Billy Bob's Wild Ride: October 2017

Thursday, October 19, 2017

Three months later...

So, we have one radiation treatment left, tommorrow at 3:20 in the afternoon. Hopefully it will go more smoothly than this past afternoon, Notbillybob fell flat on his face in the parking lot at the Anschutz. He's just dizzy as hell. His stupid sphenoid bone has a huge tumor in it. Making him dizzy.
What the hell is a sphenoid bone you ask? Bueller, Bueller? Anyone??

.

It's located behind both eyes in the skull, right in the middle, ending up as the temple bone on either side.

The goal of this radiation is to shrink the tumor in this bone, which is pressing on his inner ear, optic nerve, and corotid artery.

It is highly destructive and aggressive, and is causing all kinds of havoc. Sunday the 22nd of October is the last Chemotherapy drug for this cycle, so it will be a good week to rest, eat out, live it up! If the tumor doesn't respond

like the doc wants, the radiation will be repeated. There really are good days and bad days. It's really weird the way that goes. Some days he can't get out of bed, other days he will be deep cleaning and cooking till 4 or 5 in the morning. It's 11:41 pm and he's in there making pot roast, home baked dinner rolls, pan gravy... mmmmm.

It doesn't seem like 3 months ago that Notbillybob and his Princepessa were in this produce department when they got a phone call
from the PCP and heard the worst news, the arm is broken, it's a pathologic fracture, a large lytic lesion, meaning multiple myeloma for certain. But 3 months have passed, halloween is here, then Thanksgiving.

Left Humerus

Three months later, arm fixed, finally on Chemo to fight this hellacious thing, feeling pretty thankful.

Pelvis

We got a really good doctor to replace the fired one. The new doc listens, is courteous, and we have trust right out of the gate. We met him in the hospital when we were in there in September. He made a bedside
visit,... never had one before. Pretty cool, though.

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)