Radiation Therapy

Today has been busy. We left home at 7:30 to take Chester to the boarding kennel. Mike, one of the owners, was there and he remembered us from the previous time we had to leave Chester and Piper for two months, when Doug went through the transplant. Mike said that since we were leaving Chester for medical reasons again, he would only charge us $10 a day. And he said we shouldn't worry about how long we needed to be gone; although they were booked solid over Thanksgiving, they would put Chester up front in the office if need be. This is an answer to prayer right there. This is WagnTails kennel in Salida -- Mike and Patty Bondurant are wonderful people.

We had good driving conditions to Shaw Cancer Center. We got here in plenty of time to get checked in to our 'home away from home', Jack's Place. It is just across a parking lot from the cancer center. We have a nice hotel-like room. Jack's has a community kitchen and dining area. Everyone brings their own food - we have a cupboard just for us and use of a refrigerator. I have taken photos, but we forgot to bring the cable that connects the camera to the computer!

At 1:15, we had the consult with Dr. Patricia Hardenbergh, the radiation oncologist. She showed us the CT scan from Oct. 31; we could see quite a few "holes" in Doug's left hip and pelvis. No wonder he hurts! She is going to radiate the whole left side and part of the femur. Doug will have ten treatments.
If there is any good side to MM, it is the sensitivity to radiation. The downside is - radiation to this disease is only palliative -- used to control pain and stop further bone erosion in the treated area, not to achieve a cure. MM affects the whole body and radiation is a local treatment. Whole body radiation would be lethal. Radiation therapy can cure cancers that are localized.

I am a retired radiation therapist -- I used to give radiation treatments. Now I am on the other side.

Dr. H. also showed us the plain x-ray of Doug's pelvis taken Oct 19. The radiologist who read that film reported it as negative - meaning nothing found. However, when Dr. H. showed us, she pointed out several suspicious areas. Even Doug and I could see. Doctors almost never criticize each other, but Dr. H. did admit that it was "under-read".  That is troubling; how many other things have been missed by that radiologist? If he (or she) had been more competent, Doug might have been spared the additional week of pain, but the end result would still be the same. It makes me mad, but Doug says he won't let it upset him.

After the consult, we came back 'home' to rest, then back to the radiation dept.  for simulation. This the time of mapping out the area on Doug's body; done with a CT scanner. This information is then entered into the treatment planning computer by the dosimetrist to explore the various ways the radiation beam can be configured to minimize hitting organs in the area. Then the doc - the radiation oncologist - looks at the plans and chooses which one to use.
Radiation oncology is really a team effort -- the secretary, the nurse, radiation therapists who position the patient and operate the treatment machine, dosimetrist who does the treatment planning, and the radiation oncologist (physician). Plus the radiation physicist who calibrates the  machines.
A large part of Doug's pelvis is involved, so some bowel will get radiated. It shouldn't cause him any major side effects; maybe a little diarrhea, or if lucky, maybe not.

I asked Dr. Hardenbergh about the "Light Chain Disease" label. She said "it is still multiple myeloma." She said it could be considered a 'mutation', since the usual marker for myeloma still comes back as 'no evidence of myeloma'.  I looked back at my old notebooks and back in April 2010, at the one year post transplant visit --  Dr. Jeff Matous, the transplant doc (and our hero), reported "Light chain looks good". I recorded the Lamba light chain as 11 at that time with the comment 'excellent'.
I looked back at the most recent lab report of 10-6-11. The light chain is on page four, not highlighted, and was 47.3! I then looked back at the lab report of 7-5-11, and it lists the lambda light chain as 41.3. There was obviously an upward trend. Why was this not noticed? This pisses me off. I plan to ask some questions when we see the medical oncologist - not to accuse so much as to maybe help someone in the future.
Doug has such a marvelous attitude so I need to control myself. But if the light chain rise had been noticed earlier, we could have started back on chemo sooner.

Tomorrow we hope to get the first radiation treatment, if the team gets everything ready by then. We are both exhausted. Because of all the walking to and from today, I got a wheelchair for Doug. The fact that he actually rode in it tells you how much he hurts, even with the pain meds.

We are bouyed up by all the prayers being said for us.

Love to all.