August 2010 Test Results

By now, you're probably getting tired of hearing this litany: good blood chemistries; no bad monoclonal proteins; somewhat depressed blood cell counts. The Christiana oncologist: "I'm happy." Which seems a bit of an understatement, given the increasingly bubbly demeanor he is exhibiting during my monthly visits to his office. "It's not about me," he says when this is pointed out to him; but he's clearly enjoying the absence of drama in my case. "You were really sick -- a couple of times." And now I'm out of the woods -- for now, at least.

At some point recently, I realized that I had been taking omeprazole for what seemed like forever, and couldn't remember why. The oncologist thinks it was originally to protect my tummy from the ravages of the steroid dexamethasone; but I haven't been taking any of that since before the stem cell transplant, and it was included in the list of medications that I brought home from Johns Hopkins in January. In any case, I am now at liberty to drop it; but if doing so causes problems then I can just take it up again. So I have stopped taking it for now, which leaves me with just the prescriptions for Revlimid and allopurinol, and the monthly shot of Aredia.

I continue to try to strengthen myself against the collateral damage done by the cancer last year. I can now cover two miles on the treadmill in less than 35 minutes. I am gradually increasing the weight I will consider trying to lift and carry. My stamina is much improved. I am hovering in the vicinity of my "normal" adult weight. The pain of fractured ribs and vertebrae is slowly diminishing. I consider myself to be on track to return to work sometime in the fall.

Grandpa Shaffer's "Bone Cancer"

I think I have previously mentioned the fact that not much is known about the causes of multiple myeloma, and that most of the usual suspects don't apply to me. I was never exposed (as far as I know) to Agent Orange. I was never employed in the manufacture of herbicides or pesticides. And so on. There is a genetic component, but again, as far as I know, I am the first member of my family to have myeloma. Or am I?

Some senior members of my family are under the impression that my paternal grandfather was killed by "bone cancer". I'm not sure where this notion came from, but it's very suspicious. True bone cancers are exceedingly rare. Most skeletal tumors are caused by cancers that arise elsewhere and then metastasize. But such tumors don't thus magically become "bone cancer"; a skeletal tumor caused by a metastasized breast cancer, for example, is still considered to be a breast cancer tumor.

The situation is even more misleading where multiple myeloma is concerned. Otherwise reliable medical web sites -- even a few sites dedicated solely to multiple myeloma -- sometimes mischaracterize myeloma as a bone cancer, or as a cancer of the bone marrow. But really it is neither. Yes, plasma cells originate in, and are mainly found in, the bone marrow, but they are also transported throughout the body by the lymphatic system. They are considered to be blood cells, not bone marrow cells. Cancers of the leukocytes that are actually considered to be constituents of the bone marrow, and which thus could be considered bone marrow cancers, are called leukemias. But in multiple myeloma, it is the plasma cells that are cancerous -- not the stem cells, and not the leukocytes that eventually become plasma cells. The fact remains that, when multiple myeloma causes tumors, they usually occur in the bones, thus possibly leading the underinformed observer to conclude that the patient has "bone cancer".

So: Did Grandpa Shaffer really have bone cancer? Or was it really some other type of cancer -- was it, say, multiple myeloma? The answer would, or should, be of more than just casual interest to the other members of my family, given the genetic aspect of myeloma.

So recently I undertook to obtain his death certificate from the Division of Vital Records of the Department of Health of the Commonwealth of Pennsylvania. For a fee, it is possible to obtain a copy of such a document; it can be ordered online. But not just anyone can get a copy of just anyone's death certificate. You must fall into one of the categories of individuals having a particular relationship with the deceased; in my case, "direct descendant". And you must have an approved reason for wanting the document; again, in my case, "medical history" was sufficient (but as an aside, mere genealogy isn't a good enough reason -- I have no idea why not).

My copy of the death certificate arrived in the mail a couple of days ago. Ultimate cause of death: "Metastatic Lung Carcinoma". I'm a little disappointed by this, as it sheds no additional light on my own case. But I'm certainly not surprised.