Tuesday, June 21, 2011

Stumping my poor doctor

My life has been a bit more full than I would like this month. I'll take pity on you all and only talk about the last few days. Friday, June 17, Chris was in a horrible car accident. While Chris was driving in to work, a man in a super-duty pick-up truck drove through an intersection and hit Chris' car right in the driver's side door. The other driver did not have the right-of-way and drove across 2 lanes of oncoming traffic and through a median. The impact caused Chris to hit his head against the pillar between the driver's side and passenger window. He was taken to the ER and had a CT scan as well as X-rays.

I got to the hospital while he was out getting scanned. He was discharged a few hours later and has been recovering since. There's still a bump on his head and he continues to get headaches in addition to being sore all over. Thankfully, he didn't break any bones.

We're in the process of dealing with the other guy's insurance and that's all I have to say about it. I'll keep everyone posted as to Chris' recovery.

As for me, I had a few appointments in Houston on Monday. One was a regular check-up with my transplant doctor. The other appointment was for some testing related to my transplant, but having little to do with leukemia. I haven't blogged about the issue, and am sorry for being cryptic. I'll post about it in detail once the test results come in and I have a better understanding of what's going on. All I know is that it's not life-threatening and so you shouldn't worry.

The cytology report from the bone marrow biopsy I had done in March was finally available. My doctor had ordered several molecular studies that are routine when dealing with bone marrow transplant survivors. Some of these tests take days, most take weeks, and some, like the cytology study, can take months.

The FISH test showed no leukemia clones with a MLL gene rearrangement. Clone cells are effectively the little buggers that kick off the whole leukemia process The clinical flow cytometry study was negative for minimal residual B-lymphoblastic leukemia (this is the type of leukemia I was originally diagnosed with).

I rarely go into this much detail when sharing results, but felt it was necessary so that you all could put the next set of results into perspective.

The cytology report showed an anomaly. 20 cells were studied. Of those 20, 19 were diploid female karyotype 46, XX. This means that they were normal, female and had the correct number of chromosomes. 1 cell was determined to be pseudodiploid metaphase 46, XX, t (7;11) (q22;q13). Fundamentally, this means that the cell was captured in the midst of development, that the correct number of chromosomes was present, that it was female, and that it had a translocation of the number 7 and 11 chromosomes.

Generally speaking, a translocation occurs when portions of the chromosome swap places. That's a quick and dirty definition and doesn't encompass the whole of the process. To further put things into perspective, my original leukemia included a t (4;11) translocation which meant a transplant was my only hope.

Before yesterday, I'd never heard of a t (7;11) translocation associated with ALL. Dr. K. explained that it simply doesn't happen with my form of leukemia. My transplant doctor was very thorough in explaining what this finding could mean. She believes the cell was an artifact, meaning that it was a one time occurrence. The cell may have been created during the process of testing. For the sake of due diligence, another bone marrow biopsy was scheduled for the same day. She wants the same tests performed to see if another cell with a t (7;11) translocation appears.

If it does show up again, I'll be monitored. I'll probably start taking maintenance chemotherapy if it does, but that's not certain. As my doctor explained it to me, there are no studies to guide any treatment. I got the impression that the transplant doctors that discuss my case would be making it up as they went along.

That is the worst case scenario.

I want to stress that my doctor felt that we weren't going to have to go there. I believe her. I can tell you that I feel well. I don't have any of the symptoms that were present when I relapsed in 2008. I'll even go so far as to tell you that the cashier in the hospital cafeteria gave me an employee discount because she thought I worked at the hospital. She didn't believe that I was a patient. When strangers mistake you for a hospital employee rather than a cancer patient, you want to do a little dance, because it feels like you just regained your normal badge.

To further put everyone at ease, here are my blood counts, including normal ranges:

White blood cells: 8.8 K/UL (4.0-11.0)

Red blood cells: 3.88 M/UL (4.00-5.50) It's low, but most transplant patients have a hard time with making red blood cells. The only transplant survivor who I know that has a regular red blood cell count is Nancy and she just celebrated her 5th year post transplant. Love you, Nancy.

Hemoglobin: 12.1 G/DL (37.0-37.0)

Platelets: 414 K/UL (140-440)

Absolute neutrophil count: 6.56 K/UL (1.70-7.30)

My counts are essentially normal. When I had cancer, my white blood cell count was phenomenally high while all of my other counts were close to nothing. The same held true when I relapsed. I believe my doctor when she tells me that this new translocation is probably an artifact. I won't know for sure until the new cytology study is done. I won't have those results for a few months. Until then, I'll continue to monitor myself and check in with my local oncologist.

One more thing to help put this into perspective. My next appointment with my transplant doctor at MD Anderson isn't for 6 months. If she was anxious about anything, she wouldn't have given me such a long break between visits.

As for the other health thing that I'm being so cryptic about, the specialist I'm seeing will have the results in a few weeks. I'll disclose everything once I have the information.

9 comments:

LPC said...

Oh gosh. I hope Chris recovers soon. Not quite what you needed. And you sound like you know what you're talking about on your own health stuff, so I'm just going to cross my fingers for status quo.

Kacie said...

I hope his headaches improve soon, Ann! And I agree with your summary - if the doctor felt that you were in any imminent danger, she wouldn't wait 6 months before your next visit.

Marsha said...

So glad Chris is ok-I'll pray for him as well. Ann, you are so strong! I am so proud that you were one of my students! Continued prayers for you!

Jody said...

Ann,

I'm with your doctor:)

You do an excellent job of explaining the testing process; and especially in describing the artifact phenomena, that blip of a result that pops of as a result of the test itself. That doesn't mean that it isn't provoking for a few minutes; but you have the good sense to trust your physician's perspective. I'm sorry I couldn't scoot down to hang out with you in the cafeteria.

Hugs to both you and Chris. Keep us posted and thanks for letting us all know what's going on. We'll wait to hear about the other test.

Jody

Olivia said...

My condolences to Chris. As I read about his wreck I had flashbacks of one I had in 1992 that was similar and I could feel the pain. Loads of light for a swift recovery.

Your story had me fascinated. You have certainly taken the knowledge reigns. I would do the same in similar circumstances. You are a perfect example of life's longing for itself. I'm sure that you can overcome this little bump as you have all the others.

I hold my hand to my heart and send you beams.

Nancy said...

Ann, firstly, I am so sorry to hear about Chris' accident. I'm glad he was checked out with a Ct, etc and released. I hope he recovers quickly. Did they determine that the other driver was under the influence or had fallen asleep or anything? Going across 2 lanes and through a median can mean he was impaired in some way.

Secondly, thank you for explaining the cytology situation. You know way more about the translocations than anybody I know, including me. I'm glad your next appointment is six months out, that does mean that your doc isn't overly concerned, but I am glad they are testing again. Keep us posted. Thanks also for joining me in celebrating my 5th year! My red cells are unusually within normal but my platelets from Japan are still experiencing Jet lag! It's all good...

Take care and let us know as you receive information. thank you for keeping us informed. You are a rock star!!! Love you both lots! n

Mara said...

Geez you guys can't get a break. Give Chris my love and make sure the doctor checks him for a cuncussion. I hope your anomaly stays that way Ann but I am glad they are watching you so closely. I'd lay off the Baton Rouge tap water if I was you. That stuff's made of anomalies. :)

PJ said...

Thanks for the biology lesson. Due to recent scientific training, I was able to follow it. Your cbc numbers are fantastic!

Hope Chris mends and stays out of trouble. You guys don't need that kind of stress.

Ronni Gordon said...

Wow. Sorry to hear about the accident and glad Chris is OK. Second wow for that explanation about your cell biology. I never even knew about translocations. Definitely if they were worried they wouldn't wait six months for you to come back; it's a good sign that you shouldn't be worried either.