25 April 2007
Wednesday
[Journal not posted until 8:15 AM on Thursday. I am still recovering from not getting a nap on 4/24/07, so I once again went to bed quite early.]
High-Level Journal Summary: Results from my 4/13/07 blood work-ups to test for DVT (Deep Vein Thrombosis). I had a total of 15 viles of blood taken for these tests. Results show that I passed 11 tests with flying colors. On the 3 other tests, I had results that were out of range.
One test seems to be of particular concern. DNA testing indicates that I have one copy of the G20210A mutation in the Prothrombin/Factor II gene, thus elevating my risk for venous thrombosis.
In the end, I am happy with my general approach to my brain cancer treatment right now. Instead of focusing solely upon taking Temodar chemotherapy, I am also taking action as my body tells me things or as I learn of new risk elements for which I should be aware. It gives me peace to know that I am "on these things" as best as I know. The more I listen, the more I realize that response is necessary -- perhaps even critical.
Countdowns:
1.) Day 10 of 28 in my 20th 5/23 Temodar chemotherapy cycle. I woke at 3 AM with an extremely swollen uvula (the "floppy flesh" at the back of the throat, roughly the size of a small grape). While the swelling has decreased throughout the day, this is still a watch item. Initial research is that this is an indication of my body fighting another infection. I tried calling my local oncologist today, but I have not been able to get through to her yet. I will need to stop by her office in the morning since I was unable to get her on the phone.
2007 Seizure Activity:
1.) Last Simple Partial Seizure, or SPS, was 6 days ago.
2.) In 2007, I have had 20 SPS's in 115 days. This is an average of 1 SPS every 5.8 days.
Website Updates:
Per 4/23/07, the new "1st MRI Day" logo has been added to the Home Page and to the 1st MRI Day tab.
Actual Journal: When I had my Hematology Blood testing on 4/13/07, I also got blood work-ups to check for Deep Vein Thrombosis (DVT). I ended up getting 15 (yes, fifteen) tubes of blood taken for all the blood work-ups that needed to be done. How appropriate for a Friday the 13th! (We were laughing about it in the lab.)
Why was I getting this DVT testing done? Because I now count DVT to be a risk element I need to watch closely during chemotherapy, as discussed in detail in my 3/29/07 online journal entry. I have this concern about DVT because:
• Cancer patients have increased risk of DVT
• I have a family history of DVT, and
• I have directly seen brain cancer patients removed from effective clinical trials because of DVT.
Test results
Today, the test results came in the mail. 5 pages of dense text. No way I am going to try to transcribe the full text. Simply too much data. I can, however, boil the report down to the most pertinent data. That is, I will list the tests where my results were "In Range" and "Out of Range." Where text is provided, it is verbatim.
1.) In Range
The following tests are fine and there are no concerns:
• LUPUS ANTICOAGULANT
• PPT-LA
• DRVVT SCREEN
• ANTITHROMBIN III ACTIVITY
• PROTEIN S, ANTIGEN
• HOMOCYSTEINE, SERUM
• FACTOR V (LEINDEN) MUTATION
• MTHFR DNA MUTATION
• CARDIOLIPIN AB (IGG)
• CARDIOLIPIN AB (IGM)
• CARDIOLIPIN AB (IGA).
2.) Out of Range
The following tests are not within expectations, so I will need to discuss them with my Hematologist to understand the potential consequences:
• PROTEIN S, ANTIGEN: 69 L (Reference Range 70-150%)
• PROTEIN C, ANTIGEN: 57 L (Reference Range 70-140%)
Units are "% of normal". Decreased levels of Protein C antigen may be found in congenital deficiency treatment with oral anticoagulants, liver disease, D.I.C. and post surgery.
• PROTHROMBIN GENE ANALYSIS
RESULT: POSITIVE FOR ONE COPY OF THE G20210A (PROTHROMBIN/FACTOR II) MUTATION.
DNA testing indicates that this individual has one copy of the G20210A mutation in the Prothrombin/Factor II gene and is thus at an elevated risk for venous thrombosis. In addition, other family members may also be carriers of the mutation and similarly at risk. Consider genetic counseling and DNA testing for at-risk family members.
Laboratory testing supervised and results monitored by V.M. Pratt, Ph.D., FACMG, Director, Molecular Genetics.
The G20210A mutation in the Prothrombin (Factor II) gene is the second most common inherited risk factor for thrombosis. Individuals who have one copy of the mutation are at a 3-6 fold increased risk for thrombosis and individuals who have two copies are at an even more increased risk.
The G20210A mutuation is detected by signal amplification of the Prothrombin (Factor II) gene by allele-specific hybridizations and chemiluminescent detection of hybridized probes. Since genetic variation and other factors can affect the accuracy of direct mutation testing, the results should be interpreted in light of clinical and familial data.
This testing was developed and its performance characteristics have been determined by Quest Diagnostics Nichols Institute, Chantilly, VA. It has not been cleared of approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. Performance characteristics refer to the analytical performance of the test.
Next steps
Dr. Dipti Patel has a dual specialty. Not only is she an oncologist, but she is also a hematologist. She is the doctor who prescribed these blood work-ups. I will need to schedule an appointment with her in the next week to understand the full implications of the results that are out-of-range.
Listening is important
When I start to add things up, things get a bit interesting. I could be sitting back a bit and just taking my chemo. However, the events of the past few weeks have led to several things:
1.) Getting checked for DVT and then learning that I indeed have blood characteristics that put me at increased risk.
2.) Getting checked into the Emergency Room at The University of Virginia only to later learn that I had a stone or infection in my Parotid Gland that required antibiotics.
3.) Having a swollen uvula after a day without rest.
All these items may be completely anecdotal. I grant that. At the same time, as a patient, I am listening to what my body is telling me. As well, I am listening to new information about risks that brain cancer patients can encounter. The more I listen, the more I realize that response is necessary -- perhaps even critical.
To me, all this just makes a lot of sense, especially as I am trying to figure out the long-term impacts of taking Temodar chemotherapy for longer than one year. (And all the above things are happening after taking Temodar chemotherapy for longer than one year.)
