Box scores and Lab Tests and Biopsies, Oh my!

BOX SCORE




Element

Current

Std. Range

Trend

Hemoglobin

10.7

13-17

^

Platelets

26

140-375

^

ANC

1150

1800-8300

^

Okay, that's it. I can't stand it any longer. It's been almost two weeks since I posted, and a lot has happened. I have been waiting for some definitive direction to come out of it all so that I can give you the straight dope and not have to backpedal later. Instead, I'm going to let you know everything we've learned, except where we are headed.

As you know, if you are a regular reader, on November 14th I had a bone marrow biopsy. We have been waiting for the results to come in. They began trickling in a couple of days after the biopsy, and the initial reports were encouraging. There were numerous genetic findings that showed no mutation activity in the markers that were checked. Then the later reports showed evidence of increased myeloid precursors and blast cells. What in the name of Sam Hill are you talking about, Tom? 

Blast cells are immature cells known as precursor or stem cells. Blasts give rise to all kinds of different specialized cells. For example, neuroblasts give rise to nerve cells. Myeloblasts are immature white blood cells that develop in the bone marrow.

In healthy bone marrow, blood-forming cells known as hematopoietic stem cells develop into red blood cells, white blood cells, and platelets through a process called hematopoiesis.

In the case of acute myelogenous leukemia (AML)... there is an overproduction of abnormal myeloblasts. These cells are unable to develop further into mature white blood cells.*

So, essentially what happens in AML is that the stem cells that are supposed to become normal white blood cells fail to mature. When the marrow becomes overloaded with these stem cells they spill into the blood stream. Depending on their stage of development, they are classified as blast cells or myeloid precursors, that is blast cells that tried to become myeloid white cells but couldn't cut the mustard. An increase in blast (stem) cells and myeloid precursors above 5% in the bloodstream is a signal that something is not right in the bone marrow. 

In short, the lab tests show that my bone marrow is sick again. Relapsed.  My understanding is that the chemotherapy that is given to kill the abnormal cells eventually fatigues the bone marrow to the point where it is overwhelmed by the disease's propensity for creating abnormal blast cells and myeloid precursors. This fact explains why my medical team has had me on different chemotherapeutic drugs at different times. Each regimen works by different mechanisms. In this war against AML, imagine a battlefield where the good guys attack the enemy in different ways...maybe a frontal assault; maybe an air raid; maybe a flanking assault. Each assault requires different weapons. 

Okay, enough of the science lesson. What is going on in my life? Ironically, I am feeling better than I have in several months. Beginning in mid October, however, my platelet count started to decline. Thank God my hemoglobin, which carries oxygen to my cells has remained pretty stable, and my ANC (immunity) was chugging right along until around the time of my biopsy in mid-November. Now that, too, has become unstable, requiring us to quarantine recently. But look at today's Box Score! ANC is up. We might be able to get out for some Christmas shopping!

Yesterday, I noticed that Dr. Mansoor had made a note on my lab results. Remember him? He's the one who originally diagnosed my AML, back in June 2021. That he had made a note on my chart is no big deal, but then I got a call from Kaiser Imaging wanting to set up an appointment for an echocardiogram. It's like an ultrasound that is used to "view" a developing baby in the womb, only it's used to "view" the heart. Now THAT was curious. Later in the day, Suzanne from Oncology (my case manager) called and explained that Dr. Brow has been on vacation, so Dr. Mansoor reviewed my lab results. He apparently advised Dr. Brow of some changes, and she ordered the echocardiogram. I was still confused about that, but Suzanne explained that one option for my care going forward would involve the use of Idarubicin, one of the original chemotherapy drugs I received. Idarubicin is hard on the heart, so before I have my consultation with Dr. Brow next Tuesday, she wants to be sure my heart is in good shape, in case we decide on a treatment plan involving that drug. 

Now, what does all of this mean in practical terms? In a nut shell, we know that my AML has relapsed; we know that there are more treatment modalities available. What we don't know, prior to the consultation on Tuesday, is what exactly is going to happen. Will I go to the hospital for a spell? Will I be treated as an outpatient? Will the sun come up tomorrow (I think so)? 

Follow me for more tips on how to confuse your blog readers!  

What I can tell you, without reservation, is that God is good every single day!

The Lord is my Shepherd. I shall not want. He maketh me to lie down in green pastures. He leadeth me beside the still waters. He restoreth my soul. (Psalm 23)

*https://www.blogger.com/blog/post/edit/8347266214529792165/2260596645152601670
 

 

 

 

 

 

Comments

  1. BenjyNovember 30, 2023 at 5:06 PM

    Your strength through all this is stunning Tom - praying His presence over you and Jill today!

    ReplyDelete
    Replies
    1. TomDecember 1, 2023 at 7:37 AM

      Thanks, Ben. We really appreciate your prayers. We'll know more about what to expect soon. I'll keep you posted.

      Delete

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