Billy Bob's Wild Ride: "Win some , Lose some"

Saturday, May 16, 2009

"Win some , Lose some"

The scan is over. Commense glowing in the dark.Radioactive iodine, and the post ct scan doldrums from the contrast allergy are in full swing. I love the catch 22's you humans get to deal with. NPO before a test means the patient is almost sure to become a human pin cushion when they try to start an IV for a dual phase computed tomography. This was the case with Bobby yesterday. The nurse (male,... bummer) punted to the other nurse (female,... hooray) after four sticks, all missing the vein. The last one almost had our former beer drinker fainting. It must have something to do with anticipating one stick, but after three misses, panic starts to set in. For the patient as well as the nurse. You could see it all over his poor face. Two years ago for Sharon's brain decompression surgery, the anesthesiologist missed over 10 times. Bobby stopped counting at 10, and it took 20 minutes after that with 4 large men holding her down to get a large catheter in to her artery on her forearm. No blame on the doc, it wasn't in the card for him that day. Yesterday did not even come close to that kind of torture for Bob. Especially when you take in to account that he didn't crap out from the iodine contrast with was auto injected in to that carefully placed IV, and that the scans showed no liver cancer, which is a big risk now, and that at the end of the day, because the nice lady who placed his IV and did his scan asked him if he had any other tests later in the day, which he might need a blood draw, and they decide to keep the IV in just case. So, later after meeting with the WORLD FAMOUS HEPATOLOGIST he couldn't stop smiling, as they flushed out his hard won IV, and managed to draw fresh blood , 6 vials out of it, sparing any more punctures for one day. Win. As my old grand dad Juan D BillyBob used to say-"Unas veces se gana y otras se pierde" . Win some, lose some.

Before

After

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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)