40 mg doses three Saturdays out of four. This new schedule did a better job of controlling my readings, but I found the side effects hard to take. We then tried the dex three Saturdays at 20 mg: the side effects felt nearly as bad as before, but the treatment was less effective. We then tried 40 mg of dex one Saturday per month: this schedule was easier to take, but did not keep my numbers down.

We finally settled on the monthly dex, but with the addition of the antibiotic clarithromycin ^[4] (Biaxin) for the week that includes the dex. This treatment has been effective at driving my IgA and kappa readings slowly down, and only messes up one weekend per month, which I (and those around me!) can tolerate. So, a series of recalibrations of my treatment eventually came up with a winner.

I’m pretty much recalibrated now to think of myself as someone who may have to be on treatment indefinitely, but hope springs eternal. With myeloma, you never know.