Since I wrote my last column, winter harshly arrived with a stretch of low tem­per­a­tures that were colder than those at the North Pole. We had a heavy snowfall, which brightened up the environment even as we shivered a lot outdoors. It warmed up again in the last week to above freezing during the day, but we are not finished with winter yet.

Because my path with multiple myeloma has not been straightforward, or even predictable, I thought I would share with you how my health is now.

In a nutshell: I enter the year 2018 with no serious health concerns.

My blood markers show an M-spike of 0.14 g/dL (1.4 g/l), and the kappa-lambda ratio is in the normal range. The other dozens of blood tests show­ing other aspects of health, such as kidney function and hemoglobin level, are all in the normal ranges. I couldn’t be happier about that! As a myeloma patient, I am stable, and am not taking any myeloma medications right now. In fact, I discontinued Revlimid (lena­lido­mide) and dexa­meth­a­sone (Decadron) in September of 2016, so it’s been 16 months without myeloma treatment so far.

In summary, I have come a long way since my stem cell transplant in January 2010. That is eight years ago now! Leading up to the transplant, I had induction treatment with Velcade (bortezomib) plus dexa­meth­a­sone. My initial M-spike at diagnosis in July 2009 was 5.7 g/dL (57 g/L). By November, after several cycles of treatment, the value had come down to 0.2 g/dL (2 g/L). I cannot find values for the kappa-lambda ratio on my lab reports from that time, so I think that those tests were not yet in use where I live in Alberta. As you can see, the induction therapy worked very well for me.

The stem cell transplant also worked well, but I still had a small amount of monoclonal protein in my blood, so I went on a low-dose of Revlimid afterwards for about a year. Sometimes during that year my white blood cell counts became quite low, so I took a month off from treatment. Eventually the M-spike was not detect­able, and I went off Revlimid until I had a sero­logical relapse in the summer of 2014.

I took 25 mg of Revlimid (21 days out of 28) and 20 mg of dexa­meth­a­sone weekly from October 2014 until September 2016, to combat the rising M-spike, which had reached 1.2 g/dL (12 g/L). That treatment soon started to reduce the M-spike, which by July 2016 was too faint to quantify. In other words, treatment was once again successful, although I suffered quite a few side effects, including gastrointestinal upset, cramping in the hands and legs, and the stressful weekly ups and downs of taking dexa­meth­a­sone.

I am getting annual skeletal X-ray surveys, and so far, no more fractures or growth in lytic lesions has been de­tected since my diag­nosis. I had several compression fractures and many lytic lesions, even on my skull, at diagnosis, so it is a relief to see no growth of the cancer there (at least, no growth that can be de­tected by X-rays).

By 2016, I had resigned myself to the idea that I would be on myeloma treat­ments indefinitely, but then my health took another turn. I found that I had early stage breast cancer, as seen in a mammogram ordered by my family physician. A follow-up 3D mammogram and a core biopsy in August indicated that I would need to have surgery. At that point, my hematological oncologist suggested that I go off myeloma therapy in order to get treated for the breast cancer. I went through two surgeries and then 20 treatments of radiation therapy, which I finished a year ago in January.

My medical oncologist suggested that I take either tamoxifen (Nolvadex) or anastrozole (Arimidex) as an additional treatment for my breast cancer. Both of these drugs are used to decrease estrogen levels in the blood, which could be fueling the cancer growth. After some thought and discussions with my doctors and also my dear husband, we decided on the anastrozole. My doctor recommended that I take the anastrozole for five years.

No powerful anti-cancer drug is without side effects, and one of the side effects of the anastrozole is that it may worsen bone thinning, or osteoporosis. Of course, I already have osteo­penia, discovered before my diagnosis with myeloma, and have inroads made on my skeleton from the malignant plasma cells. So one suggestion was for me to go back onto bis­phos­phonate treatments. I had previously taken Aredia (pamidronate) for about three years. I credit that drug for helping me to recover from the bone fractures.

However, bisphosphonates also come with unwanted side effects, one of which could be osteo­necrosis of the jaw. I therefore got all outstanding dental work (three crowns and some fillings) done immediately. A bone density test last spring showed that my bone density was normal for my age group, so the decision to take bis­phos­phonates was post­poned for a year.

One way to improve bone health is to do a lot of weight bearing exercise, so I have a good reason for walking a lot. I enjoy walking, so this is no hard­ship, and I also stay active in my daily life. Along with the anastrozole pill, I take low-dose aspirin and a multi­vitamin and vitamin D tablet for bone health.

Other side effects of anastrozole may include an increase in cholesterol levels in the blood and intermittent aches and pains.

Now I have tests for cholesterol levels done regularly, and my levels are still normal.

The aches and pains caused by anastrozole are a grey area for me, since myeloma patients worry about having more lesions or fractures. So far, just taking over-the-counter medications such as Tylenol (aceta­min­o­phen, para­cetamol) sometimes is enough to deal with the aches and pains. I also have had pain in both my thumbs, and had a cortisone injection into one of them, which cleared up that pain.

A recent positive development is that my eyesight in one eye has improved. This could be due to no longer taking dexa­meth­a­sone, or just a natural part of aging.

All in all, I am fortunate right now to be in remission from two cancers, and I am planning on enjoying my life to the fullest this year.

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The quotation for this month is an excerpt from the poem 'Desiderata' by Max Ehrmann (1872 - 1945): "With all its sham, drudgery, and broken dreams, it is still a beautiful world. Be cheerful. Strive to be happy."