I'm not so boring after all...

You'll recall that Dr. Kaplan declared me "boring" after my last checkup six months ago.  This declaration was based on his determination that there had been little progression in my CLL/SLL since my treatments concluded in early March 2013. Methinks his declaration may have been premature...

Since my last visit with good Dr. K, I've continued to experience frequent joint and soft tissue swelling and pain.  It was his belief that these symptoms were unrelated to my Cancer, so I followed up with my Rheumatologist, Dr. Chaganti.  After multiple tests and much poking and prodding, including extraction of synovial fluid from a thumb joint (you haven't lived until you had that experience), Dr. C arrived at a likely diagnosis of Systemic Lupus Erythematosus (SLE).  Aside from the fact that only 10% of SLE patients are male, my uniqueness is further emphasized by having concurrent CLL/SLL and SLE, a rare combination.  Who says I'm boring?!

Dr. C initially treated me with Prednisone with little affect.  She finally relented and gained Dr. K's agreement to place me on a weekly course of Methotrexate with a daily chaser of Folic Acid.  Nearly 18 years ago I was prescribed the same drug combination upon my initial autoimmune disorder diagnosis.  Back then the combination proved effective, but I'm now much older with more severe symptoms and have a serious co-morbidity in the form of CLL/SLL.  I'll take my first dose of Methotrexate this evening and will have to wait several weeks to determine if the treatment is effective; time will tell.  Being a highly toxic chemotherapy drug, I could experience a bit of discomfort following each dose until my body adjusts.  Again, time will tell, though previously I had few ill affects.  The one "major" drawback is that I am strongly discouraged from imbibing my favorite cocktail,  Martini, or any other form of alcohol while on the drug due to the significant risk of liver damage.   What we won't do to attempt to receive relief from pain!

At today's visit with Dr. K he continued to be perplexed by my continued symptoms. He indicated that after he spoke with Dr. C, he had considered a second round of treatment for my CLL/SLL as he was beginning to believe that my symptoms could be related to the Cancer.  However, he agreed to wait to see if the Methotrexate relieved my symptoms.

It is apparent to me that my CLL/SLL is again progressing.  My visible nodes on my face and neck appear more prominent.  Dr. K appears to agree as he has ordered another CT/PET Scan to be performed in the next couple of weeks to determine if my internal nodes scattered throughout my body have increased in size.  When I return to see the doctor in a month, he will determine if it is again "time to treat".  Stay tuned...

At the conclusion of my visit with Dr. K today  we discussed the nature of my next treatment when the time does arrive.  Though I had hoped that I could be prescribed the newly approved drug "Imbruvica", Dr. K indicated that my insurance would likely decline covering the drug until I had at least one course of chemotherapy,  this being due to the exorbitant cost of Imbruvica; $130,000/year indefinitely, until it becomes ineffective.  It's his recommendation that my next treatment be a combination therapy consisting of the chemotherapy drug "Bendamustine" combined with my prior treatment drug, "Rituxan".  This combination therapy has proven effective in allowing patients to achieve multi-year remissions.

Well,  I'll end now so I can enjoy one last Martini before my first weekly dose of Methotrexate in a few hours.  Until next time,  cheers!