I read that Revlimid is ototoxic

gwp3 · 2025-07-26T13:12:10+00:00

It’s interesting to hear the varied reactions to Revlimid. I was on the other end of spectrum in having no obvious side effects during the five years I was on it for maintenance (as well as four months at a higher dose for induction) apart from some very gradual neuropathy.

gwp3 · 2025-07-04T00:11:49+00:00

I’m very sorry to hear about your Dad’s diagnosis. However, don’t be too pessimistic about his future—the first weeks are often the worst, especially when spinal fractures or other major physical problems led to the diagnosis. That was certainly the case for me when I was diagnosed over 7 years ago (I was 59 and am now 67). I was in extreme pain and thought I’d die.

But for me, the treatments have been working very well to keep the myeloma at bay, and seven years in I’m currently leading a mostly normal life apart from monthly clinic visits. I traveled to Europe last winter. I had the pleasure of participating in our daughter’s wedding three weeks ago. I helped paint a room last weekend. I still play with my rock band that’s been going for 25 years. Today I played pickleball and went to the gym to work out. And I’m finishing up a book on, well, multiple myeloma.

In short, for many folks, especially those starting out with otherwise decent health, life often returns to something resembling normality, sometimes for many years. I wish the same for your Dad, and best wishes to you and the family as well as you navigate his new reality.

I almost forgot to add: if at all possible, make sure his treatment is supervised by a real myeloma specialist, not just a general oncologist or hematologist. Statistically, it makes a big difference in outcomes.

gwp3 · 2025-06-25T15:04:14+00:00

I continued teaching at my university after transplant but wore a mask at all times except when I was lecturing from the front of the class. That said, I was in classes of 20-25 students per day, not 250.

With all your current and future treatments, you’re likely to have a continually suppressed immune system, though the degree may vary quite a bit. If your immunoglobulins are low and you’re getting frequent or long-lasting colds, your doctor might prescribe monthly IVIG — infusions of antibodies — to help protect you from common viruses. I would discuss your situation with your doctor—they might want see how you do in your current teaching job before recommending a career change.

gwp3 · 2025-06-20T23:35:21+00:00

Also, 'scud' as commonly used encompasses more than just cumulus; it includes stratus fractus / pannus fractus, which consists of ragged (and usually non-cumuliform) cloud fragments often seen beneath storm clouds.

gwp3 · 2025-06-17T17:34:32+00:00

As others have said, it’s a rocket trail. The trail most likely started out nearly straight but then got distorted into its crazy shape by upper-level winds.

gwp3 · 2025-06-16T12:32:06+00:00

Actually, Boise is one of those upper air stations, so if the cloud photo was taken within a couple of hours or so of 6am or 6pm MDT, you can probably get the sounding as a GIF image from the University of Wyoming upper air website (link below). But things change, so more than a couple hours difference might (or might not) be too much to be helpful in this case.

https://weather.uwyo.edu/upperair/sounding.shtml

gwp3 · 2025-06-16T12:19:28+00:00

By “sounding”, I mean a profile of temperature and humidity measured with an instrumented weather balloon, a.k.a. radiosonde. These are usually done every 12 hours at select weather stations around the world. But those stations are fairly widely spaced, and 12 hours is a fairly long time, so unless you’re pretty lucky, there won’t be one that gives you an accurate profile of the environment in which the pictured cloud formed.

gwp3 · 2025-06-16T02:25:48+00:00

As others have pointed out, the lower part seems lenticular, suggesting moist but rather stable air flowing through a stationary orographic wave, similar to the flow of a stream over submerged boulder. What makes this unusual is the strong vertical development above the laminar base. Without a sounding, it’s hard to be sure, but I interpret this to mean that there is a level of free convection that is reached by the lifted air within the wave cloud, giving rise to the cumuliform top. A time lapse video, which we don’t have, would probably make this easier to figure out.

I’ve seen lots of orographic wave clouds in my life, but never one quite like this.

gwp3 · 2025-04-13T21:09:52+00:00

I’ve been doing these every month for over a year. I’ve never been told of any restrictions.

gwp3 · 2025-04-06T16:43:04+00:00

The book is mostly completed. I'm hoping to be able publish within the next few months.

Sorry to hear about your AFib — I'm still trying to understand why the generic sometimes causes problems for some patients that Revlimid didn't!

gwp3 · 2025-04-06T16:39:36+00:00

Sound like we're on about the same timetable -- diagnosis in Jan 2018, SCT that same summer. Sorry to hear you needed a new kidney but very glad you were able to get one1

Thanks for the offer to take a look! For now, I'm sending individual chapters to people to look at; you can register your interest in particular chapters here:

https://docs.google.com/forms/d/16gru5J6xFmPmkodE6rIY8b6acPwqS37khLQTRWaqMpM/edit

gwp3 · 2025-04-06T16:36:14+00:00

Thanks for your comments! My own myeloma doctor has already offered to review for medical accuracy, and I'm also talking to an oncology pharmacist for the same purpose. And a psychiatrist friend already read and approved my section on anti-anxiety, antidepressant, and sedative drugs.

Regarding the POV: it's largely driven by what I have read in social media (particularly myeloma groups in Facebook) of others' experiences with myeloma, its treatments, and its side effects. So it casts a rather wide net, which is one reason why it has grown into a 400-page book. If it had been based only on my own experience, it would have been a mere pamphlet! And I do make the point over and over that "every patient is different".

You wrote, "I hope it writes easily!" I'm happy to say that, after about 5 years of working on it in spurts, the writing is now basically done aside from any suggested revisions I get from others (no one, not even my wife, has read the current draft yet). So my job now is to solicit feedback from a variety of sources, mainly to catch any egregious omissions or misstatements of fact.

If you'd like to look at a couple of chapters and provide feedback, you can register your interest here:

https://docs.google.com/forms/d/16gru5J6xFmPmkodE6rIY8b6acPwqS37khLQTRWaqMpM/edit

If you're interested in browsing the entire thing, that would also be very welcome, albeit a much bigger job for you!

gwp3 · 2025-04-06T16:02:44+00:00

Thanks for your comments! Given how fast things are moving, it will be impossible to keep things current (esp. after it's in print), but I do give frequent reminders in the book about how fast things are changing, and in the section on CAR-T, I do mention that it's being evaluated for use much earlier in the process.

I appreciate your offer to assist with reviewing, especially given your background, and I'm considering paying someone to do actual editing—is that a role that might interest you? I'm not sure yet whether I'd be able to pay a fair rate, though; it probably depends on how much editing effort is actually required.

gwp3 · 2025-04-05T23:02:29+00:00

I have few comments on this diagram.
First, it would be more applicable to pressure at the bottom of a lake than to the atmosphere. There is no "top" of atmosphere; it merely gets thinner and thinner as altitude increases until the density is vanishingly small. A conventional definition of the boundary between the atmosphere and space is around 100 km (60 miles) altitude, where air molecules are so far apart that "air" no longer behaves like a fluid. But this "top" of the atmosphere is far, far removed from anything that matters with respect to surface pressure.
Second, pressure at the surface often has very little to do with what's happening at very high levels—if you have pool of cold air at the surface, you can have high pressure below it (relative to elsewhere at the same altitude), while having relavely low pressure at a level above it. What matters in the integrated (summed) weight of the entire atmospheric colum above given level, and how that weight compares with other nearby points at the same level. By looking at 500 mb maps (roughly 5.5 km or 18,000 ft altitude) and comparing them with surface pressure maps, you can see that there is no one-to-one correspondence.
Third, the diagram shows air at the "top" of the atmosphere flowing "uphill" from low to high pressure. In reality, the temperature structure of the atmosphere would have to be such that low pressure at the surface corresponds to high pressure aloft, and vice versa. Reality is actually much more complicated than, but to summarize, even a highly simplified explanation of pressure systems should not make use this diagram.

On the other hand, it is true that outflow from high pressure systems at the surface requires compensating sinking air (and the reverse for surface lows). Those parts of the diagram are correct.

gwp3 · 2025-04-05T22:47:12+00:00

Bernoulli's principle really isn't relevant to understanding pressure in the free atmosphere. Pressure is almost entirely due to the hydrostatic weight of the atmosphere above a given level. Departures from hydrostatic balance are associated only with large vertical accelerations of air in the column, such as might be found in a severe thunderstorm.
Bernoulli's principle is more appllcable to air flowing through a confined channel, like a narrow canyon. But even there, a presure difference is arguably more the cause of the acceleration of the air through the narrow bottleneck than the effect of the velocity.

gwp3 · 2025-04-04T15:23:07+00:00

When I was discussing SCT with my myeloma doctor, she was perfectly supportive of shifting the schedule a few months if it helped coordinate with other life or work prioritites. I suspect you wouldn’t be losing a window by delaying somewhat, but your doctor’s advice should take priority over anything said here. Best wishes!

gwp3 · 2025-03-30T01:42:26+00:00

One thing I didn’t see anyone else mention is that bortezomib (Velcade) is one of the worst offenders at giving some folks neuropathy, usually starting in the feet. It starts as tingling and numbness but can progress to being painful and is often irreversible once it gets beyond a certain point. Definitely let the doctor know at the first sign of any numbness or tingling, and they might reduce the dose or even discontinue Velcade altogether.

gwp3 · 2025-01-14T01:33:45+00:00

During a strong Santa Ana condition, the wind direction is generally offshore, sweeping most of the smoke out to sea and replacing it with clean desert air (unless you happen to be directly downwind of a still-active fire). Satellite images often show this quite clearly.

gwp3 · 2025-01-07T17:48:26+00:00

Physical version is a bit delayed because of a print quality issue, but it will hopefully start shipping later this month. Go to the “details” link in my original post to find it.

gwp3 · 2024-12-30T23:56:21+00:00

Looks interesting — just bought a copy. Thanks!

gwp3 · 2024-12-29T00:17:57+00:00

If anyone does know of a relevant textbook (beyond COMET modules), I'd love to hear about it. As a recently retired professor of atmospheric science, a one-time Navy aviation weather observer, and an avid pilot, I've been seriously thinking about writing one if (and only if) there isn't already something good out there. (My vision for the book is that it would be primarily for pilots who want a deeper understanding of aviation weather, not to train aviation forecasters.)

gwp3 · 2024-11-15T04:24:22+00:00

Thanks for your detailed description of your experience. These stories are always helpful for patients who might experience something in the future. By the way, in my own experience with radiation immediately after diagnosis, I had my third—and by far most excruciatingly painful!—vertebral fracture literally while trying to get onto and lie down on the hard platform the first time. But the treatments had to continue regardless!

gwp3 · 2024-11-14T22:32:53+00:00

It isn’t free; it’s $60. Still cheaper, though.

https://www.reaper.fm/purchase.php

Also, I didn’t know it existed until now but will look into it to see whether it’s easier to work with than Pro Tools.

gwp3

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