Leukemia Types and SubTypes

I keep finding some references that suggest Leukemias are a type of sarcoma. I had come across that same information a few years ago when I was researching how many types of sarcoma there are. (about fifty some) But, I didn't give it much consideration. Sarcomas are one of the rare cancers. Only about one percent of all adult cancers diagnosed are sarcomas.

Whether all Leukemias are forms of sarcoma, I am unable to determine. And that brings up a point I wish to make. In my ignorance, I always thought that Leukemia was one disease. I was mistaken. There are different types of Leukemia.

According to wikipedia are a "total of four main categories. Within each of these four main categories, there are typically several subcategories. Finally, some rarer types are usually considered to be outside of this classification scheme."

Acute lymphoblastic
Chronic lymphocytic
Acute myelogenous
Chronic myelogenous
Hairy cell
T-cell prolymphocytic
Juvenile myelomonocytic
Large granular lymphocytic
Adult T-cell leukemia

I counted nine subtypes.

The type I have, Chronic Myelogenous Leukemia (CML) has a five year survival rate of 90%. Pretty good odds. Huh? If I last 5 years, I will be 71. I figure by that time, there will be new drugs to treat CML. Hopefully, they will be more effective with less side effects. Best yet would be a cure! Perhaps if that's the case my longevity genes will carry me into my 90's or hundred's as have been the case with my ancestors and other close kin.

Another fallacy I once believed about Leukemia (in general) was that it was a cancer of red blood cells that caused fatal anemia. I have learned that is not the crux of it.

The reason CML has myelogenous in the name is become a source of the blood disturbance that is part of the diagnoses begins with the blood cells called myelocytes, which are very immature cells produced in the bone marrow. They are not supposed to be in the blood stream. Once they get into the blood stream they crowd out the healthy blood cells and that's the problem.

I find it very difficult to explain at this time, because I am still learning. I wish I had paid more attention in college when I took pre-med courses. (I never completed my dream to work in the field of radiology as I then had recurrences of Chondrosarcoma to deal with!)

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Photo art by me, Elizabeth Munroz

Beginning Blood 101

Occasionally we might visit a doctor who will order a Complete Blood Count (CBC). This is done because the blood can reveal a lot regarding one's health.

Healthy blood cells have a certain appearance and a certain percentage of them are in the bloodstream.

There are three general types:

Red blood cells, known as Erythrocytes

White blood cells known as  Leukocytes

Platelets are known as Thrombocytes

There are also subcategories which I will discuss later.

When a tube of blood is drawn for a CBC, the blood is then tested and looked at with a microscope.

The cells should have a normal, healthy appearance. When they don't, there is a problem. One can often tell what the problem might be because of the shape or size of the blood cells. Sometimes there are too many blood cells or too few.

There are many medical health conditions that affect the blood, and a diagnosis can be determined based on what the blood test reveals. Sometimes other tests need to be done to clarify the diagnosis, as well.

One of the problems that most people are aware of regarding a disorder of the red blood cells, is anemia.

It is commonly understood that disorders of the white blood cells can be attributed to infections or immunity issues.

A disorder of the platelets can lead to blood clots.

These are simple explanations and certainly not all that a Complete Blood Count can reveal.

Note:
This is my own interpretation and understanding of the subject at this date. For accurate information please consult a scientific professional source.

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Photo art by myself, Elizabeth Munroz

CBC Blood Test Results

Component Results

Component	Your Value	Standard Range	Units	Flag
White Blood Cell Count	54.7	4.0 - 11.0	K/uL	HH
Red Blood Cell Count	4.73	3.90 - 5.40	M/uL
Hemoglobin	14.9	12.0 - 15.5	g/dL
Hematocrit	47.7	35.0 - 47.0	%	H
MCV	101	80 - 100	fL	H
MCH	31.5	27.0 - 33.0	pg
MCHC	31.2	31.0 - 36.0	g/dL
RDW	14.9	<16.4 -	%
Platelet Count	395	150 - 400	K/uL
Neutrophil	65	49 - 64	%	H
Neutrophil Bands	15	0.0 - 10.0	%	H
Lymphocyte	5	26 - 46	%	L
Atyp. Lymph	2	0 -	%	H
Monocyte	6	0 - 12	%
Basophil	3	0 - 2	%	H
Metamyelocyte	4	0 -	%	H
Abs. Neutrophil	35.6	2.0 - 8.0	K/uL	H
Abs. Band	8.2	0.0 - 1.4	K/uL	H
Abs. Lymphocyte	2.7	1.0 - 5.1	K/uL
Abs. Atyp. Lymph	1.1	0 -	K/uL	H
Abs. Monocyte	3.3	0.0 - 0.95	K/uL	H
Abs. Basophil	1.6	0.0 - 0.2	K/uL	H
Abs. Metamyelocyte	2.2	0 -	K/uL	H

Tonight's the Night

Help me, Obi-Wan Kenobi. You're my only hope!

Dasatinib - Sprycell

Dientes

Warning for the queasy: Teeth pictures

Went to the Dientes Clinic to have my wisdom tooth pulled. I felt nervous. I've had dental care before that was less than comfortable and I knew my body would rebel. Therefore I took an Ativan before leaving so I would be relaxed. By the time I got there, I was ready.

When the dentist began, he put the typical numbing lotion on my gums and a short time later, administered the Lidocaine injections. I began shaking uncontrollably. I was surprised. Why would that be?

It wasn't until later I learned the shaking was normal because another drug is also injected. It is called Epinephrine (also known as adrenaline!). This medication is used to help the action of the Lidocaine to numb the area intended for extraction. It also helps prevent excessive bleeding. One of the many side effects is tremor, which is exactly what I experienced. It calmed down shortly and I felt it was worth it if it was going to cut back on bleeding. With my blood in jeopardy already due to the Leukemia, I didn't want to compromise things.

Once this reaction calmed down a bit, the dentist tested my tooth to make sure it was numb. NOPE! It was not numb. He then proceeded to inject some more Lidocaine and we waited a little longer to take effect. He then tested for numbness again. This ended in my sudden scream. I surprised myself by that reaction, but somehow he had touched a nerve, a nerve that was supposed to be numb by then. He patted my hand and was very kind as he told me that he would not be able to pull my tooth. It was too deeply embedded into the bone due to the roots being curved instead of straight as a normal tooth should be. Therefore, the reason my nerve was so reactive.

He advised me to go see Dr. Tarsitano, who was most qualifed in the county to do extractions under anesthesia.

I was grateful for this knowledge, called and quickly made an appointment. But, I was also saddened to learn that my Medi-cal (medicaid) insurance would not pay for this. It would end up being paid for myself, a total of about six hundred dollars.

Yikes!

Oh, but the necessity was clear to me. I knew I would not be able to go through chemotherapy this way. What if there were a bigger emergency regarding this tooth in the future? This is how Dr. Wong had put it. So, I made the decision to put the charges on my credit card and deal with paying it off later. Thank heavens I have a credit card and I pay things off right away, therefore I have no credit balance to complicate things.

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You may be wondering why I have pictures of my teeth. After all, no one takes pictures of their teeth. Right? Wrong. Since I have had the OLP condition the last seven years or so, the specialist I see at UCSF has taken pictures of the changes in my oral mucosa. Therefore, I started taking pictures, too, in order to document changes that occurred when I was not seeing her.

Leukemia and Chondrosarcoma

First I'd like to clarify something right off the bat. There is NO KNOWN CONNECTION between Chondrosarcoma and Leukemia. It is just a coincidence of... what shall we call it? Fate, I guess, that I happen to now have Leukemia some forty plus years after first being diagnosed with the cartilage/bone cancer called Chondrosarcoma. So anybody reading this, get that idea out of your head. 

If by any chance you know of someone who has had another kind of cancer and then got Leukemia, it is usually because their previous cancer was treated with strong chemotherapy drugs or radiation. Those are suspected to be one of the "causes" of Leukemia. There are other factors why someone might get Leukemia, being exposed to certain carcinogenic toxic substances. Considering my long term exposure to the infamous Love Canal when I was a child, it is no surprise to me that I have this diagnosis. The picture of the x-ray is of my pelvis. The two places where the legs fit into the hips are not connected anymore. On the right side of the picture you will see part of the pelvic bones that are supposed to be present. Those are called the ischium and the pubic ramus. The ischium is the "sitting" bone. If you look at the left side of the picture, you will see that the pubic ramus and ischium are missing. I believe that officially makes me one of those "half-assed" persons you are always hearing about. Eh?

The reason that portion of bone is missing is because chondrosarcoma tumor was attached and growing there. The only treatment for chondrosarcoma is surgery. A long time ago the only surgical treatment available would have been total amputation of that half of the pelvis and including the leg. That's called a hemipelvectomy. But, my doctor had some advanced training and saved my leg. 

NOTE: As of May 26 2014 I have learned something new... it looks sort of like there is a connection somehow between leukemia and chondrosarcoma on a genetic level. I don't mean on the genes you inherit, but genes within chondrosarcoma tumor. I do not understand the science well enough yet, to explain it. But am consulting with the researchers who published about it so that I can learn... if they will correspond with me about it.

Double Check - Second Look

There was a time when you might have a blood test and later ask your doctor what the results were. During that time (in ancient medical history, not too long ago) you might be told, "everything is fine" or "nothing to be concerned about". Or maybe you would not have dared to ask in the first place.

Things have changed! Today, I can go on the internet, look up my medical file through the clinic where I get my care. and see what my blood test results are, as can any other patient of the same clinic. This is not to say that we are all savvy patients. Interpreting the meaning of blood results is the doctor's job after all!

I have been told that I have enough medical background to be dangerous. True. Having taken my CA state pre-med courses and never moving up past them to continue my education does put me at a disadvantage. I know enough to find out what those blood results might indicate. I can be dangerous by second guessing the doctor (a big no-no!). I would rather be a well informed patient (a big yes in my mind).

I like that things have changed. I like that I can have almost instant access to my test results. By having that access I can continue to learn how to help myself to be healthier so that I can discuss test results with my doctor more intelligently. It helps me to recognize the reasoning behind a possible treatment the doctor might suggest for me.

Getting to the point now... I get an email notice every time a new test result arrives, after the doctor has seen it first. So tonight I got one stating my blood test results were in. Hmmm? Haven't had any new blood tests done since last week. I wonder what's going on?

I found it very interesting to find that the doctor has ordered a "repeat analysis" of my blood test which was done on the 26th of October. He took a look at the results this afternoon shortly before leaving his office.

It makes me feel good to know he's taking a second look at my results. To me that means he is checking up on me, making sure he's doing his best for me. Hope that's not too egotisical of me, me, me, to be thinking this way. I feel reassured that he cares enough to give my case more than a glance consideration.

Photo Art by me, Elizabeth Munroz
It's called, of course, Double Check Second Look