Dad's Treatment plan

Everyone agrees- the best plan is to start treatment and to start is as soon as possible. Dad's treatment will consist of 3 drugs- dexamethasone (a steroid), velcade and revlimid. These drugs work well on their own at treating cancer, but work even better with each other at really killing off the cancer cells. The dexamethasone, or dex as I will refer to it is a pill or liquid solution he takes once a day. The velcade is given by IV injection and the revlimid is also a pill he can take.

The problem is that the revlimid can cause his body to form clots. Well as all of you know, Dad had a heart attack in May and has stents in place holding the coronary arteries open. Dad also needs to have the other artery fixed. Clots are not a good thing for anyone, but for Dad especially since it can cause him to have a massive heart attack. Originally, before the cancer, Dad was going to have bypass in October, a new type of bypass done fiberoptically through a small 2 inch incision. Dad's oncologist did not want to wait until after that to start treatment. And so it was decided they would place another stent in dad's other artery as a temporary fix so that he could start. Dr. Lyons, the myeloma specialist disagreed with this because of the chance of clot formation with the revlimid. Since the stent was a temporary fix, he suggested proceeding with the bypass after an initial round of chemo. The initial round would help get his body in tip top shape to best recover from the bypass, and also help protect his kidneys in the process.


****************THE PLAN*************
Dad will take the dex and one of the chemo drugs, the velcade for one cycle. After this cycle they will let him recover for ~ 2 weeks, recheck his blood work and then have the bypass. If everything goes according to plan, this would put his bypass at the end of September, beginning of October. After he recovers from the bypass, they will start the 3 drug cycle. He will have treatment for a few months, then harvest his bone marrow for transplant to be done several months later.

The schedule for this first cycle is over 12 days. The first day of chemo is day 1. His schedule will be Tues/Friday for the next two weeks starting on 8/26. Every Tuesday/Friday he will go to the Dr. Kahzdan's office, or boutique as we call it, have lab work done, get IV fluids and have the velcade. During the this time, he is also taking dex. He takes dex on days 1-4 and again on days 9-12. They don't anticipate that he will have any nausea with the velcade, but just in case, he gets nausea medication before they give him the velcade. He also has nausea medication he can take at home to help him feeling well.

The sticky part of the dex is that it makes your blood sugar high. The dose Dad gets is fairly high- which means his blood sugar will be very high. In order to help regulate this, Dr. Kazhdan had Dad meet with a metabolic specialist to talk with him about diabetes and insulin. While Dad is on the dex he will have to take insulin as well. This means he has to check his blood sugar, and take the insulin with the steroid dose and before each meal.

What else? Well the velcade and revlimid are medications that act like other chemo drugs- meaning they target areas of rapid cell growth. This happens in the bone marrow, stomach and intestines and on your skin and hair. Unfortunately the drugs haven't been designed smart enough yet to recognize which cells are normal cells and which are cancer cells. This is why people with chemo get nausea, lose their hair and are very susceptible to infection and anemia. With the medications Dad is getting, they don't think he will have a problem with his skin or hair loss. He might have some nausea, but usually the steroids help prevent that. He will be at risk for infection. Handwashing is the key and he needs to avoid anyone that is sick. As a precaution, Dr. Kahzdan has put him on an antiviral drug and an antibiotic to help prevent any illness. Still, we are being very cautious. So while he is undergoing treatment, he is going to avoid large crowds and anyone sick.