With his transplant behind him, now a decision needs to be made whether or not Paul should start on a maintenance dose of chemo. A maintenance dose of chemo would be a lower daily dose of Revlimid -- the first chemo Paul started on almost two years ago. The latest research shows that a maintenance dose helps some post-transplant patients extend the time before a relapse occurs and also extends longevity. However, it's not yet clear which multiple myeloma patients can benefit from a maintenance dose, and there is a down-side. In addition to the potential side-effects of starting back on chemo (nausea, neuropathy, fatigue), there is a significant risk of developing a second cancer. The oncology team at Kaiser feels that Paul can hold off starting a maintenance dose until his monthly labs indicate an increase in the cancer. At that point, they would start Paul on a full dose of chemo. Paul checked with his consultant at UCSF who, in the past, has advocated more aggressive treatments. But, he agreed that Paul can hold off starting on a maintenance dose for now. Because Paul is still recovering from his transplant and because of Tim's current situation, we both felt like holding off on the maintenance dose is a better option right now.

White Pasque Flower (Anemone occidentalis). Crater Lake National Park