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Compartmentalization

Posted by Frederick Wasti
Mar 13 2013

Hello again. I am "back on the air" again, so to speak, after a long absence from blogging, for which I apologize.

So, "What happened to February?" you ask. Yes, it's been a long while since I've put a blog entry online - in fact, I totally skipped over February. (In my defense, February ~is~ the shortest month - <sheepish_grin>.) It's actually good news that I really didn't have anything significant to share (although admittedly that's not very helpful to the reader).

The truth is that Part C of my clinical trial, with its greatly reduced treatments (once every two weeks, as compared to the three treatments per week grind of Part B), has allowed me to put CLL "on the back burner" (again, so to speak). Oh sure, I still have to take medications multiple times each and every day, but that amounts mostly to a routine responsibility that does seem relatively disconnected from the disease itself.

Merriam-Webster's Dictionary defines the verb "compartmentalize" as "to separate into isolated compartments or categories", and provides, as an example, "He compartmentalizes his life by keeping his job and his personal life separate.". In psychological terms: "Compartmentalization is an unconscious psychological defense mechanism used to avoid cognitive dissonance, or the mental discomfort and anxiety caused by a person's having conflicting values, cognitions, emotions, beliefs, etc., within themselves. Compartmentalization allows these conflicting ideas to co-exist by inhibiting direct or explicit acknowledgment and interaction between separate compartmentalized self states." Uh-huh.

I guess what I am trying to say is that I ~may~ have been subconsciously putting off updating the blog as a defensive mechanism. Perhaps. Dunno. (?) Actually, there have been several days over the past few weeks where I ~did~ intend to compose a blog entry, but I then got bogged down in reading up on the latest research news (and the news as of late ~is~ encouraging, even exciting sometimes, and I will share some of that soon - I promise), and in the end I never got around to putting any blog post online. (And, by the way, when I checked out a few of the other "CLL patient" blogs recently, I did find a couple of them that had lengthy periods of inactivity during which the blogger had probably been compartmentalizing, and had to end up apologizing for the scarcity of entries when he/she finally did resume posting again.)

 

Therefore, while I am trying to explain why I may have been so tardy in updating this blog, I still do have to apologize for leaving my own blog's readers (all two or three of you - <grin>) in the lurch, wondering how I am doing - I am indeed sorry for that.

So, in response to the question, "So, just how is Fred doing lately anyway?", I can answer, "Quite well, thank you", because I am indeed doing very well (under the circumstances). In fact, at the last visit to Dana-Farber (two Mondays ago), Michele Walsh (my nurse practitioner, who sees me nearly every time I am at D-F) pointed out that, if I had just had a "regular doctor's exam", with routine blood testing (which ordinarily would not have included a differential count of the various types of white blood cells), the doctor would have found my blood to be quite normal:

In a much earlier blog entry, "Blood Cells 101", I stated: "Red blood cells normally make up over 99% of the cells in blood, and there normally are about 5,000,000 or so per cubic millimeter. White blood cells are of approximately the same general size range as the far more numerous red cells, but there are normally 'only' about 5,000 to 10,000 per cubic millimeter, Platelets are much smaller than either red or white cells, and are intermediate in quantity, there being typically about 300,000 per cubic millimeter."

Well, my most recent blood test results (again, from two Mondays ago, but other recent results have been similar) showed my red cell count to be 4.64 million per cubic milliliter, certainly well withing the normal range of 4.2-5.6 (the normal range routinely provided for comparison on the D-F blood test printout). Similarly (and perhaps more importantly), my white cells measured at 6.3 thousand per cubic milliliter, which is also well within the normal range of 3.8-9.2 thousand (D-F) or "5,000 to 10,000" (from above). And my platelet count, which has often been quite low as a result of CLL, measured at 168 thousand per microliter, which is still a bit low, but is still (admittedly barely) within the normal range of 155-410 (D-F).

Looking at my total white cell count over time, ...

...it can be seen that it has come down greatly from where it was at the beginning of the trial, and that it has been close to or within the normal range for quite a few months now.

Of course, the routine blood testing from a "regular doctor's exam" would not have included a differential white cell count, which ~is~ routinely performed nearly every time I visit D-F, and which shows that the proportion of neutrophils and lymphocytes are currently being (intentionally) maintained at very lopsided proportions:

Considering that neutrophils normally should make up about 49% to 79% of the white cells, and that lymphocytes usually should make up about 11% to 38% of the white cells (these are the D-F normal ranges), it can be seen from the above graph that my own proportions were "way out of whack" back when treatment began, then were probably within those proper ranges for a short time last spring, but have since been (intentionally) kept "way out of whack" in the opposite direction (as my treatments every two weeks are designed to keep my lymphocyte count very, very low, as Alemtuzumab and Ofatumumab have been trying to catch and destroy as many leukemic lymphocytes as possible).

As for how I am ~feeling~, well, I'm doing quite well. I sometimes feel a bit "subdued" after treatment, sometimes for a day or two but not always. My stamina does vary a bit from day to day, but I do feel quite well most of the time. Furthermore, with the exception of that pesky pneumonia I had for a Christmas present, I have not had any serious infections, despite the fact that my immune system has been greatly compromised for a long time now. Of course, that's why I have been taking anti-bacterial, anti-viral, and anti-fungal medications each and every day (twice each day for the anti-bacterial and anti-viral meds, and three times a day for the anti-fungal).

I still have a long-term battle with the seborrheic dermatitis affecting my face, but even that seems to be somewhat less of a problem now (requiring less frequent topical anti-fungal and steroid treatments to maintain "my good looks" - <grin>). The arthritis in my fingers and in my right hip have flared up again very recently, but I had mostly been doing pretty well with those problems over the last month or so, overall.

So, how am I doing? Well, I would say that, all things considered, I'm doing ~OK~. And, you can quote me on that.

Well, that's all for now from Fred. I ~will~ try to get back to blogging a little more frequently - I promise. (Really.) Thank you for your patience in the meantime, my dear readers.

 

Categories: Leukemia