Billy Bob's Wild Ride: I've followed you on many adventures Princepesa...but to the great unknown mytsyery I great uknown mystery, I go first!

Thursday, March 8, 2018

I've followed you on many adventures Princepesa...but to the great unknown mytsyery I great uknown mystery, I go first!

Soooooooo Not Billy Bob is sleeping at the Anschutz B and B AGAIN.

To catch everyone up. Tuesday 7:30 am (ugh) Not Billy Bob had an appointment on the books for an Albumin infusion. By the time we got there it became apparent that we needed to have the extra fluid removed from us. The kind ladies at the hepatology clinic got me hooked up, took blood, took some fluid out, put some Albumin in and got us both feeling much better. The ladies are Lindsey Pratt (Dr Burton's PA) and Luda (registered nurse). No one, human or liver could ask for better care.

In the mean time.......
the blood went off to the lab. My neighbors the Kidneys are not happy. Floating in all that extra yucky fluid has finally gotten to them. Lindsey is concerned. Not Billy Bob's legs have too much fluid. The only way to remove that fluid is diuretics. The Kidneys cannot tolerate more diuretics. Lindsey, Not Billy Bob and Princepessa have a discussion and they decide we are going to the in-patient pavilion that night. We head home to pack an overnight bag and feed the fur children.

Tuesday evening Not Billy Bob is admitted, lots of blood draws, urine sample, ultrasound just for a start. The ultrasound takes a long time and is painful. This is never good news. Kidneys are even less happy than earlier in the day. No diuretics for now. The docs are calling it a kidney injury. They don't know the cause and working out a treatment plan is a puzzle.

We should back up for a moment:
2 weeks ago Denver had a snow storm on a Monday. Not Billy Bob had been to a doctor appointment at CU Med Center. Leaving after dark Not Billy Bob slipped and took the worst fall of his life in the parking lot. Me, the Kidneys and our neighbors all took a shift. He had some bad bruises on his hip and thigh, but nothing to suggest that us organs were in trouble.

We didn't sleep Sunday night or Monday night. Awake urinating, having taken diuretics. Tuesday night rolls in. Everyone knows the hospital is not the place to get any rest, let alone sleep.

Wednesday means lots more tests. Meetings with all sorts of medical professionals. Finally all the nights without sleep have caught up and Not Billy Bob falls asleep in front of his dinner. Princepessa was here for a few hours, checked in on us but we slept through most of it.

Thursday
Meeting with the Palliative Care team. Group of very kind, patient and knowledgeable people. Not Billy Bob finally admits he needs help. Team is going to work on support services for home. More tests....Meeting with the dental team.

Kidneys are happier or a least not as unhappy. Doctors has restarted the diuretics.

Dr. Burton stopped by. After what seemed like a long chat he admitted he was there for a "social call". It is common for him to laugh at Not Billy Bob's use of technology. Lots of back and forth between Dr. B, Not Billy Bob and Princepessa. It came down to this statement: this may be the liver (that is me in case you have forgotten) "new baseline". My baseline has been good for many years so this last 8 months has been one long slide downhill.The new normal aint so bad when you have such good folks caring for you.

Dr. Bowman is my main doctor during this visit to Anschutz. She is very like Princepessa She is a momma bear. Her plan for tomorrow is to get to work on the teeth. This may mean oral surgery with general anesthesia sometime tomorrow. No food after midnight.....bummer.

Friday:
No home for me or Not Billy Bob today. The fur kids will not be happy. Per Princepessa they are already out of sorts.
Morning visit with Dr. Bowman. Creatnine is up again. No diuretics today. The Kidneys and I are getting a day of rest. She is pressing the dental team to care for his teeth, and remove some while we are an in-patient. The tummy fluid is accumulating again, so a bedside tab in being considered. She talked about placing a drain in the belly so Not Billy Bob can have comfort, and avoid trips to the heptatology clinic every week.

Pallative Care came by again. Left some papers for the VA and papers to change Not Billy Bob's status to allow natural death aka DNR. Not Billy Bob asked way too many tough questions for me, just a lowly liver, to follow. Basically it comes down to this: our health is considered "fragile", our health (me (the liver) and the kidneys) are not going to recover fully from this crisis. We are close enough to the end to qualify for hospice. When Not Billy Bob asked Dr. Baily from Pallative Care "how long?" response was "weeks or months, NOT months or years. Dr. Baily and Dr. Burton concur: Not Billy Bob and Princepessa should be greatful for the years they have had together, but no they need to start making plans for the end.....

Thank you for taking the time to read this long post.

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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)