A note on capitalization: I've noticed that I'm not at all consistent in capitalization of blog post titles. I'll try to at least be slightly conscious of that in the future, but I do try to be consistent in capitalizing (or not) drug names: brand names (Ninaro, Revlimid, Darzalex, etc.) are capitalized, generic names (ixazomib, lenalidomide, daratumumab) are not. I'm convinced that pharma companies have committees whose sole job is to make generic names that are both unpronounceable and at best only vaguely related to molecular function, but that's not why we're here. We're here to bury the lede. Done!
As I have continued to enjoy good health, 3 years out from my second stem cell transplant, my complaints have less to do with multiple myeloma and more to do with being a 60 year old guy with some issues. The latter is a far less compelling reason to be blogging, it seems to me, than the former. Nevertheless I will persist and sometimes the one thing comes around to the other in a way that may be trying to tell us something.
My tears are toxic. I hardly have to say that the temptation to make this into some kind of metaphor is overwhelming, but I'm not going there.
For many years I've had rosacea, a pretty common skin condition that I've always considered (with no particular evidence) a long-term consequence of the bad acne I had as an adolescent/young adult. Over the years it would wax and wane, and I had been taking low-dose doxycycline to control the rosacea for some years before I was diagnosed with MM. It worked pretty well. After the stem cell transplants, I resumed doxycycline for a year as prophylaxis against bacterial infections. Two years ago, the docs decided I didn't need the prophylaxis any more, and I figured I could probably give my liver a break at the expense of my vanity, so I quit taking doxycycline. I replaced it with some topical stuff (metronidazole, azelaic acid) that sometimes seemed to help.
Over time, the redness and lesions increased in number and frequency. And a pattern appeared. Lines ran down my cheeks on either side of my nose, and frequently around the base of my nose. When things got bad, they'd radiate outward, but the focus was always around my nose. Meanwhile, my eyes were tearing more often and more regularly than ever before. Tears seemed to be implicated, because the rosacea was occurring right along the paths down which the tears ran, both outside and inside my nose. Often there's a clear pattern running right from the tear ducts down to the corners of my mouth.
Chemotherapy agents are absorbed into all kinds of tissues, processed in various ways, and emerge via bodily fluids of one kind or another. Mostly it's going to be urine or feces, or blood if you're bleeding, but sweat, mucus, semen, and tears also can carry the chemo agents or their downstream products. It turns out that both Revlimid and especially Ninlaro are associated with rashes and skin lesions, and excessive tearing is a common side effect of proteasome inhibitors (like Ninlaro). So I think my excessive tears, carrying enough residual Ninlaro and Revlimid to cause my already-reactive skin to become inflamed, stimulate the latter-day "rosacea." The topical treatments I've been using, while they allegedly have some anti-inflammatory effects, are probably not up to the task of dealing with this level of inflammation, so I'm going to try steroids like cortisone for a while. The early results are encouraging.
As for the metaphor, it would be way over the top. I'm as given to tears as the next guy (maybe more so), especially when they ramp up the music at the end of the movie--being fully aware that I am being cruelly manipulated makes me want to cry--but I am not in any way despondent about my circumstances, as I hope this blog makes clear. That's subject to change, of course, but I now have an objective reason to avoid tears, even if I may not be able to do much to stop them.
