tag:blogger.com,1999:blog-25488632991145112362024-03-19T01:08:33.914-07:00The LatestA blog for family and friends of Anton TolmanAnton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.comBlogger45125tag:blogger.com,1999:blog-2548863299114511236.post-40451542969624368552023-10-22T12:09:00.002-07:002023-10-29T10:21:05.306-07:00The continuing saga.....<div class="separator"><p style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: left;"><br /> </p></div> Hello, everyone. I'm sorry that this post has had the longest wait time to be published since my last one on Christmas last year. A lot has happened; this may be a bit of a longer blog, and so I recommend.......<br /><p style="text-align: center;"><img alt="We need to talk. Have a seat.... - Fishers Police Department | Facebook" class="sFlh5c pT0Scc" data-iml="58130" height="402" src="https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcSxMyNkNkiG_x6M95jj4keEttbLCZOiMvavoA&usqp=CAU" style="height: 469px; margin: 0px; max-width: 383px; width: 351px;" width="301" /> </p><p style="text-align: left;">There has been A LOT going on. Several things were happening at the start of this year: </p><p style="text-align: left;">1) I had begun losing some weight again. For the past several years, my weight had been pretty stable around 184 pounds or such which was about 40 pounds lower than my heaviest (pre-cancer), but in a short time, I lost another 10 pounds. <br /></p><p style="text-align: left;">2) I had become (and still am) increasingly tired, impacting both my ability to think clearly, especially late afternoon to early evening (I feel a bit better after dinner and then calming down and relaxing).</p><p style="text-align: left;">3) My platelet count which has been pretty stable for multiple years, ranging around 60-65 or so suddenly dropped to around 40-45; also, my M-spike which you all know by now is the main indicator of my cancer progress jumped from its value of around 1.0 (back and forth from 0.9 to 1.1) to 1.4. Together with the platelets, that worried me that it was starting to accelerate. </p><p style="text-align: left;">I
had a (regular) chat with my medical folks. They said it was time for
my annual CT scan to look for tumors or signs or things getting worse.
There was some good news -- they found no active tumors, although the
cancer is still active in my bone marrow. A recent review showed that the myeloma
was stable -- not accelerating. So....phew! But what was making everything else worse? </p><div class="separator"><p style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: left;"><br /><br /></p></div><p style="text-align: left;">From the CT scan, they told me that my spleen was also enlarged. I had heard that before, but it never seemed to concern the medical team that much. However, this time it was larger than before, enough to represent a potential danger to my life. They told me I needed to see the Gastroenterologist. He wanted to run a lot of procedures and tests, which, as a gastro guy, involved sticking cameras in various places. So after months of this, I have learned some things, and we have reached a few conclusions........(<i>I'm building suspense here</i>.......)<br /></p><p style="text-align: left;"><img alt="Detective Vector Art, Icons, and Graphics for Free Download" class="rg_i Q4LuWd" data-atf="true" data-deferred="1" data-iml="755" height="179" 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" width="221" /> </p><ul style="text-align: left;"><li style="text-align: left;">The spleen is sort of a "bank" of blood cells, especially platelets. If the liver gets damaged, these cells tend to collect in the spleen as a way to reduce pressure on the liver -- this lowers the platelets in the blood stream, making me more likely to bleed quickly (even more than before). This enlargement of the spleen also increases risk because if it is damaged, there will likely be internal bleeding that may be difficult to stop. </li><li style="text-align: left;">The enlarged spleen also signals significant problems with the liver. The doctor believes that the overall tests strongly indicate cirrhosis or scarring of the liver. I have an appointment with him next week to clarify all of this data and conclusions. After my last procedure, Patty asked the doctor if he thought what I was facing was potentially life threatening. He nodded his head "yes" - vigorously!<br /></li><li style="text-align: left;">The way the doctor described it to me, he said that there are two major stages of liver disease: compensated cirrhosis and uncompensated cirrhosis which is worse. He thought I was at "the severe end of compensated cirrhosis", so the goal is to potentially reduce the amount of fat in the liver which should increase the percentage of healthy liver I have and prevent the need for liver transplant (which they might never do for me given that I also have cancer?). However, when Patty and I looked at the symptom list of compensated cirrhosis, I have almost all of them. </li></ul><p style="text-align: left;">Lovely, eh? </p><p style="text-align: right;"><img alt="Cirrhosis of the Liver: Signs & Symptoms, Causes, Stages" aria-hidden="false" class="sFlh5c pT0Scc iPVvYb" height="307" src="https://my.clevelandclinic.org/-/scassets/Images/org/health/articles/15572-cirrhosis" style="height: 469px; margin: 0px; max-width: 800px; width: 453px;" width="297" /> </p><p style="text-align: left;">So, unless he says something different next week, we are moving on treatment right now to do the following: </p><ul style="text-align: left;"><li style="text-align: left;">Change my diet; we have already begun this. Reduce carb intake, especially sugar, but also other types of carbs -- so no cookies, spaghetti, cereal, etc. Focus on lean meats (little red meat), lots of vegetables and fruit (not too much fruit - and some fruit is at the high end of carbs, so very limited consumption of grapes and others), whole grains (need to talk to the doctor about whole grain bread, for example), and legumes (also need to talk with him about that). He encouraged the South Beach Diet, Mediterranean diet, more "keto"-ish. This reduction in carbs should increase my body's burning of fat (including fat in the liver). Patty has mostly joined me in this effort, although she just had to resume some carbs for her own energy and health. This is the first time that my diet has been restrictive than hers!<br /></li><li style="text-align: left;">Lose weight -- this is linked with diet. So far, using my home scale, I have dropped (since we started this year) from about <b>174</b> to <b>158</b> this week. Yowza. However, some of that is muscle loss, so I need to try and increase exercise and try to rebuild some muscle mass. </li><li style="text-align: left;">Changes in medication to replace my hypertension med that is harder for the liver to process and replace it with a beta blocker. We'll be making that switch soon. Wish me luck! </li></ul><p>On top of all this, this semester I continued as co-chair for our department tenure review committee, and we reviewed NINE portfolios which may be a record at UVU. It was exhausting, but part of my goal has been to train my co-chair and get her ready to take over the committee. I also continued to serve as Assistant Chair, working with the coordinators of all majors in the department to get courses scheduled (around or more than 300 classes per semester). I have also been involved in training a new department scheduler. Then, teaching. My department reduced my teaching load because of these administrative duties, and given my situation, they gave me two wonderful Instructional Assistants -- hooray! They have greatly shouldered the burden for grading and allowed me to focus on student interaction and teaching. You may have already seen this, but this is pointing to........ <br /></p><p><img alt="Is retirement good for health or bad for it? - Harvard Health" aria-hidden="false" class="sFlh5c pT0Scc iPVvYb" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/8283/conversions/Retirement-exit-here-thumb.jpg" style="height: 342px; margin: 0px; max-width: 550px; width: 552px;" /> </p><p>That is where I'm headed. I have already told my department that I will be taking Family Medical Leave next semester, and in January, we will apply for long-term disability to get me to Social Security age. I had hoped to finish up this academic year and then do this.......but I just can no longer should all those responsibilities, and trying to manage my health takes up significant amounts of my time. The past three semesters have been very difficult for me. However, I have been relieved because each time I spoke of my plans with my three doctors (GP, oncologist, and gastroenterologist) about whether they believed I would meet criteria for disability, they have all said "yes, without question." I do hope to still work on some articles, maybe even another book in my early retirement. I still want to contribute and help teachers improve student learning, but we'll see how much I can get done. I will be free from the stress of teaching loads, grading, and the work of scholarly committees. I'll have time to rest, manage my health and try and be able to spend more time with family and friends. </p><p>So, my lovely friends and family, that is the latest! Sorry for making this so long. And thank you all for your love and support. <br /></p>Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com5tag:blogger.com,1999:blog-2548863299114511236.post-48149200899553453092022-12-25T11:03:00.003-08:002022-12-25T11:03:33.884-08:00And so this is Christmas...!<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2pTi4Ac4r_qEWx8n6IfznERbdtJqmRV0LvLRxaZ7xMKW4_SjhqkLesmjd5zNp5Qecgz7leItjfTZZ-M9BUvuK4KUTs10JLCj5mzwIMZ2jx657vyQvf23-oayohDuhl1GCidEBo_VsFm88jGzkl6z3JCy-YYCfO6WiQrtvV1X5CQL2mKt72S4_SKw8Kg/s720/christmas-tree-2928142__480.webp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="480" data-original-width="720" height="301" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2pTi4Ac4r_qEWx8n6IfznERbdtJqmRV0LvLRxaZ7xMKW4_SjhqkLesmjd5zNp5Qecgz7leItjfTZZ-M9BUvuK4KUTs10JLCj5mzwIMZ2jx657vyQvf23-oayohDuhl1GCidEBo_VsFm88jGzkl6z3JCy-YYCfO6WiQrtvV1X5CQL2mKt72S4_SKw8Kg/w452-h301/christmas-tree-2928142__480.webp" width="452" /></a></div><br /><div class="separator" style="clear: both; text-align: left;"><b>Merry Christmas, 2022! </b>I hope all of you are enjoying some peace, some quiet, and some enjoyment of each other with family and friends this Christmas season. This is my 2nd blog this year, so I'm doing better with that, anyway, than last time. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">Our final day for turning in grades was December 22nd just before midnight, and I got them turned in around 9:15 pm that night. <i>Wahoo!</i> This semester was a bit difficult in that regard because I was made Assistant Chair this year (in charge of scheduling classes for 55 full-time faculty and 9 programs/majors), and also the co-chair of the tenure and promotion committee which had a lot of work to do. Whew. The department needed the help, and I am happy to help, but it has been a difficult semester in many ways. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">There have been a few other snags: Last year, I had an operation for an umbilical hernia. It was getting increasingly uncomfortable, so we had to have it fixed. It wasn't too bad apart from waiting for hours for the surgeon to arrive.......I must love hernias, because this year I had to have more surgery for bilateral (both sides) inguinal hernias!! There is a great story here.....</div><div class="separator" style="clear: both; text-align: left;"> </div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBHIyKH_VCPwA1GHtJng4LPhhJhRZ6KV5LuZzqdq9OfEW0TLzzGC4kcZXhAbOvHyEMdkQtHkzYppvfXKZN869Q_bBmoMEbUybP_2pklVJMQqIhguiWh-97kEpOgR6f4a_SrL5gx0db7NOID1xX6eiIp0ID9GjdL17YU4gY76gHjD6DvvjW5fcox4bbMQ/s300/Story.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="168" data-original-width="300" height="220" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBHIyKH_VCPwA1GHtJng4LPhhJhRZ6KV5LuZzqdq9OfEW0TLzzGC4kcZXhAbOvHyEMdkQtHkzYppvfXKZN869Q_bBmoMEbUybP_2pklVJMQqIhguiWh-97kEpOgR6f4a_SrL5gx0db7NOID1xX6eiIp0ID9GjdL17YU4gY76gHjD6DvvjW5fcox4bbMQ/w393-h220/Story.jpg" width="393" /></a></div> <p></p><p>Ready? Earlier this year, for several months I thought I was just getting some type of cramps or pulled a muscle, but the pain was slowly getting worse. During my annual physical exam, I told my provider that I was having pains, and he checked and said we needed an ultrasound. So we went and got that, and they said I had these blasted hernias! I asked if I needed surgery and the answer was it depends on how much it hurts or interferes with things. Well, as time went by it hurt more and more and was interfering in my ability to work and do things. So, back to see the surgeon. He agreed surgery would be helpful, but when I reminded him of my myeloma and low platelets, he said, "No, you probably need robotic surgery, and I don't do that, but we'll refer you to the person who does." Which he did. Things were getting worse now, so we scheduled as quick an appointment with the new surgeon as we could. </p><p>Patty went with me, and we were waiting in the exam room when he came in, medical student in tow. He was wearing cowboy boots, funky glasses, western shirt, and a long ponytail. He looked like a country singer taking a break during a concert! But he was very nice, examined me and said, "Yup. You need to have those fixed, and we'll do it via robot to reduce the blood problem. Let's get you scheduled." They also would give me two units of platelets, which to be honest I started looking forward to. But I realized I would have to wait for weeks or months to get the surgery scheduled, meaning I'd have to live with that pain even longer. Then Patty said, "How about tomorrow?" The surgeon gave us a look and said, "No, no, I'm sorry." Then he paused and was thinking. He looked at us again and said "Maybe!" We went out and spoke with the nurse, they got things going, and we were scheduled for surgery the next morning. Yowza. </p><p>I didn't even get to me the robot who worked on me; I called "The Non-Terminator". But recovery took a bit, and I still have some significant inflammation going on, but the pains I was having are gone, and I'm feeling better. So Patty has taught me a good lesson -- don't assume, and it is worth asking about tomorrow when you're talking to a surgeon! </p><p>So, yeah, this has been quite the summer and then fall semester. </p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDNsH45CcnF2MJOtQTUa8cWAfFaZwDdiB983Ezfm8CSLRsxMFxjs2qt6-v9nb8vH0cfsM3TlyZSbi99vOtwcf5mGRUk5dH4oofvE0CvFLEbxB2T5oYyyIbtfSbH97UL7NHYSKSB5VEpmDGxOrRTaunpkOvirSE8I2n5vSFwnE6q-QEMsnmziGTC8pj4w/s1200/Latest.webp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="900" data-original-width="1200" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDNsH45CcnF2MJOtQTUa8cWAfFaZwDdiB983Ezfm8CSLRsxMFxjs2qt6-v9nb8vH0cfsM3TlyZSbi99vOtwcf5mGRUk5dH4oofvE0CvFLEbxB2T5oYyyIbtfSbH97UL7NHYSKSB5VEpmDGxOrRTaunpkOvirSE8I2n5vSFwnE6q-QEMsnmziGTC8pj4w/s320/Latest.webp" width="320" /></a></div><br /> <b>So what's the latest on the cancer?</b> <p></p><p>I had my 2nd review this year in November. Across many of my labs, not much different: low white cell counts, low red blood cell counts, low hematocrit (volume of red blood cells to total blood volume), platelets back to their terribly low 53 number (remember the bottom of the "normal" range is usually 150.....). So those two units are gone now. :( Kappa light chain ratio to lambda chains abnormally high, but not the highest it has ever been. The worst result? <b>My M-spike, the main marker we watch, is up to <u>1.4</u></b>. When I was first diagnosed it was 1.7 back in ol' 2014.....it was at 1.9 when I began chemotherapy. </p><p>To think of it another way, over the past 7 years, my M-spike has <i>very slowly</i> risen from 0.3 after my transplant to 1.0, making for an average slow increase of around 0.1 per year. This year, 2022, it has gone up 0.4 total in one year -- 4x the rate from before. Yes, we are still below when I was diagnosed which is a miracle, but it was 1.2 in May and 6 months later, 1.4. If put this on one of my usual curves, that's a pretty steep rise. If it keeps this up, next May, we'll be at 1.6......</p><p>As I said in my May blog, I can feel it. Yes, this has been a very stressful 2nd half of the year and that could be contributing to this, but......I'm more tired than I have been, and especially -- my back is hurting much more than it has for a long time now. I don't know if I'm getting turmors back in my lower back like I had before or not, or if this is just from sitting too long trying to get final papers and projects graded, but I'm in more pain. So, here's how I feel:<br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFEvsRn7aLbSaCAs_edDqrdWdhWmrUajdvxBkwXEvy_cskVeRcsW9MGHX2Sue3tHasAsd0cXNach9vJYps4lNXECUe6BarQ8bBwZlaphxpsvoMAnxBNmfXuNMMGQqp_kcw5AX9yTMTQed3jSCX-IL41n9lKBOikv6l4WJMCmvEtVzg9CvtkuUQXkOGng/s800/Fingers%20Crossed.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="533" data-original-width="800" height="191" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFEvsRn7aLbSaCAs_edDqrdWdhWmrUajdvxBkwXEvy_cskVeRcsW9MGHX2Sue3tHasAsd0cXNach9vJYps4lNXECUe6BarQ8bBwZlaphxpsvoMAnxBNmfXuNMMGQqp_kcw5AX9yTMTQed3jSCX-IL41n9lKBOikv6l4WJMCmvEtVzg9CvtkuUQXkOGng/w287-h191/Fingers%20Crossed.jpg" width="287" /></a></div><p>We'll see what happens in May. In the meantime, spring semester should be a bit calmer. I'm teaching 3 sections of the same class with at least two of them livestream which reduces my grading burden (no online discussions). We still have some tenure-related issues to go over and write about, and scheduling won't be any less, but I think I'll make it. So prayers and best wishes are ALWAYS appreciated, and I thank you all for the love and support I receive from you. In the meantime, I wish you all a wonderful Christmas day and a Happy New Year celebration. Thinking of the birth of Jesus Christ helps me to remember to be humble and to appreciate every blessing that comes to us. Merry Christmas!</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpn3HKIqYVpolqT30Jy_ixWSAeVCCc9SxlffKPgZDF3Bokayc5Ew4-9rOv7olYWR7ZhsGjTUXHSffh2bT0xvdvbYEd_4O7LftQfrocESMovTeb2Vqd1_PUMsKg6LjMrvIAvAVaYRGjx9RaHtLKguhg0EPpqS0VZ8DJO4QPEWoNcxzKbTNgRRMRUWiP6A/s1920/Baby%20Jesus.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1200" data-original-width="1920" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpn3HKIqYVpolqT30Jy_ixWSAeVCCc9SxlffKPgZDF3Bokayc5Ew4-9rOv7olYWR7ZhsGjTUXHSffh2bT0xvdvbYEd_4O7LftQfrocESMovTeb2Vqd1_PUMsKg6LjMrvIAvAVaYRGjx9RaHtLKguhg0EPpqS0VZ8DJO4QPEWoNcxzKbTNgRRMRUWiP6A/w640-h400/Baby%20Jesus.jpg" width="640" /></a></div><br /><p><br /></p><p><br /></p>Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com2tag:blogger.com,1999:blog-2548863299114511236.post-6535382221569275442022-06-26T13:37:00.003-07:002022-10-15T14:58:36.346-07:00Searching for the Balance<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoaFYvn1adFoifpU9mxC9u9YwMJetb5GQSTvLRAr1yoqeamBW1KgkDdp7znCI7tqvPuKCWcub4koZpv0GN5zi7ZUcrhn_L6-MlYZGUxpNCvfaRjOMq0Tr3Ml1VaJQe7QABYcpwEdmvswE-kA5NgG-ji1N19A5fFK6c7CRYZy76YlhmgzP_l-l1uDnZFg/s2048/932831.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1366" data-original-width="2048" height="245" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoaFYvn1adFoifpU9mxC9u9YwMJetb5GQSTvLRAr1yoqeamBW1KgkDdp7znCI7tqvPuKCWcub4koZpv0GN5zi7ZUcrhn_L6-MlYZGUxpNCvfaRjOMq0Tr3Ml1VaJQe7QABYcpwEdmvswE-kA5NgG-ji1N19A5fFK6c7CRYZy76YlhmgzP_l-l1uDnZFg/w368-h245/932831.jpg" width="368" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;">Welcome back, friends and family! It has been about 15 months since my last update. </div><div class="separator" style="clear: both; text-align: left;">In searching for a theme, I settled on the idea of how I continue to try and find some way to balance my life as things continue to progress over time. Let me start with some good news. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjuoPQ15Ff7mpT8vJFjnDwgFuq48YZZeACZClsHsFbW5JodHMs71Zn64GfmhBWw86gf_vxaKJOIMNLldbDvK65fcO7ioTMChBjyJSIiImQGwXUQ49QxVHc-ngA2mCvJsSQHiTKuOwPbpS8H43FGQwNH1jdr1wBD9HkdnNYnBgjy4J_Qosv6J5LPKrW8Q/s490/GoodNews.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="275" data-original-width="490" height="125" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjuoPQ15Ff7mpT8vJFjnDwgFuq48YZZeACZClsHsFbW5JodHMs71Zn64GfmhBWw86gf_vxaKJOIMNLldbDvK65fcO7ioTMChBjyJSIiImQGwXUQ49QxVHc-ngA2mCvJsSQHiTKuOwPbpS8H43FGQwNH1jdr1wBD9HkdnNYnBgjy4J_Qosv6J5LPKrW8Q/w222-h125/GoodNews.jpg" width="222" /></a>In March, I had my 7th birthday, celebrating my triumphant return home from the hospital seven years ago having defeated cancer! Wait...hmmmm. Maybe it wasn't quite like that, but I am still alive after seven years following my transplant, so that IS good news, right? I am still working, we are enjoying redoing our entire yard right now to reduce water use and change its look, and we just found out that we have a new grand baby who will be joining us in several months. I also finished my sabbatical having accomplished a fair amount, although not all that I had wanted to, and me and my loving wife are still together after 37 years. These are all awesome, and I am grateful for all of them. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">So what's the latest? </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">Well, not as good as I had hoped. My latest blood draw, from the start of May, showed an M-spike of 1.2; this is the highest since I was diagnosed which was 1.7. After my transplant (2015), my M-spike was 0.3, so I have moved a bit up and am getting closer to when I was diagnosed. On the other hand, my annual MRI in early January did not show any major tumors yet. Wahoo! </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">On the other hand....my white blood cells counts in November and in May were both the lowest they have been in years, my red blood cell counts were stable between November and May, but also the lowest they have been since 2019 (that's as far back as I can easily see on my tracker right now); the bottom of normal is 4.7 and my counts were 3.86, and my average since my transplant is 4.14 over the years. So, my ability to fight off infections is less than it has been, and my anemia is worse than it's been for a long time. Maybe this will help: </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><u>Lab</u><span><u> </u><span><u> </u><span><u> </u><span><u> </u><span><u> 7 year average</u><span><u> </u><span><u> </u><span><u> Bottom of "normal"</u><span><u> </u><span><u> </u><span><u> <span> Me in May, 2022</span></u></span></span></span></span></span></span></span></span></span></span></span></div><div class="separator" style="clear: both; text-align: left;">M-spike<span> <span> <span> <span> <span> .84<span> <span> <span> <span> <span> <span> <span> <span> <span> 0.0<span> <span> <span> <span> <span> <span> <span> <span> <span> <span> <span> 1.2</span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div><div class="separator" style="clear: both; text-align: left;"><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span>White cells<span> <span> <span> <span> 3.06<span> <span> <span> <span> <span> <span> <span> <span> <span> 4.3<span> <span> <span> <span> <span> <span> <span> <span> <span> <span> <span> 2.16</span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div><div class="separator" style="clear: both; text-align: left;"><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span>Red cells<span> <span> <span> <span> 4.14<span> <span> <span> <span> <span> <span> <span> <span> <span> 4.7<span> <span> <span> <span> <span> <span> <span> <span> <span> <span> <span> 3.86</span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div><div class="separator" style="clear: both; text-align: left;"><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><br /></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div><div class="separator" style="clear: both; text-align: left;"><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span>In my last blog, I also noted that we have been watching my light chains from my kidneys. Well, those haven't looked that good, either. Focusing mostly on the ratio because that is what the doctors say is the most important indicator, my last two chain labs show 1.79 ratio or above; the top of normal is 1.65. So we are going to keep watching it. </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div><div class="separator" style="clear: both; text-align: left;"><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><br /></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div><div class="separator" style="clear: both; text-align: left;"><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span>Here's the other thing: I can <i>feel</i> it. I am more tired than I have been in a long time. I am having, as a result, more difficulty concentrating especially as the day goes on. This is with 7.5 - 8.5 hours of sleep a night. My back hurts more than it has in a while, and I am having more "side" problems </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span>than I have in years. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">I made a big decision recently -- while I love, love mentoring students in research and helping them develop the powerful skills that will help them in their futures, I don't think I can do it anymore. I took on one more student this summer (just one) and will no longer be mentoring students after I finish with the projects I have going on right now. I will still do scholarly work -- but more as a consultant, editor, and not as the person leading the project. I have also gone to my department chair and dean and asked for support with a student Instructional Assistant every semester and possibly reducing my work load a bit (this is still being evaluated on the basis of health accommodations). </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPq0x01TvpuMCsYw_dRHorzDATdImSEV8cByfhbiPlVedVX9OHHMU03svbksmrYlhuS5tD0Yvwtyc4eX0e1i7BLSabobiXsc9_IaUYvqZDAEDtw-bvB8_zwZYO69YjxafuBAKT6uX5TR8SWHErf7fXCss_PVO7Aht5qXLi9VmEryJrMnBI5x2d5JH3Vg/s555/main-qimg-055a312564c3272b8d34a2a207bf48ad-lq.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="363" data-original-width="555" height="128" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPq0x01TvpuMCsYw_dRHorzDATdImSEV8cByfhbiPlVedVX9OHHMU03svbksmrYlhuS5tD0Yvwtyc4eX0e1i7BLSabobiXsc9_IaUYvqZDAEDtw-bvB8_zwZYO69YjxafuBAKT6uX5TR8SWHErf7fXCss_PVO7Aht5qXLi9VmEryJrMnBI5x2d5JH3Vg/w196-h128/main-qimg-055a312564c3272b8d34a2a207bf48ad-lq.jpeg" width="196" /></a></div><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">I am very grateful for my life, my Savior, grateful to my wife, grateful for my seven years and hopefully more to come, grateful to my department and colleagues and UVU for their support. I could not do what I am doing without all of that support. But it was time to step back, acknowledge my body and how I'm feeling, and to shift towards those things I can still do well and get done. I don't necessarily believe right now that it will get better, although in my 7 year wait, there are SO many more options once I do have to go back on meds -- and I am grateful for that, too, and for my doctors who track and watch my health. This is my search for balance -- to find a place where I can try to get the support I need to carry on and continue to contribute to the world while acknowledging the reality of my situation. <br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">As the British government said in its poster before WWII: Keep calm and carry on! And thank you to all of you reading this -- I love you and am grateful for your support as well! I hope to give you a next update a little closer in time to this one. Wish me luck! </div><p></p>Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com11tag:blogger.com,1999:blog-2548863299114511236.post-1845177220213844752021-03-28T13:22:00.000-07:002021-03-28T13:22:07.420-07:00A Long Slide<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCF0tX_Fn-yvuT_M1Uw553Ok0XFbUe-Pj6Q16OtiOqluFikqjRji3TyJ7amIaHLnPCc_gzdA6foeHpjSgCu6KxHdvNXUW9_0Ahfqk1rGAVQ9gHSSQvssKfsX-WXwFCvduF4Zgf2QcqIJ5h/s251/Downward+Slide.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="251" data-original-width="201" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCF0tX_Fn-yvuT_M1Uw553Ok0XFbUe-Pj6Q16OtiOqluFikqjRji3TyJ7amIaHLnPCc_gzdA6foeHpjSgCu6KxHdvNXUW9_0Ahfqk1rGAVQ9gHSSQvssKfsX-WXwFCvduF4Zgf2QcqIJ5h/s0/Downward+Slide.jpg" /></a></div><p></p><p>I can certainly emotionally identify with the boy in the picture above! Welcome back to The Latest. I'm not publishing blogs very often, but this one is only six months after my last update in September. Good, right? So what's the latest? </p><p>Because the process of my cancer progressing VERY slowly (can you hear the "reeeeeeeeee....." sound going down the slide?), the Cancer Center has recently moved to only getting full blood work outs every six months instead of every three (I am still getting Zometa every six months). My last full work up was in September, and it was interesting and confusing. Why?</p><ul style="text-align: left;"><li>My M-spike increased to 1.1 -- only a 0.1 increase over April, but also the highest number since my stem transplant.</li><li>My Kappa free light chains was up to 30.3, also the highest since my stem transplant, up from 26 in April 2020 (highest normal range is about 3.3 to 19.4). Just as a reminder, one of the functions of plasma cells is to create antibodies which are made up of both heavy protein chains (longer, bigger), and light chains (smaller). Excessive production of light chains is a hallmark of Myeloma, and can damage kidneys over time. Some medical sites describe the serum levels of light chains to be a better indicator of clinical outcomes than the M-spike. </li><li>I've posted before about my weight loss prior to my diagnosis and transplant. At my peak, 2014, I weighed about 220. Since being out of the hospital and after recovering, my weigh has hovered around 194 or so (minor fluctuations) for the past four to five years. In the past two months, my weight has (as of my recent home weighing) dropped to about 182. Yes, we take daily "quick walks" with Belle, and my wife and I are trying to reduce our portions a bit and eat less desserts and treats, so that may be part of that. I'm keeping an eye on the weight though, because it seems to be dropping fairly quickly. </li></ul><p><i>On the other hand........</i></p><ul style="text-align: left;"><li><i> </i>My calcium and kidney markers are still very good -- so no obvious significant damage to bones or kidneys.</li><li>The single most important marker related to light chains is the <b>ratio </b>between the two types of light chains: kappa (mine) and lambda. Some folks with Myeloma have more of one, some have more of the other. The ratio should be 0.26 - 1.65 in the healthy range. My ratio has been above that, up to 2.24 in April, since July 2019. My NP even mentioned some concern and need to watch this. So, although my kappa chains were at their highest ever, apparently so were my lambda chains, so my ratio in November was 1.46?!!! What.....?? I don't really know what to make of that. </li><li>My liver function tests are still above healthy range, but look better, overall, than they have in years. </li></ul><p>So it looks like I'm still sliding, but I'm not sure how fast, and maybe I'm turning sideways as I go! Of course, that is probably true for most children on slides? I don't really know what is going on, but we'll see what the next results say in April. </p><div class="separator" style="clear: both; text-align: right;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlxvB-h_0_C45BmZOPgHjuwll8SxAFjXCw8eOE1XiM9R_lg7HiBGgrrU75QERkRBhDxx6_YaHNBda234sz98yMFGSi0SkZLA7nfp0q2ck2HMr7YAh6JD0gVRTVm7N0HPhTH-1HD71nMQHO/s1200/fireworks_via_shutterstock-1498496544-941.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="900" data-original-width="1200" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlxvB-h_0_C45BmZOPgHjuwll8SxAFjXCw8eOE1XiM9R_lg7HiBGgrrU75QERkRBhDxx6_YaHNBda234sz98yMFGSi0SkZLA7nfp0q2ck2HMr7YAh6JD0gVRTVm7N0HPhTH-1HD71nMQHO/w414-h240/fireworks_via_shutterstock-1498496544-941.jpg" width="414" /></a></div><p></p><p>But wait! There's....you know. This March, I celebrated SIX YEARS since my stem cell transplant. Wahoo! That is really a milestone. I remember wondering if I would make it to my son's wedding. Yes! And now there's two grandbabies to enjoy and love! I wondered if I would still be able to work. Yes! (Online). Since last July, I've been on sabbatical; I've gotten a lot done, and right now I'm working on a research project, starting to write a federal grant proposal, and trying to finish up three manuscripts (one is about ready to send back, hopefully for publication). Patty and I have had more time together to enjoy movies, laugh at dog and elephant videos, and look forward to our COVID shots. Huzzah! <br /></p><p>Speaking of which.....</p><div class="separator" style="clear: both; text-align: left;"></div><div class="separator" style="clear: both; text-align: left;"></div><div class="separator" style="clear: both; text-align: left;"></div><div class="separator" style="clear: both; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOnHpUrPdIDQaMY_U77fEhBptsRZWgYKweSg1awd1i4qQbC3Y2b-5GyR3ezvAfSNpkkmqYMkk88KG_ONqAmMaTPpeEiX2SnPoyBKUB15Cgv4Re-tUjYWDd72cOlW0AaUZHkKIJwI8a0ZJg/s615/covid-19-concept.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="345" data-original-width="615" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOnHpUrPdIDQaMY_U77fEhBptsRZWgYKweSg1awd1i4qQbC3Y2b-5GyR3ezvAfSNpkkmqYMkk88KG_ONqAmMaTPpeEiX2SnPoyBKUB15Cgv4Re-tUjYWDd72cOlW0AaUZHkKIJwI8a0ZJg/s320/covid-19-concept.jpg" width="320" /></a></div><p></p><p>I have now had both of my COVID shots (Moderna). In a couple of weeks, I may feel a bit better. I may have mentioned last time, that I may not respond as well as most people to the shots, but I should be more protected than I have been. So I'll still be cautious and yes, I'll still be wearing a mask to public situations until most of the population has been vaccinated. So even if you're reading this and not sure you want to be vaccinated, please do! Do it for your friends and families, and even people like me. The COVID variants are also still an issue, but we'll just have to see what we learn as the data keeps coming in. I'm truly grateful to all those who have worked to care for those afflicted and to develop these vaccines which are modern miracles. <br /></p><p>In many ways, I'm very glad that my sabbatical just happened to get sabotaged by COVID. I haven't hardly been on campus, and we are very comfortable here at home. I have had less stress since I have been focusing on writing and such, and although it is still a lot of work, it doesn't feel as pressured as grading, and I'm still enjoying working with my research students. That said, I'm looking forward to interacting with students again this fall (even if mostly still online). </p><p>I hope all of you are doing well and enjoying the somewhat lurching start of spring. Thanks for reading my blog and caring enough to check in and see how I'm doing. <b>My love to you all! </b>Until next time....stop and smell the flowers (unless you have severe allergies......)<br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg67KesCJJ7eWlMa0gaojVHlFUNWdLJisVi9x38VIUcBDG-oJDpcvdpqtAfTAVJUeMiv42LtTlSi7b1ylKdPFDDfHgbRR4Nn_5LIVifWTwV5cvj2GU2tDjDMDM1_IscsIPOTqr84y8AILxP/s1919/fleurs-sauvages-printemps.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1440" data-original-width="1919" height="296" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg67KesCJJ7eWlMa0gaojVHlFUNWdLJisVi9x38VIUcBDG-oJDpcvdpqtAfTAVJUeMiv42LtTlSi7b1ylKdPFDDfHgbRR4Nn_5LIVifWTwV5cvj2GU2tDjDMDM1_IscsIPOTqr84y8AILxP/w395-h296/fleurs-sauvages-printemps.jpg" width="395" /></a></div><br /><p><br /></p>Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com1tag:blogger.com,1999:blog-2548863299114511236.post-59856512111318242812020-09-13T15:55:00.005-07:002020-11-15T11:59:31.353-08:00What's For Dinner? <p style="margin-left: 40px; text-align: left;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEit2fCn5y-E816CpM1NVH1NYLqdr0Qf2Lu6sXa5coLymHOCfcSKeT9JpxS8HRF04F6Jpwh14qDJPBPrgu9l_AUz6M14n9AIcHjzLdZtdF8zmRmumWjx5CkEZwpjB98htBWcr33ICrbBigQe/s2048/IMG_0017.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="1536" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEit2fCn5y-E816CpM1NVH1NYLqdr0Qf2Lu6sXa5coLymHOCfcSKeT9JpxS8HRF04F6Jpwh14qDJPBPrgu9l_AUz6M14n9AIcHjzLdZtdF8zmRmumWjx5CkEZwpjB98htBWcr33ICrbBigQe/s320/IMG_0017.jpeg" /></a></div><br />10 months since my last post.....yikes. I wanted to write this post for a while, but something else always seems to come up. The picture you see really is the pile of pills I take in the evening, although we have now added <b>one more.</b> It makes me think of a conversation I was having with a friend a few months ago; he also suffers from multiple health issues, and we were commiserating about our problems. After he shared his, he asked me to describe my situation. As I finished, his eyes were a bit wide and he said, "You win!" HAHAHAHA<p></p><p style="margin-left: 40px; text-align: left;">I also take a pile of pills at breakfast, but unlike the ones in the picture, they are mostly supplements to try and keep my health up. The point here, as my wife notes, is I take a lot of pills. The good news of this is that they seem to be working! </p><p style="margin-left: 40px; text-align: left;">I may have already said this in another blog, but I am "generally" healthy in the sense that I am not in the hospital, not in painful agony, not currently taking chemotherapy, and not getting substantially worse. I am almost fanatical about taking my pills and doing my morning and evening routines. In some sense, I feel a bit like I am juggling multiple balls at the same time, and so far, things are going OK. Keep juggling! Kudos to my wife who tolerates and supports me in my fanaticism.<br /></p><p style="margin-left: 40px; text-align: left;">I admit that there is some anxiety underneath all of this. What if I miss several doses of something and one of my multiple conditions starts to get out of hand? What this be like a wooden tower of Jenga slowly tipping over? Hopefully not, but that is what is in my head!!</p><p style="margin-left: 40px; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhc41dDzdXCAKhyphenhyphenDZ3aOK2LUzNZAqzI9w1QEzI2uKfRpmnNrczSuLd8A9WuWckfgPAYjN4YsKWBY6ajKPWiCKAkUWov3WZ9r2-4QwwgLcEF6Lp9UHKE27cCkpFpnEfGOHGGSlEzWCI1Km5t/s1200/Jenga.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1200" data-original-width="1200" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhc41dDzdXCAKhyphenhyphenDZ3aOK2LUzNZAqzI9w1QEzI2uKfRpmnNrczSuLd8A9WuWckfgPAYjN4YsKWBY6ajKPWiCKAkUWov3WZ9r2-4QwwgLcEF6Lp9UHKE27cCkpFpnEfGOHGGSlEzWCI1Km5t/s320/Jenga.jpg" /></a></div><p></p><h4 style="margin-left: 40px; text-align: center;"><span style="font-size: medium;"><b>So what is the latest? </b></span></h4><p style="margin-left: 40px; text-align: left;"><span style="color: #2b00fe;"><span style="font-size: medium;"><span style="font-size: small;">Overall, more of the same, which is a good thing. <b>My M-spike is holding at 1,</b> although I don't think it has dropped below one (like it was sometimes doing before) in quite a while. My oncologist moved me to Zometa treatments every 3 months with full blood work-ups and meetings every six months. I had a recent PET scan (my annual tradition is usually a full-body CAT scan, but they did PET this year to see if there were active tumors). The results showed NO large very active tumors. 👍 Obviously, there are still myeloma</span><b> </b><span style="font-size: small;">cells in my bone marrow, or I would not have a suppressed immune system, ongoing fatigue and weakness, and any M-spike, but it seems like the cancer is just maintaining status quo for now -- it is keeping itself there and alive, but not growing quickly which would show up on the PET scan. The only worrisome sign are the labs that track the proteins that can damage my kidneys. They have been slowly going up, so we are keeping an eye on those. </span></span></span></p><p style="margin-left: 40px; text-align: left;"><span style="font-size: medium;"><span style="font-size: small;">We had another great report recently -- for the first time in 5 years, my dentist said I showed improvement in my gum disease. Wahoo! After being frustrated for all this time that I could not seem to get rid of the gum disease, I switched to a new toothpaste designed to attack gingivitis and periodontitis, and I am using an Amway mouthwash; one of these, or maybe</span></span><span style="font-size: medium;"><span style="font-size: small;"> the combo, has lead to this success. The periodontitis is not gone, but I feel like I beat it back u</span></span><span style="font-size: medium;"><span style="font-size: small;">nder the bushes. Hopefully the next report will be even better. </span></span><span style="font-size: medium;"><span style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ9xCZa0bGjqix_H-fW5SOvNTcUi0KHYhsPaPXXbsKKlSEi6FYbgfajuJGP2-u2psaMT8Pz4hrV4acSEMbqWz-Yd2f6vb30R_Jv3jUd-3mtDr__THUKS3gfN3jwMWARJhK1IxMnQkN-3pr/s300/Fingers+crossed.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="168" data-original-width="300" height="112" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ9xCZa0bGjqix_H-fW5SOvNTcUi0KHYhsPaPXXbsKKlSEi6FYbgfajuJGP2-u2psaMT8Pz4hrV4acSEMbqWz-Yd2f6vb30R_Jv3jUd-3mtDr__THUKS3gfN3jwMWARJhK1IxMnQkN-3pr/w200-h112/Fingers+crossed.jpg" width="200" /></a></span></span></p><span style="font-size: medium;"><br /><b></b></span><p></p><h3 style="margin-left: 40px; text-align: left;"><span style="font-size: medium;"><b>Having Cancer During COVID</b></span></h3><p style="margin-left: 40px; text-align: left;"><span style="font-size: medium;">I don't think I'm alone in feeling like this year has been one awful roller coaster ride. It didn't start too badly at the beginning, but now 2020 feels like: </span></p><p style="margin-left: 40px; text-align: left;"><span style="font-size: medium;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: medium;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjecylVQ7qUABJfhkzEq0KGSMrBLQYe9hZGRTdQE45Ba_wN-LGLGphCr_AVCTVidvhspsDkPH2Ci_Ji8u2ib6NahAL-RbVPP3cPypUQmRAYm1Uz51vNWGnjOZ4B0tPzy3hUjn2sqMRv4GgB/s640/cthulhu.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="640" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjecylVQ7qUABJfhkzEq0KGSMrBLQYe9hZGRTdQE45Ba_wN-LGLGphCr_AVCTVidvhspsDkPH2Ci_Ji8u2ib6NahAL-RbVPP3cPypUQmRAYm1Uz51vNWGnjOZ4B0tPzy3hUjn2sqMRv4GgB/s320/cthulhu.jpg" /> </a></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-size: medium;"> </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: medium;">Right? The recent hurricanes and massive evacuations from the fires have not made things feel any better. Having Myeloma and a compromised immune system, not to mention all of the other side-effects/exacerbated conditions that the cancer seemed to trigger off, makes me VERY high risk; most of our family is high risk. We are very cautious and wear our masks when we go into any public venue (which we usually do mostly for basic things like groceries) -- this may help protect us somewhat and if we do get infected will help others; we wash our hands, we maintain social distance, we track rates and locations of disease spread. <b>I was terrified and very anxious for the first several months of the pandemic.</b> As we have learned more about the illness, we are not quite as anxious, although we are still very cautious. We are grateful to all who also wear masks and social distance when we are out. <br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: medium;"> </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: medium;">We miss seeing friends and neighbors, and we are hoping and praying that all of you are well. We know of some (including some of you reading this!) who have suffered greatly as a result of this pandemic -- our son also came down with it back in June, I think. He came through without hospitalization, but he had a rough time of it for a while. He recovered and hopefully is protected for a few months, at least. We still encourage caution. <br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: medium;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: medium;">Now we come to the best part of the year! Our son, Wes, the Squatty Potty Prince, returned home to live with us in April because all of his work opportunities in California shut down. Honestly, given what is happening there now, it was probably a good thing. Then in August, our other son Ben, his wife Sonal, and our adorable grandson came to stay, so we have had a full (and sometimes loud 😬) household! There is another Tolman on the way, due in December, so next visit will be even a bit more chaotic. They are considering moving out to the intermountain west, so we'll see what happens. We love snuggling with the grand baby, playing with blocks again (been a while since we did that), and reading the same books over and over (THANK YOU Orem library for some variation). We hope you are finding joy in your families and peace during this turbulent times. </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: medium;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: medium;">So, on to dinner! I wonder what I should do for dessert??</span></div><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDblYLpTMeF8EL6gpMzC3HXM-5oLgMy_Y6CJDHVhUwu9KlcZt8PgCv54bjBfnBdbAZx49GVeQF7IxCayrhLejpYMNzhM4NH4W-rhafi8kUUjzwlnS7A-mcNhV8edDAdqw9DZMraejQwLTb/s2048/3B0170FB-EF83-4F94-BA59-FF025032E1F2.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="1536" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDblYLpTMeF8EL6gpMzC3HXM-5oLgMy_Y6CJDHVhUwu9KlcZt8PgCv54bjBfnBdbAZx49GVeQF7IxCayrhLejpYMNzhM4NH4W-rhafi8kUUjzwlnS7A-mcNhV8edDAdqw9DZMraejQwLTb/s320/3B0170FB-EF83-4F94-BA59-FF025032E1F2.jpeg" /></a></div><br /><span style="font-size: medium;"><br /></span></div><span style="font-size: medium;"></span><span style="font-size: medium;"></span><br /><span style="font-size: medium;"></span><span style="font-size: medium;"><br /><b> </b></span><br /><p></p><p style="margin-left: 40px; text-align: center;"><b><br /></b></p>Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com6tag:blogger.com,1999:blog-2548863299114511236.post-62395419034227587522019-11-03T16:16:00.001-08:002019-11-10T10:35:37.813-08:00The News -- from my recent Dr. visitHello everyone! I thought I had posted earlier this year, but looking the dates --- WHOOPS. It has been too long. I have been getting asked questions about how things are going, and some have even noted that I have not updated the blog recently, so it is p.a.s.t. time I did so. Sorry for making you wait so long. <br />
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So I had my most recent checkup on October 21. This was accompanied by my favorite <i><span style="color: red;">Vitamin Z</span></i> treatment (Zometa). I don't know why, but it usually does not strongly hit me for a day or two. You think I would be used to that by now, but like a board game where you think you are ahead and then everyone zooms past you at the last moment (believe me it happens to me a lot), the Zometa always hits me pretty hard just when I think I've got it down. No exception this time......I'm just glad that is over for another 2 1/2 months. <br />
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"Went to the doctor and the doctor said......" So what did the NP say????? <br />
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<b>Good News and not quite so good news. </b>Usually folks want to hear the good news first, and it is <u>very</u> good. <br />
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(Have I built up enough suspense yet?)<br />
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THE GOOD NEWS (and I'm not talking about the gospel here.....)<br />
After reviewing my most recent bloodwork, she said it appears that I am still stable, and she does not see the need to resume chemotherapy at this point. She wants to continue with the every 3 months Zometa treatments and the every 6-month check-in with her. So that is <b>GR8</b>! I was a bit worried before I saw the blood results on Sunday night that we might be heading in that direction. I have been more fatigued and hurting a bit more in back and joints. Maybe I'm just getting old..........<br />
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NOT QUITE SO GOOD NEWS:<br />
She said I'm still anemic and that might account for my fatigue. She encouraged me to continue attempting to exercise. What I've been doing lately, because our old dog Andy sometimes is sleeping when it is walk-time, I've been talking the less old and more sprightly Belle out and trying do so some interval jogging. This sometimes leaves me a bit sore and hurting (like today), but it is my attempt to do something. I also take the stairs rather than the elevator at work if it is only a couple of flights. No need for clapping, I realize I'm really on the cutting edge of fitness, here.......<br />
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However, looking at my blood results also has some wrinkles in it, and she noted these. For example:<br />
Here is my latest graph of my abnormal Myeloma protein (or M-spike) data:<br />
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This chart is data from about November, 2017 to now (October, 2019). The M-spike looks pretty stable around 0.9 to 1.0, but is also at an overall higher level than it was before. Still.....it is moving very slowly (sloth-speed I call it). Also, the <b>average</b> of all M-spike scores <i>before</i> Nov 2017 was 0.77; since Nov 17, it is 0.93. We'll keep an eye on it -- that is over a two-year period, after all. <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLPZZlbr_4kAP8n7qMc_rsBBIsFd0n8cLUjLVZ73UIuAXqh-_tSORO3J4k2kF7HCjst0I9dtv0ilfi6yTNQVSyR1tlRyM-WqRK53ApML0wmLbgAm5hiQnkS8s8S5fd0UCyQWgK_fcBnHca/s1600/M-spike+update.png" imageanchor="1"><img border="0" height="292" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLPZZlbr_4kAP8n7qMc_rsBBIsFd0n8cLUjLVZ73UIuAXqh-_tSORO3J4k2kF7HCjst0I9dtv0ilfi6yTNQVSyR1tlRyM-WqRK53ApML0wmLbgAm5hiQnkS8s8S5fd0UCyQWgK_fcBnHca/s400/M-spike+update.png" width="400" /></a><br />
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My Red Blood Cell counts are next -- low RBC defines anemia. <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqR4HR5Momkg_so1NBg_IIKPYPaMe-6x_GWBdRMguqBgVw3j7artpu23ZcNGoQGox7Sike0LrqEb6eH8REeKQIkivXtfoLQMu6CowAoXgVcLOy7oJ9dxuIuWgqA2XZSkIiWjoem0lRk_Cf/s1600/RBC+data+update.png" imageanchor="1"><img border="0" height="310" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqR4HR5Momkg_so1NBg_IIKPYPaMe-6x_GWBdRMguqBgVw3j7artpu23ZcNGoQGox7Sike0LrqEb6eH8REeKQIkivXtfoLQMu6CowAoXgVcLOy7oJ9dxuIuWgqA2XZSkIiWjoem0lRk_Cf/s400/RBC+data+update.png" width="400" /></a><br />
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This is over the same time period as above -- not a terrible drop, but there is a fairly clear downward trend. Will that continue? Who knows? <br />
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The biggest worry has become my Light Chains numbers. They have been in trouble before, but with one exception (April, 2018), even when my Chain scores have been elevated (bad), the ratio was within the normal range (good!). This reflects the relative balance between the two major kinds of Light Chains. In my last visit, she expressed some concerns about these because the ratio has shifted into the "abbey normal" range. Since April, 2019 I have had elevated Kappa chains, and since July, the ratio has also been above normal following a period of two years when they were in the normal range (with that one exception). This could mean progression of the cancer is coming and continued pattern of this could potentially damage my kidneys. The good side of this is that the ratio did drop slightly from July and is <i>not</i> way above the "abnormal" line; I think that is why she wanted to keep on the current schedule.<br />
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<table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; width: 470px;"><colgroup><col style="width: 157pt;" width="209"></col><col span="3" style="width: 65pt;" width="87"></col></colgroup><tbody>
<tr height="21" style="height: 16pt;"><td colspan="16" height="21" style="border: none; font-family: Calibri, sans-serif; font-size: 12pt; height: 16pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap; width: 222pt;" width="296">Overall Lamba/Kappa Lt Chain Ratio Average: </td><td align="right" style="border: none; font-family: Calibri, sans-serif; font-size: 12pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap; width: 65pt;" width="87">1.42095238</td><td style="border: none; font-family: Calibri, sans-serif; font-size: 12pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap; width: 65pt;" width="87"></td></tr>
<tr height="21" style="height: 16pt;"><td height="21" style="border: none; font-family: Calibri, sans-serif; font-size: 12pt; height: 16pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap;">Average before Nov2017:</td><td style="border: none; font-family: Calibri, sans-serif; font-size: 12pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap;"></td><td align="right" style="border: none; font-family: Calibri, sans-serif; font-size: 12pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap;">1.36916667</td><td style="border: none; font-family: Calibri, sans-serif; font-size: 12pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap;"></td></tr>
<tr height="21" style="height: 16pt;"><td height="21" style="border: none; font-family: Calibri, sans-serif; font-size: 12pt; height: 16pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap;">Average after Nov 2017: </td><td style="border: none; font-family: Calibri, sans-serif; font-size: 12pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap;"></td><td align="right" style="border: none; font-family: Calibri, sans-serif; font-size: 12pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap;">1.49</td><td style="border: none; font-family: Calibri, sans-serif; font-size: 12pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap;">Increasing</td></tr>
<tr height="21" style="height: 16pt;"><td class="xl65" height="21" style="border: none; color: red; font-family: Calibri, sans-serif; font-size: 12pt; height: 16pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap;">"Normal" is a ratio of 1.65</td><td style="border: none; font-family: Calibri, sans-serif; font-size: 12pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap;"></td><td style="border: none; font-family: Calibri, sans-serif; font-size: 12pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap;"></td><td style="border: none; font-family: Calibri, sans-serif; font-size: 12pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap;"></td></tr>
<tr height="21" style="height: 16pt;"><td class="xl65" colspan="16" height="21" style="border: none; color: red; font-family: Calibri, sans-serif; font-size: 12pt; height: 16pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap;">My last two ratings: 1.71 and 1.67</td><td style="border: none; font-family: Calibri, sans-serif; font-size: 12pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap;"></td><td style="border: none; font-family: Calibri, sans-serif; font-size: 12pt; padding-left: 1px; padding-right: 1px; padding-top: 1px; vertical-align: bottom; white-space: nowrap;"></td></tr>
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So -- better news than I expected in some ways. As always, some things to worry about. Sometimes people have thought that I am in remission.......but sadly, no. As you can tell from my red blood counts, that does not look like remission. And I didn't even show you the white blood counts! <br />
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So, as the Brits would say: Tally ho! Carry on! As the Lord said, "Sufficient unto the day is the evil thereof". I will value each day, do what I can knowing I'll have better days and bad days, keep working on what I can do, and play as many games as I can! :) I will love my wife and family, and I greatly appreciate the support, prayers, name in the temple, and the physical assistance that I get when needed. Thank you all for your love and concern. I'll try and write a bit more often in the months ahead. <br />
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And it HAS been five years since I was diagnosed --- what a blessing, indeed!!<br />
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-- Anton<br />
<br />Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com0tag:blogger.com,1999:blog-2548863299114511236.post-11744178337797174632018-07-15T15:18:00.003-07:002018-07-15T15:18:21.917-07:00Love and HateWe've all heard the term "love and hate relationships". Well, I have one of those. No, not with my wife! Or my dogs......or...... Anyway, I have it with my Zometa treatments. <br />
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<tr><td class="tr-caption" style="text-align: center;">My wife said use this picture because I like dice!</td></tr>
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Last week I had my quarterly visit with the oncologist/physician assistant and my lovely Vitamin Z treatment/infusion. I have been doing this now for three years, and used to do it every month, so this is easy, breezy, right? Sort of. <br />
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The process itself was fairly simple, and I am used to that. While I waited for the stuff to drip into my veins, I chatted with my neighbor and found out that he has colon cancer that has metastasized to his abdomen, lungs, and brain. Wow. That was hard to hear, but the he asked me about my situation, and I also found out that his <i>wife</i> was just diagnosed with Multiple Myeloma. When it rains it pours. I offered my sincere sympathy and gave him some suggestions for his wife to help her prepare for stem cell transplant. I've been through a bit, but I think they are really struggling. He said how fortunate he felt for the love and support he has received from his ward and community, so I am also grateful for that. I hope, in a small way, that I also helped.<br />
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After my infusion finished, I went to school for some meetings. I usually get hit by the Zometa the evening of the same day, but I didn't feel too bad. I thought, "Well, maybe I'm getting the hang of this."<br />
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Wednesday, I woke up, feeling a bit stiff and a bit more tired than usual, but doing pretty good. I had a productive day and went to game night (hooray!), but got more and more tired as time went by. Still, I thought things had gone pretty well. Hah! Wednesday night I really had trouble sleeping. I increasingly had pain and exhaustion. I felt like I had been nicked by a bus. Everything hurt from my head to my toes. In the morning, I woke up and decided no exercising for that day. I could barely walk. Arrrgh. So I think it is easy to understand the "hate" part of the dice. What is the love part?<br />
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The love part is that Zometa may be part of what is keeping me stable. During my checkup, the PA looked everything over and said I was still stable; the results didn't look too bad (especially compared to what she usually sees). She wanted to keep an eye on some of the tests, just as I do, but said for now, we wouldn't change anything. So if Zometa is keeping this going, I <i style="font-weight: bold;">love</i> it! ❤️ The best part of the recent results is that my liver function scores are dropping from moderately abnormal to less abnormal. Not sure why, but maybe exercise? That is good news, so I hope it keeps happening. <br />
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Here's the update: As noted above, things are not much worse. That said, nothing is normal. Here are the big four -- I decided to make up charts for you guys! The first chart shows my White Blood Cell counts, since March, 2016, so 2 years and 4 months worth of data. Keep in mind the later numbers are a bit more spread out over time. <b>NORMAL range for WBC's are 4.3 - 11.3</b>; my average over 28 months is the <span style="color: #38761d;">green line: 3.2</span>. <span style="color: red;">The red line is the <i><u>bottom</u></i> of the normal range</span> (most people are generally not at the bottom). So, yes, I'm still doing fist bumps, lots of hand washing, and taking antiviral medications.<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNNRXoOJZP50XWNCrOMhzaVtffz6c6t50e_XloKaEAtK-d4etsorYSk66BXWgKKJCxVrMyyVxiUi6qO4oQn34Db6ihvV1FvdH_dp1rCkAyqb-NKLqbM2KhZxKVLouVYeF-lP268TqKuaUE/s1600/WBC+2018-1.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="232" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNNRXoOJZP50XWNCrOMhzaVtffz6c6t50e_XloKaEAtK-d4etsorYSk66BXWgKKJCxVrMyyVxiUi6qO4oQn34Db6ihvV1FvdH_dp1rCkAyqb-NKLqbM2KhZxKVLouVYeF-lP268TqKuaUE/s400/WBC+2018-1.png" width="400" /></a>I almost hit bottom end of normal there, in January 2017, but they look a bit squashed the last several blood draws. We'll keep an eye on it. <br />
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Next on stage is my Red Blood Counts or RBC. This is what keeps me anemic, makes it a bit harder to breathe and have energy etc. <b>NORMAL range is 4.7 - 6.1</b>; again, the <span style="color: red;">red line is the bottom of the normal range</span>. <span style="color: #38761d;">The green line is the average over the 28 months</span> -- not terribly low which is good. Just not high enough! I'll keep eating spinach and kale. Note the chart starts at 2 and goes up to 5. Overall, the RBC's are probably the most consistent. <br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkdAitaV6ABVfy5-mU0dD15wGDymn_Tyukr6t9EbIcYCZaXhLaOM4BO0kUwzWg6cM_ZhjKrLtqaqu8h6UcumNhME2zAFzmM1PSUex86JFI6SjfGEsr-ciF4iu8iHkXr_e14NPa6ds2b04M/s1600/RBC+2018-1.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="220" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkdAitaV6ABVfy5-mU0dD15wGDymn_Tyukr6t9EbIcYCZaXhLaOM4BO0kUwzWg6cM_ZhjKrLtqaqu8h6UcumNhME2zAFzmM1PSUex86JFI6SjfGEsr-ciF4iu8iHkXr_e14NPa6ds2b04M/s400/RBC+2018-1.png" width="400" /></a><br />
Now for one of the villains; the chart below shows those pesky platelets, you know, the cells that aggregate to prevent blood loss? Thems the ones. They are not so low that I can't stop bleeding, but when I was in chemotherapy, they would not give me Velcade is my platelets dropped to 30 or less and usually would give me an infusion at that point. The latest ones are in the mid 50's, so I hope they do not drop any further. <br />
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<b>Normal range for platelets is 159 - 439. </b><span style="color: red;">The red line is the <u><i>bottom</i></u> of the normal range</span>. <span style="color: #6aa84f;">My average over the 28 months is the green line: 65.</span> So I have been below my own average now since December, 2017. You can see the blue line below the green line. The last time I was just above my own average was in November, 2017. <br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_mdmqWKeFLoYu_0XjhYOtxywzKc6in9AmFzT9ma2H8DG_H89fxoHruoptAmMrmJ35hxl18oih7wo2hQrVgS4Sw_RpbnM3qXIRK-zzknz5y033jZ5QoPaAbhkyc70LEupd-LjJfFk3Uybk/s1600/Platelets+2018-1.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_mdmqWKeFLoYu_0XjhYOtxywzKc6in9AmFzT9ma2H8DG_H89fxoHruoptAmMrmJ35hxl18oih7wo2hQrVgS4Sw_RpbnM3qXIRK-zzknz5y033jZ5QoPaAbhkyc70LEupd-LjJfFk3Uybk/s400/Platelets+2018-1.png" width="400" /></a><br />
And the <i>coup de grace</i> is my M-spike. That is the number that I personally worry about most; my doctors look at a bunch of different things, but for me, that is my indicator of cancer activity. <b>Normal is zero</b>. Hopefully all of you have an M-spike (monoclonal protein spike) of zero. <span style="color: red;">So in this case, the red line represents my average over 28 months which is 0.75</span>. Not bad compared with my 1.7 at diagnosis, but higher than my 0.3 after my stem cell transplant. However, look at the blue line. You'll see a jump above the red line around July, 2016 which stayed stable for a long time. However, the last four blood draws, going back to November, 2017 are all above that line.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibS265i90Di_MF1bOyEElgMud3OlHQH2zaXBN4riOHzCThhDOPe_vzZw1wnTF6nxOp53JVFPBglx1Puhhahxw7zjsXjr20N099oOK1Eg17o_UcguTLYkjeybH3_xK_MpaN4GFyGrUfoKHh/s1600/Mspike+2018-1.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibS265i90Di_MF1bOyEElgMud3OlHQH2zaXBN4riOHzCThhDOPe_vzZw1wnTF6nxOp53JVFPBglx1Puhhahxw7zjsXjr20N099oOK1Eg17o_UcguTLYkjeybH3_xK_MpaN4GFyGrUfoKHh/s400/Mspike+2018-1.png" width="400" /></a><br />
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So there you have it! The latest update, by the numbers. The last few M-spike numbers are moving around more than they did for a while and are ticked upwards, but not by a lot. So I'm not <i>that</i> worried about them, but I do want to see what will happen over the next six months. I am anticipating some ongoing fluctuations, and hopefully not much going above 1. A lot also depends on what happens with the other numbers, so I'll keep you posted.<br />
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So, in life we all have things that we have love/hate relationships with, sometimes even in our own bone marrow. I am grateful for my abnormal stability and hope it keeps growing v e r y slowly. Every day, new treatment are being tested and approved, and every day is one more day to enjoy my wife, my family, my friends and neighbors, and the beauty of the world we live in. I hope that I convey that gratitude in how I treat all of you and in my relationships with my students. <br />
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May the Lord bless and keep you! See you at the next update. Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com0tag:blogger.com,1999:blog-2548863299114511236.post-38165728661829201332018-04-15T14:15:00.002-07:002018-04-15T14:15:44.126-07:00Happy Birthday and MysteriesTime to update the blog! Welcome back, friends and family.<br />
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<b><span style="font-size: small;">On March 12th, I had my 3rd birthday -- wahoo!</span></b></div>
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<b><span style="font-size: small;">As a reminder, we call it that because I was given a new birth, a new immune system, on March 12, 2015 -- a day that will live in <i>infamy</i>. I left the hospital, I think, on March 28th and returned home. </span></b></div>
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So I have been around just over three years with a new immune system, and things are going relatively well. Want details? Well, you've come to the right place! If you don't want details, then skip down to the bottom for the <b>BOTTOM LINE</b>. <br />
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Last time, I told you all about our trip to SLC to visit with Dr. A at Huntsman. Well, we have been having a busy spring since then. It was time for a regular skeletal survey (x-rays of my entire skeleton) to see how things were going, so we did that. He also recommended a consult with an endocrinologist (to see if I had endocrine problems which are part of POEMS), and my skin doctor to check on the Vitiligo, but also to see if there were hemangiomas which are skin-changes related to POEMS. So we did both of those, and then the endocrinologist wanted a series of tests, and last I got an updated PET scan to compare with my earlier scan done in 2014. Oh! I also had some real fun with another bone marrow biopsy done up there at Huntsman. Then we went back to see Dr. A and go over everything. <br />
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Whew! At the very least, all of this gives us an updated picture of where things are right now. I won't go into every single detail, but here are the highlights:<br />
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<li>My most recent lab results showed an M-spike (cancerous proteins) of .91. So after having been stable at mostly around 0.7 for three years, it has now seemingly taken a step upward to around 0.9. We have three readings now at 0.9 or higher; we'll keep monitoring it. The biopsy also showed about 10% of abnormal plasma cells in my marrow which is about where it was when I was diagnosed in 2014. Kidneys are still doing OK. </li>
<li>My blood results have been more steadily lower than before (probably due to the increased M-spike), but not terribly so. Platelets continue to hover around 65 or so -- I bleed quite quickly when I am poked or whatever, but I am able to stop the bleeding. The lowered white counts mean being cautious STILL with getting sick from others. </li>
<li>PET scan showed two lytic bone lesions that were <i>not</i> active, which I think means that the holes are not getting worse. No signs of sclerotic lesions. Spleen is enlarged. </li>
<li>Other test results related to POEMS were negative, so Dr. A told me I do <u>not</u> have POEMS. (Skin results showed some small growths, one of which was analyzed, but the biopsy was negative). I still have multiple of the "lesser" or optional symptoms of POEMS, and I do have some major criteria (myeloma <i>and</i> neuropathy), but I am missing one of the other core symptoms -- so close, but no cigar! That's OK, I don't smoke cigars, anyway. </li>
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Patricia feels that the Huntsman team "led us down the garden path". I can understand that perspective, but even though all of this was quite expensive, I do feel better knowing where I stand, that I don't have POEMS, and that my bones are in relatively good shape, all things considered. </div>
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The other interesting thing about all this was the revelation that I am a <b><span style="font-size: large;">MYSTERY</span></b> patient! Don't you love a good mystery? My doctors don't!</div>
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Mystery #1: my endocrinologist was flummoxed. (I <i>love</i> to use that word!) looking at my results. Good news: no major endocrine problems other than my insulin and blood sugars. Bad news: in that regard, he couldn't decide if I had diabetes -- my regular blood sugar readings are sometimes fine and sometimes have been very high. So he had me do a Glucose Tolerance Test, and the results came back around 275! VERY high -- and normally this would be a slam dunk diagnosis of diabetes. However, my A1C results, which <u>average</u> my blood sugars over time is NORMAL. <i>Wha?????</i> He finally wondered if my A1c test was being impacted by possible autoimmune problems, so he ordered some tests to check my sugars that did not involve using my blood cells -- they came back normal. However, I know something is up -- I sometimes experience low blood sugars. He finally decided to diagnose me with Type 2 diabetes, but told me it is <u>mild</u> -- no treatment at this point other than watching my food, reducing sugar intake, and increasing exercise. He wants to check on me again in 3 months.</div>
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Mystery #2: my relative (or stepwise?) stability with my cancer. My test results suggest the cancer is impacting on me -- and I know it is; I can feel it. However, without chemo why is it progressing so very slowly? Don't get me wrong -- I love that it is -- but it is a mystery. Dr. A came up with three possible explanations he could think of, but he has no idea if any of them are right:</div>
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<li>Myeloma is heterogenous, meaning there can be multiple types, and I understood that a person could even have more than one type in their bone marrow. So he wondered if the stem cell transplant DID work, but it killed the more active version of myeloma that was in my marrow leaving behind a more "silent" or slow moving myeloma that is what we are dealing with now. </li>
<li>Maybe the transplant worked to "knock down" the myeloma -- kicked it in the teeth, so to speak, letting my immune system activate more and start to fight it. If this is the case the slow progression may mean that over time my immune system is slowly losing the fight, but the battle continues! There is more of an equilibrium between the cancer and the immune system than there was before. </li>
<li>It could be that my ongoing Zometa treatments, possibly combined with my Chaga tea (<span style="color: red;">thanks, Roy!</span>), etc. are keeping the cancer from spreading quickly as it is wont to do. </li>
<li>Dr. A did not say it, but we would like to add: <b>A MIRACLE</b>, the result of a loving priesthood blessing, and the prayers and love that have come our way. </li>
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We don't know which, if any, of these explanations is right, but they are kind of interesting to ponder. We also asked them why I was still so tired and had trouble breathing with much exertion. They said they didn't know, but that they wondered if it could be related to my heart and recommended I see a cardiologist. More doctors! So we'll wait on that a bit, but will probably check it out. </div>
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OK, here it is: </div>
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<b>== BOTTOM LINE ==</b></div>
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I am slightly worse off than I was six months ago. I apparently do have mild diabetes, my cancerous proteins have increased slightly, about 10% of my plasma is cancerous, and my blood counts are lower than they have been. However, <span style="color: blue;">I am WAY better off than I was when I was diagnosed in October, 2014</span> when I was beset by infections, etc. My ongoing home treatments, the use of my antiviral medications, and my Zometa all may be helping me prolong my days and keep the cancer at bay without chemo! Wahoo! </div>
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So we are heading off to see Wesley's graduation at the end of the month, spend a few days in the Big Apple, and then come home to finish up and submit grades. </div>
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I am grateful for each day I have; I love my family and friends, and appreciate tremendously the support I get from my department at UVU. Thank you all -- here's to the good fight! </div>
Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com0tag:blogger.com,1999:blog-2548863299114511236.post-32059558911592188412017-12-31T10:26:00.002-08:002018-04-15T13:21:29.226-07:00Then...and NowFirst of all, I write this on the last day of 2017, so let me just say:<br />
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I wish you all a terrific new year and hope it will be a great one for you and yours! </div>
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I also feel I should update everyone on my visit to Huntsman Cancer Institute in November. I've never been to Huntsman, so this was a new experience. We met with Dr. Atanakovic who is the Director of the Myeloma Clinic. This was really nice because that clinic sees over 800 patients (almost 900) all of whom have Multiple Myeloma. So, even my local oncologist who does see Myeloma patients does not see <i>that</i> many -- he mostly deals with leukemias and other types of blood and other cancers. So this was a chance to hear from someone who is immersed in just my cancer. </div>
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I will say that Huntsman is beautiful -- although I am sure it was very expensive to build, going into that setting is somewhat relaxing. To see a clinic with people wearing masks, and to see bathrooms where they have wipes next to the door handles really made me feel that the anxieties I live with every day are understood. The Dr. and his PA were both really up on my chart, asked many questions, and reviewed my prior results. </div>
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He said a few things that were interesting. Regarding my prior test results, he basically told me that I had an "atypical form of myeloma". He said that my results were quite surprising to him -- when myeloma comes back, it usually is quite aggressive, but he was impressed that I had been stable for so long. He thought that it even looked a bit like the disease had "regressed" back to what they call <i>smoldering</i> myeloma. In our discussion, he noted that it was possible that I could remain stable if this pattern continued, possibly for years. He said there was no need for any additional treatments at this time -- whew! -- and that I should keep doing that I have been doing. </div>
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He was concerned about my shortness of breath, skin vitiligo, unusual liver function scores, and other issues. He wanted to run some more tests. Then he set up a follow-up appointment, and he and his PA left. They came back in, like, five minutes! He said that they had been discussing my case as they left and, his PA said something that really caught his attention. In my original MRI skeletal scans, they had noted that one of my lesions/damaged bone areas was a <i>sclerotic</i> lesion. He said this was unusual -- usually myeloma creates holes in bones (lytic lesions), but a sclerotic lesion is like scar tissue on the bone. This linked to a possible situation that could explain many of my symptoms -- a syndrome called POEMS. This is a quite rare condition, so he didn't think it was highly likely (1 in 1 million), but he thought we should check on it. </div>
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The other thing he said that Patricia really found liberating was that since my M-spike (myeloma protein spike in my blood) was 0.3 when I went in for my Stem Cell Transplant, he would <i style="font-weight: bold;">not</i> have done the transplant. He said if the spike, the abnormal proteins, are not 0 at the start of transplant, he believes the transplant does not work. Of course, this was born out by the return of my myeloma very shortly after my transplant, although it did stabilize. She asked him to make sure to share this type of information is shared with LDS Hospital so that other patients would not have to go through what we did.</div>
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(Now to the title tie-in)......So, that was <i>then</i>. So what is going on <i>now</i>? Wazzup?<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioFUMN5kCIn_ZMYcS9E0YGwvjWf2R9fX4Brv2CLLLuGUMuVKCawaYoUbml8o2UU4lQ-VYl1TbzXZotwWQkvYMi0xlRvQnGCSdx3gwb3-83rS3yle-djkdGYimdBjC0aMo8eHKngePDUf0_/s1600/everyday-objectssterling-silver-hourglass-60558612_973809_ED.jpg" imageanchor="1" style="clear: left; display: inline !important; margin-bottom: 1em; margin-right: 1em; text-align: center;"><img border="0" data-original-height="1308" data-original-width="1308" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioFUMN5kCIn_ZMYcS9E0YGwvjWf2R9fX4Brv2CLLLuGUMuVKCawaYoUbml8o2UU4lQ-VYl1TbzXZotwWQkvYMi0xlRvQnGCSdx3gwb3-83rS3yle-djkdGYimdBjC0aMo8eHKngePDUf0_/s200/everyday-objectssterling-silver-hourglass-60558612_973809_ED.jpg" width="200" /></a>Before we left SLC, we got blood drawn (lots of blood drawn) and got a chance to visit with my Aunt. I went back in December for lots of fun including them drilling a hole into my left hip for a bone marrow biopsy and more blood tests as well as the always popular "orange jug" 24-hour urine sample which I got to carry around with me for a while. It has been a while since I had a biopsy, and it made me remember why I don't really like to do it. That was almost two weeks ago, and I am still a bit stiff, but at least the itching and pain have gone down. </div>
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I have another meeting with Dr. A next week, so he will give me all the results, and we'll discuss them. I also have another bone scan in January, so I'll have that data when I meet with Dr. Wallentine locally again. From what I can tell (<span style="color: red;">spoiler alert</span>!): I am <span style="background-color: white; color: blue;">not</span> showing abnormal levels yet of elevated free chains (which are the molecules that damage my kidneys); the POEMS results also came back, and I do <u>not</u> have that condition -- which still leaves questions about why I have so many things going wrong at the same time. I've got Questions! <b><span style="font-family: "verdana" , sans-serif;">????????</span></b> Here's the bad news: Remember that my M-spike has been stable around 0.6 - 0.7 for more than 2 years now. It bumped up occasionally to 0.8 and then would drop back down the next month. Well, my November reading was 0.91 and my December reading was 1.03; I'm hoping this is due mostly to different labs? But we'll talk about that. It may mean that the myeloma is NOT going to be stable for years and may be coming back.....if it goes up by .10 every month or so, we probably would start talking about chemotherapy again. <b>Arrrgh</b>. We'll see what Dr. A says, though, in light of ALL the test results, before I get too anxious, but it would explain my slight increase in fatigue (I'm sleeping better though as a result......). My white blood counts in December also dropped quite a bit; they had been just below normal, and this last time were a fair amount lower. I've also lost about 3 pounds in the past month, although I am cutting back after the holidays! </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3zWpO7HJQhWsOPIZ4E_gID6qgsIwDE8eNRhg2FIfBM6YcLetA3mY0PpNwjMeC7sm_HhtD_3yug_F6IwwKC6PMcOdUD-iK_XYPDmS3iUvU6mDaUn7nG6yifyR8NJ0JzEat6IiFRbSrRiwR/s1600/12025361.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="262" data-original-width="450" height="116" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3zWpO7HJQhWsOPIZ4E_gID6qgsIwDE8eNRhg2FIfBM6YcLetA3mY0PpNwjMeC7sm_HhtD_3yug_F6IwwKC6PMcOdUD-iK_XYPDmS3iUvU6mDaUn7nG6yifyR8NJ0JzEat6IiFRbSrRiwR/s200/12025361.jpg" width="200" /></a>So, that is the latest. Hate to end the year on a bit of a low note, but I am still kicking and will still be here in 2018 -- we are planning a trip to see Wesley's graduation at the end of April, and then on to NYC where we will see at least one Broadway show and other sights. I am looking forward to 2018 and my blood cells will just have to keep up! I'll leave you with these thoughts -- and my best wishes for a wonderful new year! </div>
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<br />Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com0tag:blogger.com,1999:blog-2548863299114511236.post-8100566891128119442017-11-05T10:28:00.003-08:002017-11-05T10:28:50.533-08:00A New Leaf? We'll see......<div class="separator" style="clear: both; text-align: center;">
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With the fall leaves all coming down and the beautiful colors, I thought that I needed to post an update to my blog. I have been meaning to write this now for 2-3 months, so I am glad that I am finally getting to it. <br />
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In October, we went past my 3 year anniversary of my full diagnosis. We had already been told earlier in the summer that I likely had myeloma, but it was uncertain how serious it was. Only in October 2014 after lots of testing and scanning and other things, was I diagnosed with full myeloma. Of course, you all know what happened after that. So, three years -- and I'm still kicking! Wahoo!<br />
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Am I still grouchy about this? You bet. Is every day wonderful? Ummm.......no. With more cold, my neuropathy is acting up, and I am chilled and have more trouble with my hands and feet. However, I was able to travel to Montreal for a conference a couple of weeks ago, and although I got tired, my presentation went well, and I had some great fun networking with colleagues, learning new things, and playing some board games! </div>
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Photo credit to Derek Bruff (takes great pictures!)<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgw87ljCKCo1LG5N_72q-cmZxuK2JGp3gimeQbl8aPtre2s8aB5jmwNaTi3NCIq1TkHFvfKG8VTrni3Y5HTd-Zglpc3nKmGzPDJCGuFt01wS8-BS3Di30kIRLsX4TzAbG4KHOaRAg3tmp_n/s1600/Tortuga.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1066" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgw87ljCKCo1LG5N_72q-cmZxuK2JGp3gimeQbl8aPtre2s8aB5jmwNaTi3NCIq1TkHFvfKG8VTrni3Y5HTd-Zglpc3nKmGzPDJCGuFt01wS8-BS3Di30kIRLsX4TzAbG4KHOaRAg3tmp_n/s320/Tortuga.jpeg" width="320" /></a></div>
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So what is the update? Steady as she goes.....in my last meeting with my clinician, the blood work looked about the same. My M-spike is still at 0.7, my white and red counts were a bit lower than normal although one of the specialized white counts was up. I wonder if that might be due to my system trying to fight this low-grade sinus infection I cannot get rid of and that sometimes makes it hard for me to breathe at night. My kidneys are looking OK. My weight is about the same. It has gone up slightly; in some ways this is good, right? If it was going in the other direction, my anxiety would be going up. </div>
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I also decided to start back on a regular exercise program to see if I could increase my energy and stamina, so I put my Wii exercise program to start up at the easiest level. The program builds in 4 days of exercise every week for 9 weeks. I didn't make it two weeks! I told the doctor that I cannot exercise two days in a row; it wipes me out for 3-4 days afterwards. She looked at me and said evenly, "Well, don't work out two days in a row". Yeah, OK. It is not the end of the world, but it is annoying. So I'm trying to see if I can do 3 days a week; it is better, but still difficult. </div>
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<b>So Where's the New Leaf????</b></div>
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I have been doing some soul-searching with the helpful input of my lovely wife for the past several months. I got up in testimony meeting several months ago and said that I was grateful for the fact that I was stable. I said, <i>It wasn't the miracle I asked for, but it was the miracle I got</i>. That is still true, but I realized that my thoughts and my statement was kind of like a slap in God's face -- a backhanded compliment. I have decided I need to repent, turn over a.....you know. I am working to accept what I have and to be <u>truly</u>, grateful for it. Because it is a miracle; no one knows why I am stable, but I have had 2 1/2 years without chemotherapy; I am able to work, to go to a conference, to walk with my wife and dogs. And even though what I used to be able to do is gone and probably will never come back, I am breathing and walking in the fall colors and enjoying the change in the seasons. </div>
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The only other new thing to report is that we have an appointment to go up to Huntsman Cancer Institute on Monday the 13th to meet with their Myeloma specialist. We had a physician friend tell us that it never hurts to get a 2nd opinion, a 2nd look at how things are going. I still have nagging worries that because I did not go on maintenance therapy, that I may have shortened my life, and I'd like to discuss that with another doctor. Because he is at Huntsman, I am also going to ask about clinical trials and thoughts about whether it is worth it to consider doing one to see if I could feel better. I hope that doesn't sound ungrateful after what I said above. I think they are separate things in my mind. If there is a strong chance to achieve remission, it may be worth it, but if not, I'll stay where I am and deal with it day to day, with gratitude for every day I am given. </div>
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Have a great fall and holiday season! Thank you all for your support. </div>
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<br />Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com0tag:blogger.com,1999:blog-2548863299114511236.post-77338806634403076152017-03-12T21:10:00.005-07:002017-03-13T19:10:16.148-07:00Second Birthday? I thought I was Older Than That!Is it really only my 2nd birthday? The answer is yes! If you have been tracking my posts for the past two years, this means that today I celebrate the rebirth of my immune system (and thus my life). True, the pesky buggers did not do the job of eliminating the cancer from my bone marrow, but at least I am alive and still kicking, so let's celebrate! <b>Wahoo!</b><br />
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So, what's the latest? Overall, mostly good news!<br />
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It has been quite a while since my last report, and I was somewhat worried then about an uptick in my M-spike score. However, that came back down. In December, it even dropped to 0.6, but that excitement was short-lived. It has been back up and as of my last reading on January 30th, it was still stuck at 0.7. So, basically no real change -- those were just random fluctuations. I also received my last Zometa infusion at the start of January. Why?<br />
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Because....in my most recent visit with my oncologist at the end of January, we reviewed my results and discussed the situation. He said that it was clear that I still was experiencing "stable disease" which is a term I had just seen for the first time in a webinar about Multiple Myeloma for patients, coming out of the annual meeting of hematologists (blood cancer specialists). He also said that given this situation, he did not see the need for me to keep coming in monthly or even bimonthly. He ALSO said that he just read two meta-analyses (studies of many smaller studies to look for broad general patterns) that showed that Myeloma patients receiving Zometa showed the same benefits whether they received monthly treatments or a treatment every three months. Eureka!<br />
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I say this only because.....I really, <i>really </i>hate those Zometa treatments! So my next treatment won't be until the start of April -- and then I'll probably feel like crap for the entire weekend. Maybe a good target for Conference weekend? I can stay at home.......hmmmm. <br />
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Other than the doctor visits decreasing and the Zometa treatments less often, things have been going reasonably well. In my last bloodwork, I actually had hematocrit and hemoglobin counts that were in the normal range. Wowzers, that hasn't happened (hemoglobin) since last May. This means that I had enough iron to be able to get a reasonable level of oxygen in my blood......except my red blood counts were still below normal, but not <i>terribly</i> below the bottom of normal. I attributed my higher iron counts to eating more kale. We'll see if that keeps up. More kale on the menu (crunch, crunch)!<br />
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We did have a (sort of) funny interaction with the doctor before we left. I said, "If my iron counts are in normal range, and my red counts are awful, why am I still so tired, and out of breath if I go up some stairs?" He paused for what seemed like a long moment and looked at me, then slowly said, "Well, you have gone through five rounds of chemotherapy; you went through a stem cell transplant, and you still have cancer -- you have been hammered, and your body has been prematurely aged." I am thankful he didn't pull any punches but oooof! He's right, though. I'm walking, mostly every day with my lovely wife and the dogs, and I am healthy enough to still be working. I'll be glad for whatever I can do. <br />
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Speaking of working -- about 6 weeks left in the semester. I AM taking summer off -- no more summer work for me. My book has been printed -- hooray! Available now on styluspub.com and amazon.com! And it is generating interest, so I'm glad that the book seems useful to many, and I hope it makes a difference. <br />
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I have been able to attend a couple of conferences and even presented in one (for less than an hour) -- so I'm sort of getting back in the swing. Fall semester I will probably have three classes on my workload plus my coaching stuff, so we'll see how that goes. <br />
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We will be traveling in a couple of months for my nephew's wedding -- this will be a test of whether I'm capable of doing any larger traveling which is still on my bucket list!<br />
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The overall verdict? Life is good. Cancer sucks. I still think about it every day. My wife and I have been attending some workshops on retirement and planning for the future, and it has made things a bit more acute again -- I am still hoping to retire on time, and I <b>do</b> want some time to see my grandkids! I'll take every day I can get. I am very, very grateful for all of your continued support and prayers, and for the endless support of my loving wife. I thank God for each breath I take. May each of you find joy in your days. This is a birthday worth celebrating! <br />
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Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com2tag:blogger.com,1999:blog-2548863299114511236.post-2256874332465407802016-07-31T18:08:00.004-07:002016-07-31T18:08:46.841-07:00Abnormally Stable?That's what he said -- abnormally stable. This was during my last visit with our oncologist and reviewing the latest results (this was back on June 3rd). I asked if he could summarize where we were and how he would describe it. He paused for a fairly long time and that was his term. We did have a good moment, though -- he paused again and looked at us and said, "It is beginning to look like maybe you guys were smarter than me on this." He had recommended going back on chemo back in April or May of last year -- he was acknowledging that our decision to wait and not do that seemed to be paying off. I love a humble oncologist! In my experience, humble MDs are fairly rare, and I greatly appreciate him.<br />
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In some ways, I think it is apt. Sometimes, because I am out and about and not on chemo at the moment, people think I am in remission. "Abnormally stable" does not equal remission. Sometimes I call it "limbo" -- I am in between. I am not in remission, but I am not progressing or deteriorating. It is clearly still affecting me. My results from May were somewhat encouraging in that some of my blood cell counts were up, and I was feeling a little bit better. That has slipped a bit in recent weeks, possibly because, yes, I have probably overdone it again. :) Possibly, I am incorrigible? <br />
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However, we either have a glitch now or the story is changing. :( <br />
Here's is an actual graph of my M-spike results from two years ago - July 23, 2014 - and July 27, 2016, so a two-year span:<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivnHk92V5tIgKcWjc5p-a_qnyBNQQ7Cm14LH9SGZ2Jnroe6F0Z6sPajhupoi5nV6-olMqBk6AGdSnKm4h5LSexfIbsb1AoFeoFuJMF5AD6zmKLWYRWiallNaJgshxUiaTPGXHPmaZuc9MA/s1600/M-spike+through+7-26-16.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivnHk92V5tIgKcWjc5p-a_qnyBNQQ7Cm14LH9SGZ2Jnroe6F0Z6sPajhupoi5nV6-olMqBk6AGdSnKm4h5LSexfIbsb1AoFeoFuJMF5AD6zmKLWYRWiallNaJgshxUiaTPGXHPmaZuc9MA/s400/M-spike+through+7-26-16.jpg" title="" /></a></div>
The M-spike is the main measurement I worry about (my doctor worries about that and many others). The drop you can see above is when I began chemotherapy. It lowered me from 1.9 to 0.5 going into transplant, then there is a flat line because we did not get any measurements for a while. You can see the "stability" in the measurements after we started looking at it again. What worries me: look at the last 4 dots -- there is an upward trend: 2/26 - 0.60, 3/30 - 0.60, 6/02 - 0.6999, and now it just showed up: 7/27 - 0.80. It has been at 0.7 before a couple of times and then dropped, but now it is the highest yet since transplant. Also, my free kappa chains have now crossed the line. Normal plasma cells take gamma globulin proteins and hook them together into long chains that cannot pass through the kidneys' filter and are therefore just immediately excreted. Myeloma cells, because they look like plasma cells but are NOT doing their jobs, don't do this connecting, so you get what are called "light chains" which are smaller, go through the kidney's filters and actually can start to damage the kidneys. This is a big thing they look for. Upper level of "normal" for these light chains is <b>19.4</b>. Here's my readings: 3/31 - 18.5, 5/27 - 18.56 (pretty stable), now 7/27 - 28.3 <span style="color: red;">arrrrgh</span>! Together, these numbers suggest to me that the cancer may be starting to kick into gear......?<br />
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I don't technically have an appointment with my oncologist until September......but these numbers worry me. I'll have to call the office tomorrow and speak with the care nurse. I am hoping that we will see the wonderful effect of <i>regression to the mean</i> occur next month; those who passed statistics may remember that this means that if these are random fluctuations, the next number should <u>drop</u> down closer to the average. I am just worried that this may not be the case. My other blood cell results this month also show ongoing suppression in my white cells, red blood cells, hemoglobin, and as always platelets (curse you platelets!!). Anyway, that is my cancer update portion of our show.<br />
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Oh! I forgot to mention that part of the reason I may be tired is not only traveling and stuff going on in my bone marrow, but I got 5 immunizations shots last week and one this week (6 in 6 days) with BIG honking needles!<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4AdodXhu6sKUeK7aQkLWRKYxMb7-yj_JoGpHlj2BDpQXpix-lS_73Kyd5QQ-pxffJnD4euKMUba8o_76YFwrC-F5_pThhWbwArHTq420TMTFm_g7NCtFdyRcedgLIDoLKLIR1xK_HHodq/s1600/Immunizations.jpg" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4AdodXhu6sKUeK7aQkLWRKYxMb7-yj_JoGpHlj2BDpQXpix-lS_73Kyd5QQ-pxffJnD4euKMUba8o_76YFwrC-F5_pThhWbwArHTq420TMTFm_g7NCtFdyRcedgLIDoLKLIR1xK_HHodq/s400/Immunizations.jpg" /></a>Yowch! They <i>did</i> hurt, but I think they are important to trying to keep me from contracting something really nasty.<br />
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Now, for our segment called <b><i>On the Other hand....<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJQLdpLYrJTgjgr_CRaAKH5d5RZ2zFzBoHEMHVFiHJDDhg59BCEhKOhpQ0kcypgZaL9mv0ztOE6CX8N5CDD-CiKIB3qkSUnsshj2B8hpfi0YSLUB59EEbpYIY_bUxST3dSzk_ZB1LQoOkG/s1600/left+hand.jpg" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJQLdpLYrJTgjgr_CRaAKH5d5RZ2zFzBoHEMHVFiHJDDhg59BCEhKOhpQ0kcypgZaL9mv0ztOE6CX8N5CDD-CiKIB3qkSUnsshj2B8hpfi0YSLUB59EEbpYIY_bUxST3dSzk_ZB1LQoOkG/s400/left+hand.jpg" /></a></i></b><br />
<b>I was chemo-free for our son's wedding!</b> Our oldest son, Benjamin, who lives in CA got married on July 3rd to a wonderful woman named Sonal Mittal - she is smart, funny, warm, and caring. We went to Mission Viejo for the wedding that was performed in an outdoor venue by a Hindu priest. It was a fascinating ceremony, and her family was truly amazing. They were all loving, open, friendly, and welcoming of us. I now have family members in India, Germany, and many other parts of the country and the world. The day before the wedding, we had a rehearsal so that us westerners would know the purpose of the various parts of the ceremony and our roles, and so that we would be prepared. That evening Sonal's parents, Arun and Shubra, hosted a <i>Sangeet</i> at their home. I learned several things from this. First, how warm and loving they were, and second -- Indians know how to party! The food was terrific and the dancing went on -- and almost EVERYONE danced from young to old. I did my best and participated and did a lot of clapping and stomping my feet! The wedding itself was beautiful and the young folks danced enthusiastically into the night. It was a joyous and wonderful celebration. Here's a taste of how it went:<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmb6dsGsLvYB2Ni2L-_7wc4lgedi0pa8AomgsAY6XMkcLsoee0ssCWQMCyVQ1Bu0gnq1oS1wGNDACcDU80jk7xYtFSp1KbGmT-bOcDofHLI298qLEmBHVZWXdp-KBxcoyH9WbYYgIFQqBK/s1600/Ben+and+Sonal+2+-+exchanging+garlands.jpg" imageanchor="1"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiM6PLUsiV3NaoLmCEfiuWTTLxiZFK4ZwUpp6k002vYr7rVKGwoT9Es1ZDf4U6XxgArmaXR4R1SEkdP949c3bXMo11IDPCn60XosdbMb_Joolyg6G8Q25v4PBVIDFZ5zkwmI51ZZtFPYrV/s1600/Wedding+-+Tolmans.jpg" imageanchor="1"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiM6PLUsiV3NaoLmCEfiuWTTLxiZFK4ZwUpp6k002vYr7rVKGwoT9Es1ZDf4U6XxgArmaXR4R1SEkdP949c3bXMo11IDPCn60XosdbMb_Joolyg6G8Q25v4PBVIDFZ5zkwmI51ZZtFPYrV/s320/Wedding+-+Tolmans.jpg" width="320" /></a><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmb6dsGsLvYB2Ni2L-_7wc4lgedi0pa8AomgsAY6XMkcLsoee0ssCWQMCyVQ1Bu0gnq1oS1wGNDACcDU80jk7xYtFSp1KbGmT-bOcDofHLI298qLEmBHVZWXdp-KBxcoyH9WbYYgIFQqBK/s320/Ben+and+Sonal+2+-+exchanging+garlands.jpg" width="320" /><br />
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Now for the "overdoing" it part: we also spent some time at Laguna Beach, and played in the waves -- boy are they STRONG! On the way home we stopped at Zions National Park. An item on our bucket list is to visit more national parks. This past year we have been to Yosemite and Zions. We took a hike up to Observation Point which nearly killed me coming down. I had a walking stick and Patricia was my other major walking support. It was gorgeous, exhausting, and stupid. But, here's what it looked like when we were about halfway up:<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcmmCJA48XyvNDeMUT5QVib5c_M0uMxmTrNmrAUZ1FxjdePlWkEIAU5QGeQ0RZt1NdI7ZKdSZ1pbJybDEopPkQgbqf9gkKRwWJ2yXShb9k2l8kuu8YEHkz3AlcGZpigKDshei0n52kXPhi/s1600/Zions+NP+-+Observation+Pt+Heading+Up.jpg" imageanchor="1"><img border="0" height="167" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcmmCJA48XyvNDeMUT5QVib5c_M0uMxmTrNmrAUZ1FxjdePlWkEIAU5QGeQ0RZt1NdI7ZKdSZ1pbJybDEopPkQgbqf9gkKRwWJ2yXShb9k2l8kuu8YEHkz3AlcGZpigKDshei0n52kXPhi/s320/Zions+NP+-+Observation+Pt+Heading+Up.jpg" width="320" /></a>So -- cancer sucks, but life is beautiful. We had some wonderful experiences, and we welcomed a beautiful new daughter into our family whom we will cherish.<br />
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Thank you for reading. I'll let you know what the doctor says and what is coming next.<br />
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<b><br /></b>Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com0tag:blogger.com,1999:blog-2548863299114511236.post-53781692324232354502016-05-15T15:01:00.002-07:002016-05-15T15:01:29.596-07:00Hanging in There & FarewellsSorry I didn't post an update in April. It was a hectic/busy month with the end of the semester, finals, grading, and such. A few things have been going on, but mostly, I've been:<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdy-yTmHqW-jGzBqTGzVbZ_C3vpsnrSs7KBViZLqYuiZZAnGUU2TqWjGx7GejikZhM-kIA-WiWRKlCxMrHen77QyS9qyxf9jdKfvLLsajPh94u0JdoYekC_yuLTFtw8NI4lKWyzLYBA2pe/s1600/Hanginthere2_zpsa19f491c.jpg" imageanchor="1"><img border="0" height="170" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdy-yTmHqW-jGzBqTGzVbZ_C3vpsnrSs7KBViZLqYuiZZAnGUU2TqWjGx7GejikZhM-kIA-WiWRKlCxMrHen77QyS9qyxf9jdKfvLLsajPh94u0JdoYekC_yuLTFtw8NI4lKWyzLYBA2pe/s200/Hanginthere2_zpsa19f491c.jpg" width="200" /></a> <b>Hanging in there!</b> <br />
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At the end of March, we wrapped up the 8th Annual Scholarship of Teaching and Engagement conference (SoTE) at UVU. This conference was my idea, originally, and for years I had the support and wonderful assistance of the staff at the Faculty Center for Teaching Excellence (Ursula, Trevor, the SCOTs, and Joyce Oliphant). However, this year because FCTE was subsumed into the new Office of Teaching and Learning, I didn't have the same infrastructure support. Richard Tafalla and Shelly Andrus and the folks over at the Office for Engaged Learning decided to support the conference this year, and we couldn't have done it without them, the work of the planning committee (especially my colleague Colleen Bye), and the help of the staff at the Office of Teaching and Learning. At the same time, although the conference went well and we finished up well, it really took a toll on me. I realized or decided, perhaps, that I could not do this again. I am hoping that SoTE continues in some form, but I can no longer be the main organizer and planner for the event -- it is just not something I can afford to do. So that was one sad farewell this year. <br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwoYDH4OVT1iYiNpnTO6wk4z_hVUqYV1SZL1AhGr3WMroRHV1U70LqVWK9MxreWRgqaLCrD1BQ1jGG3DT0NwxYKu3gHTvOmxclMyKt6Z1x_s9JGlqkehXb-okw-PKNkv7PTZ8E4BBoKZ8W/s1600/Farewell-pocahontas-33404834-1024-768.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwoYDH4OVT1iYiNpnTO6wk4z_hVUqYV1SZL1AhGr3WMroRHV1U70LqVWK9MxreWRgqaLCrD1BQ1jGG3DT0NwxYKu3gHTvOmxclMyKt6Z1x_s9JGlqkehXb-okw-PKNkv7PTZ8E4BBoKZ8W/s200/Farewell-pocahontas-33404834-1024-768.jpg" width="200" /></a><br />
A second is related to it -- for the past two years, I have been working with Dr. Tafalla half-time in a capacity to support UVU's Title 3 grant. The work has been rewarding and has been focused on helping to get faculty on board to teach and involve students in undergraduate research in ways that improve their ability to succeed in college and graduate. But just as with SoTE, this spring semester, it became clear that I can no longer manage to juggle as many things as I used to -- I don't have the energy or ability to stay focused that long or put that much time into it. Richard began expressing concern over my health (I probably looked really stressed?) and telling me that I needed to start to reduce my commitments. It also became clear that I was struggling to keep up with work the way I used to do it, and I didn't want that to affect Title 3 or the work that needs to be done. So, at the end of the semester, I have also bid farewell to that work. I will still be involved with undergraduate research, and I still support Title 3 and the Office of Engaged Learning -- I just won't be as personally involved or leading that effort for faculty. <br />
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This means I am back to full-time teaching; I've already worked out with the department to teach online next semester and mentor some students in research. I think that should lower my stress levels quite a bit. I'm still involved in a couple of other projects, but at a very different level. So while I am looking forward to being more involved in my department and with my students in many ways, it is hard to take a step back from projects and efforts that I believe in and have spent much of my time and effort on. At the same time, I realize and am grateful that there are openings for others to bring in their ideas, their energy, and efforts to keep these things going. It is just a part of my life right now that I need to learn how to do this. <br />
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On the home front, since I am not teaching this summer, I have been enjoying more time with my wife, staying connected to our kids, and preparing for Ben's wedding in July. We will be welcoming a wonderful new daughter, Sonal, into the family and are very excited about that and our new in-laws, the Mittals. We have also been finishing the basement (almost done!) so there is a nice welcoming place for our kids (and one day grandkids) to visit and stay with us as well as other family and friends, <i>so come on down!</i> We are hoping to take some short trips this summer -- out to the wedding and to see our folks in Albuquerque and Denver as well, and maybe stop to see some great things along the way.<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh930FHv7deYmuhzvLujjQBDgir7DQZqcSKiDShzCIcFEDPHqIz1Rx218dbuOwW0DtkN1r9QhYOaa9hd-8_3k2CODNEaQQrIPPz9tuhiEH2qwnA17iM3Je4ZE3ge5FlRgM0hZlE66ZrqPJl/s1600/weed_eating580.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="137" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh930FHv7deYmuhzvLujjQBDgir7DQZqcSKiDShzCIcFEDPHqIz1Rx218dbuOwW0DtkN1r9QhYOaa9hd-8_3k2CODNEaQQrIPPz9tuhiEH2qwnA17iM3Je4ZE3ge5FlRgM0hZlE66ZrqPJl/s320/weed_eating580.jpg" width="320" /></a><br />
I've also had some recent reminders that my wife is correct when she tries to protect me and help me to heal, and I should listen more to her. A couple of weeks ago, I went out and for the first time in over a year used the trimmer to trim the grass. It felt like quite an accomplishment, but it also felt like it almost killed me! Death by lawn trimming?<br />
I also tried to life the dresser our kids used when they were little to move it so the carpet people could get into the room and put down the carpet tomorrow, and I wrenched my back and hips. It was heavy, yes, but I couldn't even hold that thing up for more than 5 seconds. Arrrrrgh! Yes, I guess I am mortal, and yes, I had a stem cell transplant last year, and yes, my cancer came back, and is affecting me, although I am not dying right now -- but I couldn't even lift a stupid dresser! Anyway, rant over. I'm feeling a bit better today. I just need to pace myself; I just wish it wasn't slow.<br />
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I am continuing my Zometa treatments - they are not so bad now - and am working on nutrition, exercise, and some supplements to see if we can hold this beast off longer. Wish me well in that effort! I know that we all have our moments when we need to bid farewell to things, even ideas, that we have been committed to, and move on - but doing it myself has been hard. But there is a lot of life still to enjoy, and I hope to do it with less stress. Thank you for your love and support!Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com4tag:blogger.com,1999:blog-2548863299114511236.post-17924494641115691602016-03-27T14:57:00.001-07:002016-03-27T14:57:04.604-07:00Birthdays and anniversaries<div class="separator" style="clear: both; text-align: center;">
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" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="Image result for birthday cake" border="0" class="rg_i" data-sz="f" jsaction="load:str.tbn" name="Y-JNHrTE1WxOVM:" 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" 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This has been a month of anniversaries. <b>March 12th</b> was the anniversary of the birth of my new immune system (or maybe my first second birthday???), and tomorrow (<b>March 28</b>) marks one year since I escaped the Bone Marrow Transplant Unit. I continue in what my doctor called a "very slow recovery." <br />
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Anniversaries and birthdays are usually times for reflection and thinking about our lives. Mostly, I am grateful. I have been around another year since all of that trauma, and although I am not in remission, my cancer largely appears to be stable. I am grateful that I have been able to get through the school year this year without chemotherapy. I am grateful, still, for each day -- for the beauty of the mountains, for my wife by my side, for the chance to work with students and wonderful colleagues, and for the opportunity to see my sons doing so well.<br />
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At the same time, birthdays and anniversaries are times to think about what we could do better, or things we regret. I regret that I am not in remission. I get frustrated in realizing that this journey, while better than the alternative, is not a simple short sprint. I read an article recently on the Myeloma Beacon website that indicated that there is evidence that blood counts are only part of the story -- people with multiple myeloma tend to have chronic immunosuppression due to the cancer itself, the chemo, etc. In other words, it is time to gear up to this reality and just accept that it is going to be, well, ongoing. <br />
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I have struggled in the past several weeks with a cold and then some kind of sinus inflammation; I'm sure it is related to either a virus or allergies or both, but it was getting worse and affecting my energy and everything else. I am doing better now after sleeping sitting up for several night and resorting to nasal sprays to reduce my sinus inflammation. It is not gone, but it is better. All of these things combined last week to make it a bad week -- back and hip pain was worse due to sleeping sitting up, sinus pressure, fatigue, everything. It got really bad by Wednesday or Thursday, and I just had a pity party day -- it just overwhelmed me for a bit. Then, on Friday, I sat up and slapped myself:<br />
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" 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Well, or maybe Batman-slapped myself?? In any case, I am doing better since then.<br />
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It is what it is. I said in a Sunday meeting today, and I meant it, that part of what I have learned through this is that in order to move forward, I have to give up trying to get MY way -- I have to accept that whatever happens, things will work out OK; I give my will over to the Lord. That is a part of the message in a wonderful pair of books I've been reading (again) by Lois McMaster-Bujold called <i>The Curse of Chalion</i> and <i>The Paladin of Souls</i>. In her world, there are 5 gods -- they are profoundly moving stories, but the core of them both is that the main character, in order to make progress, comes to the realization that the gods cannot directly interfere in the world of matter -- they require a person to open themselves up to them, to become a gateway for them to reach out and touch the world. While we don't fully agree with that premise, I think there is a profound truth there -- at least for God to truly touch <i>our </i>personal<i> </i>world, we have to open ourselves to Him, to subsume our will to His. It is not an easy thing, and it is not a single act -- it is an ongoing process. Someone said to me, but how do we do that? I replied, "I think, for me, it was accepting and saying to Him, I trust you."<br />
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Last, I continue with the Zometa "bone juice" treatments to try and strengthen my bones and reduce my risk of future fractures. While it is still not fun, it has gotten better. The last time, earlier this month, I had a low fever of about 99 for only about 1.5 days, the fatigue and pain were not nearly as bad (maybe 40% of what they were the first time). So, we'll see how that keeps going. Here I am on March 11th, having fun (I love the poster in the background.......)<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpIYsKbEqfvRE6vq2GzgJmVck2Ne5I_Eg6TFb2IaHX1fnxKdkRK5x8AaIKuetkEe60lyhJhsTjLnn5nLDQIavn5oikQAQFp0d8oOzpjvu_BX1MYaISLQ9BUGJNes-1jdnu-5ESKbCRboU1/s1600/IMG_0569.jpg" imageanchor="1"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpIYsKbEqfvRE6vq2GzgJmVck2Ne5I_Eg6TFb2IaHX1fnxKdkRK5x8AaIKuetkEe60lyhJhsTjLnn5nLDQIavn5oikQAQFp0d8oOzpjvu_BX1MYaISLQ9BUGJNes-1jdnu-5ESKbCRboU1/s320/IMG_0569.jpg" width="240" /></a><br />
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So that's the latest! Thank you all for being my family, my friends, and for the wonderful things you do.<br />
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Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com1tag:blogger.com,1999:blog-2548863299114511236.post-65847009172323191152016-02-07T20:02:00.002-08:002016-02-08T11:52:35.340-08:00Ten months and countingI'm going to make a new year's resolution to try and update my blog a little more frequently, at least once monthly just so you don't all have to wait to see what is going on.<br />
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There is some good news to report. I am now 9 days past my 10th month anniversary since I was discharged from LDS Hospital. That's 10 months off of chemo, 10 months of trying to get back into the swing of things, 10 months more with family and friends. I am grateful for each day of it.<br />
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My "anniversary" of my discharge is March 29th, the day before the conference I am organizing at UVU! That will be an interesting week. My "birthday", a year old for my new immune system is March 12, so maybe I need to have a party or something? :) <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKBdZ_-NJvGbcRPBQrBDBaJK17tbVbelp8s7nlkZVNgDSbwZbe0HJdfora9yYCahyphenhyphenAIl14ZYlQ2Xu4zsLqO7LD-tLv68nSINO-HVKm761rBhpihhDtVIiFsGZlygAKzr28ZFcm8sFQmEqP/s1600/calendar.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: right;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKBdZ_-NJvGbcRPBQrBDBaJK17tbVbelp8s7nlkZVNgDSbwZbe0HJdfora9yYCahyphenhyphenAIl14ZYlQ2Xu4zsLqO7LD-tLv68nSINO-HVKm761rBhpihhDtVIiFsGZlygAKzr28ZFcm8sFQmEqP/s400/calendar.jpg" /></a>The only drawback to these festivities is that I will have to start my vaccinations all over again -- that is a major milestone, so I'll accept it, but secretly I'll whisper that I'm not really looking forward to it! <br />
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So, overall things have been going fairly well. I've been working. My department has been fantastic as always -- I'm teaching online and doing some administrative work. I have discovered that while I enjoy teaching online, it is not as vibrant or exciting as teaching with the students right there. However, it also protects from infection and having done one substitute class late last semester, it takes much less energy, which I'm grateful for. <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe70MmJYelc8vRR9TQN2Gdn6-kU1x3subKLUZOoaXjaNY27QQOeQavIPnO-gcW9tWXOOhper3GKfxJ_NNEX09wKGZkVY-cla0eE_btZHa3G6cazsp7NIKb7JN8evXVmgjHPO8Ktlu1RVwH/s1600/MOOC.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe70MmJYelc8vRR9TQN2Gdn6-kU1x3subKLUZOoaXjaNY27QQOeQavIPnO-gcW9tWXOOhper3GKfxJ_NNEX09wKGZkVY-cla0eE_btZHa3G6cazsp7NIKb7JN8evXVmgjHPO8Ktlu1RVwH/s320/MOOC.jpg" width="301" /></a>I am also finishing up my book. Yes, I'm writing my second book (first one was on depression) -- it is about understanding and working with student resistance to active learning. We are in the last stages! I'm excited to get this done. We had originally agreed to have this done by December 2014 but cancer made a hash of that. But I've been able to work on it, especially in the past 4 months. So, this has been a useful and productive 10 months, overall. <br />
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Now to the update -- my last blood tests were a little worrisome -- uptick in my M-spike to 0.7. It has been hovering around 0.5 - 0.6; however, it has been that high once before since I came out. The doctor said it was not enough data to make a change in our current strategy. So whew! My blood counts are also still low. <b>Arrrrgh</b>. My white counts has sometimes gone up into the bottom of the normal range, but this time they are down again. My red counts are also still low, below normal, but not too far. It's those silly platelets, too! They have hardly moved since I left the hospital. At least I have enough of them that the doctor said Patricia could stab me, and I would not bleed out right away, but I wish they were higher. <br />
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So my existential angst is a bit calmer right now, although that M-spike made me just a bit anxious. I finally started on Zometa after months of debating and trying to decide. It was NOT fun. I had flu-like symptoms and pain for 4-5 days including fevers of up to 102. The doctor wasn't certain if the fevers were due to the drug or to a viral infection that then affected me for the following 2-3 weeks in January. That was a drag. I've looked at the online message forums for Multiple Myeloma, and the suggestions included extending the time of the infusion and staying hydrated; the doctor had no problem with this, and so we are going to try it later this week. I also have read that at least for many people, the first time is the worst. I hope all of these things are true. We delayed my treatment until the end of this week so that I can get the book done and can lose the weekend if I need to. <br />
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So, hanging in there. Not recovering as well as I had hoped. Dr. W talked about it as a "slow recovery", but I'm working, enjoying each day as much as I can, and my book will soon be done! We were also able to do a bit of traveling in November and go see our son in San Francisco. I'm grateful for all of this time I've had, and I hope for even more. Thanks for reading! Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com0tag:blogger.com,1999:blog-2548863299114511236.post-83429234619511721552015-12-06T15:52:00.000-08:002015-12-06T15:52:47.106-08:00The Other Side of the TunnelBoy, looking at the date, it has really been a while since I have posted. Sorry about that, everyone. In case I don't get back to this real soon, Merry Christmas!<br />
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Before I get into my musings, let me update everyone:<br />
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<li>No significant change in my cancer readings -- hooray! It moves slightly up and down, but it is holding remarkably steady. It is like there is a stalemate going on in the battle between my immune system and the cancer (like the trenches in WWI?). Whatever it is, I'll take it. </li>
<li>Because of the stalemate, I am chemo free. My department chair and I were trying to come up with words to a Christmas song, something like: "I'm not getting chemo for Christmas! Mommy and Daddy are glad. I'm not getting chemo for Christmas. 'Cause Christmas is no time to be sad." Ok, it is a work in progress! But that is a real blessing.</li>
<li>My blood results are still not that great. My neutrophils, the ones that fight bacterial infections, have sometimes been up past the border in the bottom range of normal, but most of the others are hovering not too far below the bottom end of the normal range. The good news is that while they are low, they are not terribly low (as in need transfusions low). The doctor still calls me "immuno-compromised", but he said my wife could probably stab me, and I would not bleed out, so that is something! Because of this and getting sick twice in the past few weeks, I decided I have to keep my mask on at church and in many of my meetings on campus and be more cautious. Here is a picture from Wikipedia of Neutrophils: </li>
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<img border="0" height="145" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEhMA07xixOFW60X5TYrqt-w4o0JgJpca-we9yUUCgfTCBO1yyuf0jBfOZvYc4CWJSkljSC1iFDrvZfLC2JgpgR5RrH9y1rMylgIVNjKQq3KtGL3ahlGYarX7QQbVScBP3Nghj1CaSZTqq/s200/250px-Neutrophils.jpg" width="200" /><br /><br />
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<li>I feel a LOT better than I did after my transplant (8+ months ago) in terms of my energy levels, ability to concentrate, etc. However, my energy levels are still low. Yesterday, we went out to dinner for our anniversary and then to the mall to look for some stocking stuffers. We left there and came home about 8 pm. I was pretty much wasted, and I should have told my wife I needed to leave earlier. It is hard to do that, and sometimes I am burning reserves and don't know it until I "hit the wall". So, I am still walking, I've been working, etc. all of which is a <b>big </b>improvement. I'd like to think I can keep getting better, but it has been 8 1/2 months. We'll see. </li>
<li>We got to do some of our bucket list! Because I am teaching online, I was able to stay in touch with students and manage my classes from a distance. We went out to California to see my son Ben and his fiancée, Sonal. We enjoyed that and went with them to see Yosemite National Park. <u>UH-mazing</u>. I really enjoyed it and being with family. I stayed for a conference there in San Francisco. Two weeks later, my wife and I flew out to Denver to see her family because of a true <i>miracle</i> event: a funeral of her uncle Roger Nielson who died at the age of 22 in World War II at Tarawa. If you don't know much about Tarawa, it was one of the bloodiest battles of the Pacific Theatre in the war. Decades ago, Patricia's grandmother had received word first that her son was missing and then that he was presumed dead. However, she was later informed that they could not locate the body. That was the way it stayed for a long time; my wife thought he had been killed trying to get on the beach and his body was lost at sea. However, just over a decade ago, an event occurred that ultimately led to History Flight (a non-profit now working with the State Department and the military) discovering the remains of her Uncle Roger and 34 other US Marines who were killed at Tarawa. His DNA was matched to her surviving Uncle Cory, and he was brought home to Denver to be buried at Ft. Logan Cemetery. It was quite touching, and we all feel very grateful to History Flight for the work they are doing. </li>
<li>Unfortunately, we have not yet had a chance to take down a terrorist. We are working on the other bucket list items. </li>
<li>Our sons are doing very well. Ben is working hard at his law firm in California and Wesley is really enjoying his time in his MFA program in Florida. He will be working right up until Christmas, so we won't get to see him here, but we are thinking of flying out there in the not distant future. Ben and Sonal will be getting married in July, so we are planning to be there. Hopefully, I will STILL not be on chemo and can enjoy the celebration. </li>
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That's the latest! Now on the musings -- click away if you don't want to hear them! Last chance!.......</div>
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Last time I wrote about the uncertainty that comes with cancer and the anxiety that goes with it. We have had several real blessings in our life recently that have enabled us to pay off our house which has really reduced some of that significantly: I know that we have a place to live no matter what happens. The apparent stability of the cancer right now has been another blessing in that regard - it gives us a window of time to enjoy life and do some of the things I've mentioned above. But that uncertainty is not gone, although it is reduced. I was thinking yesterday that it is like stumbling down a long very dark tunnel with a flashlight whose batteries are running out - you can only see a little ways ahead and sometimes even that is murky. </div>
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My metaphor here may become strained, but to me, every tunnel also has another side where the light is still shining. For me, I have been thinking that gratitude is part of what helps me keep walking; I am grateful for the time I have had on the earth, for this chance to be with family and my wife, for this Christmas that I can have to enjoy without chemotherapy. I am very grateful to my doctor who found the cancer early and has given me this time - my wife and I were speculating on where we would be now if he had not found it. (<i>Shudder</i>). I am grateful to my oncologist who listens to us, who is truly concerned for not only my well being, but our quality of life. I am grateful to all of you for your support and expressions of love and prayers. Most of all, I am grateful for my wife who has been staunch and unflagging and at times irritatingly optimistic about everything going on and whom I love dearly, and for God who watches over me. In many ways, I think that gratitude is the conduit, at least for me, that strengthens my faith and that brings the hope that helps to balance that uncertainty. </div>
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Until next time! </div>
Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com1tag:blogger.com,1999:blog-2548863299114511236.post-8263909026876894742015-09-27T20:37:00.003-07:002015-09-27T20:37:35.504-07:00Through a Glass DarklyI was musing the past couple of days that I am hard upon a six-month anniversary of my stem cell transplant. I have been out now for all that time -- a really good thing! I have not had to return to the hospital and although I have had periods where I did not feel well due to small colds and such (that lasted much longer than my wife's!), but overall I have felt pretty good. I am trying hard to stay healthy, to take my protective medications and wear my mask in large gatherings, to exercise, etc. Further, I have been able to work although not at the pace that I used to. I have been blessed with this extra time.<br />
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Yet, this is also the curse. I have discovered that the clock never stops ticking in my head. My wife and I have committed to spending some of our time to work on our "bucket list", including a short visit to Yosemite and a visit with our oldest son if possible at the end of October ahead of a conference I am planning to go to, as well as some other side trips. These moments are precious and valuable....but I have no idea how I will feel. Will I be on chemo? Will I not? (hopefully!) When will I start bone treatments to strengthen my bones? Is the cancer progressing? How quickly? The answers to any and all of these questions are agonizingly difficult to get. We hope to know in the next month, maybe two, if the cancer is stable and fluctuating around 0.5 but there is a chance it is slowly going up, and at some point we will need to take action again. <br />
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So this is a part of cancer, that I don't think gets talked about as much. The pain, the suffering, the drive to stay motivated, drawing closer to others and to God - those are fairly well known by most people. But the gnawing stress of uncertainty has never really gone away since my diagnosis. The anniversary of that event is also upon me or has just passed - I didn't really mark it on the calendar. I started chemo in October last year, so I was diagnosed several weeks before that after all of the testing was done. It's not really an anniversary I want to celebrate, at least not at this point. :) <br />
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Uncertainty or not, nothing is to be gained by sitting still. I have some time now, so I will love my wife, spend time with my friends and neighbors, and enjoy my time at my work. I thank my Heavenly Father for His love and support, and I thank all of you for your ongoing prayers and love. No matter what the future brings, or when it brings it, I want to know and feel good about the journey I have made. <br />
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<br />Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com2tag:blogger.com,1999:blog-2548863299114511236.post-46054654876236081812015-09-13T12:34:00.000-07:002015-09-13T12:34:08.885-07:00No News is Good NewsUpdate 9/13/15 -- all odd numbers!<br />
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I have been meaning to post an update for a while now, but things get busy, so this blog contains two sets of musings. <br />
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The first is about my friend, Ian Sorensen. I initially met Ian, I think, as an Assistant Professor of Developmental Math when he came to work at UVU. I was directing the Faculty Center for Teaching Excellence at the time, and so I was involved with the new faculty. Ian is the kind of person that comes across immediately as warm, caring, friendly, and thoughtful. We enjoyed our interactions, and I learned more about him including his years of service as a Naval aviator. He participated in many of our events, and we had many discussions about how to improve and enhance student learning. He told me that he was going to work on his doctorate, which I encouraged. He was also an LDS Bishop of his ward, a position I thought he was well suited for. <br />
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I bring this up because months ago when I was not at school and was in the middle of preparing and then going through the transplant, he called me or sent me an email. I don't fully remember the sequence of events or exactly what happened because my brain was muddled, and I was in the middle of all that stuff going on. In any case, Ian got in contact with me because he heard that I had cancer and that I was going through a stem cell transplant. He shared with me that he had recently been diagnosed with, I think, Acute Lymphoblastic Leukemia (ALL). I shared my sorrow that this terrible thing had happened to him. He had questions about transplant, the procedures, what I thought of the LDS Transplant Team (he was trying to decide between LDS and Huntsman for his transplant). I shared my thoughts with him, and we agreed to keep in touch. I don't remember exactly when he was going to go in for his transplant, but I'm sure it was after mine.<br />
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After I got out and started recovering and trying to get back into a more normal semblance of life, I realized I had not heard back from him. I sent him an email on June 30th asking him how things were going, but I never got a reply. I was concerned and was going to follow up when I was told at work that he has passed away on August 20th. He had gone in for a donor transplant; apparently the transplant did help with the Leukemia, but his Graft vs. Host disease really became virulent shortly after his transplant, and ultimately it took his life. Ian was two years younger than I......rest in Peace, Ian and may the Lord comfort your family.<br />
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Second set of musings: His tragedy also made my wife and I more set against the possibility, at least at this point, of a donor transplant for me. As we have researched this option, it appears that for Myeloma, the success rate is unclear; many individuals go through the hell of that transplant and then instead of the donor cells totally killing the cancer, some of their own cells come back, and they live with mosaicism, meaning they have two genetic patterns in their bone marrow -- their own, and that of the donor. This creates an ongoing war of Graft vs. Host that can last for years, even a decade or more. It can also prove fatal as was true for Ian. We have also looked over clinical trials for Myeloma running in SLC and for now have decide to wait on those. There is only one trial that I am still pondering slightly, but most of them are dosage trials, and I am not at the point where I think that would be helpful to me.<br />
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But, as my title for this blog suggests, not all is bad news. We had our monthly appointment with Dr. Wallentine this past Friday. I had gone in earlier for my blood tests to try and make sure we had all of the data, but we were still missing the M-spike information - (grumble, grumble, grumble, ....laboratory....grumble). The results we did have to go over seem to indicate that the cancer is in a holding pattern; it is stable. At least it has been so for the past few months. There is no indication in the current tests that it is doing significant damage to me right at the moment. That is a real blessing. So we are going to continue to postpone chemotherapy for now. We are in "wait and see mode". Most of my blood counts are still low (white, red, hematocrit, platelets), although my neutrophils are in the low end of normal. Wahoo! <br />
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So, because of persistent anemia, I'm still tired by early to late afternoon, still a bit weak, etc. but some of that is because I am still recovering from transplant. Also, please don't stab me with a knife or sword because my platelets are low! <br />
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We may start with Zometa, a medication that is often used with osteoporosis patients to strengthen my bones now while they are not being aggressively attacked, in the near future. We don't know how long this pause stage will last, but we are grateful for it. I am able to get work done and keep contributing, and that is a very valuable thing. I just wish I could eat sushi....... :)<br />
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That's the latest. Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com0tag:blogger.com,1999:blog-2548863299114511236.post-44728233785685794392015-08-12T18:41:00.002-07:002015-08-12T19:00:39.611-07:00The DisappointmentIn my last blog post, I described how we were waiting to get the results of more recent labs and to meet with the Bone Marrow Team up in SLC. Well, we did both. Two weeks ago today, we met with the BMT my (very late) 100 day checkup. <br />
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Doctor Ash did not try to beat around the bush. She started out by saying that she had some bad news. Just the day before I had seen the latest posting online of my Provo lab results, but I was hoping there was a mistake or perhaps I was not understanding the context. That's not what she said. <br />
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So, to give you all some context. The M-spike is a lab result that shows the level of abnormal (cancerous) protein in the blood. Normal people's score is 0, none. I was diagnosed when it was 1.7 (fairly low compared to some other people we've spoken to). After my rounds of chemotherapy, it dropped (good news), and it was 0.2 just before my stem cell transplant. The most recent results available at the time we met the BMT was 0.6. This means that the cancer is back and growing.<br />
All I could think was:<br />
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Patricia told me after the meeting that she wanted to slap the doctor across the face and tell her, "Stop talking!" It was a difficult thing to hear. The lab result that shows the presence of other proteins that can damage the kidneys were also way higher than normal. She said that the team believed that my cancer was "refractory", meaning unresponsive, to the chemotherapy that was used in the hospital. In other words, I went through that, and it did succeed in killing my immune system, but it didn't kill the cancer. Again, I thought:</div>
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So we've had a hard couple of weeks adapting to the news. We met with our oncologist yesterday. He was also a bit disheartened. We discussed options including the possibility of a donor stem cell transplant; this is a fairly effective treatment for some other conditions (such as Non-Hodgkins Lymphoma), but he said he would not recommend it for Multiple Myeloma -- too risky with mortality rates around 20-30% and the evidence is not clear that the gains for many are worth the risk. Some people have done well with it, but that is apparently not the norm. We discussed participating in a clinical trial with some of the new treatments that are coming out and resuming chemotherapy at home, with new, updated drugs. We are taking a month to do some research then we'll meet and decide what to do. </div>
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So -- thank you for your prayers and support. Please keep them coming. We'll post more when we know what we are doing. There are some new treatments and opportunities. I hope to be bothering all of you for some time yet. </div>
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Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com2tag:blogger.com,1999:blog-2548863299114511236.post-23609559955361871982015-07-05T13:47:00.005-07:002015-07-05T13:47:41.568-07:00The milestoneYesterday, Saturday marked day 98 from my leaving the hospital after my transplant, if I am counting correctly! When we were at the hospital, they told us we would have a last meeting marking day 100, or the milestone for when they no longer would have any input on our case and it would all be back to our oncologist. <br />
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We got a phone call from Dr. Wallentine's (the hematologist/oncologist) office saying that the hospital had called, and we needed to get all the lab work done so they can review it. So this means going through the list of things again including lots of blood work and labs, a 24-hour urine sample, and my favorite -- the bone marrow biopsy (love that procedure). Some of the labs take time, as does the biopsy because the pathologist has to do it to count the number of cancer cells. So this week will probably be fairly busy taking care of this type of stuff. Then LDS Hospital will review all of it and make some recommendations to Dr. Wallentine. Apparently, they are saying that we don't need to drive up there for a meeting which seems both good and bad. <br />
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Good because that is a long drive with traffic and wipes out much of a day. Bad because we won't have as much of a chance to say good-bye and to hear their recommendations directly. Patricia and I are talking about whether we want to request a final meeting. <br />
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People are telling me I am looking good, that my color is better, etc. I am thankful for that and grateful that I am able to get out and ride my bike and pull a few weeds (with gloves and a mask on). I'm accelerating work on my fall courses and my book, and working part-time at home and at school. So things <i>are</i> better than they have been for months. <br />
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But as I told someone yesterday, "Cancer has a way of making one cautious." Yes, I really do hope that I am doing better. I am looking forward to continued months of no chemotherapy as we monitor the cancer and make sure it is quiet. At the same time, part of my brain is hiding in the dark closet shouting "Be careful! Things are dangerous out there!" Maybe this is part of the shock of diagnosis still lingering, I don't know. <br />
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What I do know is that life is precious. Family is precious. We are given wonderful blessings in this world to serve others, to know love and joy, to learn, and to face our fears; we have the chance to come to know God in his mercy and kindness during the worst moments we face....and He is there. And so are all of you -- thank you again for your ongoing support and kindnesses. <br />
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Let's see what the week brings. Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com0tag:blogger.com,1999:blog-2548863299114511236.post-66470024774676983392015-05-24T14:43:00.002-07:002015-05-24T14:44:08.210-07:0056 Days and CountingBoy, I know I have been meaning to update my blog, but I didn't realize <i>so</i> much time has gone by. Today is my 57th day since I left the hospital. We are more than halfway to the "milestone" 100 day checkup when we'll go back up to SLC for a final visit with the Transplant Unit. In the meantime, I'm back to working with my local oncologist. Some of you have still been sending me a joke of the day which I appreciate! :) <br />
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As of about a month ago, my white blood cells were staying in normal range -- yes! My red blood cells and platelets were below normal, but not by too much, so that is looking pretty good. We still won't know about how the cancer is doing until we do a checkup in about 6-7 more weeks. <br />
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Overall, things are going pretty well: No naps, walking around 2.5 - 3 miles, five times a week, and working part-time from home. I'm making progress on my major projects (designing my online Abnormal Psych course and working on my book), and I can go to the store etc. either when they aren't busy or with a mask. I'm going to ask the doctor about masks when I go to visit again this week. I still can't get in the dirt; my wife, bless her, is doing the outside work this spring and summer from planting, moving compost, etc. <br />
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Speaking of projects -- I am trying to build wooden tomato cages for my wife to put in the garden. Since I suppose wood does not have loads of bacteria or mold in it, I can work with it, but I am doing this in the garage with my mask on. Loads of fun! Both this project and the walking, though, have taught me something. With exceptions, I feel like I am trying to resume a "normal" life; however, the swelling of my feet and ankles, my tiredness the next day, and ongoing aches and pains tells me that I think that I am more ready for things than sometimes I am. At least I think that is what they are telling me. I feel pretty good, so I assume I can do normal things, but I am finding out that I am not quite back to normal yet. I think it will come, but I've had to cut back on some of the walking (not quite as far) and trying to get some rest in, and I may not be able to cut as much lumber in a day as I thought I would. <br />
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I think it is an ongoing issue of adjustment. But that is what all of life is, right? We all have to adjust to the things that come our way and learn how to interact the best way we know how. Thank you again for your love and support. As my friend Buzz likes to say: To Infinity and Beyond! <br />
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<br />Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com2tag:blogger.com,1999:blog-2548863299114511236.post-14327882236704565452015-04-11T09:58:00.004-07:002015-04-11T09:58:56.464-07:00Heading Toward HealthWe had a bit of a mixup, or rather the BMT clinic had a mixup on our appointments, so we ended up going in for the checkup on Friday, not Thursday. Going in, I have had no significant fevers, vomiting, or other complications or problems. Patricia is very good at making sure I get out and do some exercise every day which is good for me. Wednesday was the <i>first</i> day I went for an entire day without a major nap since I went into the hospital. I did this again yesterday but it was mostly because I could not lay down until it was bed time anyway! I still need a nap most days, but that is down from 2 a day to 1 a day. Energy level is slowly coming up -- my sense of humor is coming back.....at least <i style="font-weight: bold;">I</i> think it is.<br />
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On April 2nd, my Hematocrit (proportion of my blood that consists of red blood cells) was 34% of my cells; yesterday it was 37%. The bottom end of normal is 41%. So, still anemic, but moving forward and getting close to normal. Keep in mind that I have been anemic probably for over a year, so this is a good sign. 4/2 my platelets were at 105 (these help me to stop bleeding), yesterday they were at 155 which falls <i>within</i> the low end of normal range. On 4/2 my neutrophil count had dropped down to 1.7 after the neupogen wore off; yesterday it was back up to 4.3!! These are cells that help to develop into the infection fighting parts of the immune system, so this is great. This is in the <i>middle</i> of the normal range. Hopefully those will stabilize. <br />
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All of that was fantastic news. My immune system continues to grow and improve, getting me to within the normal range; I haven't seen scores the normal range for some of these counts for probably 6 months or so. We don't have a current read on the cancer indicators, but we'll get that in a couple of months, maybe earlier. I also have an appointment now scheduled with my regular oncologist for the end of April. At that time, I will "officially" become his patient again instead of the BMT's patient. <br />
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Doctor Peterson indicated that in their opinion, I had done fantastically well with the transplant, and my results were looking really good. The next decision we are facing (there seems to always be another decision looming) is whether to do consolidation treatment and/or maintenance treatment. I have been reading about this, but Dr. Peterson also shared his own ideas about this. The key thing that is hanging the field up is this: studies have shown that those who DO go on consolidation and/or maintenance treatment (taking lower doses of chemotherapy after transplant) have a longer period in remission. However, the same studies also do not show what they call an <i>Overall Survival</i> benefit, meaning even if they were longer in remission, they did not live longer as a group than did those who did <u>not</u> go on maintenance. He explained that this is partly because they think that going on remission enables the cancer to eventually become resistant to the chemotherapy so that when you relapse, it is more difficult to treat. So maintenance can give you longer remission, but you are still going through chemo (lower doses, yes), the drugs can actually <u>inhibit</u> your immune system's production of some of the key infection and disease fighting white blood cells, and it more than doubles your risk for developing "secondary cancers", other types of cancers or illnesses. Lovely, eh? <br />
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He thinks that we are in the middle of significant progress and that the next 5-10 years will show even more remarkable results, possibly even a cure. The goal right now is to make Myeloma a chronic disease that is treatable and not fatal. So if the transplant can give me 2 years (median) remission, we are that much closer to progress being made and new drugs being available. However, I suspect, I hope, I will get more, maybe much more, than 2 years since the group that median (or average) is based on includes those with highly aggressive genetics in their myeloma. Dr. Peterson also described a small group of patients he had personally treated who have been in remission after transplant for 20+ years -- some show signs of the cancer, but it appears to be "paralyzed" - it is not growing or progressing, but has just been sitting there for years. Of course, the chances are I will not be in that group, but we can hope! Here's a story to help you understand something of statistics:<br />
<span style="color: purple;">A biologist, a chemist, and a statistician went hunting. They spotted a large buck in the woods. The Biologist took aim and fired but missed by 6 inches to the left; trying to compensate, the chemist fired and missed the buck by 6 inches to the right. The statistician pumped his arms up and down and shouted "We got him!". </span><br />
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Last news: here is a photo that is great to see. The marks on my head are from wearing my hat a lot yesterday, but look at my chest! <br />
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No Trifusion Catheter! I am free at last! It was there only about 5 weeks, but given the trauma of the first days it was put in (go back and read early blog posts), it is such a relief to have it out. This was also a potentially high infection path, so that gives me some additional protection. I am learning to try and move more freely again and will enjoy having some scars to show people and tell them the story of how Patricia attacked me with an ice pick. <br />
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So that is the latest. Thank you all for your love and support. Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com0tag:blogger.com,1999:blog-2548863299114511236.post-47533273579840352312015-04-08T15:38:00.001-07:002015-04-08T15:38:10.948-07:00I can do anything for 10 secondsSo, the latest is somewhat more boring compared with previous posts. We are heading again to see the BMT tomorrow, to get another blood workup and probably to get my trifusion line removed from my chest. It will be a pleasure to have this thing gone. I'll update you all on the results of our visit once we know them. <br />
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It has been a tremendous relief not to be in the hospital, and to be home with actual, comfortable furniture, my wife beside me, and a chance to be around familiar things. My appetite has mostly returned, although I could not eat a frozen pizza we had cooked because it tasted like vinegar to me! So, I guess there is still some adjusting going on there. We gave the pizza to a neighbor, and her kids loved it, so it was me, not the pizza. <br />
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If you haven't seen it, I would encourage anyone reading this to take a look at the tremendous documentary by Ken Burns that aired on PBS recently based on the book <i>Cancer: The Emperor of All Maladies</i> by Siddhartha Mukherjee (he is amazing as well, and I'm sure this book is just stupendous). It goes over the history of cancer as well as how our understanding (or lack of it) has been tied to the treatments we have used over the years. It ends by helping us get a glimpse at how complex cancer really is and helping us understand that this is part of the reason it has taken so long to get where we are today. That said, the progress we have made in the past decade or more is truly amazing. Although there is no "cure" for most forms of cancer, including Multiple Myeloma, one of the goals right now is to turn the disease from a fatal one into a chronic illness like diabetes or heart disease. I think we are within striking distance of that goal, and who knows what the future will bring? <br />
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To see the film (it is in three parts), go here:<br />
<a href="http://video.pbs.org/video/2365450686/">http://video.pbs.org/video/2365450686/</a><br />
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This is the first episode, called "Magic Bullets". The second is called "The Blind Men and the Elephant", and the last is called "Finding the Achilles heel". <br />
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Now to the title of this particular post. While I was in the hospital, Patricia and I watched the pilot and second episode of a new TV series (we haven't watched it since) called <i>Unbreakable Kimmy Schmidt</i>. One thing we got out of the show was a mantra she was using to get through difficult things: I can do anything for 10 seconds (and then repeat.....). So, Patricia wrote this on the wardrobe panel in my hospital room. We expanded the 10 seconds to 10 days, but you get the picture. I kept track of each day I had completed, and it helped me think about how I was making it through my time there. Here is a picture of the panel:<br />
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Sometimes, persistence or endurance means just this -- gritting your teeth and counting to 10. It is a little harder when it is 10 days, but it still works! </div>
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So, I am grateful for being able to count to 10 twice. I'm grateful for the advances humanity has made in fighting this terrible Emperor -- I will still benefit for years to come from these advances. The dedication and perseverance of those working in this field is inspiring. I am grateful to all of you for your ongoing support and help - trying to do this on my own would be much, much harder. Hopefully, tomorrow we will have more good news, and I will return home with a healing hole in my chest, but no more tube. I'll let you know! </div>
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<br />Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com1tag:blogger.com,1999:blog-2548863299114511236.post-17727451522482850382015-04-03T14:58:00.002-07:002015-04-08T15:38:52.956-07:00The rising generationI promised I would give an update after our trip to the BMT (Bone Marrow Transplant) clinic yesterday. The news was pretty good. Here it is in table form for the most important counts:<br />
At discharge Yesterday (4/2) Normal range <br />
Hematocrit (red blood cells): 26 34 45 for men<br />
Platelets 21 105! 140-440<br />
Neutrophils (infection fighters) 4.7 1.7* 2.2 - 4.8<br />
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So, both my red blood cell production (and thus more oxygen and energy) have gone up substantially which is a good sign as ha my platelet count. I'm not going to bleed out right away! I still have a ways to go toward the normal range on both, but that is a good move in the right direction.<br />
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My neutrophils have dropped significantly, but this was expected. They were toked up on neupogen and production soared and is now dropping down to more expected levels. I hope they are stabilizing and should soon hit the normal range. <br />
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No transfusions for me, right now, thank you very much! <br />
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The PA and the doctor were both pleased with the results and said they were quite good. I have been able to walk every day with my wife and the dogs except for yesterday (cold, blah, and we were both very tired). I will try and keep that up -- it seems to really make a difference. <br />
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The doctor said something like: "These are really good results. They show that your immune system has rebooted and is working to get up to speed. Your new immune system is like a baby's, though -- it still has a lot to learn about how to fight infections, what they look like", and so forth.<br />
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So I've got a nube for an immune system, but it is working hard. Thus, the mask and avoiding lots of people still. We don't want to overwhelm it just yet. It will get a chance to learn and grow, but we want to do that slowly so it is strong enough to do well. <span style="color: red;">Keep those measles away from me!</span> <br />
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The nap attacks are still hitting me, and that is part of the process of maintaining energy through the day. Today, I laid down just for a "rest", woke up when my wife walked in the room about 30 minutes later, turned over just to get warm, and woke up again about another 35 minutes later. Whew! Growing an immune system is hard work. <br />
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I will be stopping my Coumadin on Sunday. They will check me again next Thursday, and I expect that we will remove the trifusion catheter from my chest. We will then schedule a follow-up appointment with my regular oncologist. After that hole in my chest heals, I'll be able to do jumping jacks and take showers and have fun! Now, where to get the energy.......<br />
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It will come, my friends and family -- things are looking good.<br />
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And that is the latest! I posted an announcement on my Facebook page about my hospital-neighbor Elena Jakobson. Please take a look at it. <br />
<br />Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com0tag:blogger.com,1999:blog-2548863299114511236.post-48305484186277464422015-03-31T15:42:00.000-07:002015-03-31T15:45:10.083-07:00Bald is BeautifulI know that losing your hair is usually more difficult for women; so much of women's social image and self-image is tied up with their hair and how they look with it that it is very difficult to lose it. For men, I think there is less emotion with this, although I'm sure that varies from man to man. <br />
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For me, one of the nice side-effects of the transplant is that I barely have to shave (I shaved today, first time in 3 days), and I think my head looks pretty good. So, bald is beautiful, I say! <br />
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I had more energy and felt better this morning, so I think I overdid it a bit. This afternoon I've been a bit shagged. But we are moving in a positive direction. We have a follow-up visit at the BMT clinic on Thursday. I'll let you know how it is looking. <br />
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Here I am today:<br />
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And to give you all a reference point (because some have been asking me):<br />
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Red Blood Cell Count Normal range: 42-52 My last score was 26.1 I think?<br />
Platelets Normal range: 140-440 My last score was 21 or so, if I recall. <br />
Absolute Neutrophils Normal range: 2.2 - 4.8 I hit this one out of the park the day after my last neupogen shot, at 4.7 I expect that number has now dropped. It was at 0 for quite a while. The 500K threshold I mentioned before would be 0.5 on this scale. <br />
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So, I still have a bit of ways to go, but I hope my numbers look better on Thursday. <br />
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And that's the latest!<br />
<br />Anton Tolmanhttp://www.blogger.com/profile/07461993816796290732noreply@blogger.com4