My Myeloma worksheet after 6 yrs on the journey...
The main thing is, don't die from preventable causes. More myeloma patients die from infections than from myeloma (can't find the reference).
Dr. Siddhartha Ganguly: "Myeloma is a cancer of the immune system”
Avoid dying of COVID. “The COVID-19 mortality rate in these (CAR-T) patients was about 34%, he said. That’s comparable to the COVID-19 mortality rate in patients with hematologic malignancies undergoing other cancer treatments. For comparison, the COVID-19 mortality rate in the general U.S. population is 1.8%, Dr. Baird said.”
https://www.patientpower.info/navigating-cancer/why-car-t-can-make-infections-more-serious
One in three, 17X the general population. Put this on your wall as a reminder.
Avoid getting even "mild" COVID because evidence is trickling in that it damages the immune system, specifically two types of T cells.
https://www.dailykos.com/stories/2023/12/25/2213619/-Covid-is-not-done-with-us-It-s-just-getting-started-We-really-should-be-paying-attention
Most patients are not aware of this and nobody wants to talk about it, including most hematologists.
Hemos are focused on myeloma and have limited understanding of the territory around the disease. You really have to watch out for yourself and do your own reading of authoritative sources like those above.
Myeloma science moves fast. If at all possible, go to a national center to get the latest treatments.
I have been in remission for 6 years post-transplant. I got all the re-vaccinations, and I'm up to 9 covid vaccinations. mRNA vaccines might have long term issues, but better than being dead. Everything has risks, you have to balance them.
Vaccines are essential, but may only be 50% effective compared to other people. That's why masking and other layers of protection are needed.
https://www.myelomacrowd.org/more-data-on-myeloma-patient-responses-to-covid-vaccines-1/
Shingles is beyond awful. Get Shingrix on schedule and take Acyclovir (Dr. Derman, University of Chicago)
If diarrhea persists on Revlimid, this is typically bile salt disruption. Try Colestipol (Dr. Paul Richardson, 2016).
Also try a "Low FODMAP" diet. Many hemos and gastros don't know about these things, even though they are game changers and widely documented.
Get the Low FODMAP app directly from Monash University because most of the info on the web is wrong. Portion sizes are key.
https://www.monashfodmap.com/
For chemo brain and fatigue, consider Provigil or Armodafinil. The research on cancer patients is very mixed but Provigil has been life-changing for me. Again, few hemos know anything about this.
https://healthtree.org/myeloma/connect/view-post/6SuGEaV6wxCNufCIbRif
Watch your labs to assess your immune system status, such as IgG and IgM. When your immune system is down, raise your shields up. More masking, more avoidance of aerosols carrying germs.
Eat an anti-inflammatory diet, exercise appropriately, and do breath work, meditation, yoga etc. to reduce stress. Consider an Integrative Medicine or Functional Medicine consult.
Sleep is when the immune system recharges and adapts. I have been finding Muse headband neurofeedback and the OmniPEMF devices to reduce stress and improve sleep. I would never have believed it, but they work for me. The sleep data is clear.
I wear a P100 respirator with a cloth mask over it whenever I go into shared air with more than two people. At a minimum, wear a genuine N95 (does not leak like KN95) whenever you are in clouds of germs. Even if you don't want to wear these effective masks, keep them handy in case you have to suddenly go into the ER for something or to help someone else.
Sometimes people look at me funny, but that is better than being dead or crippled by covid.
MM is a very complex disease and the road is winding. Keep a notebook.
Participate in a support group. Even if you say nothing, you will learn tips and tricks and get team support.