Billy Bob's Wild Ride: June 2016

Tuesday, June 28, 2016

Eenie meanie miney moe

Eenie meanie miney moe, catch a liver by the toe, if e hollers make im pay bilirubin every day...
We did get the results of the pelvis super torture biopsy from the 15th of June.

Phenotypic Abnormality Found.

Leukemia/Lymphoma phenotyping report-

A phenotypically abnormal population is detected. A Kappa monotypic plasma cell population is noted, positive for antibodies CD38, CD138.
The findings are consistant for a

PLASMA CELL NEOPLASM.

MALIGNANCY.

So, What's next? Well, There are three choices. Three doors. Let's make a deal.

Door number one... do nothing.
I know I know, this door is the one every one swears they will choose if they ever get THE CANCER (see Lewellen Moss' mother in law in "No country for old men" (I's 100 degrees out here, don't know anyone in El Paso and I got THE CANCER)

Door number two, Another round of Radiation. Yeesh. Anyone familiar with Bobby's "two month nap" will see the downside of this one.

Door number three, Chemo. Not exactly the same as the chemo from yesterday. There are dozens of new drugs to treat Plasma cell cancer, many of them are cortico steroids. It's still chemo, though.

In the mean time, another bone marrow biopsy is scheduled for the 7th.

These are truly awful. Even though I could swear I heard "never never never again...
The problem is that even though they can numb you, they cant numb the pressure change when the biopsy needle goes through the bone in to the marrow. When air hits the marrow. Feels like a BASEBALL BAT.
Why yes I have been hit with a bat, he says.
At age 11, little brother hit Bobby with a ball bat. Louisville slugger. In the forehead.

Time for this wacky liver to go. Nice we could chat.

NOTBILLYBOB thanks you for your outpouring of well wishes and prayers. Much appreciated. Billybob, 6-28-16

Wednesday, June 15, 2016

Biopsy Day-(Thank God it's not a LIVER biopsy...)

Today is the long awaited, dreaded biopsy day. NOTBILLYBOB's Ortho-Oncologist Dr Shark requested this back in January, but complications as well as second opinions and consultations as well as a bad cold and hyper volemic crisis(water in the lungs) have delayed it. But no more. The procedure will involve an early morning lab test to see about clotting factors and platelet count. This happens around 9:00 am and will give the team time to do a blood platelet/plasma transfusion. If the platelet count is under 50, then they will add platelets and plasma. Normal is 150-500. NOTBILLYBOB usually has a count in the 35 to 45 range. Whether or not this is really low depends upon which doctor is weighing in. A Hepatologist routinely sees patients with platelets in the 50s.
A blood cancer doc sees patients down in the teens, and wont panic until they go below 10. A primary care doc, pain specialist, pulmonologist, cardiologist, etc is freakin out under the 100 mark. The dentist... well we'll just leave him out of this equation. You need only mention the phrase "Hemophilia" and they run.
So, another mystery. Is the tumor in NOTBILLYBOB's Ischial tuberosity benign... or another plasmacytoma,,,

The PET CT scan last week showed the same cancer in the left rib cage...Not entirely gone. It showed that the tumor in the pelvis had grown, but only slightly. Surely they will say that it is within the "margin of error, and call it totally stable. Only it doesnt FEEL stable. Yeesh. Bobby's wacky liver... signin out. Roger. Wilco. See ya.

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)