Heaviest snowfall in Florence in the last 50 years…

December 19, 2010 / / 7 Comments

Stefano did make it home after all on Friday night, the night of the heaviest snowfall on record (in Florence) in the last 50 years.

First, though, he went out for dinner near his office together with a group of stranded colleagues. He managed to snag a hotel room, but by the time he’d finished dinner, he noticed that the streets were clear enough, so he called me to tell me he was on his way home.

He arrived after 1 AM…with scary stories of city buses stuck in the middle of the road, together with abandoned vehicles and motorbikes…

My neighborhood got about 10 inches of snow, more or less. It is a bit colder here than in the center of the city. Today, that is, two full days after the storm, we are still snowed in.

No ploughs have come here to clear away the snow, which means that I cannot move my car. The same is true for most of my neighbors, who don’t have snow tires or four-wheel drive…Our street is still filled with snow…amazing. Some melted today…not enough, though…

At any rate, yesterday morning Stefano and I put on our snow attire and set off on a walk around the neighborhood.It was a beautiful sunny day, as you can see.

What we really wanted to do, actually, was try to get up to the Piazzale Michelangelo, which would have offered us a unique panoramic view of the city, but we soon realized that there were no buses in our neighborhood. Not one. I later heard on the news that only about 30% of the bus service in Florence had been restored.

As a result, much to our chagrin, we have no panoramic photos of Florence under the snow…! Uffaaa…

But we did take a nice long walk in the snow, and here are some of the photos I took, including one of a pine tree that had collapsed onto the roof of a row house…not too far from where we live.

And then there is one of my Piccolo staring at the snow from my study window…

And one that shows an eerily deserted street in my neighborhood…This is VERY unusual for a busy Saturday morning. All the cars in these photos are parked…

All this snow threatened to put a bit of a damper on a friend’s plans. For weeks now she had been planning to hold her annual Xmas card-playing party on December 18th…Yesterday!

For the above-stated reasons, I couldn’t use my car, and the same was true of other friends. One of my close friends was able to free her car and started to drive over to pick me up…but she ended up being stranded on an icy street and barely managed to pull over and park her car. She was about halfway to my house…

For once, I was happy that we all have cell phones! 🙂

In the end, another friend and I met up near my house and set off together on snow-covered, rather icy sidewalks…carefully carrying about a ton of my homemade cookies (the ones you see in the photo are a few of the leftovers). We trudged on for about a kilometer before getting picked up by yet another friend who has a four-wheel drive vehicle and had picked up my stranded friend on the way…

What an adventure…

We all finally gathered together, safe and sound and laughing, at my friend’s house. We began playing cards a bit later than planned and also decided to end our evening earlier than usual, right after dinner, so that we could all make it safely back home.

As it was, even with his powerful four-wheel drive vehicle, my friend wasn’t able to drive up the slight hill leading to my street, so I had to walk part of the way home last night, which turned out to be absolutely wonderful…

So quiet…So peaceful…A sort of mist had arisen, and it enveloped me like a reassuring blanket…Oh, I am not very good with words, but I can tell you that I felt much like Lucy must have felt when she first entered the seemingly peaceful, snowy world of Narnia…

It was magical…

A magical end to an adventurous, and fun!, evening with my friends…

A winter wonderland…

December 17, 2010 / / 5 Comments

I found out last night that snow was predicted today for Florence. But when I woke up, yes, it was brrr cold outside and cloudy, but no, no snow. Disappointed not to be snowed in, I fed the cats, got ready and went off to work.

Luckily, as it turns out!, one of my students was too busy to have a lesson, so I was able to leave work an hour early. After making a brief stop at the farmer’s cooperative to get some veggies and whatnot, I headed home.

Not a moment too soon…

As I was parking my car, snow began falling. An hour later, my car had disappeared under a white blanket…

It has been snowing steadily all afternoon. And now it’s early evening. It seems to me that there are several inches of snow out there. About ten, if I am not mistaken…

It’s beautiful, really beautiful, and I took heaps of photos as long as there was enough light…But I just communicated with Stefano via Messenger, and he appears to be stuck at work. Seriously stuck…Bummer!

He told me that, once the serious snow began falling, one of his colleagues, who lives outside of the city, left the office in mid afternoon and ended up getting completely blocked in traffic. After two hours he had managed to drive only about a kilometer from the office…

I don’t have an update on him yet…But I imagine, from what I have been reading online, that he is still stuck in traffic somewhere in Florence…

Stefano’s car doesn’t have four-wheel drive or snow tires. So right now it looks as though he may be spending the night in a hotel near his office. The hotel is so close that he can walk there. This makes sense to me, since the authorities are telling all Florentines to stay put where they are, if possible…

The highways have been shut…Oh, I just read online that the airports of Pisa and Florence have also been shut…Wow. I cannot remember a snowfall like this in Florence…ever…

I just peered out my study window…The snow is still falling heavily and still accumulating…And all the neighbordhood children are out playing…So cute…

But what a mess.

A beautiful mess…

Photo 1. View from my back terrace, early afternoon. Photo 2. My Myeloma buddy, Honey, safe and snug under my hat, enjoying the view from my study (other side of the house; you can see the top of our front gate, lower left hand corner); Photo 3. A male blackcap pecking at a persimmon in our neighbor’s yard. Photos 4 and 5. Details of my magnolia tree…again, early afternoon (the accumulation has at least doubled since then…)…

Wowsie!

Around the corner…

December 16, 2010 / / 3 Comments

It’s December 16 today, and I haven’t even begun my usual Xmas cookie baking marathon (= a tradition that I carry on mainly because I have always loved making and baking cookies/sweets, and also because it makes my students and friends so happy…)…sooo, yikes! I am way behind schedule. However, in my defense, lots of things have been going on…The following will give you an idea…

My in-laws are not doing very well. A lot has to do with depression, unfortunately. It’s a difficult time for the family…
On Sunday, our 10-year-old washing machine broke…smack in the middle of a rinse cycle…lovely…peachy…sweet (not). The technician told us it wasn’t worth repairing. We ordered a new machine (uffa, this is going to take an unexpected chunk out of our household budget…), but it won’t be delivered until next, get this!!!, next Thursday. Our pile of dirty laundry will be up to the ceiling by then…sigh!
My cold (see my December 9th post) finally turned into a not-so-bad-but-still-a-bit-annoying case of bronchitis. That came as no surprise, since my immune system is feisty, yes, but almost non-existent. This temporary setback didn’t stop me, however, from being as active, or almost as active!, as usual…going out, going to work and so on…and I am almost 100% fine now. So, no big deal, but I haven’t really felt like pulling out my rolling pin…
I have also had a lot of work in this period, which is good, of course…But it does keep me from doing research, testing new cookie recipes and whatnot… 😉

But hey, c’mon, Xmas is around the corner…and it has always been one of my favorite holidays. I have to admit that I am not in the festive mood quite yet…but I am getting there. One of my very BEST friends in the universe is going to be spending New Year’s Eve in Florence…So Stefano and I invited him and his family to stay with us. This will be so much fun!

R and I have one of those rare friendships (I have actually written about him before…)…I mean, all we need to do is take one look at each other, and we start laughing until we are literally rolling on the floor in agony, begging the other to stop. Our spouses are used to it by now, but in the beginning they looked at us as though we had lost our minds…hehe. I don’t think I have ever laughed with anyone, not even with Stefano, the way I laugh with R…Sometimes for a reason, sometimes…just because…

Therefore, this is shaping up to being a “fun” holiday, in spite of, well, a few problems…

Speaking of fun, this is a photo I took yesterday of Piccolo, my 7-year-old boy, intently watching a video of Maru, the very entertaining Japanese cat whose many videos are posted on YouTube. Maru also his own website. Check out a few, as follows:

http://goo.gl/65Xb6 (=The one that Piccolo is watching in the photo…)

http://goo.gl/6jcpL (Just plain cute, with some funny, typical cat stuff…)

If you have never watched a Maru video before, have a look at the “box” one that made him famous: http://goo.gl/P8d1t

Why poke a sleeping tiger?

December 13, 2010 / / 4 Comments

A friend (thank you!) sent me a case study last week. You can view the abstract here: http://goo.gl/baWTd It actually turns out to be quite a bit more than a case study, as we will see…

Without further ado, let’s hop right into the full study. The central character, in this first part, is a healthy 72-year-old white man with smoldering myeloma diagnosed 6 months ago, a man who had an 11-year history of MGUS. Coincidentally, his MGUS was diagnosed in 1999, which is the year of my own MGUS diagnosis…

In 2009, he had a bone marrow biopsy (=BMB) that revealed 40 % plasma cells, and his free light chains ratio was 2.44. He also had a test called fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT), which showed a mild FDG uptake in the sacrum. The result, however, was: no bone lesions.

Two months later, during a follow-up visit, his M-protein had increased from 4.4 g/dL to 4.9. Since he complained of lower back pain located in the sacrum and left iliac bone areas, he had a second FDG PET/CT. This time, focal lesions were found in those two areas…

Now, okay, I know that I have a suspicious nature, but doesn’t it seem a bit too coincidental that this patient had TWO of these tests in what seems to me to be an amazingly short period (TWO months)…and the second FDG PET/CT revealed focal lesions? These, by the way, can be benign, I read. Well, forget it, let’s keep going…

You can read some details about FDG PET/CTs here: http://goo.gl/gEkdM Scroll down to “Operation,” where you can read that a short-lived radioactive tracer isotope mixed with FDG, which is an analogue of glucose (hmmm and double-hmmm) is injected into the patient’s bloodstream…After about an hour, this tracer finds its way into the tissues of interest…

Now scroll down to the “Safety” paragraph. Yikes! Now, I don’t have a whole lot of time to do research on the FDG PET/CT topic today, but I just read that it is essential to avoid unnecessary and repetitive imaging or excessive re-staging in patients who may have already been imaged previously at the same or other locations (see: http://goo.gl/hIctB).

Food for thought. Or not…

At any rate, getting back to our case study, the patient was diagnosed with multiple myeloma and began treatment with lenalidomide/dexamethasone with partial response after 3 cycles. The authors don’t mention him again…

The rest of the study is an interesting analysis of previous “progression” studies, beginning with those showing how active myeloma is preceded by MGUS and SMM. We have already discussed this topic, so there is no need for me to summarize this part.

Here is something for us to chew on: the change from MGUS to active myeloma is not sudden, the authors say. Rather, several overlapping oncogenic events within plasma cells and the marrow microenvironment accumulate from normal plasma cells through precursor disease to advanced multiple myeloma. These cellular changes can be seen in almost all MGUS patients, and from MGUS onward, and include hyperdiploidy and primary immunoglobulin translocations at the 14q32 locus. Cyclin D dysregulation is also mentioned as a very common early event.

Next, we get into a rather long overview of risk criteria (skipskipskip)…notably, the Mayo Clinic criteria and that grrrrr! outrageous Spanish SMM chemo study. Interestingly, the authors prefer the Mayo Clinic system, which is more readily available and allows the clinician to spare patients with low-risk MGUS from undergoing a bone marrow biopsy. Couldn’t agree more!

Then we get to the “Imaging” part: In current practice, imaging in MGUS and smoldering myeloma fulfills 2 roles: ruling out progression and monitoring for early complications.

The authors point out that the skeletal survey is relatively insensitive and nonspecific for detecting myeloma-related bone disease (=the lesions have to be quite evident to be picked up by an x-ray)…but it also only requires a relatively small dose of radiation to perform on the whole body.

They then describe the Whole-body low-dose multidetector row CT, which can detect lesions smaller than 5 mm. This test has negative consequences, though = heaps of radiation. Okay, neeeext!

Whole-body MRIs are more effective than skeletal surveys, they say. That reminds me–I have had a few MRIs (only of my spine), but without any contrast liquid…Let’s never forget that gadolinium, frequently used as a contrast agent, makes MM cells proliferate…!!!

Now for the “Clinical Management” part. MGUS patients apparently have a higher risk than healthy folks of developing thrombosis and fractures. I have read about those studies, but have actually not…read them (to my recollection). Concerning thrombosis, the study to read is: http://goo.gl/Be0SC. For fractures, see http://goo.gl/0qRKP The full texts are available online…for free, which is helpful. (You might have to click on “manual download.”)

Going on…ah, here is an interesting statement: Treatment trials for MGUS are problematic, as patients are relatively healthy and most patients have a low lifetime risk of progression, especially when other causes of death are taken into account. Thus, an ideal treatment would be nontoxic and directed toward patients with high risk of progression. “Nontoxic,” huh? Hmmm, I just might have a few ideas…! Hehe.

The subsequent paragraph is not as upbeat. It concerns my own condition, smoldering myeloma: Early treatment strategies for smoldering myeloma are particularly attractive as the rate of progression to multiple myeloma is quite high. Okay, while these strategies might appear “attractive,” the authors add that all the SMM chemo clinical trials have failed so far. Indeed, if anything, the smoldering patients in these studies were worse off than when they started…

I was rather surprised to read the authors’ words of caution concerning that SMM Spanish study: […] it is unknown whether treating patients with smoldering myeloma improves overall survival or quality of life, as such data are not yet available. Well, you already know what I think about that infamous study…about all the toxicities that these poor patients are enduring…Talk about unnecessary…to say the least…! Uffa! Okay, Margaret, enough…

The authors conclude that Aimed at preventing progression, smoldering myeloma could be treated as a chronic disease, with relatively benign maintenance therapy used to control the malignant clone. Alternately, highly active therapy could be used with the goal of cure, although this may prove challenging in the context of current treatment options. However, to responsibly perform any such trial, well-designed correlative studies should be performed to assess the theoretical possibility of unexpected long-term adverse events or selecting for more aggressive disease. Well, I like the bit about “benign maintenance therapy”…In Margaret’s world, curcumin and a few other things fall into that category…

The study ends with a few notes on “future directions.” And read this: even smoldering patients at the highest risk for progression, with detectable disease on advanced imaging will likely become candidates for early treatment strategies, likely with agents not currently available in the clinic. “With agents not currently available…” Well, you don’t have to read between the lines: that sentence rules out the Spanish SMM study…

And hey!, I didn’t say it…Two researchers from the Center for Cancer Research at the National Cancer Institute did…so there.

The above-quoted paragraph continues (and this is how the study ends): However, such trials should be cautiously designed to assess progression-free and overall survival, as high response rates may not correlate with survival and prolonged stable disease may provide key benefit to patients.

PRECISELY. ESATTAMENTE. Let’s focus on prolonged stable disease…

It appears clear (to me, anyway) that asymptomatic smoldering patients should NOT undergo any conventional treatment, even if they are in a high-risk category. Yes, of course that is just my opinion. However, based on the Mayo Clinic criteria, I am in the highest-risk-for-progression group. So this evening I am taking a stance, once and for all: I would rather go bungee jumping (yikessss!) every single day than have chemo at this point. It’s too bloody risky…

Paraphrasing my hero, Prof. Aggarwal (I don’t recall the exact quote, sorry, and have to go prepare dinner now…), it’s not really such a good idea to go and poke a sleeping tiger…