Week 9 to Week 16 - Account of Chemotherapy given for Multiple Myeloma

Week 9

10th October, 2012

Ninth Velcade injection Dose (2mg) administered through the Vein on Mummy’s hand using a 5ml syringe and a Scalp Vein Set followed by Dexamethasone 20mg tablets on 10^th and 11^th October 2012, respectively.

Deeply troubled by all the stomach related problems Mummy was facing in those days and weeks, on 10^th October 2012, we again visited GI-3 at Hospital No.4 to discuss mom’s issues and he advised her to take Ganoton or Cintapro when faced with acidity/gas problem.

Week 10

17th October, 2012

Tenth Velcade injection Dose (2mg) administered through the Vein on Mummy’s hand using a 5ml syringe and a Scalp Vein Set followed by Dexamethasone 20mg tablets on 17^th and 18^th October 2012, respectively.

Stomach/Abdominal pain related issues continued to trouble Mom.

Week 11

24th October, 2012

Eleventh Velcade injection Dose (2mg) administered through the Vein on Mummy’s hand using a 5ml syringe and a Scalp Vein Set followed by Dexamethasone 20mg tablets on 24^th and 25^th October 2012, respectively.

This time around, post the medication, Mummy complained of severe Pain in lower right back and right hips. We got an MRI Screening of Mummy’s Spine and X-Rays of the Back done on the advice of Orthopedic Doctor O-1 at Hospital No. 4. All reports categorically and thankfully stated that, “no obvious pathology detected”, and on 25 October 2012, O-1, prescribed my mom to take a 7-day course of Ultracet tablet, twice daily course. This course of medication helped and mummy’s pain in the backs and hips, subsided.

Week 12

1st November, 2012

Twelfth Velcade injection Dose (2mg) administered through the Vein on Mummy’s hand using a 5ml syringe and a Scalp Vein Set followed by Dexamethasone 20mg tablets on 1^st and 2^nd November 2012, respectively.

Week 13

8th November, 2012

Thirteenth Velcade injection Dose (2mg) administered through the Vein on Mummy’s hand using a 5ml syringe and a Scalp Vein Set followed by Dexamethasone 20mg tablets on 8^th and 9^th November 2012, respectively.

Abdominal pain continued to bother Mom as it has done every week since this Velcade-Dexamethasone treatment began. Week 12 and Week 13 were no different.

Week 14

15th November, 2012

Fourteenth Velcade injection Dose (2mg) administered through the Vein on Mummy’s hand using a 5ml syringe and a Scalp Vein Set followed by Dexamethasone 20mg tablets on 15^th and 16^th November 2012, respectively.

Mummy contracted Severe Gastrointestinal Infection (GI) on 21^st November 2012, she spent that night vomiting and passing loose stools. I relied on two tablets, named Imodium and Domstal that were written about in the Discharge Summary of Hospital No. 3 where she was admitted in July 2012 to provide her immediate relief on the middle of that night. On 22^nd November 2012, I took Mom to Hospital No. 4 to get her examined by GI-3, whom we trusted. GI-3 put Mom on a 5-day antibiotic course containing the following medicines, I read about all of them on the internet as I was by now, habituated into doing:

o   ORNI-O: BD i.e. Twice daily

o   VSL3: OD i.e. Once daily

o   Colimax: BD i.e. Twice daily

o   Rablet D: BD i.e. Twice daily

o   Imodium: SOS i.e. as required during emergency

Week 15

26th November, 2012

We delayed the 15^th Dose of 2mg Velcade by 3 days till Mummy’s gastrointestinal infection post the 14^th dose intake had subsided and she was comfortable enough.

Fifteenth Velcade injection Dose (2mg) administered through the Vein on Mummy’s hand using a 5ml syringe and a Scalp Vein Set followed by Dexamethasone 20mg tablets on 26^th and 27^th November 2012, respectively.

The 5-day Antibiotic course for Severe GI Infection was repeated by us in the week post 15th dose on GI-3’s advice

To combat her throat infection, she was also put on a twice daily course of Allegra 120mg tablets for 3 days, on the advice of H-2

Week 16

3rd December 2012

Sixteenth and the final Velcade injection Dose (2mg) administered through the Vein on Mummy’s hand using a 5ml syringe and a Scalp Vein Set followed by Dexamethasone 20mg tablets on 3^rd and 4^th December 2012, respectively. Mom and me breathed a sigh of relief and went to the Cafeteria downstairs for our Tea and snacks, it was a customary practice for us both after our weekly ordeal at H-2’s private OPD Clinic at Hospital No. 3; that evening was special for us both, we thought and celebrated as if our bad and tough days were now behind us.

H-2 had asked us to get Mom’s Free Light Chain Assay and Beta2 Microglobulin Tests done again and we did give the samples the next day for testing.

Week 4 to Week 8 - Account of Chemotherapy given for Multiple Myeloma

Week 5

12th September 2012

Fifth Velcade injection (Dose 2mg) administered through the Vein on Mummy’s hand using a 5ml syringe and a Scalp Vein Set followed by Dexamethasone 20mg tablets on 12^th and 13^th September 2012, respectively.

While there was no blood in stools reported that week by Mummy, she continued to experience abdominal pain and we continued with the Norflox and Colimax course from 14^th September till 18^th September 2012 for relief.

Week 6

19th September 2012

Sixth Velcade injection (Dose 2mg) administered through the Vein on Mummy’s hand using a 5ml syringe and a Scalp Vein Set followed by Dexamethasone 20mg tablets on 19^th and 20^th September 2012, respectively.

Again, like last week, while there was no blood in stools reported that week by Mummy, she continued to experience abdominal pain and we continued with the Norflox and Colimax course from 21^st September till 25^th September 2012 for relief.

When we were seated outside the H-2’s clinic that day, I also learnt another startling fact that made me understand how Doctor’s gauge the financial capabilities of patients and their caretakers so soon. I learnt through my interaction with another patients’ caretaker that though H-2 had recommended that we buy Injection Velcade (the imported variant containing the drug named Bortezomib) that was costing us Rs.25000 per 2.5 mg dose, there was also Indian pharma companies making generic variants of Bortezomib with which were approximately /6^th the price of Velcade; the ones who could not afford the original variant opt for these ones.

Also by now, Mummy’s veins in her left hand were rupturing and it was getting difficult to insert the scalp vein set, H-2 suggested we opt for a 23 Number Gauge Scalp Vein set made by a Malaysian Company named ‘TOP’, we searched everywhere for it and then finally my brother found it at a Government Hospital Pharmacy and purchased enough from there to last us for the remaining leg of the treatment.

Week 7

26th September 2012

Seventh Velcade injection Dose (2mg) administered through the Vein on Mummy’s hand using a 5ml syringe and a Scalp Vein Set followed by Dexamethasone 20mg tablets on 26^th and 27^th September 2012, respectively.

No bleeding was experienced by Mom in her stools since she was using Mesacol suppository over the past 3 weeks. This medication seemed to have successfully healed the solitary rectal ulcer detected in Sigmoidoscopy done on 27^th July 2012 at Hospital No.3. I concluded that my Mummy never had Rectal TB and the Rectal bleeding she was having was never because of Rectal TB either, she just had a stress-induced Rectal ulcer, which burst at the thought of being admitted in the hospital on that fateful afternoon of 26^th July 2012 in the Washroom of the OPD Waiting Lounge at Hospital No. 3

However, her abdominal pain continued; I think I had identified my own reasons behind these abdominal pains after a lot of reading on this subject; the reason being that Chemotherapy drugs besides targeting the cancerous cells in our body, also target a lot of healthy cells in the body and stomach lining being made up of very sensitive cells is the one that gets affected the most and the quickest post chemotherapy.

Week 8

3rd October 2012

Eighth Velcade injection Dose (2mg) administered through the Vein on Mummy’s hand using a 5ml syringe and a Scalp Vein Set followed by Dexamethasone 20mg tablets on 3^rd and 4^th October 2012, respectively.

During the course of this week, upon the advice of H-2, we gave mummy’s samples for Serum Protein Immunofixation Electrophoresis (SIFE) Tests and Free Light Chain Immuno Assay Tests to be performed.  H-2 told us that these Tests were usually performed mid-way through the treatment to check on the progress/efficacy of treatment being administered to the patient. SIFE Reports showed ‘NO M-Spike’, which implied the treatment was progressing well.

H-2 also wanted Mom to be put on a medication called Zometa (with chemical named Zoledronic Acid) that inhibits the release of Calcium from Bones; he told me it will help Mummy. I went home and read all about it on the internet, the side effects of this medication were far too many including warnings regarding this medicine not to be given to anyone with kidney related issues and with my mother already having Chronic Kidney Disease due to her prolonged NSAID intake as described earlier and too many other problems already, I strongly opted against it and told H-2 that we are not keen to start on it. Again, H-2 did not quite like me saying this because normally patients or their caretakers here in our country just go by the Doctor’s choice of medication and do not oppose or counter-question their choice, but I was. It didn’t bother me, for it was all about the well-being of my mother and the responsibility was squarely on my shoulders.

What next?...Serum Protein Electrophoresis and Serum Immunofixation Electrophoresis

Moving on…once the cause of Chronic Kidney Disease or CKD as the Doctors write it in the prescription sheet was identified by the Lady Nephrologist i.e. N-3 at Hospital No. 3, she advised my mother to go for a Diagnostic test called “Serum Protein Electrophoresis or SPEP” to test for the presence of M Protein or M-Spike in her Urine. 

She told my mother and my brother that it is the results of the SPEP Tests that will determine the future course of treatments. She got two SPEP Tests done, one on 18^th July 2012 which showed an M-Spike and then to eliminate any false positive, on the 21^st July 2012, the Doctor ordered that the SPEP be performed again along with another Test termed “SIFE” i.e. Serum Protein Immunofixation Electrophoresis.

To read more about SPEP and SIFE, please read through this link on tests to find out Multiple Myeloma, which is also added in our BlogRoll. 

On 26^th July 2012, the day I was due to return from my European travels, my brother picked me up from the Airport that afternoon and we went straight to Hospital No. 3, collected the reports and went and met N-3 to collect all reports and understand the steps forward that we both could undertake to help heal our mother.

SPEP report for Mom's samples collected on 18th July 2012

SPEP report for Mom's samples collected on 21st July 2012

Mom’s SIFE report for samples collected on 21st July 2012 

After seeing the findings of the above three reports, N-3 told me and my brother that, “the problem in your mother’s kidneys are due to some other disease, a blood-related disorder and to diagnose the same, you need to get her admitted as soon as possible, may be today itself so that our Hematologist-on-board can perform a Bone-marrow Biopsy on her”.

I and my brother decided on the way to our home that I will convince mom to get admitted later that evening. I reached home, after almost two months, to find my mother having lost oodles of weight because she was on that starving no salt, no sugar, and no protein diet she was put on by the Nephrology Team at Hospital No. 2.

Shocked at seeing her looking so weak, I hugged her tight and then saw the lunch she had lovingly prepared for me with all my favourite dishes, hand-cooked by her. With the N-3’s words ringing my mind, I was feeling so choked that it was difficult to swallow even a bite. My mom does not like it if we don’t eat our meals well, she didn’t like the way I was eating tiny portions that afternoon either, after all I was back home after about two months and she had prepared a love filled meal for me that day. I tried to tell her what the Doctor told us and convinced her to please listen to me and my brother and pack her bag for getting admitted at Hospital No.3. Very reluctantly, she agreed. I also packed a mini bag, picked up all her reports and then drove her to Hospital No. 3.