facts that mean a lot to me right now

WBC. White blood cells. (AKA Leukocyte)
We all know the term... but do you know what your white blood cells do? White blood cells fight off infections — they are our great protectors. They keep us from harm. Love these buggers. They are important. And for the record, we have much fewer WBC than red blood cells. (source)

Are all WBC created equal? (source)
Nope. There are two types of leukocytes.

1. granulocytes
   three types: neutrophil, eosinophil (or acidophil) and basophil
   
   – neutrophil attack bacteria
   – eosinophil attack parasites
   – basophil help blood to coagulate



2. lymphoid cells (aka agranulocytes)
   two types:
   lymphocytes and monocytes
   – lymphocytes are the main constituents of the immune system and yield antibodies
   – monocytes are larger and upon maturity move into connective tissues

What are normal WBC counts?
4,500-10,000 white blood cells/mcl (cells per microliter) (source)

What does a high WBC count mean? ( source )
A high WBC count may indicate

• infectious diseases


• inflammatory disease (such as rheumatoid arthritis or allergy)


• severe emotional or physical stress


• tissue damage (for example, burns)


• leukemia

Leukemia? What exactly is that? (source)
Leukemia is a blood-related cancer. Specifically, leukemia is a malignant disease (cancer) that originates in a cell in the marrow. There are four major types of leukemia:

• Acute Myelogenous Leukemia


• Acute Lymphocytic Leukemia


• Chronic Myelogenous Leukemia


• Chronic Lymphocytic Leukemia

What is the difference between acute and chronic forms? (source)
Acute leukemia is a rapidly progressing disease that affects mostly cells that are unformed or primitive (not yet fully developed or differentiated). These immature cells cannot carry out their normal functions.

Chronic leukemia progresses slowly and permits the growth of greater numbers of more developed cells. In general, these more mature cells can carry out some of their normal functions. (It is common for someone with a chronic type of leukemia to show no symptoms and not be diagnosed until they have to have blood work done for some unrelated thing).

What did Allison have?
Allison had AML, Acute Myelogenous Leukemia. There are approximately 10,500 new cases of AML in the US every year. AML is hard to treat and has the lowest survival rate — just 14% of AML patients are expected to live five years after diagnosis. I sure wish I knew that 4 weeks ago.

Allison sounded so healthy. So healthy. Vibrant. Great spirits. Anxious to get out of the hospital. Allison is young — only 30 — and takes great care of her body: she eats well, exercises a lot and doesn't do anything stupid like drink too much, take drugs, sleep with strangers, or wash windows on high risers (you know, the typical things our parents are fearful about). Allison didn't do those things. She lived right.

But the problem with Leukemia — well, it turns out that there are a lot of problems with Leukemia....

Left untreated an AML patient would only be expected to live 3 months. Acute Leukemias come on quick and fast. Acute Leukemias are not as successfully treated as Chronic Leukemias.

Typical Acute Leukemia symptoms (source)

• loss of well-being


• tire more easily


• short of breath when physically active


• appear to have a pale complexion from anemia


• bruise for no reason


• have pin-head sized spots under the skin


• have prolonged bleeding from minor cuts


• have mild fever, swollen gums, frequent minor infections


• heal slowly from cuts


• experience discomfort in bones or joints

The problem with that list is that it is like pornography for a hypochondriac. The key is that none of the things in the list are necessarily urgent, especially when you are a young, vibrant, healthy woman.

So, anyway, Allison went into the hospital a month ago last Sunday, showed classic leukemia symptoms, had the requisite tests, was diagnosed and within 24 hours had her first blood transfusion. She started Chemo a couple days later.

The problem with being a leukemia patient and going through chemotherapy is that you often (like very high statistics) become neutropenic.

Neutropenic. Neutropenia is an abnormally small number of neutrophil cells (type of white blood cells that help fight infection — see beginning of post) that occurs as a result of certain cancer treatments (source).

In other words, you are susceptible to all infections and viruses (virii?).


So what happens when you are neutropenic?
It really depends on two things:

1. How neutropenic you are.
   There are formulas here that I didn't take the time to understand, but just know that they measure the level of the neutropenia from "can't protect self" to "really really really really can't protect self")



2. Your care facility's regulations.
   Some hospitals will put you in your own room with very strict rules about who can visit and if you can have fresh fruit and flowers. Other hospitals will require much less restrictive measures. To be honest, the whole thing sounds controversial and I know nothing about any of it, so I'd rather leave that debate to the experts.

Allison's hospital had strict regulations.

• NO children visitors


• No visiting if you've been around kids (might be carrying a secret bug)


• No flowers, no fresh fruits or vegetables


• A whole lot of hand washing that would please the greatest of OCD peeps


• Et ceteras

But but but. It turns out that the riskiest things for a neutropenic person are those that are living inside of them. To quote a nurse who posted onto a nursing bulletin board about reverse isolation, "most infections come from within the patient — gut flora, pre-existing infection, etc. No amount of isolation is going to protect you from that." (source).

So what is this post about? It is just me trying to come to terms with Allison and Leukemia. Trying to make heads or tails out of something that might have neither heads nor tails. Trying to put some type of reason to the unfathomable. The unbelievable. My friend died. My friend who JUST DAYS AGO sounded healthy, vibrant and really optimistic — she died. I don't know how to wrap my head around that. At all.

More later.