Friday, November 26, 2010

Atypical Results and Some Confusion

Ah yes...the field of medicine. A person might think it should be possible to get a definitive answer - That it should be a yes or no, black or white, this or that, etc. And while medicine can often provide a concrete answer when it comes to interpreting tests and making a diagnosis, those of us who have complicated health issues know that just as our bodies are unbelievably complex, so is figuring out what the problem is when something unbelievably complex goes wrong with our bodies, especially when the presentation of illness is not "typical."

Yesterday we took Little Bittles to her pediatrician. We were hoping he had received the report from the bone marrow test (which he hadn't yet), and we wanted to discuss with him the results. Here's the thing; when we told him that the test showed she had 15% blasts but no cancer, our doctor didn't really believe that. It's not that he didn't believe she doesn't have cancer; he said, "If they said it's not cancer, then it's not cancer." However, he did not really believe that she could have 15% blasts and NOT have cancer! In other words, he suggested perhaps whoever interpreted the test got blasts mixed up with another cell such as reactive lymphocytes. I think the reason our pediatrician is wondering about this is because usually when they find 15% blasts, it IS cancer. This goes along with what the hematologist told me on the phone; he said that when he first saw the number of blasts she had, he thought that it was leukemia and phoned my husband immediately to tell him that the result on first look was very bad. When he phoned me with the full study a few days ago, he made it very clear that he really did think it was leukemia at first, but that when they looked at the cells, they were normal and not cancerous! There seems to be no explanation for this. The more research my husband and I do, the more we realize that the chance of her truly having 15% blast cells and not finding a single cancerous cell would be next to impossible a miracle.

Of course, I have to insert here that we are NOT doctors, so we could easily be wrong about this, but it kind of makes sense in light of the fact that our pediatrician has a very hard time believing the result and that the hematologist was surprised that with that high number of blast cells he did not find leukemia. I believe that time may tell if this is a miracle or if they were wrong with the test results.

Now here's where we get a teeny-tiny bit nervous. We do not doubt for a second that the result could, in fact, be a miracle. We serve a mighty and powerful God Who can heal our bodies and do the seemingly impossible. However, we are also aware that doctors, like everyone else, are human and make mistakes sometimes. So a very small part of us wonders if perhaps they did make a mistake on the test and the results are not correct (Perhaps they got blast cells mixed up with another type of cell, like our doctor suggested was possible). It struck me as odd when the hematologist who did the test told me, "Even if we would have found cancer, we probably wouldn't treat it yet anyway." That comment makes me wonder if maybe he was so surprised that they didn't find cancer when he saw the high number of blast cells that he is wondering if they might have missed it. However, the fact that Bittles is clinically fine right now indicates that if by some very, very small chance they missed finding cancer in the bone marrow, the cancer is not likely acute right now. I personally HIGHLY DOUBT that they would have missed finding the cancer cells because I would think that upon finding the high number of blast cells (indicative of leukemia), they would have been checking out those cells VERY closely for cancer. Our doctor also said that if they say the cells aren't cancerous, it isn't cancer.

Now, clinically Little Bittles is fine right now, which is an excellent sign. There were a few concerns at the beginning about some strange bruises and her not eating or drinking well. However, there is currently no issue with that at all, so it is extremely unlikely that she has acute leukemia right now, given her good clinical presentation. Nonetheless, her high number of blast cells is very, very strange, and our pediatrician wants to keep a very close eye on her for any signs of cancer.

Follow-up: Little Bittles will be having a complete blood count done next week as well as an allergy test to see if she is for sure allergic to Penicillin. Depending on the result of her cbc (complete blood count), she will be getting routine blood tests done once or twice a month until things get more normal. A fever of around 38 is not emergent but warrants a trip to the doctor the next day. A high fever with other signs of sickness is an emergency for her.
Prayer Requests: Wisdom for the doctors as there seems to be some confusion about the bone marrow test results, protection from illness as we venture out a little more, good results from the blood test and allergy test next week, complete healing of our daughter's blood and bone marrow, healing for a diaper rash that appeared yesterday and is much worse today. (Not sure yet if it's just a normal diaper rash or an infection, but in neutropenic patients simple things like diaper rashes can become concerning fairly quickly if they are actually bacterial infections.)

Grace and peace to you,

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