Undead

• Hemoglobin 12.7 (WHO normal 14.0-17.3)
• Absolute neutrophil count 3.4 (normal 1.4-7.5)
• Absolute lymphocyte count 0.3 (normal 0.8-5.0)
• White blood cell count 4.6 (normal 4-10)
• Red blood cell count 3.91 (normal 4.5-5.9)
• Platelet count 183 (normal 150-450)

Almost a month since my last post (blog followers, sorry about that). I am undead. Not a zombie — just not dead.

All kinds of things have happened, of course. Went back to the NIH for a bone marrow biopsy and a cardiac MRI. Here's the BMB report:

Cellularity is 40-90%. Megakaryocytes are adequate. M:E ratio is 2:1. Myeloid and erythroid maturation are progressive. Immunohistochemical staining shows infiltrate of atypical lymphoid cells, which are positive for CD20, CD79a and TRAP and involve less than 10% of marrow. Aggregates over 25 B-cells are not present. CD3 staining shows mild increase in T-cells (CD20=CD3). 

I won't try to translate all of this — main thing is that the percentage of bone marrow with HCL in it went from about 80% to 10% in a month. That's pretty good. In the peripheral blood (that's the circulating blood, as opposed to blood in tissues), HCL dropped from 15.3%  to 0.03% on flow cytometry. It should continue to drop steadily over the next few months, until my next BMB in May just before I start rituxan treatments.

The cardiac MRI showed nothing significantly wrong with my heart.

Blood counts are looking pretty good. I had another test two days before the one listed above and it was even better; hemoglobin at 13.5 and lymphocytes at 0.4. Lymphocytes will probably stay in this subnormal range for the next 2 years, an expected effect of cladribine. Fortunately there do not seem to be any clinical consequences.

No more blood tests for a month! After well over 300 needle sticks since September, I am really looking forward to not being stabbed in the arm for a while.

As for how I’m feeling: most symptoms are gone or much diminished. No night sweats. No longer hearing my pulse most of the time. Occasional nighttime leg cramps and headaches, but they're very minor compared with a month ago. A chest x-ray last week showed that the pneumonia in my left lung has finally cleared, much to my relief since if it hadn't they were getting ready for another CT scan and antifungals.

The one thing nagging at me right now is a minor, hardly noticeable ache in the left side of my ribcage. I mentioned this to Dr. Washer when I saw her on Monday and it cost me 6.5 hours. If you're over 40, you cannot walk into a hospital and say "chest pain" without ending up in the ER being evaluated for a heart problem. But the cardiac enzyme tests were negative, and since I've already had a heart stress test and a cardiac MRI, both negative for heart problems, they decided it was probably musculoskeletal and released me. Probably it's either (a) a side effect of the pneumonia or (b) related to starting up yoga and weightlifting again after a couple of months of being mostly idle. I've been doing a lot of backbends, which really stretch out your ribcage, so it could be strained intercostal muscles or connective tissue. It's strangely persistent, though, and hard to localize. If it keeps up for another week or 10 days I'll have it checked out. I'm still on Bactrim and acyclovir, prophylactics for pneumonia and shingles, respectively.

Best thing is being back at work. I'm teaching two courses, finishing off the process of leading some job searches, writing some short pieces. Feeling good about all this, though it's stressful, and looking forward to truly complete recovery, which is probably still a few weeks away.