Mayo Clinic Annual Checkup - The Rest of The Story

I think I have discovered air travel from here to Minnesota is much less prone to weather delays the end of June than the end of May, beginning of June. We experienced more delays and difficulties in the airport this time than we ever have both flying up to Mayo and coming back. In addition, unbeknownst to me, my absolute neutrophil count (ANC) was very low, probably around 500. Below 500 is dangerous and classified as severely neutropenic (which I was) http://en.wikipedia.org/wiki/Neutropenia . As a result, I contracted some bug (virus / bacteria no one knows). We flew Friday. I started getting sinus drainage Saturday afternoon. Sunday I had bronchitis. It only took 24 hours for whatever it was to move from my sinuses to my chest which is unusually fast. I was tempted to go to the emergency room Sunday but didn't. I started running a low grade fever Saturday and Sunday. Of course, the reason for my sever neutropenia was the cancer drugs I had been taking for the previous eleven months which had reduced my white blood cell count to a dangerously low level. But I didn't realize that was going on.

I went to see my doctor Monday with bad cough and fever of 101. She sent me down to get a chest x-ray. While I was standing in line at the receiving desk, I began to shiver uncontrollably. That continued until I got back up to my doctor's office. When she walked in, my fever was 102 and she told me I wasn't going anywhere except to the hospital.

I was put in a wheel chair and whisked off to Methodist hospital to be admitted for bacterial bronchitis. I don't think they ever did figure out what bug I had. They pumped me full of vancomyecin and cefepime (huge amounts 1.5 gm vancomyecin IV and 1 gm cefepeme IV every six hours). As you may know, these are the most powerful antibiotics available. If they won't kill what is bugging you, what is bugging you will kill you. It took two days for me to get much better. They let me out of the hospital Wednesday afternoon. Thursday I was back in my doctor's office. She told me my ANC was back up to where it should be and that I appeared to be ready to go home.

So, three days after we were supposed to leave and fly back home, we were on our way. Little did we know, we would spend all day at the airport in Minneapolis waiting for a plane which would depart eight hours late and get us in Atlanta around 10:30 PM in time to get a hotel voucher and ride a shuttle over to the hotel. Saturday, we went to the airport, ate breakfast, and waited for the 12 o'clock flight. We finally got home Saturday afternoon. What began as a short five day (two weekend days so really only three business days) in and out turned into a week long ordeal which I am still recovering from almost a month later.

After we got back home, I went back to work Monday. The cough in my chest began to return and by Friday, I was in my doctor's office. He did a chest x-ray and CBC. I neither had pneumonia nor neutropenia. But I did have this horrendous, annoying, persistent cough. He gave me an antibiotic injection and put me on a different antibiotic than the one I was taking from Mayo Clinic which didn't appear to be doing anything for me. I slowly began to get better but the cough continued. I went back to the doctor Monday much worse. I was given a nebulizer, some different cough medicine, and more pills. Friday I went back for a followup visit and was much improved. I guess the antibiotics and nebulizer kicked in. I returned the following Thursday for another follow up. I got another chest x-ray and CBC. Everything looked good except still had somewhat of a cough. I got an injection of 8 mg decadron (AKA dexamethazone) to dry me up (which did the trick and kept me up until 2 am), a new inhaler, and more cough syrup.

I am proud to say that after almost a month of suffering with persistent annoying cough, low energy, and low grade fever, I am beginning to feel like my old self again (and I am getting pretty old these days :)

Thanks for stopping by.

Blocking a Single Protein Proves Toxic to Myeloma Cells

National Cancer Institute (NCI)

Embargoed for Release Sunday, June 22, 2008 1:00 p.m. EDT

Contact:NCI Office of Media Relations 301-496-6641


Blocking a Single Protein Proves Toxic to Myeloma Cells in Laboratory Studies

Researchers have found that cells from a blood-borne cancer called multiple myeloma rely on the activity of a single protein, called IRF4, for the activation of a wide range of genes responsible for cell survival and spread. Blocking the production of this protein can be strikingly effective in eliminating cancer cells in laboratory models of multiple myeloma. Scientists at the National Cancer Institute (NCI), part of the National Institutes of Health (NIH), published their results in the June 22, 2008, issue of Nature, which highlight this potentially powerful new therapeutic target in multiple myeloma.

"These findings reveal a hitherto unknown and, for myeloma cells, critical network of gene activity centered on this one protein," said Louis M. Staudt, M.D., Ph.D., deputy chief of the Metabolism Branch at NCI’s Center for Cancer Research. "What we have now is a new window of opportunity for therapeutic development in multiple myeloma."

Multiple myeloma arises from blood plasma cells, antibody-producing cells that develop from the immune system’s B cells. There is no cure for multiple myeloma, though the disease can sometimes be controlled with chemotherapy, stem cell transplantation, or newer treatments.

To expand the therapeutic options for multiple myeloma patients, Staudt, Arthur Schaffer III, Ph.D., NCI, and collaborators employed a system for identifying potential drug targets that was recently developed in their laboratory on the basis of a phenomenon called RNA interference (RNAi). This system employs small snippets of RNA, called short hairpin RNAs, to effectively turn genes off one at a time, and allows researchers to measure the subsequent effects on cells’ survival and proliferation.

The researchers applied this system to 10 laboratory models of multiple myeloma, each representing distinct genetic subtypes of the cancer. In all of these models, the scientists found that quenching IRF4 production caused the myeloma cells to die.

IRF4 is a transcription factor — a protein that helps to activate other genes. The Staudt team noted that the list of genes that interact with IRF4 in multiple myeloma cells included genes that are normally activated, not in plasma cells but in mature, activated B cells. This finding suggests that myeloma cells are somehow able to redirect IRF4 to activate a genetic program that it would not normally affect in plasma cells.

One gene in particular that stood out from the rest of the list was an oncogene called MYC, known to play a significant role in multiple myeloma and other cancers. Further investigations revealed that IRF4 and MYC form a feedback loop: IRF4 activates MYC, and MYC, in turn, activates IRF4 and — by extension — itself and the myeloma-fueling gene networks that rely on IRF4.

The discovery that multiple myeloma cells are dependent on IRF4 for survival puts a new twist on a hypothesis known as oncogene addiction. This hypothesis suggests that certain cancers rely on the activity of a single mutated gene pathway for proliferation and survival. If this Achilles' heel can be identified and shut down therapeutically, the hypothesis contends, the cancer can be eliminated.

However, the case of multiple myeloma and IRF4 differs slightly. Although the gene for IRF4 is not mutated in multiple myeloma, myeloma cells are addicted to the protein’s ability to activate normally inactive genetic programs inappropriately. Therefore the dependency of myeloma on IRF4 may be best described as non-oncogene addiction, which is the dysfunction of a normal protein that is required for cancer cell survival or spread.

For more information on Dr. Staudt’s laboratory, please go to http://ccr.cancer.gov/staff/staff.asp?profileid=5780or http://lymphochip.nih.gov/index2.html.
For more information about cancer, please visit the NCI website at http://www.cancer.gov/, or call NCI’s Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov/.

Reference:Shaffer AL, Emre TNC, Lamy L, Ngo VN, Wenming X, Wright G, Powell J, Dave S, Yu X, Zhao H, Zeng Y, Chen B, Epstein J, and Staudt LM. IRF4 addiction in multiple myeloma. Nature. Online June 22, 2008.

2008 Mayo Clinic Trip

There is something about the word "Rochester" that demands a "D" from the mouth. There is no "D" in Rochester. But there it is. A good percentage of the time, Rodchester. Be it Minnesota or New York.

A lot of things in life are that way, we give it what it needs. And that is what we did a week ago Friday. We checked in at the appointed hour, around 5:30. We loaded the plane. Plane backs out and begins to taxi. Plane comes to a screeching halt. Pilot announces we will sit on the tarmac for an hour due to fog in Atlanta. Sure enough, when we arrived at Atlanta over an hour late, there was a lot of fog. Of course, our layover in Atlanta was about one hour and fifteen minutes so chances of us catching our flight to MSP was about slim and none. Also, arriving at the end of gate D and having to ride the train to gate B didn't help either.

When we got to B17, everyone was gone. We asked the agents about the flight but they said the door was closed and the plane was loaded, and it was. As it turns out, they gave our seats to someone else so even if the door was opened, we were out of luck. They issued us new tickets with confirmed seating for the next flight out.

It wouldn't have been such a big deal except I was trying to make a 2 PM appointment for blood draw, followed by x-ray skeletal bone survey. Arriving at 11:30 to catch the 12:30 shuttle van to Rochester was critical and I was waving bye-bye to my flight while standing in the terminal in the Atlanta airport.

The next flight out got us to MSP about 2. There was one seat on the shuttle so I took it and my wife took the next shuttle. I made it to Mayo in time to have the blood draw followed by the bone servey x-rays thanks to some last minute rescheduling.

If I had known what lay ahead waiting in the plane on the tarmac in Columbus, I would have demanded to get off the plane. That is the beauty of hind sight. Read following posts to learn more of our ordeal which motivated us to search for a myeloma expert closer to home.

Mayo Clinic Annual Checkup

My M-spike (and thus my disease) continues to be low and stable which is good. However, the cancer drug I am taking has my neutrophil level so low, I am neutropenic which means if I ride in a jet with no mask, I will get sick - no two ways about it. Therefore, we are going to reduce the dosage from 25 to 15 mg and hope to see the neutrophil count to increase and the M-spike level to stay the same.

http://www.mayoclinic.com/health/neutropenia/HQ01112

Stand Up to Cancer

Please visit this web site:

http://www.standup2cancer.org/

It has been said, "There will not be a cure for cancer because there is no money in it. After all, look what happened to Polio. They will find a way to allow us to live with cancer. As long as you pay, you live." - paraphrase of an excerpt from a Chris Rock comedy show.

I have thought this for a long time and was amazed to see someone say it on TV - even more amazed to see Chris Rock say it. I am sure there are a lot of us who have arrived at this conclusion. However, if you want to get a bit of a different spin on cure-for-cancerism, please visit the above web site. Standup2cancer is being cosponsored by the Multiple Myeloma Research Foundation. Read the excerpt from the MMRF SmartBrief newsletter as follows...

"The MMRF is proud to partner with the three major television networks, the American Association of Cancer Research, and many others representing cancer advocacy, the entertainment and sports industries, and corporate organizations on this new initiative to raise philanthropic dollars for accelerating ground-breaking research. Get more information here."

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I have long realized that if we found a universal cure for cancer tomorrow that was "affordable" to all, the medical "industry" would be immediately devastated. As I am sure you are aware, there are a huge number of extremely high paying jobs associated with cancer.

Being the somewhat astute economics student, I have concluded there is no reason there can't be some money in a cure for cancer. The treatment and its administration could be so expensive that it would more than make up for any losses due to displacements caused by the cure.

Therefore, it is conceivable curing polio was just a lesson to us. It is conceivable there will be a cure for cancer, it just won't be "affordable."