Billy Bob's Wild Ride: SO,WHATS NEXT?

Saturday, August 19, 2017

SO,WHATS NEXT?

WHAT IS NEXT?

CHEMOTHERAPY?

                                                        OR RADIATION THERAPY?

OR DO NOTHING...

YIKES, DONT LIKE THAT ONE A WHOLE LOT.

Notbillybob has a lot to thinkabout the next

two weeks. He'll see his orthopedic surgeon then. get stitches out. Most likely going home today. Then again maybe not. Just saw the pain service and they said they dont want him in the ER tonight if we cant get hold of the pain.

It IS like a ROLLER COASTER!

Emotional as well as physical and financial.

No one really has any answers to the big questions. There is a lot of
'Risks out weigh the benefits.... and Benefits out weighing the risks...

There are statements like this;

"most of the time we like to see.....bla bla"

and 'There is something we can do to.... bla bla"

"We'd like to try and....bla. "

But mostly there is the "we just dont know for sure. There are risk factors any time we...bla bla ba bla."
What they are saying is

ANYTIME A SURGEON IS GOING TO CUT YOU WITH A 10 BLADE NO ONE HAS A CRYSTAL BALL.....

SAME FOR
MEDICATION.

AND

THE

BIG

QUESTION**********HOW LONG DO I HAVE?????

GOOD QUESTION. (not very easy to answer.)

NOTBILLYBOB STARTED OUT WITH A SINGLE TUMOR. TOOK LESTER DIAMOND OUT TWO YEARS AGO LAST MONTH.

THEN THEY FOUND LUCY IN THE SKY. (PELVIS.)

NOW THESE THREE MORE. CHANGED HIS DIAGNOSIS
FROM SOLITARY PLASMACYTOMA TO
MULTIPLE MYLOMA.   MM IS QUITE A DIFFERENT BEAST.

like yesterday for instance. He finally consented to a nerve block.
A very lovely senior nurse came in, pulled up a chair and explained the nerve block in great detail. It worked. He trusted her.
The anesthesia service from the surgery came up here to the 8th floor and stuck a long needle in his neck. They used an ultrasound
machine to see where it was going. Not painfull, but lots of pressure. I'm totally lyin here! It HURT...bigtime.
   But it worked. somewhat. The arm felt like a large
      piece of beef tenderloin.
Then a few hours later, in the middle of the night it WOKE UP.
   By now it is barking like a junkyard dog. WOOF!

                                   WOOF!!                 LOL!

                                                   WOOF???????

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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)