Follow Up With Dr Phan

Earlier this week, I was tired. Super tired. Typically 3-4 days after chemo, I am tired. I've come to expect it. But the tiredness this week was much more intense. I even left work early to come home and sleep. That hadn't happened in over a year.

I thought I might be overly low on blood. And naturally, with this tiredness comes a worry about the myeloma. But we did lab work and my counts weren't too bad. And now it's Friday and I feel great. Worked out this morning, getting in shape. The tiredness has passed.

Nonetheless, I wanted to follow up with Dr Phan. I just came home from that follow up, and he reminded me why he such a great doctor and why I am so lucky to have him.  He explains stuff and he explains stuff in a way that non medical people can understand. Berenson is a great doctor, but he's not real chatty. So we rely on Phan to answer our questions.

Phan's take on my tiredness is that the non stop steroids are taking a toll on my body's natural adrenal system and is not at all an indication of anything the cancer is doing.  Typically, the brain sends a signal to the adrenal gland to produce a natural steroid that gives us energy.  But what might be happening to me is that my adrenal gland is in sleep mode. Because of the steroids I take the brain rarely needs to send a signal to my adrenal gland. But when I come off my steroid high, the brain does send a signal, but the gland is snoozing and doesn't respond.  Hence fatigue. 

Steroids are a hugely important aspect of my chemo treatment, so I'm not going to get rid of them.  My routine is such that I get a massive dose during chemo.  In every other non chemo day, I take a different steroid via pill at home. But there's a 48 hour gap between the infusion steroid and the home steroid. Phan's suggestion is to make it a 24 hour gap between the infusion and the home steroids.  My routine was developed by Berenson, so we'll bounce this off of him.

Things are good though.