MDS Becomes AML - You're Not Going Anywhere, Mister

Yesterday's counts were:

• Platelets: 11,000
• Hemoglobin: 7.3
• White Cells: 1.6

Today's counts are:

• Platelets: 6,000
• Hemoglobin: 9.1
• White Cells: 0.3

Initially, these counts were alarming. What the hell was going on? I thought they were supposed to start coming back up by now.

Turns out we'd all miscalculated. Even Dr. O.

We were a week ahead of ourselves. The counts should be bottoming out right about now, and starting back up early next week. This is a three-week process; not a two-week process, which I had somehow convinced myself it was.

Dr. O had lost track of when we'd started. But, when Penny and I corrected her (it was a week ago Monday), she relaxed, saying, "Oh, then we're right on schedule.

"This treatment is actually more intensive that the initial one, even though you get the drugs on fewer days. The drug is stronger and the dosage larger." It bottoms out at about 15 days.

Maybe it's a good thing I didn't know that. If I had, I might've just stayed home.

As with January's treatment, home is beginning to seem like a mythical dream, a fantasy place that's far away and unattainable. Oh, to be able to walk from room to room, floor to floor; to be able to wander into the kitchen and to open the refrigerator door just to see what's inside; to eat real food at a real table; to luxuriate in the decision of which TV to nap in front of; to have commercial-free movie channels to watch.

This is wearing on me. The room is a small universe, made smaller by the frequent need to close the door to shut out ambient noise. Cleaning ladies yelling orders at each other; my next-door neighbor's TV blasting in a desperate effort to penetrate her deaf ears.

"It's going to be a beautiful weekend," Laina said the other night.

"Doesn't affect me," I replied.

Okay, okay—I know that in the end, this will all be worth it. Still, when you've largely confined to a small room, living a daily life whose few variations are comprised mostly of what medications are being pumped into you, patience is sometimes hard to muster.

Yesterday, between two bags of blood transfusion, I showered. Lord knows I needed it. I'd begun to stink in my private areas like a homeless person. But, the best part? I left the room independently to do it.

I shoulda stayed all night in there.

MDS Becomes AML - No Platelets, No Energy

Today's counts:

• Platelets: 6,000
• Hemoglobin: 9.1
• White Cells: 7.8

Six thousand isn't a record low for platelets, but it ain't far off.

No platelets means no energy.

So, today I've slept.

While I've waited four-plus hours for the platelet transfusion bag to show up.

Even Ms. I.V. Pole is wondering what's going on.

There have been better days.

But, also worse.

MDS Becomes AML - Blood Counts Drop, Mood Drops

As expected, the counts continue to descend.

• Platelets: 12,000
• Hemoglobin: 7.9
• White Cells: 11.8

Although Dr. O promises that today is "bottom out" day, it's difficult not to wonder, the doubt exacerbated by the fatigue factor.

I was sound asleep by 8:30 last night, awakened by the nurse at 9:45 to be fed meds and be disconnected from Ms. I.V. Pole and, apart from the usual multiple, fluids-fed, pee-trips to the bathroom, I slept straight through almost to 7. This morning my butt is dragging.

It's gotta be all about the counts.

But, as the counts and energy drop, so too does the mental set. By day's end yesterday, discouragement predominated. All the nasty, niggly little discomforts were poking at me like rambunctious older kids piling on to jab and tickle a little guy.

Avoiding negative contemplation becomes harder. My physical world has been reduced to this room, and the occasional stroll down the hall. Ironically, my hour-to-hour care needs are few, giving me whole clumps of time to sit alone, the primary human contact being whatever complaints, crises or staff gatherings I hear drifting in from outside my door.

One's world shrinks. And with it, one's focus.

There's a book review in the NY Times this morning of Lionel Shriver’s new book, “So Much for That”, a novel centered on families with health issues, cancer in one character's case. The reviewer writes that Shriver...

manages to convey Glynis’s fear and bewilderment and isolation. What it’s like, especially as her illness progresses, and the chemo takes more and more of a toll on her body, to have to stop thinking about the future and simply focus on getting through that afternoon or evening. What it’s like to see others jogging or working out when it’s a struggle for her simply to walk up the stairs to her bedroom. Disasters reported in the morning newspaper, relatives’ difficulties and complaints, the weather outside that day are all equal to Glynis:

“There were no big things and little things anymore,” Ms. Shriver writes. “Aside from pain, which had assumed an elevated position of awesome sanctity, all matters were of the same importance.” 

No—I haven't reached this point. Yes—I remain terribly (absurdly?) optimistic. But—sometimes the demons gather round the door and try to sneak in, as happened when an in-depth discussion about hospice care for one of my neighbor patients broke out just outside my room.

How not to think, "Is that where I'm going?" One must make a concerted effort to shunt out the notion.

I still can. And do. Which is why the trip to Idaho takes on such importance. Because it symbolizes still being able to function, an opportunity to actually get out of this room (or, by extension for post-hospital release, out of the house) and interact in the world at large.

That is large.

MDS Becomes AML - Good Counts But Endless Treatments?

Business first (as my friends at Continental Airlines would say).

Today's counts:

• Platelets: 109,000
• Hemoglobin: 9.5
• White Cells: 6.1

Those are pretty good counts. With one more day of chemo on the schedule, the question, of course, is how low will they go? Ah, only time will tell.

Conferred with Dr. O this morning on how many of these consolidations we'd actually have to do. Basically, it sounds like we keep doing them until a morrow donor is found. So, chances are I'll be in here for two-week sessions, after two- or three-week home intervals, for the foreseeable future.

C'mon donors!

It is a bit strange to be building my life around indeterminate hospital visits. One would like some respite from this routine. Which is why the transplant, as it's the only chance for any kind of respite. But, somehow imagining myself doing these two-week stints for another three or four months can be onerous.

Especially since it's snowing outside, and I should be playing in it.

And, especially since I feel fine. I'm chipper, have good energy, am getting work done, and have been downright outgoing with all the staff. Much more outgoing than normal.

Probably the extroversion is generated by the socks.

The snow is complemented by e-mail alerts announcing great powder skiing everywhere from here to California. Which just makes me more determined than ever to get back out there.

"Think Snow" has always been a good mantra.

MDS Becomes AML - Chemotherapy Day 4

For yesterday, there are but two things to report:

• Platelets went back down from 10,000 to 4,000. More platelets were transfused.
• Energy level went to zilch, and most of the day was spent sleeping.

In truth, the day passes much more quickly when most of it is spent sleeping. There's no clock watching, wondering how to divert myself with the little energy I have, or flipping around trying to find a comfortable position in this bed.

I will say I'm reaching the point where I'm tired of being here. Of waking several times a night to pee (thanks to the constant chemo-drip) and re-remembering where I am and why. Of dreaming dreams in which I'm active and doing things and waking to re-realize that I'm not active and can't do anything.

I've experienced this before—back in 2001 when I was hospitalized for 3.5 weeks with a liver abscess—and I know it's a normal stage to pass through during an extended hospital stay. But, this stay looms much longer than did that one, or the one last April when all this began, and I'm having a hard time imagining how I'm going to feel two weeks out.

Guess it's best no to dwell on that.

Better to think longer term, and imagine myself back on the golf course come summer. To spend my day visualizing perfect golf swings wouldn't be such a bad thing, I imagine.

Fore!

MDS: Cells Acting Poorly

As I've said many times, part of the danger of doing a blog like this is that if the posts become less frequent, people begin to worry.

I'm still in-hospital, as the Brits say, running platelet counts that are lower than I thought possible (3,000). So, my energy level is equally low, and merely typing this short message strains my stamina.

Anyway, Penny has been circulating updates by e-mail. I've pasted the latest missive below. If, for some reason, you're not getting her emails and want to join her list, zap an email to me or her, or leave a comment saying you want to join the party.

Trying my best to stay awake.

The Daily Mitch Report

At the moment Mitch is resting a bit more comfortably.  The results are in from most of the tests with the infectious disease men finding nothing.  A second look at the bone marrow, however, was not reassuring.  There are preliminary evidences that the MDS has progressed into AML leukemia, but more staining and studying is needed to classify and type it.  Based on that, we’re probably looking at intensive chemotherapy, but that’s all we know now.  More details will be forthcoming.  The possibility of a bone marrow transplant is out there, but wouldn’t happen until after chemo even if he is a candidate.

More platelets and red blood cells were infused today and we think his temperature is more even.  Dr. O is making every effort to increase his platelet count and is starting prednisone and gamaglobulin which worked once before.

And he is eating a stale French crueler now, and that’s a very good sign.

MDS: Back in the USSR

Houston, we have a problem. The Great New Year's Eve Platelet Transfusion didn't take.

Yesterday—Sunday—we finally gave up on pretending I could muscle through another day. Not a hard decision since I'd reached a point where I couldn't even walk a flight of stairs.

So, here we are. Back in the hospital.

And no wonder I couldn't walk the stairs:

• Platelets: 4,000
• Hemoglobin: 7

The lowest numbers ever.

I was immediately put on a variety of IVs, and we spent the night transfusing one unit of platelets and two units of whole blood. This literally took all night, complemented with checking of vitals every 30 minutes.

No sleep was achieved.

We are now awaiting the blood culture results, along with the new, post-transfusion counts. Tonight we'll likely be enduring another bone marrow biopsy.

The bigger question, of course, is this: why would the counts drop so precipitously so quickly?

And, why did the platelet transfusion not take at all?

MDS: Sleeping the Day Away

Another day. Another day of napping.

Slept from 9:30 til 11:15 this morning. From noon-thirty til 2:15 this afternoon. And, am now about ready to go back to bed.

Was running a low-grade fever yesterday, which started me to worrying. Who the hell knows what a fever might mean with MDS? Whatever it might really mean (likely, nothing), it raises the specter of vulnerability that’s been looming since Day 1: susceptibility to getting sick.

Today, the fever’s gone. The sleep continues.

I take this napping predilection to be a sign of the low blood count. It’s not dissimilar to what I was feeling when I was in Minnesota with the MDS first manifesting itself.

That begs the question—how low is the actual count right now?

We know what it was on Monday. But, is it lower now? I see little signs that it might be (i.e., the site where the blood was taken on Monday shows a bruise instead of just disappearing). But, what’s a real concern and what’s my imagination?

And, at what point do you call the doctor? Especially given that the day after tomorrow is Christmas, and then it’s the weekend.

And, if you do call, which doctor do you call?

Well, this thing put me in the hospital for Easter. Maybe it’s on a pattern to flare up for Christian holidays. Silly? Yes. Still, a silly superstitious notioin seems as logical as anything else I’ve encountered in dealing with this disease.

Enough. I’m going back to bed.

MDS: Blood Count - How Low Can You Go?

Yesterday’s count:

• Platelets: 26,000

This number hasn’t been that low since I left the hospital last April.

Dr. O says it explains why I’ve been so tired during this past Shots Week. She also reminds me that the count goes down during Shots, then rebounds later.

But, I’m not pretending. This bothers me. A couple of week ago the count was 179,000. Now this?

Okay, okay—I’m probably spending too much time and energy ruminating about these numbers. They seem to go up and down like an elevator gone wild. And, yes, I know all too well that Shots Weeks make me feel like doo-doo.

But, if you’re stuck lying around on the couch for a week watching old movies and football game you don’t care about, it’s not difficult to overly focus on what’s bothering you.

Which leads to all kinds of bad mental games: i.e.

• fixating on your own mortality;
• wondering how your own body, seemingly doing just fine nine months ago, has become something rather delicate;
• trying to understand why TV advertising is so stupid.

But, the hardest part is trying to get your head around the idea that this routine—these week-long sessions of feeling terrible and being useless—are going to go on forever.

Whatever forever is.

So, if there are 10 or 20 more years to live, I’m going to feel like crap for one-quarter of the time?

Now there’s a great prospect for you.

But, as the pundits say—it beats the alternative.
                                       

MDS: Two Steps Forward - One Step Back

Well, judging from the last two weeks, it seems like we’ve taken two steps forward and one step back. Let’s start with yesterday’s blood counts:

• Hemoglobin: 12.4
• Platelets: 63,000

Needless to day, that platelet count is not what was expected or wanted, especially after some delightfully high counts in recent weeks.

And, there are other developments.

Small lumps began to appear all over me about a week ago. Unlike the inflammations already present on the lower legs, these have no color, nor do they hurt or itch. They’re just there.

• on the arms
• on the chest
• on the back
• on the beautiful tush.

I’m reminded of our beloved family dogs who’d grown old and developed fatty tumors.

So, now I’m an old dog. Just may have to change my name to Lumpy.

You remember Lumpy, yes? Wally Cleaver’s friend from Leave It To Beaver.

So, this Lumpy, accompanied by his wife in hopes that together they might actually remember the answers to their questions, ventured to Dr. O’s yesterday, reciting the following symptoms:

• fatigue
• headache
• some light-headedness
• fatigue
• body aches
• random shooting pains
• fatigue
• inflammations getting worse on the left leg, better on the right
• fatigue
• and, lumps.

Dr. O’s immediate diagnosis:

• these are likely random leukemic cells that are popping up (which is what the red inflammations contain, as well)

The reasons:

• The fatigue comes from the low platelet count;
• and both the lumps and fatigue result from too long between Vidaza and Depatoke treatments.

The concern:

• Why are they happening?
• Are the leukemic cells in the bone marrow?

With the drugs re-started as of yesterday, the hope is that the lumps and inflammations will abate somewhat. The fatigue should lessen in the next between-shots time.

And, the doc announced in no uncertain terms, the next down time will be shorter. From now on, we’re back to a strict one-week-on/three-weeks-off schedule.

Okay. I never really wanted to extend the period between shots. I’d much rather we do this on the same week every month. Much easier to keep track that way.

I’d like only five shots, not seven. Not likely in the foreseeable future.

And, if the lumps, etc., don’t improve, it’ll be another bone marrow biopsy.

Everyone seems to agree that this diagnosis explains the fatigue, lumps and other symptoms of the past week. I’m really too tired to be discouraged, even if the winter travel schedule will have to be adjusted to fit the meds schedule.

I’ll just sit passively, let ‘em shoot me up, and do my best to stay awake.

MDS: Good Blood Counts, Bad Fatigue

Another day. Another MDS anomaly.

Excellent blood counts. Extreme fatigue.

Yesterday's counts:

• Platelets: 130,000
• Hemoglobin: 12.4

Yesterday's energy level (on a scale of 1-100 with 1 being low): 12.

What is up with that?

The counts are right on for the third week after shots. But, this boy tossed in the towel at 4 p.m.—after napping for more than an hour at noon-45.

Some say it's all the driving to/from New Hampshire, but I'm not sure. I mean, whilst in NH there was at least one day with a healthy nap.

Beats me.

But, here I am, 4 a.m., wide awake, feeling fine, lots of energy, and typing this missive. Jeez—by noon I should be able to conquer the world.

So, the ongoing puzzlement continues.

• What's an MDS effect?
• What's a Vidaza side effect?
• What's a Depakote side effect?
• What's psychosomatic?
• What's just me and my lifetime sleepiness?
• What's in a name, Rose?

So many questions. So few answers. So much better stuff to think about.

Like the blueberry-raspberry scone I had for breakfast the other day. So good. Clearly—thankfully—the MDS hasn't affected my taste buds.

Skiing with MDS: Fear of Falling?

"Is your red cell platelet count good enough to let you ski?" asked my cousin-in-law, Dr. Bob.

Bob's an emergency room doc for whom I've a lot of respect as one who's on his game as a diagnostician with excellent broad medical knowledge. ER guys see it all, after all.

A question like that, coming from a genuine, licensed, for-real doctor, should've given me pause.

It didn't.

"I'm okay," I replied without hesitance, and perhaps a bit to much certainty. "Dr. MDS says 100,000 is the bottom line. As long as I'm above that, I'm okay."

He did say that, Dr. MDS.

But, if I acted like I was 100 percent sure, I was faking it. The season's first fall on the slopes looms ghostly in the back of my brain. I distinctly recall last season's first fall: a major crash on a steep slope in Jackson Hole in which I pretty sharply cracked the back of my head on hard ground. It was a real-life ad for helmet wearing (which I always do).

Head trauma ranks among the most salient watch-out-fors for those with low platelet counts. Smacking your head with low counts can, I understand, lead to brain hemorrhage. Even for guys like me whose head is most likely empty.

Now, my counts have been bottoming out at 112,000 to 120,000-ish, so I'm above Dr. MDS's bottom line. And, as time moves along between Shots Weeks, the count rises nicely, having gone as high as 179,000, which is higher than they were before MDS arrived.

Still, that little birdie of doubt tweets in the background. What if I really crash?

Well, it's like the old joke: "Doc, it hurts when I do this." "So, don't do that."

Crashing might not be an issue this weekend. There's little or no snow up in New England where I'm bound. But, in the long run, I guess I'd better implement Plan-A: stay upright, stupid.

MDS Thanksgiving Yields Good Blood Count?

It appears that holiday over-eating has no deleterious effect on the MDS blood count.

Yesterday's blood numbers:

• Platelets - 112,000
• Hemoglobin: 11.9

These digits are decently high for halfway through the non-shots period.

And, they seem to provide living proof that stuffing one's self with—among other things—stuffing (not to mention

• turkey
• macaroni and cheese
• myriad salads
• tofu veggie loaf
• several types of pie
• and ice cream;

and, the next day,

• a Thai feast
• several types of pie
• and frozen musk melon bars;

and, the next day

• lasagna
• ravioli
• spaghetti
• myriad salads
• several types of pie
• and ice cream)

does not harm the MDS patient. Indeed, it might do him good, since he doesn't consume much food during Shots Weeks.

I must consult Dr. O about recommending that Thanksgiving be staged more regularly so as to fatten the MDS-er to best be ready to face winter's cold. Maybe we have T-day about twice a month, say?

Dee-lish.

MDS: Surviving Another Week

Another week-plus of needles have passed.

I'm still standing.

Well, actually, I've been lying down most of the time, but metaphorically the standing bit still holds.

The blood counts continue to amaze and confuse. Yesterday:

• Platelets: 142,000
• Hemoglobin: 12.3

Why they continue to be this high, even during shots, means one of two things (or a combination of both):

• the Vidaza is working
• I'm really good at MDS.

Nice to be good at something.

Meanwhile, the effectiveness of the new medication added to the drug "cocktail"—Vidaza, Zofran, Depatoke—is hard to assess. The leg splotches look like they're fading a bit, but that could just be wishful thinking; seeing what I want to see.

We'll see.

MDS: Good Blood Counts Battle Bad Stomach

Ah, yes. The good news/bad news scenario continues.

The Good

Monday's blood counts (which I forgot to ask about on Monday):

• Hemoglobin: 21.1
• Platelets: 172,000

This is a bit startling, actually. The platelets have never been that high. Not even before all this nonsense began, when I was ostensibly a healthy boy.

And, since we waited this time an extra week between Vidaza treatments, I'm wondering if an extra week wouldn't always be a good thing. Perhaps there's an interval "tipping point" after which the counts begin to descend. Logical question on that one would be, what is that tipping point? Five weeks? Six? Ten to twelve years?

Mr. Science, here, realizes that only trial-and-error can answer that question. But, first, I'll have to ask it.

The Not-So-Good

The meds combo is wrecking havoc with the digestive tract.

• Shooting gas pains are firing there as if there's WWI trench-style warfare taking place.
• The region is bloating like a zeppelin is being inflated in the belly.
• And, gas is shooting out the back like an Atlas rocket at ignition and lift off.

Good thing I'm home alone this week.

Under normal circumstances, continuing this good/bad scenario continues, would raise fears in me that I'd drift into some schizoid state. Luckily, one of those battling battalions of pharmaceuticals (Depatoke) is designed to prevent just such a personality split.

Guess I'm safe from that consequence.

But, pity the fool who wanders within smelling distance of that Atlas launch pad.

MDS: Vidaza Postponed

Dr. O threw me a curve ball yesterday. Maybe it was more like a change-up, where the ball comes in so slowly that you swing so early and so hard that you almost fall over.

She postponed the Vidaza shots til next week.

You'd think this would make me happy. But, no. It just threw me off balance.

I'd been busy Sunday evening indulging myself in some pre-shots misery—you know, "Oh woe is me; in 48 hours I'm going to feel like crap"—and by yesterday morning I'd built up my resolution to once more sink into discomfort.

Plus, I'd kind of psyched myself up for the grand 5-shots sequence experiment, which will begin with the next series.

And, worse, I'd called last Thursday to confirm we were doing shots this week. We were, I was told.

So, I swallowed my Zofran pill, and drove to Dr. O's office. But, when I got there, she asked if it would be okay to do shots next week. She was going to be in NYC, you see, a few days this week.

Well, at least she asked, rather than announcing.

"We'll just check your blood today," she said.

Good news there:

• Platelets: 156,000
• Hemoglobin: 12.1

Still, I'm all aflutter. I'd made myself ready to be useless, and I'd taken the Zofran for nothing.

Now, here I am with my bowels semi-clogged from the Zofran, but the rest of me perfectly functional.

I mean, really.

I've lost my excuse for doing nothing this week.

Guess I'll just have to do something.

MDS: Today's Blood Counts & Other Good Stuff

Today, lots of good news na things I want to hear, starting with this week's blood counts:

• Hemoglobin: 12.6
• Platelets: 101,000

Dr. O was particularly pleased with the hemoglobin counts.

She also said we'd add an extra week between shots and, even better as far a I'm concerned, said it was alright with her to try doing five-shot sequences rather than seven.

Excellent.

Being shot-up from Monday-Friday only should provide a huge psychological lift. It should also give me 2-4 more functional day per month.

Let's just hope it works.

And . . . this just in:

The skin biopsy apparently show nothing new. Dr. D says if the bumps need to be treated, it's have to be done systemically, and that's Dr. O's call.

Now—enough with the medical stuff. Penny and I are off to London for a week. Pip-Pip, and all that.

MDS: Up for the Count

Yesterday's counts:

Platelets: 139,000
Hemoglobin: 12.6

I think I'm finally getting it. The counts go highest when I feel the worst—as the end of the shots cycle approaches. After that, they descend for a couple of weeks, then ascend for a couple of weeks.

Yes, it's true. It has taken me quite a while to figure this pattern out. But, as the mystery and thriller writers often remind us: things are best hidden in plain sight.

So, here I am:

• arms itching/hurting like crazy
• fatigue engulfing me
• legs still breaking out in mysterious bug-bite-ish bumps
• stomach in flux from liberally mixing Zofran and Metamucil
• my sweet tooth run amuck, as often happens when I feel poorly

and I'm showing some of the best counts since this all started.

Good thing I know I'll feel much better in a day or two. Otherwise this high-count/feeling-lousy phenomenon might be discomfiting.

Uh-huh.

MDS: Good Blood Count plus Questions Answered & Not

Yesterday's blood counts:

• Platelets: 119,000
• Hemoglobin: forgot to ask . . .

. . . or I didn't hear Dr. O when she said it.

I was too busy trying to remember all the questions I intended to ask.

Like?

• Did the thyroid function test results come back? (Answer: no; have to do that over again.)
• When she said the frequency of Vidaza shots could be decreased, did she mean after nine or 10 months total or in nine or 10 months? (Answer: nine or 10 months total; that's good.)
• Can shots be skipped in January, when I've two major trips scheduled nearly back-to-back? (Answer: we can be flexible.)
• Can flu shot(s) be done by her, and when? (Answer: none; despite my concerted effort to remember all the questions, I couldn't remember that one. Must ask today.)

So many questions. So little brain power.

A note about the thyroid: back in the first or second entry of this blog ("Backstory") it was noted that his entire adventure began with a pre-surgery MRI of my shoulder in which an unexplained "anomaly" appeared in the humerus bone. That led to scans of all kinds which, along the way, turned up hypothyroidism. That must be monitored every six months. I figured it could be done from Dr. O's office, since she's taking blood from me all the time. It can. But, the sample sent to the lab two weeks ago traveled with the wrong instructions. Thus, the do-over yesterday.

Still, the big picture continues to look pretty good. Getting that platelet count over 100,000 provides a huge psychological boost me for. Its carries a sub-text of "now you can do anything you can do"—ride your bike, knock your head against the wall, ski, eat your heart out, run, fall down the stairs, whatever.

And, I guess I've earned my certificate as a professional needle recipient. Four of them yesterday:

• finger prick for blood counts
• two for Vidaza
• one for thyroid.

Don't tell me I don't live an exotic and rewarding life.

MDS: Good Blood Counts & Good Vidaza News, too

Good news comes on the heels of another football Giants victory (3-0).

Yesterday's blood counts:

• Hemoglobin—12.2
• Platelets—97,000

I'm not personally thrilled with the 97,000 count because it remains below the magic 100,000 mark (magic for me, anyway, although I may be the only one). But, Dr. O was very pleased.

And, anyway, that count comes after Non-Shot Week Two, which means by the time we go back to shots next week, it'll likely be up some more.

The better news:

Dr. O has confabbed with Dr. MDS about the bone marrow biopsy report. Dr. MDS has declared that we should

• continue with the Vidaza treatments
• forget about a bone marrow transplant for the foreseeable future
• and plan for a reduction in Vidaza treatment frequency in either 10 months time or after a total of 10 months of treatment.

But, which is it? Ten months time or 10 months total? I'm not sure.

Okay—go ahead and accuse me, as my mother often did, of not listening. Or of not absorbing what I've been told. But, c'mon—I'd just spent an hour-plus in the waiting room, the joint was jumping with patients in all examining and treatment rooms, and, after all, Dr. O speaks with a pretty strong Indian accent.

Those are my excuses.

No matter. Either in 10 months or after 10 months total, we're talking about shots only every four or five weeks instead of every three.

I'll take that.