Recently in Patient Perspectives Category
My life was deeply touched this fall by three special, hardworking couples: Karl and Lorraine Vollstedt, Howard and Teresa Martinson, and Harold and Sue VanDuyn. Each went out of their way to welcome me into
their local myeloma support group community.
With the help of myeloma survivor Barb Davis, Karl and Lorraine are co-leaders of the Stillwater, Minnesota Multiple Myeloma Support Group. I met them when I attended my first ever support group meeting five years ago.
I am fond of telling anyone who will listen that the education I received—and the friendships I made there—helped save my life.
After a number of years, Karl is still alive and kicking. Myeloma and advancing years have taken their toll on Karl. And Lorraine recently had both knees replaced, along with a painful foot surgery. But you wouldn't know it by talking with them—two of the most positive, upbeat people I have ever met
Lorraine was kind enough to invite me to stay with them during my recent visit north. I was scheduled to speak to a myeloma support group in Minneapolis, but I set up my schedule to allow me to spend a couple extra days with Karl.
We drove into the city for a tour of Target Field, the new Minnesota Twins'
ballpark. We visited a homeless center there, too; Karl is a member of their board of directors.
And speaking of homeless shelters, my new friends and support group leaders, Howard and Teresa, in Spokane, Washington, also help to run a shelter in nearby Coeur d'Alene, Idaho.
What? Like dealing with their own cancer and helping other patients and caregivers—doesn't keep them busy enough? Amazing!
I met Howard and Teresa—and our third couple, Harold and Sue—in Dallas at the IMF's Support Group Summit. Harold had just introduced himself when he started bragging-up their hometown of Grand Rapids, Michigan. They invited me up to speak to their group and I eagerly accepted. Even thought Grand
Rapids is the state's second largest city, there wasn't a support group for myeloma patients anywhere to be found nearby. So of course, this energetic couple started one ten months ago.
With the help of the IMF, the new, fledgling group is already amazingly successful. Over 40 patients, caregivers and family members somehow squeezed into a room in the world famous Gilda's Club to hear my story on Monday. And Harold was right! Grand Rapids was a very impressive city, with new medical and research buildings rising everywhere.
But it's the people that make Stillwater, Spokane and Grand Rapids so special. Everyone I met was warm and helpful.
Harold only recently recovered from a stem cell transplant, and some of his counts haven't recovered. But like Karl and Lorraine, you wouldn't know it! Harold may be the patient face of the new group, but Sue pulls everything together. She's the organizer.
Isn't that always the case? Behind most every helpful myeloma survivor, there is a dutiful caregiver that helps monitor their medications, gets them to
appointments on time and helps emotionally hold things together.
At breakfast Tuesday, Harold started rattling-off examples of all the new myeloma friends the couple had made since starting their group. Right
back at you, Harold! I hope I make the list. I can't imagine having better friends than Karl, Lorraine, Howard, Teresa, Harold and Sue!
Three exceptional patient/caregiver teams and support group leaders. Six exceptional friends.
Funny how a cancer like multiple myeloma can bring out the best in people, isn't it?
Feel good and keep smiling!
I met a wonderful woman recently at a support group meeting. Before and after I
spoke to the group, she shared her experience with me, gushing several times
that her new medical oncologist made her feel special.
He doesn't enter the room keeping one hand on
the door while he pretends to listen to me," she said.
Apparently she had recently relocated from a larger metropolitan area to a much
smaller, friendlier town in the Pacific Northwest. But the woman suffered
from significant bone damage caused by her multiple myeloma. And she also
mentioned several serious co-morbidities that would have me packing my bags and
heading to see a big city specialist!
Considering that a number of other support group members had expressed
disappointment with their local oncologists, I'm pleased for her. Crafting
a good relationship based on trust of one's doctor can be a special
But it can have a dark side. Blind trust in the guidance of any physician
can become problematic for a multiple myeloma patient, especially if the physician isn't a specialist. And even then, a second opinion is almost
always a good idea whenever we find ourselves facing an important therapy crossroad.
Bedside manner is important. But I will take a curt, hurried or
difficult-to-understand specialist who will work with me to craft a new therapy course of action over a friendly, less well-informed doctor who tends to make
decisions for me any day!
Several of my uncles were physicians. One of them was the chief of staff
at a large western hospital. When my wife, Pattie, was first diagnosed
with cancer 16 years ago, he advised me to "Find the most knowledgeable specialist you can for her, then do whatever it takes to get an appointment."
He made no mention of how that physician and my wife might or might not get
along. It was all about the insight and expertise her new specialist brought to
Finding a medical oncologist that is ready and willing to help you coordinate
your therapy is the cornerstone of building a solid healthcare team. My
advice? Shop around until you find a medical oncologist that gets you. But
make sure that he or she is willing to work closely with--and ultimately follow
the recommendation of--one or more myeloma specialists.
Feel good and keep smiling!
You have been diagnosed with multiple myeloma. You and your family are shocked, scared and
shaken. The initial reaction--by you and
your doctor--is to start treatment immediately.
STOP! Time is rarely
of the essence following a multiple myeloma diagnosis. Multiple myeloma tends to be a slow moving,
plodding yet unstoppable disease. A few
hours, days or even weeks are unlikely to affect your overall prognosis.
Even if you have already started treatment, it is never too
late to re-evaluate your treatment plan. Have you considered a second opinion? Why are you and your doctor doing what you are doing? What are your expectations and goals? When is it time to change course, continue
with your current treatment regimen or watch, wait and do nothing at all?
These are big decisions--and very difficult to make on your
own, even with the help of a caregiver.Unlike some other cancers, myeloma patients often face overwhelming
treatment options. Most work at
first. But what then? Do you undergo an autologous stem cell
transplant now, or wait? If you do
decide to transplant, do you start maintenance therapy soon afterwards or
wait? When do you resume treatment if
and when your numbers start to rise again?
And which drugs should be used to best slow your relapse?
By assembling a comprehensive health care team, you can
surround yourself with experienced, qualified health care professionals to help
you make the treatment choices which are best for you.
Think of yourself as the CEO of a major company. Or a general contractor of a building
project. Are you into sports? How about acting like you are the owner of a
professional sports team? Or the
president of the PTA?
Regardless of which leadership style you emulate, remember
that powerful leaders in important positions surround themselves with
experienced support staff. You should do
the same. Here are the positions you
need to fill as you create your winning support team:
ï¿½ Primary Caregiver. This may be the most important position. It can be a spouse, family member or
friend. While it is best to if one
person fills this role, it can be done by a combination of people. Your primary caregiver is responsible for
reminding you to take your meds and help you get to and from medical
appointments--and to take careful notes and help you ask questions at those
appointments. They are also there to
provide emotional support and help you coordinate your health care team.
Myeloma Specialist. This can be an
oncologist or hematologist, preferably from a regional or nationally known
cancer center. Once you decide which
treatment course to follow, this specialist becomes a consultant, keeping your
team on course, or helping you make course corrections as necessarily.
Oncologist. This is the doc you see
regularly. He or she consults with your
specialist of choice, working together to make your day-to-day treatment
Nurse(s). Let's face it; oncology nurses run the show! They keep track of prescriptions and remind
the doctor about day-to-day details.
They are the ones who administer your IV and help minimize treatment
side-effects. Oncology nurses coordinate
your labs and make sure you are doing OK.
In my next life, I am going to be an oncology nurse! These brave, skilled women (and men!) have
the difficult task of working directly with the patient day to day. They rock!
or Family Doctor. Don't let cancer
dominate your entire health care world. You still need a regular doc to handle
non-cancer -related issues.
Group. Multiple myeloma support
groups share all kind of details and data. Learn how other patients cope with
side effects. Learn what other patients
are using and why. Your support group
members will become like family. They
understand what you are going through.
and Friends. Your friends and family
want to help--they just don't know how--and you can't expect them to read your
mind. When they offer to help, try and
assign them small, simple and achievable tasks.
They will feel good about themselves--and you will feel better knowing
you have people surrounding you who love and care for you.
You don't have to stop there! Add a nutritionist and/or naturopathic
MD. How about a massage therapist or
acupuncturist? Try a physical trainer or
therapist. You can make your medical
team as large or small as you like. Keep
it simple or expand it as you go--it's up to you--you are your own team's leader!
Of course, you won't be able to build a winning medical team
overnight. It may take months or years
to develop. And, like a good team owner
or coach, you may decide to make changes as time goes on. Remember, winning owners change coaches and
team personnel as needed. Team chemistry
is important. If someone isn't
contributing, or can't get along with other team members, find someone who can!
Good luck building your winning health care team! Come on--I know you can do it--your life may
depend on it.
Feel good and keep smiling!
Late last year I met a 19-year multiple myeloma survivor at the American
Society of Hematology (ASH) meetings in San Diego.
She was an elderly African-American woman who seemed to be in surprisingly good
As I often do when I meet any long-time survivor, I asked her what her secret
was for living so long. She thought a moment and said, "Therapy is like riding
"A horse?" I
a horse," she repeated a bit mysteriously. "You should ride that horse until it
drops--then wait for it to get up, and ride it again!"
As we talked some more, I began to understand her point. Patients should use a
therapy for as long as they can, then go back to it and try it again and again until
their doctor is sure that they have gotten every possible day--or mile--out of
the drug or drugs that they've been using.
She explained that there are only so many myeloma drugs available to use at any
one time. She felt that getting the most out of each of them had added years to
her life. "And I've been lucky!" she said. "Just when I thought that I was
running out of time, another drug came along to help me live a while longer."
My conversation with this wise and elegant survivor changed the way I think
about myeloma therapy.
So many of us can be in a hurry to change horses midstream, abandoning a
therapy that might not be working as well now as it did before. But that can be
Even if your numbers aren't going down anymore--maybe they're stable, or even
rising slowly--squeezing every precious day out of your therapy can add up to a
lot of extra living in the end.
Who knows? A few extra months here and there might make the difference between
becoming a statistic or living to fight another day! Wise advice, indeed!
Feel good and keep smiling!
This is a story sprinkled with equal parts of sadness,
admiration, and inspiration about a rugged Nebraska farmer and his courageous approach
to myeloma. Glen Potter was no stranger to myeloma when he
was diagnosed in 1999. His father had
died with it. His response to the
shocking diagnosis was, "Well, how do we fight it. What do we do first?" He had an auto transplant in 2000 and was
more or less on continuous treatment for the rest of his life, rarely
mentioning his painful Thalidomide neuropathy, chronic fatigue, or innumerable
long trips to Arkansas.
Glen was a member of my Central NE Myeloma Support Group for
10 years and rarely missed a monthly meeting. He wore his burgundy IMF bracelet continuously and was a constant
spokesman for more myeloma research and better public understanding of this
horrible cancer. No one will ever know
how many countless conversations were started by that burgundy bracelet. As he cared for his cattle and grew his crops
the sun eventually faded the constant companion on his wrist from burgundy to
pink to tan to off-white. It was as
much a part of him as his white Stetson hat. It is impossible to tell you what a truly nice man he was...unbelievably
optimistic, supportive, and a friend to everyone he ever met.
Our group was planning our annual summer evening picnic and
it was to be on Glen's 65th
birthday. I planned to have a special cake from a local
grocery and nearly 40 voices would sing "Happy Birthday" that night. Food plans were made, tables and chairs
secured, and our speaker from Omaha was anxious to attend. A few days before the party Glen was playing
with his grandchildren. His family reports
that he felt well, but in an amazingly short time he began to feel sick. High fever forced him to the ER where he was admitted. Despite IV fluids and supportive care he
rapidly deteriorated and within hours was put on life support technology. Cardiac irregularities and renal failure
quickly followed, most likely all caused by overwhelming sepsis. Despite
the best of care, Glen died.
Our group was devastated. Glen's funeral was scheduled for Saturday, the day of his 65th
birthday and the day of our summer evening party which we obviously
cancelled. The day before his funeral
his daughter Shelly called to ask me if I had any more of the burgundy IMF
bracelets which I had given to her father, the one faded nearly white with age
and exposure. She explained that Glen
would be buried with that faded bracelet still on his wrist, and she wanted to
hand out new burgundy bracelets to all the close family members. The Potter family hates myeloma as much as
anyone possibly could, and they plan to continue spreading the word about
multiple myeloma. Their new burgundy bracelets
will start many conversations. Glen's
commitment to fight this disease and find a cure will continue long after his
death. At his funeral the church was
full and overflowing with people. In
several eulogies myeloma and Glen's battle with it were mentioned. Myeloma. Not cancer.....myeloma! Too often
when people with our disease die, cancer is listed as the cause when it is "myeloma"
which needs to be emphasized for better public awareness.
Glen Potter lived and died with myeloma for 13 years, but he
never gave it a chance to rule his life. By his IMF bracelet, and the bracelets his family will still wear, he
will continue to silently advocate against our awful disease.
Energizing. Life changing. Hopeful. All adjectives that can be used to describe
my experience at this week's IMF Support Group Leader Summit in Dallas, Texas.
I must admit that I was reluctant to attend this year's meeting. I had lots of
excuses. I had just returned from speaking to a pair of support groups in L.A,
and I knew I was returning to California again this Thursday to speak to a
group in Orange County, so I'm way too busy. I'm only one of three co-founders
of our Nature Coast (Florida) Multiple Myeloma Support Group - and probably the
least active at that. Or how about his one: my platelet and white blood counts
were very low and I wasn't feeling well. Pick an excuse, any excuse.
Thank God the IMF's Support Group Director, Robin Touhy, encouraged me to go!
It was an amazing experience! Dozens of support group leaders from all over the
U.S. and Canada attended, too. Some were first-timers, like me. Others had
attended for many years.
But we had two important things in common. We were all myeloma patients
or caregivers, and we all volunteered our time this weekend--and each month--to
give our time and help our fellow survivors.
I was impressed with updates provided by IMF Chairman and Co-founder Dr. Brian Durie
and a half dozen or more medical experts. Highlights included in-depth
presentations about state-of-the-art advances in imaging, treating high-risk
myeloma patients, and a series of updates by leading medical spokespersons from
Millennium, Celgene and Onyx pharmaceuticals companies.
I was surprised to learn that Onyx, makers of the newly FDA approved proteasome
inhibitor, Kyprolis, is already testing a similar oral chemotherapy drug. Moreover,
I know from first-hand experience how exciting Millennium's new Sub-Q
administration method for Velcade can be.
After taking Velcade by IV for only ten weeks, I was close to being forced to
discontinue my treatment six months ago. The peripheral neuropathy was simply
too intense. But about that time, my myeloma specialist switched me to Sub-Q
Velcade. It was like a miracle! My neuropathy didn't get any worse, I
felt better and I spent far less time at my local infusion center, too.
Additionally, Millennium is also close to submitting its new version of an oral
proteasome inhibitor, MLN9708.
But as exciting as all of this was, the human side of the gathering made the
biggest impression on me. What a wonderful, selfless group of dear
friends I made this past weekend!
Even though it was my first Support Group Summit, I knew a number of the group
leaders from visits I had made around the country to their groups to share my
story with their members. And I knew most of the IMF staff from our trips
together to American Society of Hematology (ASH) meetings in New Orleans,
Orlando and most recently, San Diego.
We all worked hard, spending the weekend learning and sharing ideas together.
Sure, the primary goal of the Support Group Leader Summit was to bring back lots
of ideas and information to our respective support groups. But in one
short weekend, I was able to turn a dozen former acquaintances--along with more
than twice that many survivors, caregivers and IMF team members that I just
met--into what I hope will be life-long friends.
It was an experience I will never forget!
Feel good and keep smiling!
This week I am going to examine the many side effects of dexamethasone--and what we as patients can do to help minimize them.
In my first book, "Living with Multiple Myeloma," I feature a chapter titled, "Demon Dex." Here's an excerpt:
Dexamethasone is the generic name for Decadron, a powerful corticosteroid. The good news is that it is inexpensive--and it works! Dexamethasone can be used to fight myeloma by itself, or in combination with other drugs.
The bad news is that Dexamethasone comes complete with a long laundry list of possible side effects. A very long list! Possible cardiac arrest, arrhythmias, cardiac enlargement, congestive heart failure, blood clots, impaired wound healing, hair loss, fluid retention and weight gain, weight loss, abdominal distention, loss of muscle mass, abnormal fat deposits, decreased resistance to infection and osteoporosis to name just a few...
Many dex-related side effects can be annoying. Some may even put your life at risk.
Two months into my treatment in 2007, I developed a pulmonary embolism and was forced to spend a week in the hospital. I have been forced to take prescription blood thinners daily ever since.
Most patients who use dexamethasone over long periods of time experience muscle wasting, retain water and begin to develop extra belly fat. Not what you want to experience when you are an aging 56-year-old trying to maintain a positive body image! And did I mention possible hair loss, a hoarse, raspy sounding voice, insomnia, extreme mood swings and feelings of anger and rage?
But as I wrote above, dexamethasone works. It enhances the performance of all three of the novel therapy agents: Thalomid, Revlimid and Velcade. Most patients take dexamethasone in pill form. Some patients receive dex by IV along with Velcade. But more often it is taken orally, especially now that many patients are taking Sub Q Velcade.
A day doesn't go by that I don't receive one or more emails or comments complaining about dexamethasone-associated side effects. Not taking dex isn't an option for most of us. It is too important to our therapy results to drop--at least at first.
So what can we do about it? How can we minimize dexamethasone-related side effects?
See if any of the suggestions on this list help you:
- Accept it. You can hate taking dex. But for most of us, the benefits outweigh the risks.
- You may be able to minimize insomnia the first night by taking dex right before bedtime.
- Since most patients experience side effects for two or three days after using dex, taking an Ativan tablet on nights two and three works for me!
- Try to time activities to correspond with your dexamethasone cycle. I know a patient who loves taking dex because it reduces pain and inflammation in her joints, and the "upper affect" helps keep her active for two days. "I can clean my whole house and have energy left over!" she exclaimed. So take advantage of your side effects whenever possible. Can't sleep? Read that book you hoped to find time for. All wound-up and feeling energetic? Clean the garage or those overstuffed closets. Get the idea?
- Experiment with your dosing schedule. Of course, as is true with all medicines, changes in
dose and schedule should be discussed with your doctor. Maybe my "before
bedtime" tip doesn't work well for you. Doctors don't seem to care how you do
it, as long as you take 40 milligrams of dex weekly. So maybe taking two or
three 4-milligram pills daily works better. Or 20 milligrams on Tuesday and 20 milligrams
on Thursday or Friday.
- Watch what you eat. Taking dexamethasone can raise your blood sugar dramatically. So don't eat a lot of sweets or other high carbohydrate foods the day after you take it.
Hopefully, realizing how important dex is to your lifesaving therapy regimen will help you deal with the unwanted side effects. But if things get out of hand, ask your doctor if you might be able to reduce your dose--or stop using dex altogether. Research shows dex loses its effectiveness over time. So if it has been a year or more since you started taking dex, asking your doctor to drop it may make sense.
Embrace the challenge and try and find ways to co-exist with "demon dex." Your life may depend on it!
Feel good and keep smiling!
Novel therapy agents are a mixed blessing. Yes, they are helping me and a number of my fellow multiple myeloma patients to live longer. And compared to the harsher cytotoxic agents that many patients with other types of cancer are forced to take, the side effects for most of us aren't so bad.
But with more of us using maintenance chemotherapy for longer periods of time, the side effects can become harder to manage. This is especially true for those of us who have had a stem cell transplant. I seem so much more sensitive to most any drug I take now.
Just because a side effect isn't life threatening doesn't mean it can't negatively affect our quality of life. Last week I focused on nausea. This week I would like to share some tips for how to control another common therapy side effect--constipation.
Isn't it funny how the same drug can have such a different effect on different people? For example, I know several patients who get diarrhea from using Revlimid®, Thalomid® or Velcade®.
But in my experience, it is much more common for patients who are using these chemo drugs to experience constipation. Mix in a variety of other medications--especially pain killers like oxycodone--and chronic constipation is almost guaranteed.
Let me share how I overcome my day-to-day constipation challenges.
Regular exercise can help. So can drinking lots of water. Yet as many of you may have already experienced, simply staying active and changing one's diet may not be enough. But it is the beginning to a long-term solution.
I start my day with a vegetable smoothie that includes spinach, tomatoes, carrots, celery, cucumbers, kale and milled flax seed. And I eat two or more vegetables at every meal.
Since I'm on a low carbohydrate diet, eating a lot of sugary fruit isn't practical for me. But blueberries, strawberries, raisins and a few prunes can also help.
But modifying what you eat by adding a wide variety of fiber-rich foods is only a start. I quickly learned that no matter how many vegetables I ate, it sometimes wasn't enough.
I never liked the idea of using a product like Metamucil or over-the-counter stool softeners for an extended period of time. Instead, I use a safe and simple substitute--magnesium.
Magnesium is the number one ingredient in a number of laxatives. It is inexpensive and has the added bonus of helping prevent cramping caused by taking Thalomid or Revlimid.
You can experiment with how many magnesium tablets to take and when. I'm not a physician, but I believe the worst that can happen to you if you take too much magnesium is a case of the "runs."
For me, a 100-mg tablet or two with each meal--along with my high fiber diet--is enough to keep me close to regular.
I already mentioned how I add milled flax seed to my morning smoothie. Flax seed is an amazing food, full of omega 3's and fiber. So is wheat germ. Sprinkling one or both of these concentrated super foods on your cereal is both good for you and can be a "constipation buster."
Over the years I have received a number of suggestions from readers about ways to overcome constipation. I would like to share a few of those with you now. Because what works for me may not work for you:
- Drink a large hot glass of water with lemon slice every morning
- 2 or 3 tablespoons of mineral oil daily
- 2 or 3 tablespoons of coconut oil as needed. They also agreed adding flaxseed can help
- Probiotics help prevent the problem before it occurs. Eating yogurt with natural cultures daily is the most common way to build up the live microbial organisms that should be active and present in everyone's digestive tract. I have been told that Kefir, sauerkraut and Asian foods like kimchee, natto, tempeh and miso can all be incorporated into your diet to help build up the natural digestive process
- Using herbal teas containing rhubarb, aloe, senna or buckthorn
Try to remember that overusing laxatives and/or stool softeners can make the problem worse. This also applies to the herbal teas I mentioned above.
Also remember, multiple myeloma patients tend to take a lot of calcium, which can cause your muscles to contract and make constipation worse. Again, magnesium helps counteract this problem.
All set? Next week, I will suggest ways to deal with side effects caused by "demon dex," or dexamethasone.
Until then, feel good and keep smiling!
I would like to continue our discussion about ways to deal
with treatment-related side effects by focusing on nausea and what I call a
Nausea is a common side effect among multiple myeloma
patients who are undergoing chemotherapy. And almost all stem cell transplant
recipients experience nausea following high -dose chemo and the infusion of
Severe nausea should be treated by a physician. Powerful
drugs like Zofran and Compazine are often used to help. So is my anti-nausea
drug of choice, Ativan.
But once a patient's severe nausea is under control, he or
she is often left with a less intense form of nausea that can linger for
days. Not severe enough to require
prescription meds, chronic nausea can be quite unsettling.
The same can be said for a sour stomach. In between waves of
nausea and an assault by any number of medications, it's no surprise that a
patient's stomach can feel out-of-whack and need attention!
Bear in mind that what follows are suggestions based on my
own experience as well as suggestions from fellow myeloma patients. Remember to
let your oncologist know before trying any herb or supplement. It's best to err
on the side of caution before making any significant changes to your diet or
So what do we do to help get our chronic nausea and/or sour
stomach symptoms under control?
- Let's start with ginger. I can remember my
mother always poured me ginger ale following childhood bouts with the flu. And
you know what they say: mother knows best!
Ginger is inexpensive and safe. It can
be purchased whole, as a powder, in capsules or processed foods like Ginger
Snaps or ginger candy. One of our readers last week recommended drinking hot
ginger tea. Great suggestion, Diane!
- Ginger is also a powerful
anti-inflammatory. I take two grams of
ginger (four 500 mg capsules) daily to help with both.
- Something as simple as sipping hot lemon water
might also be worth a try.
- Sucking on peppermints can also help. I keep a few mints in my pocket just in case
my stomach acts-up.
- If peppermint isn't doing the trick, you might
want to try sucking on a Queasy-Pop. A
regular reader of my blog sent me a package and I love them! Advertised as "the natural way to ease a
queasy stomach," these inexpensive and tasty suckers work for me. You can find a local supplier or order them
online at www.queasypop.com.
- I previously mentioned that calcium supplements
can help settle a sour stomach.
Calcium-based antacids do the trick here. Look for the active ingredient "calcium
carbonate" on the back of the package.
- Several patients I know swear that eating a
banana helps them. Worth a try!
- Simply keeping something in your stomach and "grazing"
throughout the day can help. Well-cooked rice might be a good place to
- If you can keep it down, yogurt works for some,
although I find it to be too high in acid for me, and yogurt can be difficult
Remedies.com describes the herb, Mentha piperita as a "calmative and
analgesic herb which aids digestion, prevents nausea and vomiting and promotes
the flow of bile."
- And I wouldn't be surprised if someone hasn't
suggested marijuana once they hear you are on chemotherapy. I never did try pot
to help with my chronic post-transplant nausea. But lots of patients in states
where medical marijuana is legal swear by it.
- Switching gears, what about acupressure? Some
studies suggest wrist acupressure can help manage nausea caused by
chemotherapy. One pressure point thought to help nausea is on the inside of
your arm, a few inches above the wrist.
Any time you are dealing with chronic nausea or pain,
meditation and guided imagery might also be worth a try. But if you do, might I
suggest enlisting the help of a professional at the start? The same advice
applies to using different herbs and things like acupressure, too. Alternative
therapies can be incredibly effective, if you know how and when to use them.
Can you think of any stomach settling tips I might have
missed? Please don't hesitate to share them.
Next time I will pass along a number of helpful suggestions
for those of you that are battling another common myeloma therapy side effect:
Feel good and keep smiling!
By Jim Omel, MD
All of us with myeloma were thrilled to get a resounding
11-0-1 vote in favor of carfilzomib at the FDA's Oncologic Drugs Advisory
Committee (ODAC) meeting on Wednesday, June 20.
Prior to the meeting, the general mood was neutral at best for carfilzomib's
chances, and many financial analysts even predicted a negative outcome. The FDA had identified significant cardiac,
pulmonary, and liver toxicities with the drug and clearly stated their doubts
about carfilzomib's Risk-Benefit ratio in their briefing document.
When the FDA has strong sentiment for a new drug's approval
they say so. When they have doubts
however, the agency calls in a panel of outside experts for advice. ODAC is a standing FDA committee of 13
oncologists and biostatisticians, very few of which treat myeloma
patients. For every new drug application
with an identified cancer indication, the committee also selects a patient
representative (PR) with that specific cancer to join the committee for that
meeting. The FDA PR program involves
about 125 individuals with a huge spectrum of first-hand disease experience. There are two to three of us with myeloma who
are PRs, and I was the one selected to represent our disease last Wednesday.
The meeting began with a presentation by Onyx
Pharmaceuticals of their phase II trial results for relapsed and refractory
myeloma patients and FDA official's enumeration of their significant
concerns. Committee members then asked
pointed questions of the sponsor (Onyx), the tone of which sounded very
negative. Most of us in the room frankly
had a sense that the drug would not be approved based on the sharp tenor and
tone of the questions. I badly wanted to
comment on the drug's good qualities, but strict committee protocol only
allowed sponsor questions at that point.
Following a scheduled break, nine members of the public were
each allowed three minutes to comment on the value (or not) of the drug. People from the DC area, the MMRF, and the
IMF truly ruled the day and gave new breath to carfilzomib. From the IMF, Michael
and Robin Tuohy and Diane Moran made exceptionally eloquent statements. The
committee of breast cancer, prostate cancer, and childhood cancer experts saw
firsthand that myeloma is NOT a disease of old peopleand other "typicals" they
had been taught in residency. From my
vantage point at the table I watched them INTENTLY listen to all 9
speakers. No one surreptitiously checked
their cell phones, fidgeted with their ties, or yawned as if to say, "I've
heard these meaningless anecdotal testimonials before." They were mesmerized!
The formal meeting schedule finally allowed comments from
panel members. I quickly got the
chairman's eye and indicated my desire to speak. As he jotted my name I prepared my thoughts
and waited my turn. I used Dr. Durie's
words and said that myeloma is "a sneaky disease." When it appears to be stopped, its genetic
expression changes and myeloma cells escape death (apoptosis) by utilizing
metabolic "escape pathways." Myeloma
physicians need multiple drugs (like carfilzomib) to block multiple pathways to
control this cancer. Though carfilzomib
will not cure myeloma, it will buy precious time to stay alive until research
finally gives us a cure. I made other
comments which countered a panelist's earlier assertion that "only the best
patients were pre-selected by this phase II trial by living 5 years." I reminded him that many of us now live 5
years because of treatments developed since 2000. I also pointed out that 85% of myeloma
patients present with "standard risk" genetic profiles and 15% are classified
as "high risk." In the Onyx trial, fully
28% of the patients had high-risk cytogenetics.
Discussion around the table had a decidedly different tone
after the 9 powerful public speakers, and I had great hope for a vote of
approval. Topics centered on the fact
that various toxicities identified by the FDA would be expected in the heavily
pre-treated patients of this trial. When
the time came we all cast our electric votes, and no one had access to anyone
else's vote. At last the tally appeared
on the screen. There it was: 11,0,1.
The one abstention was cast by a biostatistician who explained that he
opposed trial design, not the drug.
A few of us shared broad smiles and later tight hugs. The ODAC is only an advisory body and the FDA
will make its own decision on approval or not.
By law (PDUFA) this decision must come by July 27 of this year. I think the resounding 11-0 vote will heavily
Following the meeting, the FDA's official who organizes the
PR program told me she "nearly cried" when the vote tally flashed on the screen
and she considered the relief which all of us with myeloma felt. Deb is a wonderful government official with
warm humanity and empathy.
Next up is pomalidomide, an immunomodulatory drug (IMiD)
with proven clinical activity in patients NOT responding to Revlimidï¿½
(lenalidomide). It too is at the FDA
right now awaiting approval based on a phase II trial. A decision is not expected until late 2012 or
early 2013. I hope pomalidomide is so
impressive that an ODAC evaluation will not even be necessary. If it is however, bring it on! Either I or another capable myeloma PR will
gladly represent those of us with this horrible insidious cancer again. With the IMF's help we WILL find a cure!