Tuesday, 30th September

At last some news to pass on to you all...

Jimmy had chemo yesterday afternoon and then we saw Prof afterwards.  Basically Prof has had a look at what he calls Jimmy's 'trend' which is how he is reacting to chemotherapy and Prof feels that it is not bringing down the cancer cell counts enough to warrant having chemo.  Jimmy has been on Velcade from the beginning as well as Endoxan during his first treatment and then this was changed to Doxorubicin when they started the second treatment.   From May, when chemo started, the only real positive was by the end of the second cycle when his cancer cell count came down from 75 to 21 and since then he has basically plateaued - dropping a further 2 to 19 and then going back up to 23. 

He explained to us that we have 2 options:
1)  We keep on with the Velcade but he changes the Doxorubicin to Revlimid.  He would have to motivate with our medical aid again as this is a very expensive drug.  And to see any possible positive change he would have to do a couple of cycles so we would be looking at approximately another 3 months of chemotherapy.

2)  We can chemotherapy now and go ahead and do stem cell transplant.  Because his cancer cell count is still so high the hope of being in remission after stem cell transplant is not as good as it would be if this cancer cell count was say down to 5 or best case scenario 0. And more than likely, Jimmy will have to carry on with chemotherapy afterwards.  Velcade again plus something else.
We discussed this and then asked Prof what he would do and Prof said he would go ahead with stem cell transplant. 

This is not really the news we wanted to hear but there does seem, to us, to be more positives going this route.  Jimmy will complete this 3rd cycle of chemo with last treatment being this Thursday.  They took bloods last night and will be doing the M protein reading to see what is cancer cell count is at the moment.  We should get these results back on Monday.  What we have decided is the following:  If there has been a significant drop in the cancer cell count from the last one after first cycle when it was 23 then Jimmy will finish this treatment which is one more cycle and Prof will motivate for another 2 cycles before he does stem cell transplant.  If there is no significant drop in the cancer cell count, which is what Prof is suspecting, then he will motivate for stem cell transplant.  This takes a couple of weeks.  Once the medical aid authorises the stem cell transplant he will give us a six week plan broken up into days which will lay out the whole stem cell transplant process from start to finish.   This 6 week period would involve a heavy dose of chemo, Neupogen injections to stimulate stem cell production, the harvesting of stem cells (which will get frozen - enough for 3 transplants), going into F4 (isolation ward) for between 20 days and a month where he will have another huge dose of chemo to wipe out all blood counts and as many cancer cells as possible and then they will do the transplant where they put back one bag of frozen stem cells.

The positive of this is that even if Jimmy does have to continue with chemotherapy after the stem cell transplant his body will be rejuvenated and not at the cancer low that it is now and his immune system would not be as compromised as it is now either. This means he could go back to work and if chemo is eg once or twice a week he would have chemo on his way into the office. 

So....basically we now wait for the M protein results on Monday (cancer cell count) to decide which way we going to go.  This is all allot to take in and a big decision to make as there are positives and negatives with each option. The big positive of doing stem cell transplant now is that there is a good chance Jimmy's body will react better to the chemo after stem cell transplant.  The negative being that it is always better to start the stem cell transplant with the cancer cell count as low as possible as this is more beneficial for a longer remission.  The reason for this being that the blood is run through a machine which is computerised to 'clean' the stem cells but it is impossible that the stem cells that get put back are 100% cancer free (unless he is in remission) and over time these cells will start to reproduce again.

I noticed a bit of a rash on Jimmy's stomach on Friday when I gave him an injection.  Prof had a look at it and said we must keep an eye on it as it might be Shingles. 

I had my check-up with Dr Gotlieb this morning and the new medication he put me on for my Psoriatic Arthritis and Fibromyalgia is working like a bomb.  He can only pick up very slight inflammation in my wrists.  And my blood pressure is completely back to normal!

We have been given allot to think about and these decisions can't really be made lightly but I believe Jimmy's body will guide us and this will be possible with the results of the cancel cell count.