Tuesday, July 24, 2007

Widespread Panic

Day +55 (D 193)

Ann's CBCs for today...

WBC 9.80 K/uL (4.0 - 11.0)
RBC 2.96 K/uL (4.0 - 5.0)
HGB 9.80 G/dL (12.0 - 16.0)
PLT 264.0 K/uL (140 - 440)

Lymphocyte Absolute Count 0.98 K/uL (1.0 - 4.80)
Neutrophil Absolute Count 8.23 K/uL (1.7 - 7.30)
Monocyte Absolute Count 0.39 K/uL (0.08 -0.70)

Neutrophil Percent 84.0% (42.0 - 66.0)
Lymphocyte Percent 10.0% (24.0 - 44.0)
Blast Percent 2.0% (0.0 - 0.0)


Panic: Defined as the primal urge to run in fear, or an overwhelming feeling of fear and anxiety. Also as sudden mass fear and anxiety over unanticipated events. Today I feel like the last definition is the most accurate in the context to today's CBC.

The results of Ann's CBC certainly fall into the category of "unanticipated events" mainly due to the presence of blast cells. Blast cells have been present in Ann's blood three separate times. First when we came to MDA, 193 days ago when there where so many of them in her blood that she was bordering on a stroke. Second after she was in remission and Neupogen was being used to regrow her marrow after chemo. Then finally today.

The problem with the blasts on today's CBC is that today is not 192 days ago and Ann has not been on Neupogen for almost a month. That left a couple of uncomfortable possibilities in my mind when the transplant APN handed us her results. The first was a clinical mistake...possible but not likely. Maybe those 2 cells out of a 100 counted where the baby stem cells reacting to something, or maybe it was a relapse.

It was the last possibility that sent me over the edge today. I should note that when I say "me" I mean me and not "me and Ann". Ann is quite the cool customer and very little fazes her. Fine I freely admit to being a worry wart. That is what Engineers are supposed to do, worry and obsess over the small details that foul up otherwise well laid out designs. So 2% blast cells looked like the end of the world to me around lunch time today. By contrast Ann wasn't bothered and actually took a nice big nap.

It wasn't until a good friend pointed out a few things that I had not considered that climbed down off the ceiling. The presence of blast cells in the blood can be caused by strenuous exercise. Ann has been doing plenty of that at the PT gym as of late. On a scale of 1 to 10 she rates her 2 hour morning works, out at an 8. She has begun to sweat so much that the PT's are starting to offer her a towel when she starts on the nautilus.

Blast cells can also be caused when your immune system reacts to a bug. In line with this over the last three days Ann has had some GI issues that have already bee ruled out as being related to GvHD. So they are likely caused by a bug that she picked up. This would explain general rise in WBCs over the last couple of days and the current higher than normal level of Neutrophils in Ann's blood. Neutrophils are the grunts of the human immune system, so an increased level of them and the GI issues tends to support the presence of a bug.

Our next clinic visit is Friday so we will find out if this is the case. If it is then Ann will probably get put on antibiotics (Levaquin is the one of choice) for a week. That is, if Ann's new immune system doesn't handle the problem all by itself before then.

Finally our friend pointed out that the "r" word would be highly unlikely because we just had a positive BMB that showed 100% engraftment of both cords on day +30. Recurrent leukemia would have to take hold in her marrow before overflowing blasts out into the blood.

So my panic has subsided and my emotion meter is back to the "cautiously optimistic" setting it was at before. Also Ann did compromise with me about her reation some what. She curled up on the couch where I could watch her sleeping.


Kacie said...

Sounds like a scary day, guys :(

Hopefully it is one of the possibilities you mentioned, Chris. I'm sure it is - Ann hasn't come this far to turn back now!

Anonymous said...

Keep your chin up and think positively. Flucuations were always expected and you knew that going into this. Now you have a flucuation. Put it in perspective with the bigger picture and realize this is just a little bump in the road. It will and can be dealt with. Breathe deep, think positively, move forward affirmatively and with conviction.

Prayers from out west...