The blood test numbers continue to edge up -- monoclonal proteins are now 0.4 g/dL, vs. 0.3 last month; and kappa free light chains are 23.1 mg/L, up from 21.3. Lamba free light chains also increased, though, so the ratio actually declined to 1.24, from 1.46. Nevertheless, this "progression" -- the oncologist allowed himself to utter the word this time -- is "real", not some noise in the testing process.
We agreed that, since in a couple of weeks I will be leaving the country for several weeks, now would be a bad time to make any changes to the medication regime. Given the seemingly glacial rate of progression, the risk that the disease will suddenly get out of control in that time is comparatively lower than the risks potentially arising from a change in medication. Also, there remains the psychological barrier: "Once you go from 'maintenance' to 'treatment', there is no turning back."
And having said that, with one engine on fire and the other one losing oil pressure, the oncologist strapped on his parachute and lept out of the open hatch. Shortly after my last visit with him, I received a letter from his group announcing his retirement, effective August 1. So my next appointment will be with a physician I have never met.