Sunday, February 27, 2011

I'm no stranger to the pain.....

We arrived in Dallas Thursday about quitting time (5:00 p.m.), although Dallas traffic looks like "quitting time" almost anytime of the day! As we left Mississippi and home, we drove toward the dark clouds, all day. It appeared that we might get into a storm at just any minute, and the wind was blowing fierce. It was definitely one of those "two hands on the wheel" kinds of wind. Not too far outside Tyler, TX the downpour came - a hard, blowing sideways, driving type of rain. Just minutes before, I had given in and let Bob get under the steering wheel so that I could rest. With his pain-killers, the fact that his legs are weak, and his reflexes not so good; I now do all the driving (so you wonder, what was I thinking, letting him drive – on a major Interstate!).  I was glad he was driving during the downpour; it would have been "white knuckles" for me. We switched back, after about 30 minutes.

We're back at the hotel that I stayed in, as I completed my consulting career. We are just about 10 minutes from the Bone Marrow Transplant Clinic; and just across the street from my last client. Little did we know that this is how we'd use all those hotel points that I had accumulated.

On Friday, he got three of the sixteen appointments, over the next seven days, out of the way. He had his first two Neupogen (one of the brand names for the drug,  Filgrastim) injections – 480 micrograms or 1.6 ccs in each arm. The Neupogen is given to treat neutropenia (a condition where the body makes too few white blood cells). Neupogen also stimulates the release of neutrophils (a type of white blood cell) from the bone marrow, and helps to increase the number of stem cells.  In patients receiving chemotherapy, Neupogen can accelerate the recovery of neutrophils, reducing the neutropenic phase (the time in which people are susceptible to infections).

We had been told by multiple (no pun intended) Myeloma patients that these injections can cause bone pain. The oncologist and the Transplant coordinator both advised that Bob could have pain. We just didn't realize that it could come so quickly and with such intensity. We had also been advised (maybe to make Bob feel better about the pain) that the hurting is means that the Neupogen is doing what it's supposed to do and is creating cells. The pain is "supposed" to stop as soon as the collection process begins, but since he'll continue to receive the Neupogen injections during collection, we don't know what to expect.

Side effects to Neupogen are:
·    Bone pain
·    Nausea
·    Vomiting
·    High Blood Pressure

Friday night, the pain started suddenly in his lower back and radiated into his chest, and his blood pressure shot sky-high (from the pain).  I pulled out my magical bag of drugs, as daughter Robbie continued to check his BP (what a nursing team, we made.) We made it through the night and back to the Cancer Center at St. Paul Hospital for another round of (dreaded, this time) injections on Saturday and Sunday morning.

And, as the nurse readied the syringes for the injections, we learned:
·    The pain in the back and sternum are normal because that’s where the largest amount of bone     marrow is found.
·    The Lumbar Radio Frequency Denervation (nerve burning) will do nothing to appease this pain.   
·    The “magical bag of drugs” really don’t help with this Neupogen generated bone pain
·    Tylenol “might” work (so, I have morphine and he needs Tylenol!!)
·    Claritin or Zyrtec “might” work

 And, I have discovered:
·    The pain does persist, in almost “wave-like” sequence, in his back and chest.
·    The nerve burning has not helped this pain
·    The “magical bag of drugs” does not work, with the exception of the muscle relaxer, which helps him to sleep.
·    Tylenol does work, unless he has to get up and move around – then the pain returns.
·    Claritin does not work!

On Saturday afternoon, his sister Sue arrived from Winchester, VA and even though he hasn’t felt well, Robbie and I are enjoying her visit and are making her trip worthwhile!

Tomorrow, several hours of our day will be spent waiting for Bob to have the Tri-Fusion Catheter implanted in his right chest. The day will end with another Neupogen injection, as well as an injection of Mozobil, given in conjunction with the Neupogen to help mobilize the stem cells prior to the collection process.

As Bob says, he’s no “stranger” to this pain …..but enough is enough!!

Tuesday, February 22, 2011

A drug without side effects?.......

Bob has been feeling pretty bad lately, with no appetite. He reminds me of the "early days" when he was so sick; before we had a diagnosis. He says he feels almost as if he has the flu. He's weak, fatigued, lethargic, feels yucky - in short, just miserable, most of the time. And, often it's accompanied with waves of nausea (yes, I have a pill for that!) There are days, that he can sit on the porch and enjoy the sun, and days when he doesn't feel well enough to get off the sofa.

The Myeloma, and the treatments, as well as all the other associated medications affects each "victim" differently. The cancer causes pain, the chemo to treat the cancer can cause pain, the medications to treat the pain causes side effects, and the medications to treat the side effects causes other side effects. It's like taking dominoes and standing them up, in a line, then having them topple over - each affects the other. Cancer, and all the related drugs, seem to do about the same thing to the human body.

Bob's test results, from the Dallas trip, are pretty good. There are some that are out-of-line, but nothing major. Nothing that should make him feel as badly as he's feeling. The Multiple Myeloma numbers were down, so it shouldn't be that.

Was it the after effect of the Velcade (chemo)? He hasn't had a treatment since 1/18/11, and it stays in the system two months, An online review of the side-effects of Velcade, revealed many of the symptoms that he was having - as well as many others. It has almost sent his cancer into remission, but might be taking its toll in the process.

Earlier, I had been concerned that he was depressed because of the cancer, so I had requested that he be given some type of drug for anxiety. Now, I was concerned that the Cymbalta he had been given might be causing an adverse reaction. With the doctor's direction, I was slowly getting him "weaned". An online review of this drug also revealed some of the symptoms he is experiencing. He was taking it to combat depression, and that is a side-effect!

This morning, just to ensure that there was nothing physically wrong (other than what's already wrong!), we went to see his oncologist. Even though his lab numbers still looked good, he didn't feel well. The assessment, by the good doctor, was that it was a combination of the Velcade and the Cymbalta. Just for grins, he ordered 1,500 units of fluid - which always makes a body feel better.

So for half a day, I had my old honey back - talking and laughing like in the days when we didn't know there was Multiple Myeloma looming in our future. We sat on the front porch and watched the birds flock to the feeder, as the tall pines swayed in the wind. The clump of yellow daffodils, heralding warm weather, reminded me that there are good days!

Will tomorrow be just as good? Will the 1,500 units of fluid give him another good day? When will they develop a drug that treats the problem, but has no side effects?

Saturday, February 19, 2011

What is the reason?.......

Our sixteen year old granddaughter, Sydney, asked me if I could come to her school and talk about Multiple Myeloma. She then told me that she was using her grandfather (she calls him "Papaw") and his disease as her "project", and she was using my blog as reference.

I asked her "Do you read the blog?" And her response was "All the time." That surprised me, I guess I never thought that the grandkids would read the blog. I'm not sure that I would have been so interested, at her age. Teenagers always seem to be in their own world, and involved with themselves. I asked why she was doing her project on MM, and her reply was "Because I want to know about this disease that Papaw has".

Last night while I was on Facebook, as she and I were "chatting", she asked "Granny, did you know that Sam Walton had Multiple Myeloma?" And then, she shared some other names of celebrities that had had this disease. The things we might learn if we'd listen to the kids!

She started me thinking, and I started doing some research on "famous" people with MM. I'm not sure why I hadn't thought to do it earlier. Again, the things we learn from the kids!

Not that it really mattered, cancer knows no boundaries; nor does it care about status. Cancer does not care if you're rich or poor......cancer does not care.

As I researched, I read an article that the Senior VP of the Orlando Magic Basketball team, Pat Williams, has recently been diagnosed with MM. This cancer, which has been considered one of the "rare" blood cancers seems to get more attention when "famous" or "popular" people have it. Multiple Myeloma needs attention and awareness, because it needs a cure.

Geraldine Ferraro, 1984 VP candidate, has been living with MM for 12 years, and has helped to put a "face" to this disease.

Peter Boyle, the grumpy father on "Everybody Loves Raymond" - had MM
Eppie Lederer (Ann Landers) - had MM
Jim Davis, played Jock Ewing on "Dallas" - had MM
Roy Schneider - Actor on "Jaws" - had MM

Multiple Myeloma has no regard for age. It was once a cancer of the elderly; people over 65, specifically males. That seems no longer to be the case since younger patients are now being diagnosed, both male and female. During my searching, I located the blog of a young man who was diagnosed with MM, in 2009, when he was just 17!  They get younger and younger.

The cause of Multiple Myeloma is unknown. Articles indicate that it is probably caused by herbicides, pesticides, petroleum based products, chemicals, wood dust, and the list probably goes on and on. My husband's oncologist stated that most of the cases, in Mississippi, are found in the Mississippi Delta; an area where chemicals are used in massive amounts. As a friend said, "While those planes were poisioning the cotton, they were also poisioning us."

The founder of WalMart, actors, a candidate for Vice President, a 17 year old, my husband - what is it that they, and everyone else, has in common? Before a cure can be found, maybe the reason should be found!

Thank you, dear Sydney, for making me look further!

Thursday, February 17, 2011

Finally, the probing, prodding, and "picture" taking is over.....

On Monday Bob completed his testing, at UT Southwestern in Dallas. He has been poked, prodded, and stuck, and infused with radioactive material a couple of times (will he glow in the dark?). All the while, I sat and worked my crossword puzzles, and waited. And, I owed him that! There were years that he had to wait while either the girls, or I, were tested or hospitalized for various and sundry reasons.

His PET/CT Scan shows increased FDG uptake (lesion, tumor, or inflammation), measuring approximately 9 mm (a little larger than a pencil eraser), in his sacrum (the large, triangular bone at the base of the spine).  Prior to the PET Scan procedure, Bob was injected with 11.6 mCi (millicurrie - the way radioactive material is measured) of Fluorine-18 Deoxyglucose (FDG) a substance like glucose (a type of sugar), with a radioactive tracer attached. After 90 minutes, he was imaged in the PET machine. Tumor cells require more energy to survive and spread and consume larger amounts of the radioactive material than normal cells. The PET scan can detect cells as small as one centimeter. 

The PET scan also showed some other FDG "activity", which indicates that the Myeloma cells don't want to give up. His Bone Marrow test still shows 10% - 15% myeloma cells; better than in the beginning but still more than we had hoped. Just more indication that it's going to take the high dose Chemo (Melphalan) and SCT to get him into complete remission (CR). Right now, he's probably considered to be in VGPR (Very Good Partial Remission).

I had concerns that his Beta-2 Microglobulin (protein found on the surface of many cells) continues to increase, even after 4 Cycles of Chemo. This, and the 24 hour Urine test, indicates that his kidneys aren't functioning as they should which is common among many MM patients.

His PFT (pulmonary functions) test was great, but no results yet from the heart test. The Multiple Myeloma has caused kidney problems, neuropathy, back pain, and hearing loss (although I'm not so sure if it's the MM or he's just "redefining" his selective hearing!)

Even though he doesn't feel good, and hasn't for quite awhile, his back and leg pain has responded extremely well to the injections. For a couple of weeks, he's been on 30 mg. of MS-Contin twice per day, with 4 mg of Dilaudid around midnite. Last night, we reduced the Dilaudid to 2 mg., and this morning I gave him just 15 mg of MS-Contin. What a change from those days when he was taking pills every 4 hours and was still in excruciating pain .....but we didn't have the wonderful Dr. S. in our lives, at that time.

Next week, before we head back to Dallas for the Stem Cell collection, he'll return to the PMS for the radiofrequency lumbar facet denervation (burning the nerves). This has to be completed prior to the Stem Cell transplant, and should assure Bob of no additional back pain - for several months, anyway!

Phase One - Induction Therapy (4 Cycles of Chemo) - Completed
Phase Two - Testing, Testing, Testing - Completed
Phase Three - Stem Cell Collection - Begins 2/25/11 (Prayers, please)
Phase Four - High dose Chemo and SCT - Begins 3/14/11 (Prayers, please)

We're halfway through this journey, and what a trip it has been; one we had no idea we'd be taking. We're so glad that you're going along with us! It hasn't been fun like the journey we all took to Europe in 2009, or the journey that we started last fall, over this beautiful land of ours, when MM decided to interrupt our lives. It has certainly been educational and informative, and we've learned a lot. As I've so often stated, I could have lived a lifetime without knowing anything about Multiple Myeloma!

We hope you'll continue with us - we still need your support and your prayers as we tackle the last, and hardest part, of the entire trip!

Monday, February 14, 2011

Why do I still feel bad, if my numbers are good?

Almost from the beginning, Bob began to respond well to the Chemo (Velcade/Dex). Of course, he was so ill and so near death, I think he had nowhere to go but up! His MM was very aggressive, and had gotten a  hold on his body, before it was diagnosed. Like many MM patients, he had no lesions, in his bones, but his kidneys had begun to be affected. His lab work, and his M-Spike, showed positive response after treatment was started. .......But, he still felt so bad, so weak, so fatigued, so "not like doing anything", and I worried, but I kept smiling....and trying to assure him that the drugs were making him feel like crap.

Monoclonal Protein (M-Spike) is a type of protein made in large amounts by malignant plasma cells and secreted into the blood. His M-Spike (cancer count) was at almost 6.0 and he had 21% plasma cells. After 4 cycles of chemo, his M-Spike was at 0.19 and there were only 3.3% plasma cells. This was remarkable!

Per a pamphlet distributed by The Leukemia and Lymphoma Society, the myeloma can stop making an M protein, and based on lab tests (blood tests) the condition can appear to be improving, but the myeloma is actually progressing, and the patient feels worse. Was this happening to my honey?

Beta-2 Microglobulins is a cell protein found in the blood. A high level may be a sign of faster-growing disease. Bob's Beta-2 Microglobulins should be decreasing, but was continuing to increase.  On 10/26/10, it was 2.60 and now, on 2/8/11 it is 2.82. (The acceptable range is .70 - 1.80.) Is this an indication that things aren't as good as they seem?

I reviewed UT Southwestern's "My Chart" (the online test results available to patients and caregivers) and decided to send an email to the MM Specialist. He replied that Bob's symptoms probably had nothing to do with the Myeloma, but were a result of the Velcade, (which is what our oncologist at home has been saying). Even though he hasn't had a Chemo treatment in one month, it will take a couple of months for his system to recover from the after-effects.

The Specialist at UT Southwestern felt that his Beta-2 Microglobulin is elevated because his kidney functions aren't normal, which means that his kidneys will have to be flushed, a couple of days, after the high dose of Melphalan and before the SCT.

We are sill awaiting results of the Bone Marrow Aspiration and Biopsy to get a true picture of what's going on. He still doesn't feel good - no temperature, but says he feels like he "has the flu". Could it be Mono? The Epstein-Barr (Mono) numbers are up, a little, probably because of the stress his system is undergoing.

Why does he feel so bad?  I don't know, but I do wish that I did.....would make my "job" easier!!!

Please continue to send prayers our way!!

Saturday, February 12, 2011

The testing continues.....

Bob only has 3 tests remaining before we head back home. He's been through the Pulmonary Functions test  (the technician said "I shouldn't be telling you this, but he did great!"), a PET Scan (to determine if the cancer has metastasized to any other parts of his body, as well as to locate masses of cells), a skeletal survey, and a chest Xray.

Monday, he still has the 24 hour Urine test (to provide an accurate measurement of the level of kidney functions as well as any possible kidney damage caused by the myeloma, protein in the urine as well as the light chains wil provide information about the extent of the disease), an MRI of his spine and pelvis, and a Heart test (to determine if his heart can withstand the SCT). I'm thinking it may be my heart they need to check!

By the time we leave Dallas, he will have been checked "six ways from Sunday" (as the old saying goes), and they will know everything about him! Lucky for me, I brought several things to read since I've clocked lots of waiting time. I think Bob's just paying me back for all those times he had to sit with me (C-Sections, hysterectomy, gallbladder).

We really could have worked out another way for me to pay him back!

Wednesday, February 9, 2011

Phase Two of this Journey.....

Bob is now in the Pre-SCT workup phase of this "4 Phase" process. Yesterday was a full day, beginning with blood work and ending with a Bone Marrow Aspiration (the one thing he dreaded most, loomed ahead of him for the entire day). In between, there were meetings with a representative from the Carter Blood Center, which will process and freeze his Stem Cells; an Insurance Representative; a Social Worker (required by Medicare) to ensure that both Bob and I have the support we need through this process; Christen, the Transplant Coordinator; and of course,  Dr. Anderson, the Specialist in whom we have put our trust.

The large waiting room in the Bone Marrow Transplant Center, outside the lab where blood is collected, was filled to standing-room only. It's always such a sobering experience to see so many people, in every age group (except children), with varying stages of cancer. One has to wonder why? What has changed, in our society, to cause so many to have cancer. Is it the processed food we eat, our environment, genetics, what?

We met first, with Stephanie from Carter Blood Bank. This facility will process and freeze Bob's cells, for the Stem Cell Transplant procedure. Bob has an Infusion Port, on his upper left shoulder, which is used for his Chemo treatments. A Trifusion Catheter will be implanted, on his upper right shoulder, for the collection of the stem cells (called the Apheresis Process), as well as for the Stem Cell Transplant.

For four days, beginning February 25, prior to the collection of the Stem Cells, Bob will be given injections of Cytokines (Neupogen and Mozibil) which will stimulate cell growth. On the fifth day, the Stem Cell collection process will begin.

The blood, in the human body, is made up of four layers: White Blood Cells, Red Blood Cells, Platelets, and Plasma. The Apheresis Machine will be connected to Bob's Trifusion Catheter in order to initiate a continuous circulation of blood. The machine separates the blood layers by centerfuge (spinning), extracts the Stem Cells, and returns the remaining blood to his body. A blood thinner is added to the apheresis machine to prevent the blood from clotting, which reduces the calcium in the blood. When the blood is returned to the body, some of the blood thinner still remains which lowers the calcium in the body. This can cause tingling in the hands, feet, and around the mouth, as well as pain in the bones (which Bob already has). Calcium replacement is given intravenously during the collection process, to reduce some of the pain and tingling.

20 litres of blood, per day, will be harvested until 10 million Stem Cells have been collected! The cells will then be frozen until it is ready for the Stem Cell Transplant procedure.

The final procedure of the day was the Bone Marrow Aspiration, which Bob has dreaded for weeks! We had asked for sedation in order to reduce some of the pain that he had experienced during his first aspiration, in October. During the October aspiration, I remained in the room - after which, I vowed I would never do that, again! I sat, just outside the clinic room for this procedure, and was so happy when I heard him exclaim "I didn't feel a thing!"

How fitting that the tool used to obtain the Bone Marrow sample and a piece of bone is called a Jamshidi (Jam Sheety) Biopsy Needle!  It is a tubular needle with a cone-shaped tip, with cutting edge, used for obtaining a bone-marrow core.

I think it definitely makes a big difference when someone, who does this procedure 4 or 5 times each day, is the one holding the tool. And, I was also very happy that we requested sedation.  I was thankful that he hadn't gone through the pain of the first aspiration.

The remainder of our time will be spent with Bob undergoing more MRIs, Xrays of the entire body, PET Scans, Heart Tests and Lung Tests. Dr. Anderson has to ensure that he is physically able to withstand the stress of the Stem Cell Transplant.

Since Bob was diagnosed with Multiple Myeloma back in October, 2010 (it seems like forever ago), I've read everything I could find about this incurable form of cancer, treatment options, and treatment locations. Much has been posted on various blogs and MM websites regarding the decision-making process of selecting a treatment facility. It actually boils down to personal preference and how comfortable the patient, and the caregiver, is with the facility and the location.

We are extremely pleased with our choice of UT Southwestern in Dallas. It is both a research and a clinical treatment facility, and has received a designation from the NCI. It does not treat just Multiple Myeloma, but our oncologist is a Multiple Myeloma Specialist. It's about personal preference, and confidence .....and we're confident that we have made the right choice!

Friday, February 4, 2011

It really does, take a village.............

Back in August, 1996 when Hillary Rodham Clinton gave her "It Takes a Village" speech, at the Democratic National Convention in Chicago - she was referring to raising our children. People helping people, families helping families; insuring that the children aren't forgotten. Mrs. Clinton was not inferring that parents are not capable of raising their children, but rather that more people are involved in the process: teachers, doctors, babysitters, grandparents, and the list goes on and on.

Little did I realize in 1996, that later her speech would also have an impact on our lives, not because of our children or grandchildren, but because of ourselves.

In October, 2010 when Bob was diagnosed with Multiple Myeloma - an incurable cancer of the plasma cells, I slowly began to realize what her speech really meant. Suddenly, we needed an entire "village" to get us through this terrible nightmare into which we had plummeted.

We had a great oncologist and wonderful nurses, but we needed more than that.  We knew, at this point, that we needed our friends and family - their support and their prayers. The support extended to the Internet, Facebook, this blog and other blogs. Others, going through the same experience as we were, continue to reach out to offer support and information.

Phone calls come, on a daily basis, offering help and support. Bob's name has been entered on many prayer lists, and prayers have been offered up on his behalf.

I now know that it does take a village, whether it is to raise a child; help a family in need; or as in our case just to help us get from one day to the next as we deal with the pains, and the treatments, that Bob is going through. It helps to be able to pick up the telephone, and "call a friend". It helps to be able to ask for prayers, and support.

Yes, it really does take a village -

Thursday, February 3, 2011

It's okay to cry...............

Before Bob was diagnosed with Multiple Myeloma, but when I knew he was really sick and didn't know why .....I started crying....

crying because I was scared.........

crying because I knew something was wrong, but I couldn't seem to make the doctor hear me.......

crying because my honey, whom I had always called my "energizer bunny" was fading before my very eyes.......

crying because I thought he might actually die before we could get a diagnosis.......

crying because it seemed there was nothing else I could do......

And then.......

he was diagnosed with Multiple Myeloma

I didn't know anything about it, but I knew it was cancer.......and I cried!!

I cried everytime I tried to talk about it........

I cried in the shower, as the water washed over me........

I cried into my pillow, at night.........

I cried as I sat rocking, on our front porch, listening to the wind as it brushed the tops of the tall pines near our house.........

I cried as I tried to talk to our daughters, over the phone, about their father and his cancer.......

I cried because I couldn't believe this was happening to him - to us........

I cried, and I cried, and I cried. I cried when it seemed there should be no more tears.......

I couldn't understand how there could be so many, and where they came from, but they were there.......

And, when he was in so much pain that he cried - I cried with him, because I could do nothing for him, except cry with him...........

I had become an expert, at crying.....

And then, I got angry.

Angry that I couldn't stop crying........

This was the time that the two of us had to talk, to discuss things......and everytime we would start a discussion, I couldn't complete a sentence without breaking down, and crying........

Someone suggested that I "take something" .....a drug to help me cope. I didn't want a drug to dull my emotions of these days. I didn't want to cry, but I did want to feel; I didn't want a drug that would stop me from feeling. I didn't want a drug to stop me from being me. I realized the time might come when I would have to "take something", but I didn't want it to be now........

Finally, I began to be able to discuss Bob's cancer with others, without crying. Now, if I could just get to the point where I could discuss it with him!..........

And then the anger extended  from being angry that I couldn't stop crying, to being angry that my husband had cancer...........

I was angry that we were in the winter of our lives; the time when we were both retired and could travel......and he had been chosen as the one to bear this burden..........

I was angry that this good man who had never smoked or drank and had lived a pretty good life, had cancer......

I was angry that he was in so much pain..............

I was angry when we went to the ER and had to endure doctors who knew nothing about Multiple Myeloma and the pain that it caused..........

I even found that I was angry with my husband - I knew it was a stupid emotion, it wasn't his fault that he had cancer, but I was angry.......

And then, it turned to depression.

I still didn't want to "take something", but I knew I was depressed.......

I was finally, for the most part, past the crying stage, but I was depressed.......

It was hard to smile, and remain upbeat......

I found myself going through the motions of everyday, because I had to.......

I was depressed because I was sorry for Bob, sorry for me, sorry for what might be........

I had always been a strong woman, not physically strong but mentally strong. I knew that I could bring myself out of the depths of my depression because I had to. When our girls needed strong advice, my mantra had always been "pull yourselves up, by your boot straps". Now, I needed to heed my own advice!.....

I knew that I was in Elizabeth Kubler-Ross' "5 Stages of Grieving".........
  • Denial (Crying)
  • Anger
  • Bargaining
  • Depression
  • Acceptance
I hadn't yet "bargained" with God (had I?) although I had prayed and prayed. I knew that everything was in God's time - not mine - and I doubted that bargaining would do any good.

I wasn't sure that I could ever "accept" what had happened, what was happening. How could one "accept" cancer and all that it meant?  I was dealing with it, and all that it entailed, but I wasn't sure that I had completely worked through the "Acceptance" stage.

Finally, I knew that all my tears were okay. I loved this man, beyond measure. We had been together over 50 years.....he deserved every tear that I had shed for him, and with him, and any that I might have to shed in days to come.

I am thankful for every day, together........

It's okay to cry..............

Tuesday, February 1, 2011

Continuing this Journey.....

A doctor, with empathy and "bedside" manner can deliver news, that might otherwise be upsetting, in such a manner that it's almost palatable. We've been so fortunate, in this journey we've been forced to take, to have an oncologist with both. When I think back over some of the comments that we've heard from other doctors, I know we've been blessed.

Rather than telling us that Bob's Chemo is no longer effective - Dr. H. advised that his M-Spike has plateaued. It meant the same thing, but it sounded so much better!

Bob was given the choice, and has made the decision, to continue on this journey by proceeding with the Stem Cell Transplant - if he's eligible. We'll go to Dallas - UT Southwestern Bone Marrow Transplant Clinic next week, for further testing. And, how lucky we are that the MM Specialist there is just as caring as our doctor, at home.

As we continue our journey, down this long road, we ask that you remember to include us in your thoughts and prayers.