2004 Toyota SiennaI had an appointment with my Pinehurst oncologist this morning. I called in to say I wouldn’t make it, and they gave me a later appointment time. I’ll be seeing Dr. R. in Boston in less than a week, and I’ll have an appointment with Dr. O. in Chapel Hill after I get back from Boston.

Yesterday was kind of a fun day. I got a Toyota Sienna. It’s a nice van. I got the van so I could take my dog places with me. She was never able to get herself into the back seat of my car. I always had to lift her. I don’t lift anything over 25 lbs anymore, so no more car rides. She doesn’t have trouble stepping up into a van though, so this problem is solved. I hope to take lots of trips over the next few years. I went many years without taking any vacations, and am going to catch up now.

I have an appointment for acupuncture later today. I kind of lost interest in a lot of things over the last 3-4 weeks. I need to get back to doing some of the things that helped me so much in the beginning, like acupuncture and guided visual imagery.


Jon Siegel is going to be having his stem cell transplant at the Brigham & Women’s Hospital when I’m in Boston, which is right next to the Dana-Farber Cancer Institute, so I’m going to see if I can stop by to say hello. He said he could have visitors, which is nice!

Dex misery

Monday was my dex day (down to 40mg once a week now). I was able to fall alseep at midnight, which was great! But I was awake at 3 am. This may have been due to two factors. Dex causes sleeplessnes and it also causes (in me) really severe indigestion. It’s known to cause ulcers in long term use. My friends are Xanax, Mylanta and OTC Zantac. Sometimes Alka-Seltzer helps, but I have to limit my use of aspirin products since I take some every day for blood thinning.

Dr. Orlowski

Here’s some information about Dr. Orlowski at UNC:

Robert Z. Orlowski, MD, PhD
Assistant Professor, Department of Medicine, Division of Hematology and Oncology
Molecular Therapeutics Program; Clinical Research Program

Clinical Interests
Dr. Orlowski’s clinical areas of focus include the treatment of patients with hematologic malignancies, including multiple myeloma, acute and chronic leukemias, and Hodgkin’s and non-Hodgkin’s lymphomas, and also Phase I clinical trials, which apply novel agents or drug
combinations to the therapy of patients with refractory malignancies.

Research Interests
The research being pursued by members of our laboratory focuses on three goals:

1.) To evaluate the mechanisms by which inhibitors of the multicatalytic proteinase complex (proteasome) induce apoptosis, with a focus on human malignancies in which the oncogene c-myc is involved, such as Burkitt’s lymphoma and breast cancer. Work performed in our laboratory has revealed that proteasome inhibitor-mediated programmed cell death occurs in part through effects on the p44/42 mitogen-activated protein kinase pathway. Current and future studies will evaluate other signal transduction pathways involved in this process, including the c-Jun-N-terminal kinase (JNK).

2.) To determine the potential therapeutic benefit of modulation of proteasome activity for patients with refractory malignancies. Our previous work in this field has included a Phase I clinical trial of the proteasome inhibitor PS-341 in patients with hematologic malignancies, which was the first study to show the activity of this agent in patients with multiple myeloma. Based on an understanding of the mechanisms of action of other chemotherapeutic drugs on cell death and survival associated pathways, novel drug regimens will be evaluated for their anti-tumor efficacy, and those which prove promising will be translated into clinical trials. This approach is exemplified by a current trial of the combination of PS-341 with pegylated liposomal doxorubicin (Doxil).

3.) To examine the potential impact of dietary agents which influence apoptosis-associated signal transduction pathways on the efficacy of cancer chemotherapy. This line of investigation led to our previous demonstration that the dietary additive curcumin can inhibit chemotherapy-mediated apoptosis, generation of reactive oxygen species, activation of JNK, and mitochondrial release of cytochrome c in both in vitro and in vivo models of human breast cancer. Future studies will evaluate the possibility that other factors may also inhibit, or in some cases promote, the anti-tumor efficacy of chemotherapeutic drugs.

Yale University Ph.D. 1990 Molecular Biophysics and Biochemistry
Yale University Ph.D. 1990 Medicine

Board Certifications
Internal Medicine 1994
Oncology 1997

Small, G.W., Chou, T.-Y., Dang, C.V., and Orlowski, R.Z. Evidence for involvement of calpain in c?Myc proteolysis in vivo. Arch. Biochem. Biophys. 400: 151-161, 2002.

Somasundaram, S., Edmund, N.A., Moore, D.T., Small, G.W., Shi, Y.-Y., and Orlowski, R.Z. Dietary curcumin inhibits chemotherapy?induced apoptosis in models of human breast cancer. Cancer Res. 62: -, 2002. In press.

Orlowski, R.Z., Small, G.W., and Shi, Y.Y. Evidence that inhibition of p44/42 mitogen activated protein kinase signaling is a factor in proteasome inhibitor-mediated apoptosis. J. Biol. Chem. In press.


I just wanted to post a reminder to always check your medications prior to administration. It’s not impossible for mistakes to be made. Thanks to MM list members, I have made it a habit to check everything. Recently I had an Aredia infusion that was ordered to be given over 4 hours. The hospital pharmacy typed 3 hours on the label. I told the nurse, and she went and checked the order. Sure enough, a mistake had been made and she adjusted the flow accordingly.

Something that’s really nice to have is ePocrates on your PDA. I was able to check drug interaction precautions between Thalomid and Zometa vs Aredia. None listed for Aredia, but there’s a warning for Zometa, as we know.


I have all my xray/MRI/CT scan films in my possession to take along with me to my appointments with various doctors. Today I pulled out some xrays done in March in Pinehurst to see what I could see. I was just curious. I have a great deal of pain in the right sacral area, and I wanted to look at that. What caught my eye was a film of the right humerus. There were red circles around 2 dark spots on the bone. I compared them to text book images, and they sure do look like small lesions. I’ll consult with Dr. Richardson about these when I see him in less than 2 weeks in Boston at the Dana-Farber Cancer Institute. In any case, I was not told about the possibility that I may have some lesions. This is one reason I am changing local oncologists. I have to beg for information! When I asked the Dr. about the xrays back in March, he said something like, “I don’t remember seeing anything unusual.” I should have asked to him to go check for sure, but just accepted that as an all clear. I really can’t assume anything. Every test has to be followed up on! I’ll be getting a copy of my file to take with me to DFCI in Boston and to Dr. Orlowski at UNC, so I’ll get to see everything that’s been withheld from me so far.


If you’re reading this and don’t have cancer, I recommend the AFLAC cancer policy. I don’t know what possessed me to get this for myself, but I’m glad I did. AFLAC pays money to help cover costs by sending checks for chemo and trips you might make to get a second opinion. So far, they have covered my bone marrow biopsy, each month of Zometa/Aredia, Thalomid and dex. It doesn’t pay for everything, but is intended to provide supplemental coverage. It’s paid directly to you, not the healthcare provider. For example, each month I have received a check for $300 for my Thalomid rxes. I have also received $300 for each of my Zometa infusions. Whatever I paid in was well worth it. I hope I don’t ever need it, but I also bought the long term care policy (AKA nursing home insurance).

My AFLAC rep’s sister has MM.

AFLAC’s web site