Monday, December 31, 2007

New year

New charts of my blood counts.

It's New Year's Eve. And time to celebrate. This treatment is working. Another milestone: normal neutrophil counts. That means my immune system is almost completely functional again. Lymphocytes are still low, 0.4 (normal 0.8-5.0), but that's double what they were 2 weeks ago.

At 11, hemoglobin's about where I thought it would be. Still three points to go before I hit normal, but with this much I'm nearly out of the woods. I still feel a bit less energy than usual, but I can go all day now. This is fantastic.

I have to say that for me — and not just because of the last three months — 2007 basically sucked.

So Happy New Year, everybody. 2008 looks really good.

Thursday, December 27, 2007

Comeback

No blood test this week, so no objective indicators — but I'm feeling better fast.

My extended family all made the trek to Ann Arbor for Christmas, six from North Carolina and four from Connecticut. They arrived late on the 22nd. That day and the next couple of days I got pretty tired and had to take naps in the afternoon. But starting Christmas Day, I abandoned the naps. On the 26th I spent 25 minutes on exercise machines, 25 minutes of yoga, then took an almost 2-hr walk with my brothers. And no nap. That would've been inconceivable a week earlier.

My mental hemoglobin calculation goes like this: I was at 9.1 on Dec. 17, four weeks after starting chemo. The median patient reaches normal (14-17.3) eight weeks from the start of treatment. Should be a linear progression, since it's based on red blood cell genesis replacing 1 percent of cells per day. So I should be going from 9.1 to 14 (or higher) in four weeks. That would be a gain of at least 1.25 each week.

It's been eleven days since Dec. 17, so I should've gained about 2 — which would put me at 11.1 today! Feels like it, too. Next test coming on Monday. By then white counts should be normal, except lymphocytes.

Strange: I've been dreaming a lot recently. No dreams at all during and after chemo, or at least none that I remember. Maybe my brain was too oxygen-starved to have any.

Tuesday, December 18, 2007

Midway

New charts of my blood counts.

Yesterday was my 2-week followup with Dr. B. He showed up 2.5 hours after our scheduled appointment, but apart from almost falling asleep in my chair, I didn't mind. Now I know to always try for a morning appointment with him.

The best news: I'm out of the danger zone for opportunistic infections. My neutrophil count has climbed higher (1.0) than before I started treatment (0.7). That's still below normal, but anything 1.0 and above is OK. Lymphocytes, the second most numerous type of white blood cell, are at 0.2 (normal 0.8-5.0). Dr. B said lymphocyte counts might stay depressed for 2 years. Fortunately this has few or no clinical consequences, so the neutrophils (see the picture) are the thing to watch.

Now I can finally go out in public, stop worrying so much, and drop some of the more draconian precautions. No more face masks. I actually went to the YMCA with Gabrielle to pick up Luka from day care — first time I've done that in 5 weeks. But with family coming for Christmas in just four days, in general we'll continue the cordon sanitaire through the holidays.

For one thing, my hemoglobin's unchanged, at 9.1.

Hemoglobin, also spelt haemoglobin and abbreviated Hb, is the iron-containing oxygen-transport metalloprotein in the red blood cells of the blood in vertebrates and other animals. In mammals the protein makes up about 97% of the red cell’s dry content, and around 35% of the total content (including water). Hemoglobin transports oxygen from the lungs or gills to the rest of the body, such as to the muscles, where it releases its load of oxygen.

At 2.82, my red cell count is just a hair higher than last week's 2.79 (normal 4.5-5.9). So I'm oxygen-starved until that number comes up. Red cells live about 120 days. They travel 200-300 miles during their lifespan. The body normally replaces them at the rate of about 1% new red cells each day. We can see this happening now, since reticulocytes — new, immature red cells — make up a higher proportion than normal of my total red count. The figure I'd seen in the literature was 8 weeks from start of chemo to normal hemoglobin. In any case, it'll be at least another week or two before I have real energy again. Disappointing, but that's leukemia for you. Also a good reason not to get sick anytime soon. I feel crummy enough without having a cold.

From now on, I'll only get blood tests every 2 weeks. I won't see Dr. B again for 2 months. Then it'll be time for another bone marrow biopsy, to see exactly how well the treatment worked. Fingers crossed.

While I wait, I won't be posting so often to this blog. I need to start working again, anyway, though until that hemoglobin comes back, concentrating on anything for more than five minutes feels like swimming in molasses. I'm not too good at keeping a reduced schedule — it's more of an all-or-nothing thing with me — but I guess it's time to learn.