Mari Jo and I arrived at the Emily Couric Cancer Center at
UVA early Tuesday morning, August 8. Within minutes of our arrival we were
called to one of the registration desks where I was debriefed about my personal
and insurance information then briefed about what to expect going forward. (Good
thing I don’t wear boxers.) The nice lady at the registration desk paged Bryna
Shemo, the new LGLL Registry Coordinator and Dr. Loughran’s right-hand person,
to let her know we had arrived. I was given a rather thick ID badge/tracking
device to clamp on my shirt lapel – no annoying plastic arm bands – which I
thought was a technological leap forward. As I attached it to my shirt I
wondered if someone could see exactly where I was in the building at any time. I
couldn’t get the visual out of my head that I was some blinking dot on a
computer generated 3-D map of the hospital. Since I’m not prone to terrorism or
other acts of violence I decided this was really nothing to concern myself
over.
After registration Bryna came down promptly to take us up to
the lab where 10 vials of blood were drained from my right arm. Chris was the
lab tech and a really cool guy. The needle stick wasn’t even noticeable but
after about the 7th vial I began to feel clammy. When Chris asked me
if I was OK, I told him there was some pain at the needle site and he
apologized all over himself repeatedly. It seemed that each time a vial was
taken off and a new one pushed into place, there was a sharp pain at the site.
I got through that without passing out and went back to the waiting area.
After a very brief wait again, a nurse came to get me to
take my vitals. About the only thing that was the same as last time was my
height. Thank god for small victories! Weight, up by 15 lbs. Ugh! BP, high,
initially 140/93 then on a second reading, 132/90. “Wait, take it a third time
and I’m sure it will be within normal limits!” I felt like saying. “Three times
is a charm. Or better still, take Mari Jo’s BP on my behalf, she always has
great numbers.”
The vitals nurse then took me to the examination room where
I waited less than 5 minutes before Dr. Loughran entered. He explained that my
lab results hadn’t arrived yet but went ahead with the physical examination. It
was a relatively routine exam where he checked for swollen lymph glands, a
swollen spleen and mouth ulcers, none of which he found. We had a very short
discussion about my overall health and I explained to him that I was not
exercising at all anymore which was vastly different than when I visited him in
December, 2015. At that time I was running 5K races and doing strength
training, but no more; I’m going for couch potato of the year in Lewisville! He
suggested that if we had time to wait for the lab results he would review them
and go over them with us. We agreed and returned to the waiting area.
In about an hour, my lab results came back so Bryna called us
back to the examination room again where we reviewed them with Dr. Loughran. My
WBC count decreased since my last labs, from 17,200 to 14,130 and my lymphocyte
count decreased from 12,900 to 9,600. I suppose that’s somewhat good news that
the total counts for both came down some but I’ve been told that the total lymphocyte
count is less important than counts for neutrophils, platelets and hemoglobin.
My neutrophils actually increased since last time but my platelets and
hemoglobin were down slightly.
After a complete review of my lab results with Dr. Loughran,
the updated diagnosis is that I have LGLL and have likely crossed the numerical
threshold into chronic lymphocytic leukemia (CLL), which he predicted would
likely happen when I first visited him back in November of 2015. Apparently my
B cell lymphocytes are jealous of all the attention being paid them so decided
to become as deranged as the T cells. T cell LGLL and B cell CLL, what a fucking
alphabet soup that is! A diagnosis of LGLL requires a clonal T-cell population
of greater than 500 while a diagnosis of CLL requires a clonal B-cell
population of greater than 4,000. (According to Dr. Ellis at WFBH and the CLL
Society, the threshold number is 5,000 clonal B cells for a CLL diagnosis.) Dr.
Loughran hypothesized that most of the additional lymphocytes (as compared to
last time) are B cells and through mathematics, experience and the application
of arcane medical hocus-pocus, he calculated I have exceeded the 4,000 count of
clonal B cells. I’m being dramatic, it’s really very simple. Here are his exact
words from the notes.
“His atypical
lymphocytes I am sure represent the LGL population. Clonal B-cells are in the
typical lymphocyte population which now number 7320. Therefore, it is likely
that he also has now developed stage 0 B-cell CLL.”
Here’s the way the math works. Normal adult blood has between
1,000 – 3,000 B cell lymphocytes per microliter. Since my typical lymphocyte count is now 7,320 and about 3,000 of those
should be typical B cell lymphocytes, the remaining 4,320 must be atypical or clonal, meaning mutated
(deranged?). However, using the higher 5,000 clonal B cell threshold means I have 680
additional B cell lymphocytes to go before the CLL diagnosis is rendered. There
are five stages of CLL. At stages 0 and 1, no treatment is considered. At stage
2, treatment is discussed and considered. At stages 3 & 4, treatment is
strongly recommended.
For the time being, I’m still on the watch and wait program
meaning that treatment for either of the leukemias is not even considered.
After Dr. Ellis saw these blood work results and the notes from Dr. Loughran, she
scheduled me for additional blood work in early September. I also have a follow-up
appointment with her in February when I will have blood work and a consult.
Below are the updated cool graphs I mentioned in the title
to this blog post.
