Peripheral edema - Kyprolis cycle 1

On May 7 Doug had his first full strength dose of Kyprolis. His weight was good at 160.
All his lab work came back okay:
WBC    7.6
HGB     12.4
PLT       209
ANC     7.1
Creatinine   1.1
Sodium 136

The NP (nurse practitioner) came to see how he was doing. He told her 'no problems'.

The next day, Friday 5-8-20, he weighed in at 162. No big deal.
He had a full strength dose of Kyprolis with the usual fluids.
On Thursdays the lab work is done; on Fridays lab work is not done.

Friday evening at home, we noticed his leg swelling was a little worse than usual. We checked his weight - it was 165. Up 3 pounds since morning. He felt fine.
Saturday his weight was 166.2. His feet ankles and lower legs on both sides were puffy. He still felt fine, no other problems except fatigue. (For the medical folks - I checked and it was not pitting edema.)
Sunday his weight started to go down - 165.1
Monday he weighed 162.4 and the edema was quite a bit less.
Tuesday's weight was 161. Just the 'normal' swelling on left side.
I called to report all this so the doc would have a heads-up before Doug went to infusion today, May 14.

Today Doug weighed 159, a good number for him.   BP was 114/71.
His lab work was:
WBC 9.0
HGB 12.3
ANC  8.3
PLT   107
Creatinine 1.3
BUN     32
Sodium 134

Dr. A came to see Doug. Peripheral edema is one of the possible side effects of Kyprolis. But she was a little surprised the edema came back down so quickly. She made a phone call to Dr. Matous in Denver to get his opinion. Meanwhile she ordered an EKG to be done before infusion. That didn't show much. His heart sounded okay to her.
Dr. A told us she thought the Kyprolis dose needed to be lowered back down to the starting dose on days 1 and 2, which was 20 mg (calculated by a formula for his weight). Dr. Matous called her back and he agreed with Dr. A to go ahead with the lower dose and also cut his saline fluids in half for now.
He tolerated the infusion well, no drama.
Doug will go back tomorrow, Friday, and then he will be off for one week. Three weeks on, one week off.
When Doug resumes treatment on May 28, that will be the start of cycle 2. Dr. Matous wants Doug to get an intermediate Kyprolis dose; higher than he got today. He says if we have to keep the Kyprolis dose at the very low level, then he would probably need to add another drug to the mix. And he really would prefer not to do that.

We will continue to monitor Doug's weight and leg/feet swelling. Dr A says to call her on her cell phone if he has any more edema/weight gain.

Doug is also supposed to have another echocardiogram before cycle 2, to be compared with the baseline one he had before Kyprolis started.

We are aware there could be complications ahead, but we try not to focus on that.

Love to all.

Today's verse:
"God is your refuge, and his everlasting arms are under you."  
Deuteronomy 33:27