Tuesday, June 2, 2009

Low immunity

My immunoglobulins are very low.

That is not a surprise as they are the antibodies made by mature B cells, and I don't have many.

It is a well recognized, but poorly understood fact that even in remission, patients with CLL rarely see their immunoglobulins return to normal. The white count and red cells, the blood chemistries, even the tumor markers such as B2M may all return to normal. In a complete remission you could pass any insurance physical if you didn't have to answer any questions.

Until they checked your IGG, IGA, and IGM. They would invariably give away your cancer secret.

They just don't bounce back up. Mine sure haven't. Quite the opposite.

My IGM and IGA have been nearly the lower limits of the ability to be measured for a long long time, and they are still miserably low. That was expected.

The news is that my IGG sank below 400 to 369 for the first time since my diagnosis. Normal is between 700-1600. It fell 73 in less than two months.

What does this mean?

In terms of the CLL, probably not much. My B2M (an important prognostic factor that reflects tumor load) was a real low 1.4 and my CBC was great, so I don't think my cancer is active again. 

In terms of infection risk, it could mean a lot. You really need IGG to fight infections, especially bacterial invaders.

The good news is that there is an option: IVIG or intravenous immunoglobulin. It is a very expensive pooled blood product that is given over several hours in the infusion lab. Studies suggests it can reduce by half the risk of infections, especially life threatening pneumonia.

It means back to the cancer center, back in the IV chairs, back to all those awful premeds (steroids and anti-histamines).

So much for being Mister Natural.

It is a reminder of the cancer and will likely become a monthly routine.

But there is a good reason I am doing all this.

I need my immunity boosted because....

I am returning to work. Very very part time. Less that a full day a week. But it's a start.

It's been almost a full year since I last saw a patient in the office. It will be so good to get back to practicing medicine.

I am so happy and so excited.



Blogger Mikha'el said...

It's good to read of your excitement for returning to work. It would be great to hear what your experience will be after returning to seeing patients. Take the time with the IVIG to rest, read and catch up on good music as this is what I do for my monthly chair visit as I call it.
All the best

June 3, 2009 at 6:04 AM  
Blogger gottwinsandmore said...

Dr. Koffman... we too were very excited to hear of your return to work. Take care and you are continually in our prayers.

The Schaefer-Brown Family

June 3, 2009 at 9:50 AM  
Blogger Judy Cleri said...

I'm sorry to hear that your immunoglobulins are so low, but am so thrilled to hear that you will be returning back to work. Maybe in a few weeks/months you will be able to work half days and work your way up to full time. I am so happy that you are feeling well enough to even consider going back part time. Gosh......I'm so healthy right now, I have no reason to even come see you.....

Take care Dr.K...........If we can help in any way, please let us all know.

Since my Ducks didn't make it all I can say is Lets Go Pinquins!

Judy C

June 3, 2009 at 10:17 AM  
Blogger Ronni Gordon said...

Congratulations on getting back to work!

June 3, 2009 at 2:09 PM  
Anonymous Anonymous said...

I don't want to give myself any "KIna Herras" but my immunoglobulin levels have all been incredibly low (much lower than yours) ever since my diagnosis was made without clinical impact to date (IgG about 200mg% and IgA, IgM in the same range of 1/3 the lower limits of normal).

When I consider the risks of IVIG (not to mention it's cost) I plan to wait until clinical evidence (ie, recurring bacterail infections) indicate that the benefits outweigh the risks.

Good luck,


June 3, 2009 at 3:24 PM  
Blogger Marcia said...

I know something of how you feel about going back to work! Next fall I will venture into schools again, supervising student teachers. During this past year of treatments I have only been in my classroom and office, and felt like I was doing half a job. At least I could handle that much. I'm pleased at your excitement, and hope for the best for you!

June 3, 2009 at 9:18 PM  

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