Imbruvica & Opdivo COMBO

 Bristol-Myers Squibb, Pharmacyclics and Janssen Announce Clinical Collaboration to Evaluate OPDIVO® (nivolumab) and IMBRUVICA® (ibrutinib) in Non-Hodgkin Lymphoma

   

                                                                    

NEW YORK & SUNNYVALE, Calif. & RARITAN, N.J.–(BUSINESS WIRE)–Bristol-Myers Squibb Company (NYSE:BMY), Pharmacyclics, Inc. (NASDAQ:PCYC), and Janssen Research & Development, LLC announced today they have entered into a clinical trial collaboration agreement to evaluate the safety, tolerability and preliminary efficacy of Bristol-Myers Squibb’s investigational PD-1 immune checkpoint inhibitor OPDIVO® (nivolumab) in combination with IMBRUVICA® (ibrutinib), an oral Bruton’s tyrosine kinase (BTK) inhibitor co-developed and co-marketed by Pharmacyclics and Janssen. The Phase 1/2 study will focus on evaluating the safety and anti-tumor activity of combining OPDIVO and IMBRUVICA as a potential treatment option for patients with non-Hodgkin lymphoma (NHL), including diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL) and chronic lymphocytic leukemia (CLL). Bristol-Myers Squibb has proposed the name OPDIVO (pronounced op-dee-voh), which if approved by health authorities, will serve as the trademark for the investigational drug, nivolumab.

Alcohol and Cancer

Alcohol use is one of the most important preventable risk factors for cancer, along with tobacco use and excess body weight. Alcohol use accounts for about 6% of all cancers and 4% of all cancer deaths in the United States. Yet many people don’t know about the link between alcohol use and cancer.
Cancers linked to alcohol use

Alcohol use has been linked with cancers of the:
Mouth
Throat (pharynx)
Voice box (larynx)
Esophagus
Liver
Colon and rectum
Breast

Alcohol probably also increases the risk of cancer of the stomach, and might affect the risk of some other cancers as well.

For each of these cancers, the more alcohol you drink, the higher your cancer risk. But for some types of cancer, most notably breast cancer, consuming even small amounts of alcohol can increase risk.

Cancers of the mouth, throat, voice box, and esophagus: Alcohol use clearly raises the risk of these cancers. Drinking and smoking together raises the risk of these cancers many times more than drinking or smoking alone. This might be because alcohol can help harmful chemicals in tobacco get inside the cells that line the mouth, throat, and esophagus. Alcohol may also limit how these cells can repair damage to their DNA caused by the chemicals in tobacco.

Liver cancer: Long-term alcohol use has been linked to an increased risk of liver cancer. Regular, heavy alcohol use can damage the liver, leading to inflammation and scarring, which might be why it raises the risk of liver cancer.

Colon and rectal cancer: Alcohol use has been linked with a higher risk of cancers of the colon and rectum. The evidence for this is generally stronger in men than in women, but studies have found the link in both sexes.

Breast cancer: Drinking even small amounts of alcohol is linked with an increased risk of breast cancer in women. Alcohol can raise estrogen levels in the body, which may explain some of the increased risk. Avoiding or cutting back on alcohol may be an important way for many women to lower their risk of breast cancer.  SOURCE:  American Cancer Society

Cats and Cancer

From the Leukemia & Lymphoma Society

For many people, pets feel like a part of the family. After a cancer diagnosis, pets can offer many benefits. 

Benefits include: 

1. companionship
2. improved mood
3. motivation to stay active

Some hospitals and treatment centers even use animal therapy to help improve patients’ well-being. (Don’t be surprised if you get a visit from a specially trained therapy dog during a chemo infusion!)

However, as a cancer patient, there are some things you need to keep in mind when it comes to pets during cancer treatment.

Talk to your healthcare team about your treatment plan and your pets. Some cancer treatments can weaken your immune system, so you may need to take special precautions. Being around animals, including pets, may increase your risk of infection. 

While going through cancer treatment, it’s best to follow some basic guidelines:

• If you live with family or a roommate, ask someone else to clean up after pets such as cleaning the litter box or changing dog pads. If you need to clean up after a pet, wear gloves and wash your hands well after the cleanup. If you are cleaning a litter box, wear a mask to avoid inhaling the litter dust. Keep the litter box away from the kitchen and dining room.
• If your pet is sick—vomiting, diarrhea, or sneezing—take your pet to the vet right away. Your pet may have an infection that could be passed on to you if your immune system is weak. You also want to make sure your pet receives the care it needs!
• Avoid scratches. Keep your dog’s or cat’s nails trimmed to minimize the risk of scratches. If you do get scratched, clean it well and keep it covered with a bandage. If it becomes red, warm, swollen, or oozes pus, call your healthcare team as soon as possible. It may be infected.
• Keep your pets up-to-date on vaccines, heartworm prevention, and flea and tick medications to reduce your exposure to infection as well as for their own protection.
• Do not adopt new pets or take in strays during cancer treatment. Strays are more likely to carry unknown germs and not be up-to-date on vaccines, even if the animal appears healthy. (Additionally, new pets take a lot of time and energy which you may not have to give during cancer treatment.)
• Some pets and animals do need to be avoided during cancer treatment when your immune system is weakened. Reptiles, chickens, ducks, and rodents can carry salmonella and other germs that may cause infection. Salmonella can lead to severe diarrhea, and it can be especially dangerous for cancer patients.
• Find a good pet sitter! If you have to spend time at the hospital for surgery or treatment, make sure you have a reliable pet sitter lined up to take care of your pet while you’re healing.

As long as you talk to your healthcare team and take the appropriate measures to reduce your risk of infection, your furry friends can stay by your side during cancer treatment!

Is Lymphoma Inherited?

Lymphoma is not inherited – it is not passed from parent to child. However, your risk of developing lymphoma is slightly higher if you have a close relative (parent, brother or sister, or child) who has had lymphoma. This increased risk is usually not linked to a particular gene.  SOURCE:  Lymphoma-action.org/uk

IN MY PARTICULAR SITUATION THIS IS GOOD BECAUSE I DO NOT WANT MY DAUGHTER HAVING TO DEAL WITH ALL THE CANCER RELATED PROBLEMS WITH WHICH i HAVE HAD TO DEAL OVER THE LAST 12 (going on 13) YEARS.

IT IS ALSO NICE TO KNOW THAT MY MOTHER, WHO CONTRACTED LYMPHOMA IN HER 90's DID NOT PASS IT ALONG TO ME IN HER GENES...  I GOT THIS BAD BOY ALL ON MY OWN...

Venturing Out

The Corona Virus Pandemic or COVID-19 has really changed the way I live my life from the standpoint of leaving my home and venturing to other places like I used to do.

I am in the HIGH RISK CATEGORY because:

1. I am 72 years old
2. Have had a heart attack
3. Have experienced AFIB
4. Currently being treated for Lymphoma
5. Currently being treated for Melanoma
6. Have non existent immune system

Change in LIFESTYLE

My wife and I used to go out to dinner

My wife and I used to go out to a movie

My wife and I used to vacation at Myrtle Beach

My wife and I used to go shopping at Malls

My wife and I used to like to travel 

Now...

the only time I leave the house is to go to my necessary doctor's appointments, cancer treatments, and dentist appointments which gets me out of the house half a dozen times each month...  and, that ain't much.

Day - to - Day

There are some cancer patients that have been told or were told that they only had days, weeks, months, maybe years to live; and, there are those cancer patients who struggle with cancer for several years and lose the battle to that cancer or lose the battle to some other disease because they have/had no immunity.

And then...  there are other patients, like myself, who have been fortunate enough to live with cancer for over a decade and have been told by their Oncologist that there is a good possibility that they will die of old age...  but this news is always followed with a CAVEAT of:  your cancer could become aggressive and there might not be anything we can do to stop it.

What do you think a comment like that does to one's anxiousness?

In my case, I am fighting Lymphoma and Melanoma and may soon be diagnosed with Prostate Cancer...  so, my mental outlook is constantly being challenged and while my cancers seem to be suppressed (THIS DOES NOT MEAN REMISSION), I am under a constant fear of what might happen should this change...

Keep A Record

Even if your employer responds well to your initial conversation and grants accommodations, it’s a good idea to keep track of discussions you have with your boss or human resources office. Keep copies of emails related to your diagnosis and requests. Also, keep copies performance reviews or other documents related to your job performance. This documentation will be helpful if you feel your cancer diagnosis or accommodations are ever held against you.

Discrimination can sometimes be subtle, such as being excluded from meetings or being disregarded for assignments or promotions. You have 180 days from the date of an incident of discrimination to report it to the EEOC, which is another reason to keep records.

It may be difficult to talk about your diagnosis and expectations with your boss. However, it is almost always the right thing to do to protect yourself. Armed with an understanding of your potential needs and rights, you are in a better position to take control of your cancer and your career.

Sharing Your Cancer Diagnosis at Work

You don’t have to tell an employer about your cancer at all. An employer can’t ask about an employee’s medical situation unless they believe a medical condition is negatively affecting job performance or workplace safety.

However, your employer needs to know you have cancer for you to be protected by the ADA. It is within your employer’s rights to ask for medical documentation if you request disability or medical leave.

Once you have decided you have enough information about what to expect during and after treatment, start by telling your direct supervisor. He or she may ask you questions you aren’t able to answer and that’s ok. Your goal is to open communication and set expectations. Don’t expect your supervisor to be familiar with your protections under ADA. However, your company’s Human Resources department should be. If your supervisor doesn’t inform HR after you disclose your diagnosis, you should.

After that, it’s up to you who you would like to tell. Your employer is not allowed to tell other employees about your medical situation, not even if coworkers notice you receiving accommodations and ask about it. It is up to you which coworkers to tell. Some people tell only a trusted coworker. Some people want everyone they work with to know.

Decide how much information you want to share. If you are comfortable sharing your story, this is a great opportunity to educate others. People will likely make assumptions about your ability to work, or your long-term prognosis. They may comment on changes to your physical appearance or ask personal questions. Most people have beliefs about cancer that are incorrect or based on experiences that have little to do with your diagnosis and treatment. People are rarely intentionally nosy or hurtful. 

However, if you feel comments or questions are excessive or constitute harassment, report it to your company’s human resources right away. This is a form of discrimination and your employer has an obligation to address it.

Immunotherapy

Immunotherapy is a type of cancer treatment that helps your immune system fight cancer. The immune system helps your body fight infections and other diseases. It is made up of white blood cells and organs and tissues of the lymph system.  Immunotherapy is a type of biological therapy. Biological therapy is a type of treatment that uses substances made from living organisms to treat cancer.

As part of its normal function, the immune system detects and destroys abnormal cells and most likely prevents or curbs the growth of many cancers. For instance, immune cells are sometimes found in and around tumors. These cells, called tumor-infiltrating lymphocytes or TILs, are a sign that the immune system is responding to the tumor. People whose tumors contain TILs often do better than people whose tumors don’t contain them.

Even though the immune system can prevent or slow cancer growth, cancer cells have ways to avoid destruction by the immune system. For example, cancer cells may: 

• Have genetic changes that make them less visible to the immune system.
• Have proteins on their surface that turn off immune cells.

Change the normal cells around the tumor so they interfere with how the immune system responds to the cancer cells. Immunotherapy helps the immune system to better act against cancer.

Several types of immunotherapy are used to treat cancer. These include:

Immune checkpoint inhibitors, which are drugs that block immune checkpoints. These checkpoints are a normal part of the immune system and keep immune responses from being too strong. By blocking them, these drugs allow immune cells to respond more strongly to cancer.

T-cell transfer therapy, which is a treatment that boosts the natural ability of your T cells to fight cancer. In this treatment, immune cells are taken from your tumor. Those that are most active against your cancer are selected or changed in the lab to better attack your cancer cells, grown in large batches, and put back into your body through a needle in a vein.  T-cell transfer therapy may also be called adoptive cell therapy, adoptive immunotherapy, or immune cell therapy.

Monoclonal antibodies, which are immune system proteins created in the lab that are designed to bind to specific targets on cancer cells. Some monoclonal antibodies mark cancer cells so that they will be better seen and destroyed by the immune system. Such monoclonal antibodies are a type of immunotherapy.  Monoclonal antibodies may also be called therapeutic antibodies.

Treatment vaccines, which work against cancer by boosting your immune system’s response to cancer cells. Treatment vaccines are different from the ones that help prevent disease.

Immune system modulators, which enhance the body’s immune response against cancer. Some of these agents affect specific parts of the immune system, whereas others affect the immune system in a more general way.

Targeted Therapy for SLL

Targeted therapy

These drugs attack one or more specific targets on cancer cells. Your doctor might suggest them if you've already had another treatment that didn't work. Two examples are ibrutinib (Imbruvica) and idelalisib (Zydelig). Both are pills.

Scientists also are looking for new ways to treat SLL in clinical trials. These test new drugs to see if they are safe and if they work. They often are a way for people to try new medicine that isn't available to everyone. Your doctor can tell you if one of these trials might be a good fit for you.

Besides new drugs, another treatment that may be part of a clinical trial is a stem cell transplant.

Stem cells are in the news a lot, but usually when you hear about them they're referring to "embryo" stem cells that are used in cloning. The stem cells in a transplant are different. They live in your bone marrow and help make new blood cells.

This procedure may use your own stem cells or stem cells from a donor.

If a donor supplies them, you'll need to find one who is the right match for you, so your body doesn't reject the new stem cells, or start fighting them the way it would fight an infection.

Close relatives, such as your brother or sister, are the best chance for a good match. If that doesn't work out, you need to get on a list of potential donors from strangers. Sometimes the best chance for the right stem cells for you will be from someone who's the same race or ethnicity as you.

Before the transplant, you'll most likely need to get treated with high doses of chemo for about a week or two. Sometimes radiation therapy is also used.

This can be a tough process, because you may get side effects like nausea and mouth sores. Certain medications can make these side effects less severe.

When the high-dose chemo is done, you'll start the transplant. You get the new stem cells through an IV. You won't feel any pain from this, and you're awake while it’s happening.

After your transplant, it could take 2 to 6 weeks for the stem cells to multiply and start making new blood cells. During this time you may be in the hospital, or at the very least, will need to make visits every day to get checked by your transplant team. It can take 6 months to a year until the number of normal blood cells in your body gets back to what it should be.

Keep the Faith

 

End and Begin

Yesterday, I ended my lower back physical therapy and began my return to the gym and re-establish an exercise routine of 60-90 minutes each day.   What I was doing was walking on the treadmill for about 20-30 minutes, whatever it took to walk a mile...  then I would get on the stationary bike and peddle for another mile which would take about 20-30 minutes...  once this was accomplished, I would use the strength machines designed to strengthen the muscles in my shoulders and lower back while also benefitting other muscles and tendons throughout my body.

This first started several years ago after my 3 heart surgeries to build my heart back up from the damage done to it by a heart attack.  However, side effects from chemo had me exercising sporadically and after exercising for several weeks in a row, I would not exercise for several weeks in a row, putting me into the position of having to build my body back up again.

Hopefully, with this return to the gym I will be able to stick with it from now on...

 

Cancer Related Fatigue

Cancer-related fatigue (CRF - sometimes simply called "cancer fatigue") is one of the most common side effects of cancer and its treatments. It is often described as "paralyzing." Usually, it comes on suddenly, does not result from activity or exertion, and is not relieved by rest or sleep. It may not end - even when treatment is complete.

What causes cancer-related fatigue (CRF)?
The exact reason for cancer fatigue is unknown. CRF may be related to both the disease process and treatments, including surgery, chemotherapy, and radiation therapy. Cancer treatments commonly associated with CRF are:

Chemotherapy. Any chemotherapy drug may result in fatigue. This may vary from person to person. Some people say it lasts only a couple of days. Others feel the CRF persists through and beyond completion of treatment. Drugs such as vincristine, vinblastine, and cisplatin often cause CRF.

Radiation therapy. Radiation therapy can cause cumulative fatigue (fatigue that increases over time). This can occur regardless of treatment site. CRF usually lasts from 3-4 weeks after treatment stops, but can continue for up to 2-3 months.

Bone marrow transplant. This aggressive form of treatment can cause CRF that lasts up to one year.

Biologic therapy. Cytokines are natural cell proteins, such as interferons and interleukins, that are normally released by white blood cells in response to infection. These cytokines carry messages that regulate other elements of the immune and endocrine systems. In high amounts, these cytokines can be toxic and lead to persistent fatigue.

Other factors that may contribute to cancer-related fatigue include:
Anemia. Anemia can result from blood counts that are reduced by treatments reducing the oxygen-carrying ability (hemoglobin) of the blood. About 7 in 10 patients experience anemia during chemotherapy.

Combination therapy. Patients experiencing more than one treatment at the same time or one after the other may experience more CRF.

Tumor-induced "hypermetabolic" state. Tumor cells compete for nutrients, often at the expense of the normal cell's growth and metabolism. Weight loss, decreased appetite, and fatigue are common results.

Decreased nutrition from the side effects of treatments (i.e., nausea, vomiting, mouth sores, taste changes, heartburn, and diarrhea).

Hypothyroidism. If the thyroid gland is underactive, metabolism may slow down so that the body does not burn food fast enough to provide adequate energy. This is a common condition in general but may happen after radiation therapy to the lymph nodes in the neck.

Medications used to treat side effects such as nausea, pain, depression, anxiety, and seizures can contribute to CRF.

Pain. Research shows that chronic, severe pain increases fatigue.  Many patients try to maintain their normal daily routine and activities during treatments. Modification may be necessary in order to conserve energy.

Stress can worsen feelings of fatigue. This can include any type of stress: from dealing with the disease and the unknowns to worrying about daily accomplishments to worrying about not meeting the expectations of others.

Depression and fatigue often go hand in hand. It may not be clear as to which started first. Families may be confused as well. One way to sort this out is to try to understand how much of a problem is caused by the depressed feelings. Are you depressed all the time? Were you depressed before your cancer diagnosis? Are you preoccupied with feeling worthless and useless? If the answers to these questions are yes, you may need treatment for depression.

Insomnia. Inability to sleep 8 hours a night will cause both mental and physical fatigue.

Cancer and Sunlight

National Cancer Institute

The sun, sunlamps, and tanning booths all give off ultraviolet (UV) radiation. Exposure to UV radiation causes early aging of the skin and damage that can lead to skin cancer.

People of all ages and skin tones should limit the amount of time they spend in the sun, especially between mid-morning and late afternoon, and avoid other sources of UV radiation, such as tanning beds. Keep in mind that UV radiation is reflected by sand, water, snow, and ice and can go through windshields and windows. Even though skin cancer is more common among people with a light skin tone, people of all skin tones can develop skin cancer, including those with dark skin.

Follow these tips to protect your skin from sunlight:
Wear a hat with a wide brim all around that shades your face, neck, and ears. Baseball caps and some sun visors protect only parts of your skin.

Wear sunglasses that block UV radiation to protect the skin around your eyes.

Wear long sleeves and long pants. Tightly woven, dark fabrics are best. Some fabrics are rated with an ultraviolet protection factor (UPF). The higher the rating, the greater the protection from sunlight.

Use sunscreen products with a sun protection factor (SPF) of at least 15. (Some doctors suggest using a product with an SPF of at least 30.) 

Apply the product’s recommended amount to uncovered skin 30 minutes before going outside, and apply again every two hours or after swimming or sweating.

Keep in mind that the sun's rays...

• are strongest between 10:00 a.m. and 4:00 p.m.
• can go through light clothing, windshields, windows, and clouds
• are reflected by sand, water, snow, ice, and pavement

Cancer and Dieting

From the National Foundation for Cancer Research

Approximately 30-40% of cancer diagnoses could be prevented by modest diet and lifestyle changes. This number increases to 90% for certain cancers, like stomach cancer. In 2017 alone, 675,512 cancer diagnoses could have been avoided! Healthy eating is important, especially as it related to cancer. And in recognition of National Nutrition Month, this National Foundation for Cancer Research blog post will offer a deeper look into the science of this important correlation.

AVOID
Alcohol is one such substance that can have a carcinogenic effect on the body.
The second common potentially carcinogenic food is red meat

INCLUDE
Antioxidants are chemicals which oppose free radicals (compounds which react uncontrollably with oxygen) by stabilizing the cell. Micronutrient density has to do with the amount of vitamins and minerals within foods. Each vitamin and mineral plays an integral role in the healthy functioning of various body tissues. Important anti-cancer micro nutrients include calcium, zinc, vitamin A, vitamin K2, vitamin D, vitamin C and the B vitamins—with are loaded with folates. Fruits and vegetables are both incredibly important to ensure that antioxidant and micronutrient status are good. Fruits and vegetables are also important for their inherent fiber which has been proven to help reduce certain cancers.

Finding A New Normal

Because of my staph infection that caused afib and the fact that I did not feel my heart fluttering or beating rapidly, my Cardiologist has decided to put me on Xarelto, a blood thinner that will hopefully eliminate blood clots and potential strokes from happening to me...  however, this new adventure poses a different problem with which I must contend and that is the fact that it will be difficult for me to stop the bleeding even from a small cut or scratch.  And, when approached my Cardiologist refused to lower the dosage however he did say it was ok that I stopped taking Xarelto for a couple of days in order to get a cut to stop bleeding.

AND...  that will be my new normal.

So, we I am bandaged because of a cut or from giving blood or from accessing my port for chemo, the bandage MUST REMAIN for several days in order to insure that the bleeding has stopped.  A longer time with a bandage, the more I risk bruising when it is removed but that is also the price that I must pay for this new development in my health.  I also have the option now of stopping Xarelto for a couple of days which is a good backup plan, but that is all it should be is a backup plan.

EXPOSED At An Early Age

 In Light of my Blog Name Change

As far back as I can remember, perhaps age 9 or 10, my parents required my sister and I and later our baby brother to attend Sunday School and Church Services every Sunday regardless of weather and sicknesses unless we were contagious. The only exception to this rule was when the family was on vacation and then we were only required to attend Church Services.  This practice continued until we graduated from high school.  In the summer, we attended Vacation Bible School but as I got older and joined the Boy Scouts, I was allowed to exchange Vacation Bible School with Boy Scout Camp if I wanted; and, it was in Boy Scout Camp that I learned that KOOL AID was referred to as BUG JUICE and even though it was loaded down with sugar, we were allowed to drink as much as we wanted at camp.
In order to understand my parent strictness in raising their children, my sister and I had daily chores that had to be executed before we left for school or before we went out to play after school or before we did our homework or before we went to bed.  We were given additional chores in the summers that typically required yard work.


Our breakfasts were no different...

• Mondays, Wednesdays, and Fridays we had eggs (usually scrambled) and something else like
  bacon/sausage.
• Tuesday was Oatmeal
• Thursday was French Toast
• Saturday was Cereal and Fruit
• Sundays was Waffles

So, for a good 8 years, I was EXPOSED to approximately 416 Church Sermons and in the United Methodist Church, many of those Sermons, especially around Holidays and Special Events were repeated.  Additionally, Methodist Ministers NEVER take obscure passages out of THE BIBLE and try to explain them...  their sermons are carefully designed around the MAIN PARABLES but they are targeted from different vantage points in order to provide a sort of 3-D Religious Experience.

During my first marriage, my wife and I went to an Episcopal Marriage Counselor and in order to get that counseling for free, we had to attend the Episcopal Church every Sunday unless we were on vacation.  This counseling lasted for another 5 years or I was EXPOSED to another 250 sermons, but this time the sermons delved into some areas with which I was not familiar.

During my second marriage, my wife convinced me to attend a local Baptist Church and I was so impressed with this Baptist Brother Pastor that I had him Baptize me for a second time which resulted in full immersion into a tank of water.  He wore "waders" whereas I was not allowed to so I had to bring a change of clothes.  This Brother Pastor was so impressive because he took all the familiar and unfamiliar PARABLES and approached them in logical, common sense way that explained THE BIBLE in such a way that it actually started me on the path on questioning what THE BIBLE had previously taught me but in so doing I was actually strengthening my faith.

This time period (12 years) added another 600 sermons to the list, making a grand total of 1,266 Religious Sermons to which I have listened or been EXPOSED.  Of course, my numbers may be off a little, so let's assume that the number is at least 1,000 or more.  So, one could say that I have a pretty good (relatively speaking) of BIBLICAL TEACHINGS from 3 different points-of-view, giving me a unique and wide understanding.

During my time at the Baptist Church, I put myself on a mission to read THE BIBLE from cover-to-cover, taking as much time as I needed to write down any questions that I had, take notes on everything I read, and cut and pasted into a CD all verses printed in RED because those were the actual words of Jesus.  I saved that Word Doc to my HDD, then later to a flash drive and later to a CD.  My desire was to refer back to it from time-to-time, but I never did.

I did not attend Church after high school or either before or after counseling with my first wife and after 12 years of attending my last Church, I stopped because the Baptist Brother Pastor was released by the Board of Elders because he had been convicted of 3 DUI's.

What a multiple dimension might look like...

Also during this time with the Baptist Brother Pastor, I met with him outside of Church for a couple of hours (about 100 times) asking him the questions that I had about THE BIBLE, about passages I found that no one ever discussed, and about the BIG BANG, joining science with religion, multiple dimensions, life on other worlds, and spiritual life after death.  He was sad because his congregation was not as open minded as me and he knew he could never have these conversations with any of them, even outside Sundays.

I did not feel sorry for him because he had made his own choices just as I had made my own choices.  The last of our sessions revolved around a NOVEL idea that I had rolling around in my head like a pair of CRAP DICE that had just be tossed velvet, entitled YOU CANNOT GET THERE FROM HERE.  The idea was to create a self-help book that was basically a SPIRITUAL JOURNEY from birth, life, death, and then finally into some sort of heavenly existence.  I actually drafted about 100 pages of a 300-500 word manuscript and put it on hold because of the probability of publishing it bordered on highly unlikely to not at all.

QUESTION:  What would GOD look like if GOD was a multiple dimension entity and GOD entered our 4 dimension world (height, width, depth, time)?

Potential Answers:  maybe a burning bush or a tornado-like storm or a black cloud or a spirit type image?

Changing the Name of this Blog

Meaning of Odyssey a long wandering or voyage usually marked by many changes of fortune

Meaning of Pilgrimage a journey, especially a long one, made to some sacred place as an act of religious devotion

Now... let me tell you a true story...

Almost 13 years ago, I was diagnosed with Non-Hodgkin's B Cell Lymphoma after going through many embarrassing and humiliating tests of which I was then unfamiliar so they made me feel very uncomfortable.  To determine staging of the cancer, I was told by my Oncologist that he would be performing a BONE MARROW BIOPSY on me in his office.  If it was going to be in his office then I would not be put asleep.  I asked as many people as I could think of and did as much research as I could imagine to determine the extent of the PAIN that I was going to have to endure.

I was enormously anxious for about 3 weeks and as the date got closer, I got more nervous and anxious, not being able to sleep just thinking about it.  My wife told me I was being silly and that it could not be as much pain as having a baby.  Her comment made me furious because she was showing no empathy for my plight and I did not realize that I was being selfish.

On the day of the procedure, I start sweating all over my upper body as we drove to his office.  I wanted to stop the car...  turn around and never look back...  I knew that I could not...

Once in the exam room where the procedure was to be performed and as I lay on the table, I felt like I was going to pass out as waves of increasing nausea rummage around throughout my entire body.  Then...  I remembered what Jesus said on the cross, just as he began to stick the large retrieval needle into my hip...  so, I said to myself,  "JESUS INTO YOUR HANDS I PLACE MYSELF."

Today, I cannot remember how many times I said that phrase...  once...  twice...  more than twice...  and today I wonder if I was being sacrilegious or not...  but, as he push the needle in I told him that I was feeling a little pressure that was making me feel very uncomfortable...  so, the Oncologist said, "let me try another spot."

                                                             

As the Oncologist pushed the large retrieval needle into the second spot on my hip, something totally unexpected but HOPED FOR HAPPENED...   I FELT NOTHING...  NO PAIN AT ALL...  and, to make matter even more unusual than they already were, the Oncologist had to stop turning the large retrieval needle and rest his hand because my bones were so HARD that the turning was hurting his hand(s).

I still cannot believe that this really happened but it did...

Was it the skill of my Oncologist or was it my FAITH?

I have thought about this event off and on again during the entire extent of my journey thus far and today came to the conclusion that my cancer journey was neither a journey or an odyssey, but a PILGRIMAGE that was only designed for one...  ME...

As\I was writing this and thinking about the photos I wanted to use to illustrate my pilgrimage, religious photos that I reviewed did not seem to capture the struggle of my journey or the mental religious turmoil with which I would struggle...  until I realized that the character in KUNG FU made a similar solitary journey encountering both good and evil along the way.  I remember watching the shows and seeing him walk through valleys, fields, and deserts alone yet always with his spiritual beliefs.

While I am not alone because I have my family, what I actually experience both physically, emotionally, and mentally puts me in the ALONE CATEGORY and it is ONLY ME who must deal with ME and MY FAITH...  the faith that I exhibited on the day of my bone marrow procedure...  this cancer journey is my pilgrimage toward my faith...

Not only did I share this story with my SUNDAY SCHOOL CLASS but I added to it with another story immediately following...  in this story I simply said that contracting cancer was like the shepherd who broke the legs of a straying lamb and then carried that lamb around on his shoulders.  GOD broke my legs with cancer and now HE is carrying me around on HIS SHOULDERS...

Meeting with Oncologist

When I met with my Oncologist a couple of days ago, I asked about Clinical Trials, and he said that it was ok if I wanted to pursue them on my own, but with having two types of cancers at the same time, I was automatically disqualified.

He then went on to tell me that his colleagues were against his decision to treat both cancers at the same time, especially since the Melanoma was aggressive and he reminded them that the Lymphoma had turned aggressive as well, and that he had no choice but to treat them simultaneously.  His idea, at least on me, worked better than anticipated and while there is NO REMISSION, there is no growth either.

And, I am still on the schedule to receive either a PET or CT scan every 3 months alternating from one scan to the next since the insurance will only pay for one type of scan every 6 months.  The efficacy of my treatments based upon the scan is not hindered by the type of scan.

In closing, he told me he was extremely pleased with my progress.

The Return of IVIG

Intravenous Immunoglobulin (IVIG) is a therapy treatment for patients with antibody deficiencies. It is prepared from a pool of immunoglobulins (antibodies) from the plasma of thousands of healthy donors. Immunoglobulins are made by the immune system of healthy people for the purpose of fighting infections. While IVIG is derived from plasma (a blood product), it is so purified that the chances of contracting a blood-borne infection are extremely low.

Unlike many of the medications prescribed by rheumatologists, IVIG does not increase the risk for infection. IVIG works in different ways to prevent the body from attacking itself and to decrease several types of inflammation in the body.

IVIG is given as an intravenous infusion (through the vein in the arm), which takes several hours to complete. Frequency of infusions vary according to the patient’s need. It may be given as a one-time infusion (such as for Kawasaki’s disease). For other diseases, it may be given from anywhere between one to five days on a monthly basis. Frequency and duration of infusions depend on the underlying disease and the clinical course. IVIG can take several weeks to fully take effect.

                                                               

Yesterday, during my visit with my Oncologist and because I was experiencing frequent infections, he decided to return me to receiving IVIG every other month. I will be meeting with the Oncologist every month at least during these first few months to make sure that I am tolerating IVIG.

Potential Side Effects
The majority of people do well with IVIG, experiencing only minor side effects. IVIG may cause infusion reactions, including fevers, chills, flushing, rash, muscle aches, and nausea. Headaches are also relatively common. These are generally not severe and improve with analgesics and antihistamines. Additionally, because the medication has a large volume, it may worsen heart failure and may cause the blood pressure to be elevated temporarily. IVIG also increases the risk for blood clots slightly when given in high doses.

Staying Physically Fit

At 72 years old, I do not move as quick as I used to move nor do I exercise as often or as long as I used to exercise, but I do exercise unless that routine has been postponed by other issues like fatigue, nausea, diarrhea, or being hospitalized like I was recently.  Not only did that hospitalization keep me from exercising, the 28 days of antibiotic infusions 3 times a day kept me away from the gym for over 6 weeks.  In essence, I had to start all over again in building up my strength.

However, after 2 months of not taking my chemo treatments or daily meds, when I finally resumed those activities, my body had to re-acclimate my body to daily fatigue and nausea.  These types of conditions prevent me from exercising as I am waiting for my body to regain its strength.  My physical therapy on my lower back was also postponed during that time as well.

I have returned to my physical therapy but my lower back is not hurting like it was when I first started my therapy.  What I would like to do is finish my therapy and transition into the gym so I can return to a daily exercise routine.  This routine will no doubt start out as M-W-F one week and T-TH the next week before I can feel comfortable with daily activities that push my muscles...  that is to say I would increase time and/or reps rather than increase weight.

My exercise routine typically lasted 60-90 days and was shortened usually because of available machines I wanted to use.  I always tried to find an exercise time where the gym was relatively empty.

Infusion Day

Up at 5:00 am this morning to get ready for my monthly infusion of Opdivo along with lab work and a visit with the Oncologist or one of his NPs or both...  I never know how that office visit will turn out.  I will be bring with me info on clinical trials at MD Anderson to see if the Oncologist might be interested in signing me up even though my cancers are not growing...

According to my internal constitution, drinking coffee stimulates my bowels and since my movements have not been completely normal, I wanted that action to take place in a comfortable environment in case there is an accident.

I have nothing to report except the Xarelto med that was added which is causing me difficultly in clotting no matter how small the cut may be.  If this keeps up, I will need to reach out to my Cardiologist.

I typically ask for and receive an early appointment so I can get a parking place and that puts me back on the road around 10:00 or 10:30.  A test must be performed on my blood before Opdivo is administered and that usually takes an hour or so.  Then with normal delays at the 3 stages of my visit, I am usually in the recliner by 9:30 or so.  My infusion only take 30 minutes.

Leukemia and Lymphoma Society

The Leukemia & Lymphoma Society (LLS) was born out of a family's grief following the death of their teenage son.

Robert "Robbie" Roesler de Villiers
December 24, 1927 - October 20, 1944

Robert "Robbie" Roesler de Villiers, son of a well-to-do New York family, was only 16 when he quickly succumbed to leukemia in 1944. Five years later, frustrated by the lack of effective treatments for what was then considered a hopeless disease, parents Rudolph and Antoinette de Villiers started a fundraising and education organization in their son's name.

Headquartered in a small Wall Street office, the Robert Roesler de Villiers Foundation had only a few volunteers and a tiny budget. The task was daunting. Most leukemia patients, especially children, died within three months. Even by the mid-1950s, when the first-generation chemotherapy drugs began appearing, the disease remained a stubborn challenge. The Foundation reported in its 1955 annual report: "As of this date, Leukemia is 100% fatal. This is almost a unique situation among the many diseases to which man is susceptible."

Driven by the de Villiers' nearly boundless belief that leukemia and other blood cancers were indeed curable, the Foundation grew steadily, opening its first chapters in the New York City area. The organization, after changing its name to The Leukemia Society, was renamed The Leukemia Society of America in the 1960s to communicate a broad, national reach.

* * * * * * * * * * 

Dedicated to curing leukemia, lymphoma, myeloma, and other blood cancers, we are now The Leukemia & Lymphoma Society (LLS), the world's largest voluntary (nonprofit) health organization dedicated to funding blood cancer research and providing education and patient services.

Since 1949, we’ve invested nearly $1.3 billion in groundbreaking research, pioneering many of today’s most innovative approaches. We work tirelessly to find cures and ensure patients can access the lifesaving treatments they need. When someone experiences the fear and uncertainty of a cancer diagnosis, we provide hope, compassion, education and support. And we are making an impact in the cancer community.

Inspirational

COVID Vaccine

Clinical Trials

Clinical trials are a type of research that studies new tests and treatments and evaluates their effects on human health outcomes.

After pre-clinical research, tests and treatments go through a series of clinical trials. Clinical trials assess if tests or treatments are safe for and work in people. Clinical trials have five phases. The phases are described next using the example of a new drug treatment:

Phase 0
Phase 0 trials are the first clinical trials done among people. They aim to learn how a drug is processed in the body and how it affects the body. In these trials, a very small dose of a drug is given to about 10 to 15 people.

Phase I
Phase I trials aim to find the best dose of a new drug with the fewest side effects. The drug will be tested in a small group of 15 to 30 patients. Doctors start by giving very low doses of the drug to a few patients. Higher doses are given to other patients until side effects become too severe or the desired effect is seen. The drug may help patients, but Phase I trials are to test a drug’s safety. If a drug is found to be safe enough, it can be tested in a phase II clinical trial.

Phase II
Phase II trials further assess safety as well as if a drug works. The drug is often tested among patients with a specific type of cancer. Phase II trials are done in larger groups of patients compared to Phase I trials. Often, new combinations of drugs are tested. Patients are closely watched to see if the drug works. However, the new drug is rarely compared to the current (standard-of-care) drug that is used. If a drug is found to work, it can be tested in a phase III clinical trial.

Phase III
Phase III trials compare a new drug to the standard-of-care drug. These trials assess the side effects of each drug and which drug works better. Phase III trials enroll 100 or more patients.

Often, these trials are randomized. This means that patients are put into a treatment group, called trial arms, by chance. Randomization is needed to make sure that the people in all trial arms are alike. This lets scientists know that the results of the clinical trial are due to the treatment and not differences between the groups. A computer program is often used to randomly assign people to the trial arms.

There can be more than two treatment groups in phase III trials. The control group gets the standard-of-care treatment. The other groups get a new treatment. Neither you nor your doctor can choose your group. You will also not know which group you’re in until the trial is over.

Every patient in a phase III study is watched closely. The study will be stopped early if the side effects of the new drug are too severe or if one group has much better results. Phase III clinical trials are often needed before the FDA will approve the use of a new drug for the general public.

Phase IV
Phase IV trials test new drugs approved by the FDA. The drug is tested in several hundreds or thousands of patients. This allows for better research on short-lived and long-lasting side effects and safety. For instance, some rare side effects may only be found in large groups of people. Doctors can also learn more about how well the drug works and if it’s helpful when used with other treatments.

Proton Therapy

Proton therapy delivers a precise radiation treatment while destroying cancer cells and minimizing damage to healthy tissue. This reduces side effects and lessens the risk of developing complications from treatment in later life. Proton therapy is at least as effective as conventional radiation therapy, but with fewer side effects. In some cases, proton therapy is not only the best but also the only option.

Studies have shown proton therapy to be effective in treating many types of tumors, including tumors of the prostate, brain, head and neck, central nervous system, lung, and gastrointestinal system as well as cancers that cannot be removed completely by surgery.

Proton therapy is often the preferred option for treating solid tumors in children because protons can be controlled precisely so there is less radiation of normal tissues, helping prevent serious complications and lessening the chance of secondary tumors.

Proton therapy research is ongoing and has shown promising results in the treatment of other tumors. Proton therapy shows proven results in treating prostate cancer, brain, head and neck, base-of-skull tumors, lung tumors, tumors near the spine, pediatric cancer, gastrointestinal cancer and melanoma of the eye.

In addition to cancer, proton therapy has been effectively used to treat Parkinson’s disease, epilepsy, macular degeneration, arteriovenous malformations, severe rheumatologic conditions and seizure disorders.

Smile and Respect Not Forgotten

Yourself and Otthers

What is AFIB?

AFIB --  An irregular, often rapid heart rate that commonly causes poor blood flow.  The heart's upper chambers (atria) beat out of coordination with the lower chambers (ventricles).  This condition may have no symptoms, but when symptoms do appear they include palpitations, shortness of breath, and fatigue.  Treatments include drugs, electrical shock (cardioversion), and minimally invasive surgery (ablation).

Can AFib go away on its own?
AFib may be brief, with symptoms that come and go. It is possible to have an atrial fibrillation episode that resolves on its own. Or, the condition may be persistent and require treatment. Sometimes AFib is permanent, and medicines or other treatments can't restore a normal heart rhythm.

According to the MAYO Clinic...
During atrial fibrillation, the heart's two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart. Atrial fibrillation symptoms often include heart palpitations, shortness of breath and weakness.


Episodes of atrial fibrillation may come and go, or you may develop atrial fibrillation that doesn't go away and may require treatment. Although atrial fibrillation itself usually isn't life-threatening, it is a serious medical condition that sometimes requires emergency treatment.

A major concern with atrial fibrillation is the potential to develop blood clots within the upper chambers of the heart. These blood clots forming in the heart may circulate to other organs and lead to blocked blood flow (ischemia).

Treatments for atrial fibrillation may include medications and other interventions to try to alter the heart's electrical system.

Blood Thinner

A week ago, my Cardiologist took me off of baby aspirin and put me on a stronger blood thinner called Xarelto because I experienced afib and did not feel anything with my heart beating irregularly, especially since my afib could be a precursor to having a stroke.  Therefore, Xarelto will hopefully prevent a stroke even though I am not feeling my irregular heart beat if and when it happens.

DOWNSIDE:  Xarelto is causing me to bleed more, from places I was not or never bleeding before.  For instance, when I shaved in the shower, if there were any small cuts the water would help clot them by the time I was finished with the shower.  I shaved yesterday, and this morning I woke up with 30+ tiny scabs where blood had clotted on my face, upper lip, cheeks, chin and neck.  I looked like I had the measles.

Additionally, something is causing me to have loose stools (not quite diarrhea) for two days in a row and I am not sure if it is the Xarelto, or the return to my cancer meds:  Opdivo and Imbruvica.  But, hopefully my body will acclimate in a few days.

Returning To A Previous Normal

It's been over 2 weeks since I returned to taking INBRUVICA daily for my Lymphoma and during that time, I have had to readjust to fatigue, nausea, and loose stools and sometimes a little slow to fall asleep at night.  This week, those side effects have started to disappear and my thyroid meds are taking over and eliminating the fatigue.

In a couple of weeks, I will have another infusion of OPDIVO for my Melanoma and my system will again be experiencing what I was experiencing before my hospitalization.  In addition, I will be finished with my therapy for my lower back and can return to the gym to begin my exercise routine.  Exercise will not just improve my overall physical health but strengthen my heart as well.

It is my hope that these last two weeks has allowed my white and red blood cells to increase in numbers and thereby improving my immune system that naturally gets weakened when taking cancer drugs.  This is especially important to me because of COVID-19 and my mobility.,

Costs of Being Hospitalized

I just received a Medicare Summary Notice for Part B Medical Insurance from May 22 through August 21, 2020 or 3 months worth of activities that for me includes Physical Therapy and Hospitalization.

What I find interestingly curious about this summary is how much the hospital or doctor billed Medicare...  how much they approved...  and, how much they paid.  Of course, I still pay nothing because I also have supplemental insurance to cover what Medicare does not pay which still leaves me with an increasing amount of out-of-pocket expenses.

For example, my new medication of Xarelto will cost me $1/day even though my supplemental insurance is covering most of the costs...  if you take more than one pill in a higher tier then you are going to be paying.

The delivery of critical care in the ER of UT Hospital for ONE HOUR AND TEN MINUTES was billed out at $1726 but Medicare only approved $214 and only paid $172...

This leaves me wondering what non Medicare Insurance Companies do when it comes to being billed by Hospitals and Doctors.

It also leaves me wondering if Doctors in ER's do procedures because they need to or because they want more money?

For example, when I was in the ER, a central line was inserted into my chest just in case it was needed later in the night when the doctor was not around.  The cost of that procedure was billed out at $831 but Medicare only approved $83 and only paid $67...

Every doctor in the ER billed Medicare for whatever services they rendered on me...  Every time a doctor saw in while I was on the heart wing for about 15 minutes they got paid $100 including the doctor who was responsible for the whole heart wing floor.  No only did he get paid for those 5 minute visits, he also got paid $100 for supervising my discharge. 

One doctor got paid $500 for spending 30 minutes of time with me...

This is why our healthcare costs are increasing...