More Good Lab News

Our EHR (the electronic chart of all the medical records where I work and get my care) is down again, but before it crashed, I was able to view most of my lab results from 3 days ago.

Remember that I had gone a full six weeks between my lab tests and IVIG infusions to control by ITP, representing the longest period my veins haven't been probed for blood in the last seven years and the longest period ever between immunoglobulin infusions.

And the news was only good.

First the CBC.

For first time in many years, I have two blood counts in a row that showed no anemia. My hemoglobin was a robust 14.4.

My platelets were even better, an amazing 405,000. Although I have had a splenectomy, and they would be expected to be higher than in the reported average, this is still a super result, reinforcing the safety of the move to extend the time between infusions. It wasn't that long ago that I needed treatments every two weeks to keep my platelets in a safe range.

My absolute lymphocytes (ALC) was nice and low at 1.2. I want it low because those are the cells that make up my cancer. A high ALC usually means the leukemia has returned. My ANC (infection fighting neutrophils) was a healthy 6.2.

Blood chemistries showed that my liver and kidneys are doing a superior job of ridding me of any toxins or waste, and my sugar, minerals, and electrolytes are well balanced. Uric acid which often rockets up when taking cyclosporin as I do stayed well below the point when it comes out of solution and can cause the agonies of gout. This last result I particularly attribute to my vegan and nearly completely alcohol free diet.

Even my iron studies, consistently low in the past and likely one of the negative results of my longterm meatless diet, had inched their way into the bottom of the normal range, suggesting that using the cast iron skillet and eating more collard greens and molasses was slowly filling my empty tank.

And to top off the good times, my blood pressure was around 110/60 even with an IV in my arm.

When the computers are back up, I will check my Vitamin D, zinc and IGG levels.

I have grown accustomed to getting good lab results, but I never take them for granted and I am always grateful.

Next week, I am off to Ohio for my 84 day check in with yet another set of CT scans and more lab. On the way there, I am leaving early so that I can stop in the bay area to kvell (Yiddish for to feel proud and happy, especially applicable to one's offspring) over my granddaughters, and on the way home, I will be visiting friends in Missouri.

But that is the only travel planned for all of July! It is great to have some down time at home. Even with my boring labs, I still get tired and need my rest. Except for the fatigue, and the constant background noise about my impaired immunity and a host of other potential but G-d willing never going to happen concerns, my CLL is a non-event.

I believe that after this set of scans, I can go a whole six months between imaging, but not between visits to OSU and Dr. Byrd.  Enough scans already!

Starting late in August, American Airline will offer direct flights from LA to Columbus. It may be almost worth the unpredictable drive up the 405 from Newport Beach to LAX to avoid the stopover in Dallas or Chicago for my next trial visit. That could be nice.

I remain busy with prepping video and news material for the blog. Expect the second part of my ASCO 2013 Wierda interview on prognostic factors to be posted here soon.

More Good News

I stopped my diuretic (water pill) that tends to raise uric acid. Replaced it with losartan, an ARB that blocks renin from the kidney that constricts blood vessels and raises pressure. In the blockage, the pressure drops and the kidney does better. I am also aware that it can modestly lower uric acid. This is one of the benefits of doing so much lecturing. This little known beneficial side effect of this common blood pressure pill is something I learned when teaching about gout. I am very lucky to have such access to such helpful esoterica.

The magic worked. Uric acid fell in a week to 7.9 from 9.4 suggesting either:

1: I heal fast

2: My medication changes were magical

3: The prior test was a lab error

4: My uric acid has a mind of its own

Moreover, my blood pressure is back in the normal range, though it could be better. My kidney function remains normal and stable.

On the hematology front, my platelets were a remarkable 344,000. The rest of my CBC is all good, though my Hbg (hemoglobin) was down a bit at 13.7 and my MCV (mean cell volume) up a bit at 100. More on that later if it turns out to be an actual worrisome trend. Right now I feel very secure in ignoring it. Or at least just monitoring it.

Had my first rituximab of six weekly infusions (500mg/M2) last week, and happy to say it went off without a hiccup. My small neck nodes and even smaller, but not gone so that suggests I am still sensitive to its effects and still need more. It is probably busy shrinking my critical mesenteric nodes as I am typing away.

This is all good news.

That's good because I am scheduled to be in 7 cities for lectures or meetings over the next 4 weeks.

Included is a visit with Dr. Kanti Rai in Long Island, while I am lecturing nearby, also Chicago, then St Charles and Springfield, Missouri, another visit to my daughter and son-in-law in San Francisco, and a very short drive to speak in Anaheim.

I am already tired before the first flight.

It's Always Something: High Uric Acid

My uric acid or UA level shot up to 9.4 over two weeks from 7.9. It should be under 6, but up to 8 is rarely an issue.

This jump is a recognized complication of my miraculous cyclosporin or CSA that has greatly helped me hold onto my platelets.

In fact, aggressive, destructive gout is a well known risk of CSA. My personal risk of getting that pleasant malady unless things change is about one in four. Besides pain and joint destruction, it can damage kidneys.

Like it does to many others, cyclosporin has also pushed up my blood pressure. That lead to a slight increased dose of my thiazide diuretic to control the pressure. That too can raise the uric acid.

Cyclosporin also is tough on kidneys itself. My kidney function is still normal, but not as good as it was before I started the CSA this time. Last time I took it for this same problem, I had to reduce the dose as my kidney function was compromised. The reduced dose continued to work just as well for my ITP and my renal function normalized.

So I am rechecking the lab in two days, stopping the thiazide, adding losartan for BP control, an ARB that tends to lower UA while it blocks renin receptors that tell the blood vessels to constrict. It is not only good for BP, it is protects the kidney, and it just went generic. Still, I had to get a prior authorization to get the insurance to cover it.

And I will be drinking lots of water. That is easy and should help all the issues.

None of my docs seem keen on reducing the cyclosporin like last time, but rather want to fuss with my other meds to lower the UA while controlling my blood pressure.

The consensus is no allopurinol yet. No gout symptoms, so why add another complicated drug to the mix.

I also got my flu shot today, before I restart rituximab in two days. Normal dose. Don't trust the pharmacists to give me the shot (I am not over 65) and they seem to be the only ones to have the high dose vaccine. Started on the unproven ranitidine trick (300 mg. 2 x a day for 6 weeks, then repeat the flu vaccine) to see if I can boost my response that way. Honestly, I doubt I will mount much of an antibody response, but I am 100% certain that I won't get any after all my vitamin R wipes up the the remnants of my antibody forming B cells.

And just to add another twist, rituximab may raise the uric acid as it goes about the business of killing my cancer cells. This is not very likely as most of my cancer is my nodes and marrow and not in my bloodstream (my lymphocyte count is already suppressed from my last rounds of R) where the kill rate is much slower, so the chance of a tumor lysis leading to another jump in UA is extremely remote.

So many balls in the air for such minor issues.

As Roseanne Roseannadanna said: It is always something.