We had an early start this morning after a really bad night's sleep. I fell asleep around midnight last night and woke up at 4 am and couldn't go back to sleep. Checked out and then drove the short distance over to the main building.
6th Floor - lymphoma/myeloma for blood works - the waiting room was empty to our surprise but soon realized it was quite a few early birds for blood works. :)
I saw a couple of older people that we have seen before when we have been there, funny that you can actually recognize someone in a place as big as MD Anderson!
The lady who did the blood work was from Africa and she called herself a vein surgeon... hmm... interesting... :) or as she said a Vampire. Tell you what, she looked more like something out of Blade than ER.
All done with that and we had breakfast and then up to the cyber center for a while. Aj had to print some stuff and we had time to waste. There were the same two gentlemen who worked last Tuesday when we were there. They were having a blast - even cracking me up! Talk about positive spirits!! They were both volunteers and one Eric worked one day a week and the other 3 days a week.
Eric told us that his wife had had lymphoma and then when that cleared she got ovarian cancer, but she was still live and kicking, he said :). He decided to become a volunteer when she was ill. Now, listen to this, because its impressive - there are 1900 volunteers at MD Anderson and they save the clinic $54 million in wages every year that goes to research instead!!! It almost gave me goose bumps! WOW!!
That is incredible and I feel like I want to do more to help out clinics or something.
I did do a small deed, I think... Drove outside Whole Foods the other day and a guy who was dressed all in bike clothes stood on the side walk with a bucket and a sign. Last second I could see the sign and it said "Biking to Alaska for CANCER" so I slammed on my brakes (lucky its the loaner car Subaru :) ) and found some cash to give him. Chloe asked why I gave him money and I told her he needed food for his lunch box, because he was going on a field trip to Alaska. I felt pretty proud for a while and then it hit me... biking to Alaska or down to 6th street to buy drugs.... hmmmm... tricky one... Oh well, if people have the guts to joke and lie about cancer, they might just experience it one day and that will be punishment enough.
When we came up to 6th floor again Amira was standing in the door calling out Adrian's name. So perfect timing. She went over the paperwork and asked normal health questions. She checked the computer and of course the biopsy results weren't back yet.... Then the weird asian lady came in again. Think she is a practicing Dr. from China or something. She checked out the lymph nodes to see if they were swollen and then looked at the CT/PET scan papers and said something about increased activity in the auxiliary area on the right hand side.
We both knew better than to question her what she meant. (last time we were here she came in the room and I hope for the patients that hey have a translator when she becomes the main Dr.) So we just looked at each other and kept quiet.
Then Dr Fayad stuck his head in the door and said - I am coming to see you in a sec, the biopsy were negative and disappeared.
He came back and told us, the CT and PET Scan came back and they were good. No activity on them. Then he had just spoken to Pathology and the biopsy had looked good, no trace of CD 30 or ALK1+ on the stains that he did. No Lymhoma cells, the only thing they see is white cells and that is due to Neulasta.
Pathology didn't mention anything about Histiocytes, but Dr. Fayad said that if they had seen something 'bad' they would have told him. There are a couple of other tests that they are waiting for that are more refined tests.
FLOW CYTOMETRY LABORATORY & PCR
Clinical Flow Cytometry:
Peripheral blood, bone marrow, various body fluids, fine needle aspiration samples, and tissue biopsy samples can be analyzed utilizing flow cytometric techniques. Normal and abnormal cells in these samples are characterized based on the presence or absence of certain molecules on the cell surface or inside the cells. The samples are stained with a carefully designed panel of specific antibodies coupled to four different fluorescent dyes. The stained cells pass through two laser beams in the FACScaliber flow cytometry analyzers and the molecular signature of each cell is recorded as the intensity of fluorescence for each of the four colors. Our highly trained and experienced staff of five technologists then perform sophisticated computer analysis of the data acquired on each sample. The final diagnostic interpretation is rendered by a hematopathologist after correlation with morphological findings.
The Flow Cytometry Laboratory is a vital part of our comprehensive approach to the diagnosis of hematological and lymphoid malignancies. A diagnosis is provided based on all available material and additional tests are suggested when necessary. Conversely, when flow cytometric analysis is unlikely to yield useful diagnostic or prognostic information for the patients condition, the submitting clinician is so advised. Samples with very limited number of cells are handled to optimize diagnostic information. Recurrent disease and minimal residual disease can be identified accurately as experts in the laboratory correlate clinical findings and previous flow cytometry results.
Peripheral blood, bone marrow, various body fluids, fine needle aspiration samples, and tissue biopsy samples can be analyzed utilizing flow cytometric techniques. Normal and abnormal cells in these samples are characterized based on the presence or absence of certain molecules on the cell surface or inside the cells. The samples are stained with a carefully designed panel of specific antibodies coupled to four different fluorescent dyes. The stained cells pass through two laser beams in the FACScaliber flow cytometry analyzers and the molecular signature of each cell is recorded as the intensity of fluorescence for each of the four colors. Our highly trained and experienced staff of five technologists then perform sophisticated computer analysis of the data acquired on each sample. The final diagnostic interpretation is rendered by a hematopathologist after correlation with morphological findings.
The Flow Cytometry Laboratory is a vital part of our comprehensive approach to the diagnosis of hematological and lymphoid malignancies. A diagnosis is provided based on all available material and additional tests are suggested when necessary. Conversely, when flow cytometric analysis is unlikely to yield useful diagnostic or prognostic information for the patients condition, the submitting clinician is so advised. Samples with very limited number of cells are handled to optimize diagnostic information. Recurrent disease and minimal residual disease can be identified accurately as experts in the laboratory correlate clinical findings and previous flow cytometry results.
(Dr Fayad's way of explaining this was: put the material in a blender and the stain would stick to cells a certain size. It would be a more specific test than when you look under the microscope because you are using more cells. The flow and CPR can detect much smaller cells so that is why its more defined.)
FIG 2. An apparently normal appearing bone marrow (left panel) is shown to contain a small monoclonal B-cell population (right panel, green colored dots) indicating involvement by lymphoma.   |
PCR testing
Lymphoma cells are very very small. For example, a one centimeter tumor has about 1 billion lymphoma cells. So lymphoma cells will not be detected by many standard tests unless there are a significant number of cells to form a mass (a tumor) in the sample.
Returning to the analogy of testing for leaves in a pool, a sample taken with a bucket that has no leaves (tumors) might have small traces of leaf fragments (individual tumor cells) that are not visible with plain sight, which might be detected by other tests.
One very sensitive test for lymphoma cells is called PCR. It can detect for the presence of genetic translocations (that are unique to some kinds of lymphoma in the sample).
One very sensitive test for lymphoma cells is called PCR. It can detect for the presence of genetic translocations (that are unique to some kinds of lymphoma in the sample).
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We won't have the answers on both these tests until next week or the following. If they come back with something on them, that would mean that something is 'cooking' in the bone marrow. But once we have that and they are good, we can say that AJ is in remission with no question marks! Right now, Dr. Fayad said that we can say that 'we think he is in remission' :) Basically, this is what it would look like when a person is in remission, but we need to have a written report from Pathology and then its all set.
After that I think there will be check ups every 3-6 months and after 5 years they will call him 'cured' :)
I asked Dr. Fayad about the CD 56 test, but they weren't able to do it because they didn't have enough material to do it on. Now there is no point in doing it, because all the disease is gone.
Good its all gone, but bummer they couldn't do the test...
Dr. F also said that he thinks that Aj doesn't need the Neulasta shoot anymore - YEAY!! no more bone ache!!!!!!! We also mentioned the head aches and he asked to get a copy of the MRI from Austin, so I have to get it from Dr. H's office and send to Amira.
So, the game plan now is to do the last three cycles of Chop and then come back to MD Anderson in 10 weeks to do another staging and then its all done! He said that nobody would get less than 6 cycles of chemo when they are diagnosed with stage 4 lymphoma with such ugly presentation as Aj had and no less than 4 spinal injections. So when the 6 cycles are done, Aj will be at just those numbers.
To finish this off... Dr. Fayad managed to get a few hinters again about no sweeping, vacuuming preferably breakfast in bed and you know all that... Talk about being on Team Aj. Luckily Amira came in and it became a tie. :):):) She goes ' You can NOT get away with that, that is mean! :) :)
It turned out to be a great day and we went out and celebrated with the girls and Fabby tonight!
Rock on Babe!!!
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