Much News: Almost all of it Good on the CLL Front

At the beach and connecting by a tethered Iphone which is a whole other story.

In the midst of the sad visit to a long time patient getting compassionate hospice care, and in the process of digesting the loss of Dr. Hamblin, surely one of the kindest and brightest lights in the world of CLL, and in the aftermath of responding to a scare about a long time friend's daughter's cancer reoccurring, I got a bunch of good news.

The finding on my bone marrow are subtle, and the report is preliminary, but it is not bad. The CLL is now about 10% of the marrow, up from 3% only nine months ago, but it is not racing out of control. I take this news as neutral.

The health and cellularity of the marrow itself may be better than the last sample suggested when the report said my marrow had been damaged. There is some contradictory findings that I need Dr. Kipps to help me understand before I declare this a victory. Dr. Kipps may demand a recount.

The flow cytometry shows my clone is CD20 dim which means that ofatumumab (the other drug used with PCI-32765 in the OSU trial) may have some real therapeutic effect and all my infusions of rituximab have been cleared away. No CD20 positivity on my B cells might have given Dr. Byrd some pause as to my acceptability to a trial that relies heavily on an anti-CD20 antibody to clear the blood of the leukemia cells once they are flushed from the nodes by PCI-32765. I see this as one more obstacle removed on the road to Ohio.

FISH is still pending and has taken on a surprising new importance that I will explain in a follow-up post. (Hint: My 11q deletion may not be real).

My gastroenterologist called me to say that all 15 biopsies of my stomach and duodenum showed no metaplasia, no abnormal lymphocytes, and no H- Pylori. No hidden lymphoma or leukemic infiltrates. Another worry crossed of my list.

No wonder my tummy hurt that night. 15 biopsies!

And...... (drum roll, please)

My case manager at Blue Shield says that my consult with Dr. Byrd has been approved. Ohio State needs to call her and work out the details, but it's a go. Thank you, thank you.

So Columbus, here I come.

But wait, there's more!

A dear friend offered to take Patty and me to Italy next year for a month to stay at his rented villa. All expenses paid!

And my friend's daughter's imaging came back negative. No new cancer.

And finally my daughter and her boyfriend in Chicago are committed to switching to a plant based diet. And his employer is supporting it!

Sometimes we get an embarrassment of good fortune.

A Mitzvah: Visiting the dying

It is a mitzvah (a Jewish commandment/good deed rolled into one) to visit the sick and dying, so Patty's and my beach retreat can wait a few hours. My friend/patient may not. This is no burden. In fact, I am lucky and privileged to be invited into these moments, these turning points and passages.

What I do miss is the other end of the cycles, the births, the bar mitzvahs, the graduations, the marriages. Those are less frequent these days, and a "senior" family doctor like me get called to less and less of them as my patients get older too. It's especially true for me as I no longer sees all those germy kids.

This serves as a reminder to celebrate the big events when they do appear and gives even more reason to squeeze the joy out of all life's little wonderful moments, victories, and treasures.

A Mitzvah: Visiting the Sick

Today I am doing something which might surprise you when I tell you that it something I don't do much anymore

I plan to visit a friend in hospital with complications from his transplant for CLL. Make rounds so to speak.

You would figure as a doc, I would round on patents daily. Not that long ago, I would proudly have said that was the case. Not today. A  family doc, outside of a rural setting, is a specialist in the outpatient setting. It is inefficient and costly for us to care for patients on the hospital wards. And if don't use it, you lose it. Would you want a doc who sees a few patients a month caring for you, or one who sees ten new admissions a day? Actually that may not such an easy question to answer.  

True be told, over the last few years, the rounds I made were mostly social and for patient reassurance. I would review the chart, and check all is on course, and maybe explain the likely trajectory of the healing with a little more time than the hospitalists could afford.

Soon after my CLL diagnosis, I stopped taking hospital call. ERs and acute medical wards are no place for a boy like me with a shaky immune system. 

So this trip to the bedside is actually pretty rare for me.  

I do it, not because I am such a great guy (and if the infection risk is high, I'll back out). No, I do it because it is a commandment, a mitzvah that I visit the sick. I do it for my sake. 

I do it because we are all in this together.