Billy Bob's Wild Ride: March 2008

Monday, March 31, 2008

Arterial Blood Gas

these are Bobby's grandfathers
in the form of red blood cells (click to enlarge)

Bobby started having breathing problems years ago when he was hospitalized for shortness of breath and chest pain in 2003. His primary care doc was not surprised when her office was notified that he had been transported by an ambulance to a local hospital on valentines day. Sharon had been recently diagnosed with a host of problems and was on a wild roller coaster ride, trying to come up with a suitable treatment, and it would be almost a year before she found a good doc, and he got her somewhat stable. Now, after 3 different sleep studies, a pulmonary function test and a shunt study, he has hepatopulmonary syndrome. It is thought to be mild. But there is the key word. Mild. Mild has been the hallmark of this wildride from the git go. Don't ,whatever you do develop a severe case of this stuff or you might die of frustration. Mild is good for now. Mild means he cannot qualify for MELD exception points. The hitch is, that if it becomes worse, he will no longer be a candidate for a transplant, because HPS carries a poor prognosis after it progresses, and it is a progressive condition not dependent on the severity of the underlying disease. That means it can get worse even if the liver disease does not. Because it is thought to be a result of chemicals responsible for dilating blood vessels, it can just keep getting worse and worse. The red blood cells cannot reach the oxygen because the blood vessel is now too big around, and the blood is now going too fast. That is how the doctor explained it. He feels himself suffocating at times, even with his oxygen turned on, and he told De Wippersnapper pulmonologist that he didnt care if they say it's considered mild on paper, he cant breath. His chest pain started to ease a bit after being on the oxygen for a while, thank God, but there are still times he will wake with chest pain. The restaurant up the street, Casa del Rey, has green chili in three heats, Mild, Medium and Hot. Only there, the mild aint so mild either. And mild rhymes with wild, and beguiled.

Solitary plasmacytoma

Solitary plasmacytoma is a large solitary focus of plasma cell proliferation.

This tumor has a median patient age of approximately 10 years younger than multiple myeloma.

Pain is the most common symptom. However, if the myeloma occurs in the spine, it will usually present with fast developing paraplegia and gibbous deformity due to the vertebral collapse.

Complete Information on this Tumor

Introduction and Definition:

Solitary plasmacytoma is a large solitary focus of plasma cell proliferation. This tumor is extremely rare and is found in the proximal femur, vertebral bodies, and pelvis in order of descending frequency. Solitary plasmacytoma occurs 70% of the time as an osseous lesion, and the rest of the cases are non-osseous lesions usually found in the upper respiratory tract. Approximately 70% of the patients with solitary plasmacytoma develop multiple myeloma.

Incidence and Demographics:

This tumor has a median patient age of approximately 10 years younger than multiple myeloma, and affects men more than women.

Symptoms and Presentation:

Pain is the most common symptom. However, if the myeloma occurs in the spine, it will usually present with fast developing paraplegia and gibbous deformity due to the vertebral collapse.

X-Ray Appearance and Advanced Imaging Findings:

Radiologically, solitary plasmacytoma appears identical to multiple myeloma.

Differential Diagnosis:

Most authors agree on a strict diagnostic criteria for solitary plasmacytoma. There may be no other radiological identifiable lesions, and bone marrow at another site must have no abnormal plasma cells. There may be no serum abnormalities and no Bence-Jones proteins in the urine. Some authors believe that the diagnosis can only be made if no other lesion is found for a period greater than 1 year.

Preferred Biopsy Technique for this Tumor:

Bone marrow biopsy

Histopathology findings:

Microscopically, solitary plasmacytoma appears as well to poorly differentiated sheets of plasma cells. These cells produce the same osteoclast stimulating factors found in multiple myeloma.

Treatment Options for this Tumor:

Treatment of solitary plasmacytoma includes radiation or en-bloc surgical resection. If abnormal serum or urine findings are present then the patient must be treated as if they have multiple myeloma with chemotherapy and bone marrow transplant 2.

Outcomes of Treatment and Prognosis:

Patients with solitary plasmacytoma have a better prognosis than patients with multiple myeloma, but 70% of solitary plasmacytoma patients develop multiple myeloma, and usually die within 5 years.

Graduation Day

LINAC U

You'd think that 25 radiation treatments wouldn't amount to much of anything. It doesn't sound like a lot.

...25 trips to the hospital. We were wrong. We started the week before Thanksgiving after a month long delay because of a bad bad flu like cold I developed. They wanted a commitment, with as few absences as possible, so we waited. The coughing up blood and fevers subsided, then we started, and got our groove. I say WE because Notbillybob's wife, Sharon drove most days. I was just along for the ride. Well, after 10 treatments, the tiredness set in. Especially for her. Like a new part time job. Notbillybob feeling like a roast ham most days. Kind of like a sun burn inside your guts. He made a big mistake in eating jalapenos one night. Ooh, the burn. So, they asked the doc if the stomach was getting radiation. They said "lets pull up your treatment plan... Yes, see here, inside this red line. The treatment plan showed that it was. The innermost red line is the most radiation, the outer one is the least. The green one is in the middle. A good part of the stomach is even inside the blue line.

The pain was accounted for. They told us that they were also concerned with his platelet count. It was going down again. Down to 37! (Low is 150) It has since stabilized at 40. The thing is that the white cells, red cells, hematocrit are all low. Way low. Bilirubin is elevated. INR is elevated. Not billybob began wearing a mask to treatments. Don't need cooties at a time like this.

Then the really cold weather set in. I know, I know- it doesn't really cause colds and "death of pneumonia" like our moms used to say, but when you have cancer of the immune cells, and then your white cell count goes in the toilet as well...

Notbillybob is going to stay a hermit for the foreseeable future.

But SMILE!

New Years eve was treatment number 25. Graduation day! Graduation from LINAC U!

(LINAC is a Linear Accelerator, an IMRT radiation therapy machine)