Sunday, July 14, 2019

Two Days in Myeloma - A Short Screenplay

                                                                                                                                     FADE IN:

EXT. PARKING KIOSK AT THE ENTRANCE OF A PARKING STRUCTURE
A car pulls up to the kiosk. The window goes down. From the driver’s point of view, an attendant slides open a window on the kiosk and leans out.

ATTENDANT
Good morning. It’ll be five dollars.

DRIVER
Here you go.
Hands over a card.

ATTENDANT
Will you be coming back tomorrow?
DRIVER
Tomorrow no? Friday, yes.
ATTENDANT
Sorry, if you were coming back tomorrow, it’d be 8 dollars for the two days.
DRIVER
Oh well.
ATTENDANT
Receipt?
DRIVER
Sure.

The attendant hands back the card and a receipt.

ATTENDANT
Have a blessed day.

The gate opens and the car pulls into the structure. It’s early enough in the day that his usual parking spot is available. It’s a corner spot on the second level, near the stairs. 

INT. PARKING LOT STAIRWELL
Matt is rushing down the stairs. A couple of years back he couldn’t make it down the stairs at all, too weak and too shaky. He makes a mental note that catching a deep breath on this day is a bit more challenging than usual.

INT. EXAM ROOM
Matt sits and looks at his phone. On the chair next to him is his hat and sweatshirt. He’s already weighed in and had blood pressure taken. There’s a gentle knock on the door. The doctor walks in, holding an open laptop in his hand. He has a serious look on his face.

MATT
Why the glum look doctor?
DR PHAN
Have you seen your lab results yet?
MATT
Um, nope. Usually I do, but not this month.

Dr Phan sits down across from Matt. He places his lap top on a small rolling table. He rolls the table so Matt can see.

DR PHAN
Ok, well look. A couple of things have changed.
MATT
Uh oh. Really?
DR PHAN
Yeah, see you creatinine? It’s gone up. And your m spike has gone up. How are you feeling?
MATT
Well, I’ve been more tired than usual. And the other day on a walk up the hills of Signal Hill, I had difficulty getting deep breaths. Kind of like when I first diagnosed.
DR PHAN
When did you do your IVIG? There’s no literature to support this, but my theory is the  IVIG can impact the efficacy of darzalex.

(IVIG is an infusion of immunoglobulins to help boost a patient’s immune system.) 

MATT
Well, I did only half the IVIG dosage last week, since there is a shortage. Seems like no one wants to donate anymore. But, you know,  I did labs before I did the IVIG.
DR PHAN
Well, we may want to start thinking about changing things up.
MATT
Yeah, I’ve been on darzalex for over two and a half years. Longest I’ve been on any drug.
DR PHAN
That’s a while.
MATT
Definitely I’ve been on cruise control.
DR PHAN
Well let’s do this. Don’t do another IVIG. Do your darzalex this Friday, then we’ll check your labs and see what’s up.
MATT
Fair enough.
DR PHAN
What else is going on?
MATT
I took a ceramics class. Here let me show you.

Matt grabs his phone and searches for photos of his ceramics projects. He hands the phone to Dr Phan.
DR PHAN
Nice. I wish I had time for something creative. What about the guitar?
MATT
It’s on my list.
DR PHAN
All right, well keep me posted. I’ll see you next month.

EXT. MARINE MAMMAL RESCUE - LATER THE SAME DAY

Matt is dressed in large waterproof overalls and knee high boots. He walks out of a pen, carrying an empty container. Inside the pen are sea lions, eating fish. Matt walks in to the break room.

INT. BREAK ROOM
Matt goes to locker and grabs his phone. He walks to a chair and sits and dials.

MATT
Hi, this is Matt, I’m wondering if I can get in to see Dr Berenson this week.
RECEPTIONIST
Sorry he’s busy all week.
MATT
He doesn’t have anything for a quick visit?
RECEPTIONIST
Afraid not. Plus he is leaving early Wednesday and Thursday, so he is jam packed.
MATT
Argh. Ok thanks.

Matt hangs up. He dials another number.

MATT (CONT’D)
Hey.
LESLIE
Hi. What’s up.
MATT
Can you do me a favor?
LESLIE
Sure
MATT
Call Susan at Berenson’s office and see if she can squeeze me in this week. I haven’t see him in a while and I think I should.
LESLIE
Yeah, let me check.
MATT
Plus. If he has anything, also see if we can get in to the kidney doctor the same day.
LESLIE
Will do. I’ll let you know.

EXT. PARKING LOT OUTSIDE MARINE MAMMAL RESCUE - EVENING
Matt is walking to his car. He makes a call as he walks.

MATT
Hello. I’m done.
LESLIE
Cool. Long day.
MATT
Yep, lots of animals here right now.
LESLIE
I talked to Susan and she was able to fit you in at noon tomorrow. And Dr Froch also had an opening tomorrow.
MATT
Perfect, thanks.

INT. EXAM ROOM - THE NEXT DAY
Matt and Leslie sit and wait for Dr Berenson. They can hear him outside the closed door, talking and walking back and forth, giving direction to his nurses and offering positive messages to other patients. Dr Berenson then enters the room, followed by a young scribe with a laptop on rolling table.

BERENSON
Good morning, good morning. How are we doing?
MATT
Pretty good, pretty good.
BERENSON
Hey, I like your shoes.
LESLIE
Ah thanks. Converse.
BERENSON
So what’s going on? Your labs all look good.
MATT
Um, really? Dr Phan thought he saw some changes.
BERENSON
Hmm. I don’t see it. How are you feeling?
MATT
A little more tired lately.
LESLIE
A lot more tired lately. He’s taking daily naps.
MATT
That’s true. And it takes a while to wake up from the naps.
BERENSON
Well, everything looks fine.
MATT
Even my creatinine and m spike?
BERENSON
Yeah, they’re up a bit, but I don’t think it’s anything to worry about.

Dr Berenson turns to the young scribe.

BERENSON (CONT’D)
You should have seen this guy when he first came in. How long ago was it?
MATT
8 years.
BERENSON
He was in horrible shape. We had to really get creative to save his life.
Berenson turns back to Matt and Leslie
BERENSON (CONT’D)
Listen, you’re doing great. Let’s not change a thing.

EXT. TREE LINED STREET - DAY
Matt and Leslie are walking down a steep hill to where the car is parked.

MATT
Well, that’s confusing. Talk about two different messages.
LESLIE
Sure is. I guess you just do your treatment and we’ll see what labs look like next month.
MATT
I guess so. Sheesh, that’s the thing with this fucking disease. It’s such a mind game.

They arrive at Matt’s car. Screen fades to black. A message is displayed: To be continued.
FADE OUT.


Sunday, June 30, 2019

A Horse Race Without A Horse: How Modern Trail Ultramarathoning Was Invented


Back in the day...way back in the day, I did a trail running event called in the Dipsea in Northern California. I even once did the Double Dipsea, a 14 mile trail run. Kicked my butt.  But 100 miles....holy mackeral.




#dipsea #doubledipsea #mttam #wbur

Friday, June 28, 2019

Good News on the Myeloma Front for Newly Diagnosed Patients

From Cure Magazine:

The Food and Drug Administration (FDA) has approved the combination of Darzalex (daratumumab) with Revlimid (lenalidomide) and dexamethasone (DRd) for the treatment of patients with newly diagnosed multiple myeloma who are ineligible for autologous stem cell transplantation.

The approval, which was granted through the agency's Real-Time Oncology Review pilot program, is based on findings from the phase 3 MAIA trial, in which Darzalex regimen led to a 44% reduction in the risk of disease progression or death in transplant-ineligible patients with newly diagnosed multiple myeloma who are transplant ineligible versus Revlimid/dexamethasone alone.

In the open-label, multicenter, phase 3 MAIA trial, 737 newly diagnosed patients with multiple myeloma who were ineligible for high-dose chemotherapy and ASCT aged 45 to 90 years old. Patients were randomized to receive either DRd or Rd alone in 28-day cycles. Treatment was administered in both arms until disease progression or unacceptable toxicity. The median age was 73 (with and age range of 45 to 90), and 52% of patients were male and 92% were white. 

At a median follow-up of 28 months, results also demonstrated that the median progression-free survival for DRd has not yet been reached compared with 31.9 months for patients who received Rd alone. Moreover, DRd led to deeper responses versus Rd alone, including higher rates of a complete response or better at 48% versus 25%. The overall response rate was also higher with the triplet regimen, at 93% versus 81%, respectively.

"Multiple myeloma can become more difficult to treat after relapse, so it is important that patients receive an efficacious upfront therapy with a goal of extending their first remission period," Saad Usmani, M.D., FACP, Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Carolinas HealthCare System, and a lead investigator of the MAIA study, stated in a press release. "This regimen offers an important frontline treatment option for this patient population, and it has been submitted to the NCCN Multiple Myeloma Panel for review and consideration for potential inclusion in the NCCN Clinical Practice Guidelines."

Regarding safety, the most common serious treatment-related side effects for DRd (greater than or equal to 10%) included neutropenia (5%), lymphopenia (15%), pneumonia (14%) and anemia (12%). Infusion-related reactions occurred in 41% of patients, 3% of which were serious. The safety profile of Darzalex was consistent with what has been reported in prior studies.

The most common serious hematologic side effects in the DRd arm were neutropenia (50% vs 35% with Rd), lymphopenia (15% vs 11%), anemia (12% vs 20%) and thrombocytopenia (7% vs 9%).

The most frequently occurring nonhematologic side effects in the DRd arm included pneumonia (14% vs 8% with Rd); fatigue (8% vs 4%); diarrhea (7% vs 4%); deep vein thrombosis, pulmonary embolism or both (6% in each arm); asthenia (4% in each arm); back pain (3% in each arm); constipation (2% vs less than 1%); peripheral edema (2% vs less than 1%); and nausea (1% vs less than 1%).

Sunday, May 26, 2019

Bonus Time

I'll admit it, I'm feeling good right now. I've been on darzalex and pomalyst for about 2 and a half years. I just got my latest lab results and my numbers are as good as they've been since I was diagnosed, and probably better than from before I was diagnosed. It's interesting, you look back on a few things and you wonder how long you had myeloma before it was diagnosed.  Like how I tried to donate blood in 2009 and I was denied and told to go eat a steak because I was anemic back then. Anyhow, I'm getting in good shape, volunteering, taking classes and all is well.

And I'll also admit this, feeling this good makes me a bit nervous. 8 years. Honestly, it's exceeded my expectations.  There's nothing really special about the number 8, but since May 2, I really feel like I'm on bonus time. This is all gravy...provided I keep feeling well and keep checking things off my theoretical list. I haven't yet put together my 30 by 60 list, but it's in progress and I'm working on stuff already.  Plus, no one really knows how long darzalex will work. It doesn't work for everyone, it's a newer drug. And it's not like I'm waiting for it to stop being effective, but I ought to prepared for that eventuality

In April 2011 I went to Las Vegas for a friend's birthday. I was there for perhaps 3 hours and I got so bleeping sick. Fever, chills, uncontrollable shiver. I went to bed at 5 in the afternoon scared out of my mind. The next morning, I had a powerful sensation that I was dying. I flew home that day. The next day I went to a doctor to discuss why I'd been feeling weak and tired and fatigued and sweating at night and so on. He had me do a simple blood test as a normal thing before I'd do a colonoscopy the next day.  He called and said I needed to be in the hospital because I was super anemic. Like how was upright type anemic. I was hospitalized that day for a week or so. A day after my hospital release I was diagnosed with myeloma.  The next day I got a port, full body scan, transfusion and started chemo. And the rest is history.

I think in 2013 I went to Vegas with a friend. But I really wasn't feeling good, so I'm not counting it as a visit.  Tomorrow that friend and I are going back to Vegas and I'm viewing it as my first visit since being diagnosed. I'll definitely stop by the Mirage and have a beer at the bar where I couldn't finish a beer 8 years ago because I felt like crap. I'll walk through the casino where I had the "I'm dying" sensation. Wow, writing this sounds a bit morbid and strange...retracing my steps.  But for me, I suppose it's important. I'm closing lots of loops and this is one of those.  I'm super excited.  And of course I'll get my annual bet in for the Vikings to win the super bowl this coming season.  I've made that bet every year since 1995.  I did a calculation not too long ago, that if I'd invested that annual $100 bet on amazon stock instead, I'd have nearly half a million dollars.  It'd be nice, but come on, I'm locked in to making the bet at this point.  The Vikings winning the  super bowl is also on my theoretical list.  They say don't fret about things you don't have control over and the Vikings winning might be of those things. But I say hogwash....my energy has to translate into some semblance of a positive effect.

And that's it. Really not much to report. Cruise control. The first time I met Dr Phan he said that's the goal.  And here we are.

Friday, May 3, 2019

8 Years and a Day

Let's look back on the past 8 years.


This is two months before I was diagnosed. I was so weak and tired on this ride, that I had to be pushed on my bike.


This amazing group of friends got together for a haircutting show of solidarity.


The cutting begins.


The hair cutting result. It's hard to see but I had a mini mohawk going.


Even Gracie got into the spirit and asked for a mohawk,


I was admonished by a UPS man for abusing Gracie by giving her this cut.


My first port, just under the skin. It makes infusions so much easier.



For my first birthday post diagnosis these three took me out for a lot of eating. Oh and it was also my 50th.


For the first 12 months or so after diagnosis, I slept a lot. A LOT.

 
Being a caregiver is one of the very hardest jobs and Leslie totally nailed it. She's been with m every step of the way and even gave me shots to boost my immune system.


We even got married in 2012 in the midst of the scary times. Love is very powerful.


I can't even imagine how frightening it most be for a parent when their child is diagnosed with a serious illness. My mom is amazing and continues to inspire me.


Team Goldman's first event. The Big Climb in Seattle. It's a fund raiser for the Leukemia & Lymphoma Society. It's a wonderful organization with many patient support programs.


#TeamGoldman


#Team Goldman


Team Goldman's second event. The Boulder Boulder 10k in Colorado.


For the Boulder Boulder, we raised money for the Institute for Myeloma and Bone Cancer Research, who along with Dr Berenson have been instrumental in my success.


I always represent the Vikings at treatment.


I typically get a huge dose of bendryl with my treatments and it leads to some crazy dreams.


I had to stop commuting by bike after my diagnosis. Eventually I was able to ride to work again and Momentum Magazine allowed me to share my story.



Health care is obviously a huge concern for all cancer patients.


At the Relay for Life, an American Cancer Society event.


Victory!!


I have been super fortunate to climb mountains with an amazing group of people, including these fellow survivors.


A couple of years ago, I climbed Mt Kilimanjaro with these fellow survivors and other folks who lives have been impacted by myeloma or are helping to find a cure. We raised money for the Multiple Myeloma Research Foundation.


Packing my pills for a two week trip to Africa took a bit of planning and effort.


And 8 years later, I'm going to continue to fight and make the best of it. As best I can I am going to live life and enjoy life. And of course throw some humor into the mix.

Saturday, April 27, 2019

T minus 122

122 hours till I hit the 8 year mark. I was diagnosed on May 2, 2011 at roughly 10:30 AM. I didn't know until several days later that May 2, 2011 was also the day the U.S. got Bin Laden.  Two days prior I had been released from an 8-day stay in the hospital for severe anemia and near kidney failure. One day earlier, May 1, I actually went to work for a bit. That was weird. What the fuck was I thinking? Well, looking back, I ask myself that a lot. The shock and fear and exhaustion and unknown makes so much a blur.

To this day I thank my lucky stars that Dr Phan just happened to be the oncologist on duty when I was hospitalized in late April 2011.  The myriad of other doctors I saw had no fucking idea what was wrong with me.  An infectious disease doctor spent 30 minutes with me trying to figure out if i had traveled to some foreign land and got too close to an infected farm animal. A trio of doctors from my primary care office came by every day and asked the same questions over and over, day after day.  Dr Phan knew right away, but he wanted a bone marrow biopsy to confirm.  Hence on May 2, we (me, Leslie and my mom) went to his office to get the word.  When I saw the hematologist sign outside his main door, I think it hit me what was up. Sort of.  In the meeting, he said the bone marrow results were due any minute. He sent me upstairs to get a blood draw, where I listened to a tattoo covered fella talking on the phone about how he hated needles but had to give blood. By the time I returned to Dr Phan's office, the results were in. He explained multiple myeloma to the three of us. He explained our plan of attack. I basically stopped listening when he said it was incurable.  Well shit.

May 3, I did a full body/bone scan and had a port inserted. I was hit by a fever and cold sweat while doing the bone survey.  I would have died right there, if I had my druthers.  The same day, I did my first chemo treatment. Whoa! whirlwind.

Dr Phan is still who I turn to when I need to talk or need to understand something about my disease. I love him. I saw him earlier this week and we chatted about sea lions, bikes and Flagstaff. A few days earlier I had returned from a road trip with my nephew and Gracie, to Flagstaff, Santa Fe, Colorado to see my mom who was celebrating her 83rd and hasn't slowed down a bit, Moab, Las Vegas and then home. It was an awesome trip. Really helped put things into perspective. Gracie got to experience snow for the first time and loved it. She's 12 and super healthy, but honestly I saw the snow experience as something on Gracie's bucket list. Dillon who lives in Lake Tahoe has his first petrified forest beer on the trip. I imagine he didn't know this was on his bucket list.

After May 2, the remainder of 2011 was a battle to stay alive. It took 4 different (or is it 5) regimens to find one that worked. Initially I went to City of Hope thinking I'd do a transplant, but they wouldn't take me, given the condition of my kidneys. The was my first education into the health care system and how we aren't always people, that we're numbers. And City of Hope worried that if I didn't survive the transplant given my kidneys might fail, that it would impact their stellar 95% success rate. What also makes Dr Phan great is he doesn't have a huge ego and he recognized that I needed to see a true myeloma specialist. He sent me to Durie and Berenson. Berenson was first and the three of us (Leslie, mom and me) went to see him. I loved his philosophy which was to focus on the individual and get them to where they have a quality of life that is acceptable to that individual. He is also anti-transplant. From Durie, I was convinced to harvest my stem cells, just in case I needed them at some point. 5 million of those suckers sit frozen in the bowels of Cedars Sinai.  Leslie and I were so scared to tell Berenson that we were doing this knowing his feelings about transplants, Durie and anything not Berenson.

I discovered that support groups aren't always the best thing for me. I went to one and left depressed with all the talk about who had died. I also learned that many folks saw Berenson as a  quack. But you can't argue with success.  I can share that in the fall of 2011 when we were still struggling to find anything that worked on me, Berenson blurted out that if we didn't find a successful treatment, I might not make it the end of the year.  I remind him of this, but he denies it. My first kidney doctor also mentioned death to me several times. She sucked and was summarily sent packing. I never did dialysis but she did bully me into getting an AV fistula that made for fun party tricks, with the high powered blood pulsing through my left wrist. She signed me up for dialysis without telling me at 5 AM in the dialysis center in her own office and told me I couldn't go anywhere else. Well, shit, that's not at all true. I declined and never did dialysis. I mentioned the other day my creatinine is 1.99, down from a high over 8 that first year. From statistical kidney failure to now just kidney damage. A renal diet, lots of water, and getting the myeloma under control did the trick.  For me dialysis is a line I won't cross.

For the first six years I kept working. For the first year and a half, it wasn't full time, but I was able to maintain insurance and a full paycheck thanks to the generosity of my co-workers who donated their sick and vacation time to me. That blew me away. However I had to go back to full time well before I was ready thanks to those mother fucking assholes in human resources, who pulled the rug out from under me and changed the rules just like that.  Leslie and I tried are darndest to have meetings and talk to people to plead our case. Leslie, as she has done for 8 years, fought for me and went all out to make things happen and nobody would talk to either of us. It was some real bullshit. At that point I was still in the throes of shock, fear and confusion and basically work pressured me into dropping the issue and returning to full time.  That is absolutely one thing when I look back where I should have fought back harder and sued their asses. Seriously.  But my mind wasn't right to take that step. Now that I'm not working I look back on those six years where I busted my ass to keep all the balls in the air and so much of it makes no sense. Like how did I do it? Work, treatment, sleep. That was it. How was even able to make any decisions?  High up the anger list is how work tried fucked me over. I mean I kicked ass at work. I didn't want cancer to interfere and I became a much better worker. Working allowed me to have some normalcy and to not think about cancer for several hours a day. And most people understood this, the ones that didn't....oh boy. But we move on.

I've come to realize that for the first several years, while I fought and battled and made sure I was as healthy as I could be, I wasn't really enjoying life. My expectations were that I wouldn't get to 8 years and that was fine seeing how life kind of sucked. And I'll be the first to admit that I am super fortunate to be able to not work now. It has totally changed my outlook on life and I'm able to enjoy things much more. I still feel a internal pressure to do shit sooner rather than later. We have no idea how long the darzalex will work. It's been 2 and a half years now and it's the best drug I've been on. But at some point it will likely not work. Myeloma is smart like that. And I now know what survivors guilt is all about. I have a couple of friends who are struggling right now and I feel guilty for doing so well. I try to minimize how good I feel when we talk.

And this leads me to a discussion of how much I have changed in 8 years.  I am much more understanding, empathetic and sympathetic of the challenges everyone faces. Perhaps to a fault.  I've always been big on personal space and HATED hugs, but now I'm a hugger.  I HATED public speaking but now I kind of like it and as an (unexpected) advocate I do a fair amount of it and I think at times I can go on and on and on.  We try to look forward but I struggle with regret and guilt from actions from pre-cancer Matt, and am even bothered by actions from the first six years of cancer Matt. I'm a huge softy for animals. I mean I always liked them, but now, if I was young and had energy and money I'd have a few acres for rescued animals of all kinds. And I do my best to not eat them,  I'm a home body now.  I still like going out for a beer now and again, but I really like quiet time and solitude. I no longer mind when people say they are praying for me. And where I used to get annoyed when people say "god bless you" as a sign off, I now actually return the sentiment. And I'm not even a god believer, but I like the heartfelt kindness when people say it.  I am a bit more spiritual just given some of the dreams I've had over these year that left me thinking I might be dead already and in purgatory, or left me feeling that I was about to die but I'm not ready for it. My step dad Ed who passed in 2005 has played a powerful role in letting me know it wasn't my time yet.  He visits me in my dreams every now and again and reminds me of that fact.  I'm a fledgling cook now. There is something meditative and escapism about it. I have a much firmer grip on who I am and as opposed to those first several years, I now look forward to living a long life and experiencing things to the utmost degree.

Yesterday was my monthly infusion, so today I'm flying on dex, which gives me a combination of rage, irritation, energy and so on. By Monday I'll be an emotional wreck and that lasts for a couple of days. By the middle of the week I'll be back to normal, whatever the hell that is. And Thursday at 10:30 marks 8 years. Who would of thunk. My goal has changed. At first it was to get through 2011. Then it was to make it two years, then five years, then ten years and now, I'm not sure. A lot I suppose.  We'll see.








Two Days in Myeloma - A Short Screenplay

                                                                                                                                     FADE I...