Tuesday, September 15, 2009

Average Life (Read: Death) Expectancy

Yesterday I began the third chemotherapy cycle. I took the Revlimid capsule and the 10 dexamethasone 4 mg tablets. Due to the big steroid hit, I had the usual trouble getting to sleep last night.

Ah, see what I mean about having trouble finding things of interest to blog about? I seem to have settled into a routine that somehow seems almost normal. I do have to make an important strategic decision about whether to return to work full-time now, or to go on long term disability for a time before going back to work, but I'm not yet quite ready to talk about that. So instead of the hard, crispy technical details of most of the previous posts, I guess I'll have to go all foggy and philosophical on all yall for now.

Now that Huong's nursing burden is gradually diminishing, as I do more and more things for myself that she would have had to do for me not so long ago, she has had more time to read up on multiple myeloma. And so recently she asked about this factoid:

Average life expectancy for multiple myeloma patients, from initial diagnosis: 3 -5 years.

Her question: Do I think about dying?

My answer: No I do not. Well, hardly ever. Since I do not currently have a will or a living will or an advance directive, all of which I probably should have, I do feel more urgency than previously about creating them in the relatively short term. But I don't spend much time terrorizing myself with visions of the Grim Reaper suddenly appearing to collect me. Doing that would not advance the primary mission here, which is to get better, to get back to being as normal as possible as quickly as possible. Dwelling on fantasies of the circumstances of my death, what people would say about me at my funeral, and the final disposition of my body, would be a misallocation of psychic energy, a commodity that I must husband and expend as carefully as possible. So I try to avoid indulging in them.

Besides, that 3-5 years figure is a gross arithmetic mean that obscures some important facts about the underlying data.

A large majority of newly-diagnosed multiple myeloma patients are over-65 seniors. It's largely an old folks' disease, and the older the patient, the more challenging is the battle for survival, and the more likely that the battle won't last very long. There are plenty of patients that survive a decade or longer, meaning that there are also plenty that succumb within the first year, in order to arrive at that relatively low average. And the younger the patient, the more likely that patient is to push out to the higher end of the curve. Not that I'm a spring chicken myself, but the chances are good that a patient my age will beat the average, possibly by a substantial margin.

Multiple myeloma is difficult to detect, even if you are testing for it; and of course, since it is a rare form of cancer relative to the much more popular forms, such as lung or breast cancer, no one is routinely tested for it. So it is usually discovered, as in my case, when it has presented itself by causing some sort of obvious damage, usually to the skeleton. At that point, the chances of survival are substantialy dependent on how far it has spread. In many cases, because the cancerous blood plasma cells can pretty much travel anywhere the circulatory and lymphatic systems can take them, the cancer will have spread widely, making it all the more difficult to stop and roll back. In my case, it was apparently caught at a fairly early stage, and does not appear to have spread much beyond the spine and skull. So again this fact increases my chances of beating the average.

So, on the whole, at this point I like my chances of being here five years from now, and maybe a long time after that. I do not yet feel death's cold breath on the back of my neck.

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