Off topic (sort of)

So I'm going to have to go see the dentist, I guess. It's not that I have any tooth pain, though the gums are receding a bit--it's just that a good cleaning would be nice, as long as the hygienist doesn't get overly aggressive with the floss. I remember describing a session ~20 years ago as having been "flossed within an inch of my life" and that might even be almost true now if it happened again. Also dentists seem to hate Zometa (a bisphosphonate that helps keep my bones from eroding) because it can cause horrible jaw necrosis if too much is given for too long. So I will have some explaining to do, but I would like to get the teeth cleaned.

The point is that even last year, going to the dentist seemed silly and pointless. I've been certain that, whatever their flaws, my teeth were going to outlast the rest of me. You could argue that maybe this reflects my bias as a former mortuary site archaeologist (trust me, really they do keep very well, for thousands of years or more, depending on geological conditions). In fact, everything except the cancer faded into the background, especially anything health-related.

My heart, for example. Or my arteries and their contents. It seems that my cholesterol (specifically low-density lipoprotein, or LDL) has been creeping upwards in the last few years. Last year I would not have given it a second thought. This year, with things looking good, it's worth at least a little bit of thought. And there's an interesting complication with myeloma: it seems that the tumor cells themselves consume LDL, so that people with advanced MM tend to have very low LDL, and low LDL is correlated with worse survival (if you have MM). So it might be that my rising LDL is another sign of the myeloma being under control. It's probably not only that, though: high LDL could kill me all by itself.

I raised the question of taking a statin with my hematologist a couple of weeks ago, because I've read a couple of papers indicating that statins reduce the risk of death in myeloma patients, results that reinforce the idea that the tumors are competing for LDL. In fact, 10 years ago there was a lot of research built around the idea of using statins to treat myeloma--which mostly dried up when other drugs such as thalidomide and proteasome inhibitors emerged as game-changing therapies.

So, the question is simple: should I add a statin to the already-impressive list of medications? The answer is not so simple. The U.S. Preventive Services Task Force (USPTF) guidelines say that  I should have a 10% chance of dying from heart disease or stroke in the next 10 years in order to make low-dose statins worth bothering with. They calculate my risk at 5.5%, not taking the myeloma into account, of course. So really the absolute risk for me of dying from heart disease or stroke in the next 10 years is much smaller than 5.5% (because the risk of dying from myeloma is so large [~ 100%] , the risk of dying from anything else has to shrink). But will the statins reduce my risk of dying of myeloma in the next 10 years? Probably not nearly as much as just keeping up with the many new myeloma drugs that have become available in the last few years.

But I will try to work at keeping the LDL down with diet and exercise, at least. Apparently the tumors like cheeseburgers and fries. I don't eat a lot of cheeseburgers, but maybe I could cut down on the fries.