Quick disclaimer (and humble brag): I’ve been able to accurately “diagnose” a few things before the medical staff treating my husband. That being said, the only medical school in my repertoire is Google and the only accredited degree I hold is in the very closely related film & television arts.
Now that we have that out of the way, here’s why it’s important to understand lab results…
If you’re like me, you assume a lot about medicine. You probably assume doctors have access to a program where they can easily identify trends. They don’t. They look to see if anything’s in the out-of-normal range as they happen and if something is off (or trending in the wrong direction) but they don’t catch it, it can cause real problems. Being a proactive patient in this scenario can only benefit you.
I know this because Jeff had blood work that should’ve alerted his physician to his cancer back in March of 2015. His doctor noticed the high WBC (White Blood Cell counts) and noted that it likely signified a virus but did not catch his incredibly low HGB (Hemoglobin) which should have been a red flag for additional testing. That was enough reason for me to learn the meaning of every acronym and how they relate to each other.
Alright, enough explanation. Let’s run through the big ones. Don’t feel intimidated.
(me in June of 2015)
When a doctor orders lab work he will likely, first and foremost, order CBCs – the Complete Blood Count. I’ve found the below to be the most important parts of the CBCs:
WBC (White Blood Cells): a high white cell count can signify anything from an infection, to a virus, to inflammation, to cancer. If your white cell count is high, you can look at the results that follow the white cell count to get more of an idea of what is going on – the results I’m referring to are Lymphocytes, Neutrophils, Eosinophils. Each of those cell types have a different purpose when it comes to attacking things in the body that shouldn’t be there. I’m going to stop here on the high white blood cell counts so your eyes don’t glaze over.
A low white cell count leaves you to prone to infection. This normally occurs right after chemotherapy and that’s why, post chemo, Neupogen shots are given. Neupogen shots make sure your ‘good’ white cells replicate quickly so you aren’t compromised. These shots cause bone pain (because of the white cell count being forced to quickly grow in the bone marrow) and generally suck.
Hgb (Hemoglobin): Chemo can cause anemia aka low hemoglobin, and so can cancer. This seems like a good time to mention that the more you learn about lab results, the more you’ll realize that a single result can point you in a handful of different directions. If you suffer from anxiety, good luck.
A high hemoglobin can signify something called Polycythemia. Then again, it could be that you are dehydrated so that your lab results are just falsely high.
Platelet: Platelets prevent you from literally bleeding out. Without the ability of your blood to clot, you’re in big trouble. The normal platelet count (by MD Anderson standards) is 140-440. Jeff’s platelets like to hover around 40, which sounds insanely low, but a lot of patients don’t even have results of 10 and need replacements daily. Platelets are hard to come by and it can often take 3-4 donors to make a single bag of platelets. Now that you know this, you’ll hopefully feel inclined to donate platelets, which you can find out how to do here: Donate Platelets
Now for my absolute favorite…
LDH (Lactate Dehydrogenase): it’s a lab result with an identity crisis. It has no idea what it’s signifying, but it’s there and it’s gonna love watching you lose sleep at night. High LDH! What could it be? It could be the chemotherapy working, could be cancer growing, could be an impending heart attack, sepsis, a virus taking over, who knows! It simply signifies cells being destroyed and it’s the most ridiculous of them all.
Creatinine: Having creatinine be a little low doesn’t normally signify a huge problem, high creatinine tends to be a problem. The kidneys are under stress for some reason (like a blockage, or medication toxicity) and they’re going to start getting cranky. When they start getting cranky you have to find ways of removing some of the stress or they’ll eventually shut down, leading to kidney failure, dialysis, and eventually a transplant. eGFR is another way this is monitored, but it’s taken less seriously than creatinine.
eGFR: This monitors the filtration rate of the kidneys. You’ll watch these numbers slowly decline if the creatinine is high (not confusing at all, thanks!) but the difference with this result is that it takes other lab results into account. It should be monitored to better identify kidney stress, even when creatinine is in the normal limits.
The normal eGFR for Jeff was 185, but the normal population eGFR is around 107 (that’s by MD Anderson standards). So, when Jeff and I saw his eGFR hit 110 one day, we knew his kidneys were not happy. The doctors would have not caught this because he was still in normal range to them, but we’d been steadily tracking it. They quickly made some substitutions to solve the problem when realizing the decline was after taking a new, high toxicity medication.
Bilirubin, AST, and ALT: These are liver lab results. When they’re high, it could be anything from drug toxicity, to liver cancer, to Graft versus Host disease. When one organ is under too much stress, the rest usually follow. When Jeff’s kidneys were unable to handle the toxic burden of medications we often watched these numbers slowly creep up.
Protein: Gastrointestinal issues often cause low protein. When the intestinal walls thicken, they can’t absorb as much protein. The malnutrition caused by this can also have an affect on your electrolyte panel – sodium, potassium, calcium – you’ll likely need replacements via pill or IV.
Albumin: Low protein causes low albumin. It’s a problem because low albumin causes something known as ‘third spacing’ – that’s when fluids no longer hydrate your organs and actually sit in places like your feet. This is called nephrotic syndrome and can be extremely uncomfortable. There’s no cure except for to figure out the underlying problem and fixing that. Now you’re on the journey of trying to figure that out. Great.
Now that you know what is low or high in your lab results and your symptoms, you can take to Google (but ONLY MEDICAL PAPERS – NO WEBSITES). Part of the challenge is finding free medical papers. Some want payment. I find this ridiculous. Almost as ridiculous as learning how political medical papers are, with doctors fighting over who gets to be lead author on the research.
I plan to fight for all free medical information – but right now Jeff has to get over this GHVD, first things first.
You’ll quickly find that a lot of symptoms and/or lab results add up to be the same things. That’s why WebMD makes hypochondriacs.
But good doctors will listen to why you think symptoms are adding up to a certain diagnosis. Chances are, they’ll give you piece of mind as to why it’s not what you think it is – you know, because they spent years in medical school where they’ve had to learn all of the small details surrounding what makes up a particular diagnosis.
And try to keep in mind you don’t want to be the patient advocate that cries wolf to the point that no one takes you seriously (although I know first hand it’s undoubtedly difficult when you feel like you know what is suddenly wrong and it needs to be fixed immediately). Always check your sources, do your own research, trust your intuition, advocate, advocate, ADVOCATE.
But, please, with gentle persuasion.
I’d like to start this story off with some good news. The flooding around the hospital finally cleared and I was able to reunite my husband and our dog. You can see their excitement in this video:
My husband and I were on our 50th straight night in the hospital when we heard that Hurricane Harvey, a category 4 hurricane, was barreling towards us in Houston – one of the most flood prone cities in the United States and home of the biggest Medical Center in the world. I guess fighting an extremely rare cancer and nearly going down in an airplane within the last year wasn’t dramatic enough (Lifetime Network, hit me up).
This hurricane felt way too ‘on the nose’. A giant metaphor. Symbolically, a hurricane is a lot like cancer. When you’re told about it, you’re not sure how much damage is coming and you can try to prepare yourself for the overall experience, but only when you’re in it do you finally see all the hurdles that make up the bigger picture. Like…
For Houston, the flooding is what truly made Hurricane Harvey terrible. Jeff’s Graft Vs. Host Disease, what we’re inpatient for now, is just like the flooding in that it’s the dangerous after effect that lingers. I’m sure you’ve seen a ton of media coverage on the floods, but here’s some pictures of what the outside and inside of MD Anderson looked like for us on day #1:
Yes, that’s a car flooded and abandoned in front of the hospital. One of many. Some of them positioned as if they were turning into the employee parking lot.
I spent most of the time we were on lockdown scrolling through Facebook and there were a surprising amount of people who thought those who didn’t evacuate were “stupid” and deserved no help. That was when I learned that nothing magnifies rage like cabin fever.
I’m making Jeff a shirt that says’I Survived Cancer and all I got was this Hurricane Harvey T Storm’.
So let me explain something about evacuations from the point of view of being in this cancer hospital…
If evacuating isn’t mandatory, that means businesses can stay open. Which means hospitals stay open. And, just to reiterate, this medical center is the biggest in the world. That’s a lot of employees (around 106,000) keeping A LOT of people alive.
HERE ARE SOME REASONS WHY STAFF DIDN’T EVACUATE: They were told to come into work and their coworkers and patients were counting on them.
Our night nurse worked 17 hours straight that first night. Nurses normally work on 12 hour shifts and I can only imagine how critical thinking holds up past 12 hours, much less 17. A simple mix up of medications or forgetting to flush a cvc line could mean someone’s life.
The flooding was so bad that nurses were sleeping in shifts of 4 hours in their offices and covering for each other, all while hoping their families and homes were surviving the storm. Eventually water had to be released from reservoirs, threatening even more homes that weren’t originally at risk. One of our nurses was sure it’d flood her house but all she could do was continue her shift and wait and see.
By the second day, a nurse arrived to work in the flooding. Did she kayak in? It was still badly flooded and constantly raining. All of the other nurses on the transplant floor cried when they saw her (I assume partially because they were exhausted and knew she’d provide some relief, but also because they knew how risky it was to try to make it in). Emotions were as high as the water. All sorts of lives were on the line. Doctors couldn’t make it in and were having to review things from home and call in orders.
The hospital was waiting for blood products to be flown in. Transplants could reject without them. On top of that, they were out of coffee. The staff were sleeping in 4 hour shifts on floors with NO COFFEE. It’s amazing how little coffee was available after one single day of lock down. I’m letting you know because if you’re ever in a hospital during a storm, bring coffee to barter with.
Stock up on your bartering foods early. This is the selection Target had to offer just 3 days before the storm. Apologies to my mother in law.
HERE ARE SOME REASONS WHY OUTPATIENTS DIDN’T EVACUATE: They could need daily infusions that MD Anderson provides – blood products, platelets, other infusions that literally keep them alive day to day. Do you know how difficult it is to get complete records sent to another hospital while they’re prepping for a hurricane? Do you know how difficult it is to get records sent to another hospital on an average day? Many people travel to Houston for special treatment because it’s one of the few places that handle rare diseases. It’s financially draining to do this, even without factoring in an evacuation.
HERE ARE SOME REASONS WHY OTHER PEOPLE DIDN’T EVACUATE: Some people didn’t evacuate because they don’t have the means. Or maybe because they thought they’d go over to Joel Osteens church and be taken care of there?
I dunno, I think those cover A LOT of people.
As much as I’ve wanted to be out of the hospital and back in the comfort of our apartment over the last couple of months, I feel grateful that we were in MD Anderson during the hurricane. I knew that Jeff was being taken care of. If we had been home and something happened to him, who knows if I’d been able to get him help. But I do know that with the incredible care we’ve been given at MD Anderson over the past year, we would have also chosen to stay. It’s something I think a lot of people outside of the Texas Medical Center fail to think about.
The people of Houston deserve all of the help you can give. Here are a few links to start, and the NY Times link to some additional resources:
The South Texas Blood and Tissue Center is reporting a critical shortage, and has extended hours at all of its San Antonio-area donor rooms. To donate, call 210-731-5590 or visit their website for more information.
Carter BloodCare covers hospitals in North, Central and East Texas. To donate, call 877-571-1000 or text DONATE4LIFE to 444-999.
To help animals suffering from the disaster, visit the Houston Humane Society or the San Antonio Humane Society. The Houston Society for the Prevention of Cruelty to Animals has set up an animal emergency response hotline (713-861-3010) and is accepting donations on its website.
The United Way of Greater Houston flood relief fund will be used to help with immediate needs as well as long-term services like minor home repair. Visit their website to donate or text UWFLOOD to 41444.
GLOW. It’s a fantastic Netflix series I binge watched the entire first week of July. Little did I know, while I was watching lady wrestlers battling it out in the 80’s, there was a battle going on right next to me…
It was Graft versus Host. Jeff’s New Immune System versus Jeff.
Jeff and I were totally under the impression that we were in the clear by July. The more dangerous stages of GVHD normally occur in the first 100 days and he had avoided it. Or so we thought.
GVHD occurs when immune cells identify the body as something foreign. You actually hope for a LITTLE bit of GVHD, because the cell’s ability to recognize what’s foreign is what fights the cancer. If your new immune system is too similar to your old one, it won’t know to fight the cancer.
This is why GVHD has a higher chance of occurring if your stem cells are from an unrelated donor. Jeff’s stem cells came from his sister, and they were a complete HLA match (jackpot!) but GVHD also has a higher chance of occurring when stem cells are given female to male (or vice versa). ISN’T THIS ALL EXHAUSTING? But wait, theres more:
All allogeneic stem cell transplant patients are given drugs to suppress the new immune system. They’re slowly weaned off so that the cells have time to get familiar with their new body and not attack it. Here’s a gif representation:
IN THE BEGINNING THE CELLS ARE LIKE THIS
BUT AFTER WEANING OFF IMMUNE SUPPRESSANTS THEY CAN GET LIKE
Jeff’s new immune system seems to have qualms with his digestive tract specifically. It’s preventing him from absorbing protein, which didn’t sound so terrible at first – big deal! We’ll go to GNC and get some Muscle Milk, solve this here and now. Except it doesn’t work like that (but I, a non intellectual, was willing to try it). The lack of protein becomes a big problem because protein begets albumin, which is what keeps water in your veins. Without albumin, things (your organs, specifically) can take a quick turn.
The first thing doctors do when they realize you have GVHD is give you a very high dose of steroids and cross their fingers and hope it works. It only works for about 30% of patients. When that doesn’t work (like it didn’t for Jeff), photopheresis is the next option. Here’s what it looks like:
The photopheresis machine has a very nonthreatening sound to it – like a Cessna during taking off.
Jeff had a new access line placed into his chest so that they could run his blood through this machine. The photopheresis machine separates the immune system cells and – for lack of a better word – sunburns them so they become less cranky. They then circulate the cells back into his body. He does this 3 times a week, for 2 hours at a time, and it takes weeks to see an effect. This is rough because sometimes the GVHD is so acute that people can’t wait weeks to see results. There has to be something better than this, right?
Jakafi is the drug’s given name but I prefer to call it Jafar.
Jakafi was originally created for Polycythemia Vera, a slow growing blood disorder. The pill works by lowering your blood cell counts (it’s essentially chemo). Researchers found that it’s effective on some GVHD and so it was approved for off label use only in the last couple of years.
So we waited for the drug manufacturer to approve Jeff’s use of Jakafi, then we had to wait for insurance to approve the cost. This took a week and it often takes much longer. This is a huge issue when each pill costs around FOUR HUNDRED DOLLARS. Jeff takes 4 of these a day. A nurse dropped one on the floor yesterday and I nearly threw up.
Jeff is on day 12 of Jakifi and it can take weeks to work. Each day in the hospital stretches into the next. I find it ironic that the only thing that gets Jeff’s mind off of everything is watching back to back episodes of HGTV shows when we’ve had our fill of acronyms this year.
Every day we risk a life threatening infection by continuing to wipe out his immune system to control the GVHD. Because of this, numerous antibiotics and antifungals are given daily via IV. This puts incredible strain on the kidneys. There has to be perfect balance, so nurses and doctors are working around the clock to keep his body running. It’s a lot like a symphony. The most expensive, anxiety inducing symphony. It’s like the symphony they hired to record the score for JAWS. And for now, all we can do is “wade”* it out.
*I’m so sorry, but not sorry for this.
MY CURRENT LEVEL OF CASUAL EVERY TIME A NEW HEALTH ISSUE ARRISES
Back in February I had to call 911 when Jeff was having chest pains. I went downstairs to let the EMT’s in and they thought I was the landlord because I was super chill opening the door for them like, “just bring that stretcher right in here.”
There’s only one thing people want to talk about less than cancer and that’s the ICU. Shortly after my last blog post in February, my husband ended up there. I always thought being sent to the ICU was the “beginning of the end”, but I was wrong. The Intensive Care Unit saved Jeff’s life. Now I want to sing their praises. Literally, with ‘Private Eyes’.
“I.C.U. and you see me… They’re watching you.” How comforting! They’re watching out for you. So closely.
Let me back up and tell you how we got there.
Something no one warns you of is how, post chemo, your veins can get a little…leaky. I don’t want to be too graphic (novel) here but did you see the first X Men movie? Do you remember what Magneto did to Senator Kelly? Do you know how much I hate myself for using this reference? Senator Kelly went from 70-ish% water to 100% water and that was the end of him.
Chemo can cause fluids to go to places they aren’t supposed to go. Sometimes the fluid will cause your legs and feet to swell. It can also end up somewhere dangerous, like in your lungs. Sometimes the water will go straight past your kidneys and your body will believe you’re dehydrated, causing you to drink more water. The cycle continues.
This is what happened to Jeff. He hadn’t been eating well post transplant yet he also hadn’t lost any weight for weeks which was confusing. We didn’t know he was carrying around 20 pounds of water weight around his organs. They warn you that transplant patients can lose or gain weight because of changes in metabolism, so we chalked it up to that. It’s an incredibly insidious thing. More insidious than the amount of Insidious sequels that exist (give it a rest Hollywood). Even now, with Jeff no longer retaining fluid and eating enough to feed a family of four, he’s still losing weight. Most of our conversations are like this now:
So, one morning Jeff wakes me up with chest pain that’s a 5 out of 10 and it quickly progresses to an 8 out of 10 and I call 911. When we get to MD Anderson they do some scans and his lungs are full of fluid. They do a thoracentesis, which is just a Harry-Potter-mythical-creature-sounding word that means they took the fluid out of his lungs. They did this by – how do I explain this technically – punching a hole in his back and putting a suction tube in it. They got a couple of liters (!!) out and he was able to breathe without the chest pressure… temporarily.
That’s when his lab results showed abnormal kidney function. It suddenly plummeted. Our doctor came in to tell us he’d like to send us to the ICU but that it was “precautionary” – not that he needed it immediately, but better safe than sorry. I remember thinking, “this is what they tell everyone I bet”. I was numb. Jeff wasn’t protesting. I knew that was a bad sign.
Let me be honest – the walk to the ICU feels BLEAK. It’s always tucked away from the higher traffic floors. There’s even a special elevator to get to them. There are less windows, if any. The rooms are small and cramped with all sorts of machines. There’s only a recliner, unlike on the regular floors there’s at least a bench to sleep on. I’m actually still confused by this, considering the ICU seems like the place you’d be much more likely stay overnight as a caretaker.
As a side note: I am a terrible sleeper and I can’t sleep unless I’m completely flat. In the ICU I ended up shoving my suitcase in between the recliner portion and the ottoman so I could lay down. It worked perfectly. I highly recommend.
It was around midnight when they transferred us and I couldn’t help but pay attention to every single detail. Patients hooked up to breathing machines, unable to move. The doctor asked me to go to a waiting room while Jeff had an arterial blood pressure line placed in his wrist. It seemed painful and he seemed so out of it (they wouldn’t give him pain medication for fear his blood pressure would get dangerously low). I was so worried that I lasted in the waiting room for about 10 minutes before I was right back outside of his room. He could look out at me through the glass doors while they did the procedure, but I knew I was blurry to him without his glasses on. I just kept making a heart with my hands at him like I was in a stupid Taylor Swift music video.
It was all I could do and I LOST IT. I moved around the corner where Jeff couldn’t see my blurry figure and collapsed on the floor. His nurse happened to just be coming out of the room to check on the dialysis machine when he saw me. He stopped, knelt down and said, “Everything is going to be okay”. He got right back up, helped me into the room, and then assisted another nurse in lining up the 100 or so clear bags needed for the dialysis machine (I wish I could explain what these were for, but I have no idea. Still today I’m convinced dialysis machines run on magic).
I found the nurses in the ICU to be the most empathetic, strong, tactful people in the hospital. They were always aware, walking a fine line with their interactions: not too jovial because the place is a constant reminder that people die, but also not despondent because people are trying to cling to any trace of hope. This just a small layer on top of their many daily actions that make a difference between life and death.
I don’t know how much time I spent thinking about the lives of ICU nurses. It’s amazing what the brain does when simultaneously in trauma and void of stimuli. I don’t even remember Jeff looking as sick as he did at the time. I was like the Shallow Hal of health. I’m pretty sure this was my brain’s way of protecting itself.
Jeff remembers very little of any of this. I had spent most of my time worried about the amount of pain he was in to later find out that his brain was also protecting him. The extreme stress on his mind and body took him to a dream like state where all he remembers is thinking he was on a train with me.
Over the next two weeks Jeff had:
- a groin catheter placed for dialysis
- a drain placed in his heart for pericarditis
- his picc line replaced
- an endoscopy and biopsy to check for GVHD
- around the clock breathing treatments
I made a lot of Top Gun references. It was my excuse to call him Goose.
After his kidneys normalized, we were transferred back to the transplant floor where we spent another two weeks. We were discharged from the hospital in mid March after a full recovery. What transpired was something known as Multisystem Organ Failure and when it happens after transplant it is, more often than not, the cause of mortality. We’d been on the lookout for something like sepsis, not something as simple as excess fluid. We now know how important it is to carefully monitor fluid intake and output after chemo, but especially after myeloablative conditioning.
Jeff and I celebrated with a big ceremony on May 13th – it was the goal line we’d set at the start of transplant. Because of MD Anderson’s ICU team’s care, we made it. We are day +160 post transplant.