Saturday, May 20, 2017

The Terminator

I’m not a big fan of Arnold Schwarzenegger movies with the exception of his Terminator series.   If ever there was a perfect role for him, this was it.   Scary massive robot guy who has super strength, single track mind, gets to show off his muscular naked body and has very few speaking parts.     For those who haven’t seen the movies he is a cyborg from a future where computers rule the world.  He is sent back in time to kill the future mother of the one person who can stop them.    This quote from the movie describes the Terminator It can't be reasoned with, it can't be bargained doesn't feel pity or remorse or fear...and it absolutely will not stop. Ever. Until you are dead.”    I can’t think of a better description of cancer, especially leukemia.   

It’s easy for me to think of leukemia as this “thing” that you have to go to war with.  Like a Terminator it shows no mercy, the battle has one outcome….it or me.    If my story were a movie, in the first one I kicked its sorry butt. 

One of the few lines Arnold has is in the movie has become a hallmark for him.   When his attempts to reach the person he is trying to kill are thwarted he leaves but announces “I’ll be back”.   He of course returns with a vengeance. 

When it comes to my fight, “I’ll be back” is not what I want to hear, but unfortunately, we weren’t so lucky.   In movie parlance, it’s time to make a sequel.  The same stars are all back and the stakes are the same.    The plot starts with our main character (me of course 😉)  living a quiet life believing he has terminated the Terminator.    But the Terminator was never completely destroyed and has been in hiding.    The main charater's side kick (Dr. Kropf) suspects something is not right and deploys some new  technology to detect if the Terminator is still alive.    The hero gets the bad news, the Terminator survived the last battle and will be back.   This time the hero has time to prepare and Dr. Kropf has some new weapons to deploy in the battle.   The rest of the script is still unwritten.

Now the back story.   Several months after chemo the basic monthly blood test had improved to just below normal ranges in most categories but the platelet counts had not recovered and the white blood cell counts were a bit low.   The Feb. bone marrow biopsy didn’t show signs of the disease but given the sluggish recovery of the blood counts the Dr. wanted to run a more advanced test.   Back in for another biopsy mid-March (having a love affair with those 6 inch needles in your hip bone). 

Those of you not interested in the science can skip this paragraph.   I find the technology of the testing fascinating.   If you don’t, well tough, it’s my blog.  You can skip ahead.   There are for 4 levels of testing that can be done to detect Leukemia.  The first is simple blood testing which shows bad blood cells (what are often called immature cells or blasts).  These are visible in more advanced stages of Leukemia like when I first entered the hospital.   The second is using Flow Cytometry.  This is typically done on a bone marrow sample and involves passing a sample through a device with a laser beam that causes cells to “light up” if they have a specific Leukemia antigen.   This can tell you the presence and type of Leukemia earlier than waiting for it to show up in the blood tests.    The third is a FISH test.   They compare your cells to those of a salmon or flounder if they match you have Leukemia or are going to grow gills.  Only kidding.  FISH stands for Fluorescence in situ hybridization, a mechanism used to look at bone marrow at a cellular level to determine not only the presence of cancer but also the type.  In simple terms (mostly because I don’t understand the details) the process goes into a cell and pulls apart strands of DNA in the targeted gene to see if there are chromosomal abnormalities.    The type of abnormality determines the severity of Leukemia and treatment options.   My initial FISH test showed I had t16 which is a translocation of chromosome 16 (one of the better abnormalities in terms of survival rates).     The fourth test is called a PCR (Polymerase Chain Reaction).    I never took molecular biology so I am way out of my knowledge base here but in my simple (potentially slightly inaccurate) translation, this test looks into the cell for the presence of the protein that would cause the abnormalities in the DNA.   The presence of that protein foreshadows the return of the disease.    When monitoring a patient in remission the monthly blood tests are the typical regiment with a more aggressive monitoring being periodic bone marrow biopsies with Flow Cytometry tests.   FISH and PCR tests also require bone marrow biopsies, are substantially more expensive and take several weeks to get results. 
Now back to the back story.    With the March biopsy, the Dr. ran all 4 tests.    The first three came back clean but the PCR showed the return of the Leukemia causing protein in the cells.     While I’m not showing signs immediately, the return is just a matter of time.   “I’ll be back” are never the words a cancer patient wants to hear form their disease.      In early May we returned to the porcupine ward for another biopsy which should tell us the speed of the resurgence and the plans for starting treatment.

This blog is already too long so I will leave the details on treatment plans for future writings.  In the meantime, I’m following my son’s mantra and doing the 3 L’s…..“living life large”.   If only we didn’t need things like cancer to remind us to do it.