Day 308 - goodbye to Dr. T
I had another clinic appointment yesterday, my last with Dr. T, the oncologist who took me all the way through my transplant experience to this point. I will miss him.
WBC – 4.1, up from 4.0, normal
Hgb – 12, up from 11.4, higher than it’s been in a while and still below normal of 13
Plt – 238, down from 248 and still at a good level
AST-SGOT – 68, up from 54 (below 42 is normal)
ALT-SGPT – 92, up from 69 (below 40 is normal)
My blood counts were OK, except that my liver enzymes went up some more (wrong direction). They were up enough that the doctor bumped up my Cellcept (immune suppressant) back to where it was last month. He’s not too concerned, however, because his experience leads him to believe that the liver gets stressed to a certain level and stays there for a while, whether the immune suppressant is adjusted or not. It would then stay there until the grafted immune systems just gets “worn down” is the phrase I think he used, at which time it would just give up attacking the liver. He’s recommending just leaving the Cellcept level where it is for another month or two and then try cutting it back again. I asked him if the level of immune suppressant affects how quickly the immune system gets worn down and he said it didn’t.
He seems to think my getting winded is due more to being out of shape from getting no exercise for 8 months or so than to being anemic. I guess I’ll have to make more of an effort to get some aerobic exercise.
The doctor and the PA both think my taste problems (no food tastes good) are not due to meds. It’s just one of the unpredictable things about going through this process – some people have negative taste experiences and some have enhanced taste experiences. I just hope it gets better sometime so I can enjoy eating again.
Lastly, I feel like moaning a bit about my HMO. Basically, they have been good and have paid for everything except my copays for meds and visits to a specialist (which add up pretty quickly themselves). What I am quite unhappy about is that starting earlier this month, they are requiring me to get my blood labs drawn at an independent lab instead of at the BMT clinic. This means another trip on another day to a lab that is not easy to get to, requiring more time, another car trip, remembering to get it done, remembering to get a prescription for it at my clinic visit prior, remembering to get them to include the diagnosis code on the scrip, remembering to take the scrip, waiting for the results when I go in for my clinic visit because they have to call and have them faxed, which adds up to an hour to my clinic visit, plus the fact that at the clinic, they like to have blood smears so they can look at the blood cells, and there are no smears. And if, for some reason, the results aren’t available when I go for my clinic appointment, it becomes a wasted trip and I would have to reschedule. I guess it is all about saving the HMO money (isn’t that what HMOs are all about?), but I’ll wager the amount they save withers in comparison to what it costs me in time, money, and inconvenience. Oh well. I plan to appeal to someone at the HMO, but have very low expectations about the odds of any satisfaction. I guess I’m lucky to be around and healthy enough to be irritated.
Love,
Justin
WBC – 4.1, up from 4.0, normal
Hgb – 12, up from 11.4, higher than it’s been in a while and still below normal of 13
Plt – 238, down from 248 and still at a good level
AST-SGOT – 68, up from 54 (below 42 is normal)
ALT-SGPT – 92, up from 69 (below 40 is normal)
My blood counts were OK, except that my liver enzymes went up some more (wrong direction). They were up enough that the doctor bumped up my Cellcept (immune suppressant) back to where it was last month. He’s not too concerned, however, because his experience leads him to believe that the liver gets stressed to a certain level and stays there for a while, whether the immune suppressant is adjusted or not. It would then stay there until the grafted immune systems just gets “worn down” is the phrase I think he used, at which time it would just give up attacking the liver. He’s recommending just leaving the Cellcept level where it is for another month or two and then try cutting it back again. I asked him if the level of immune suppressant affects how quickly the immune system gets worn down and he said it didn’t.
He seems to think my getting winded is due more to being out of shape from getting no exercise for 8 months or so than to being anemic. I guess I’ll have to make more of an effort to get some aerobic exercise.
The doctor and the PA both think my taste problems (no food tastes good) are not due to meds. It’s just one of the unpredictable things about going through this process – some people have negative taste experiences and some have enhanced taste experiences. I just hope it gets better sometime so I can enjoy eating again.
Lastly, I feel like moaning a bit about my HMO. Basically, they have been good and have paid for everything except my copays for meds and visits to a specialist (which add up pretty quickly themselves). What I am quite unhappy about is that starting earlier this month, they are requiring me to get my blood labs drawn at an independent lab instead of at the BMT clinic. This means another trip on another day to a lab that is not easy to get to, requiring more time, another car trip, remembering to get it done, remembering to get a prescription for it at my clinic visit prior, remembering to get them to include the diagnosis code on the scrip, remembering to take the scrip, waiting for the results when I go in for my clinic visit because they have to call and have them faxed, which adds up to an hour to my clinic visit, plus the fact that at the clinic, they like to have blood smears so they can look at the blood cells, and there are no smears. And if, for some reason, the results aren’t available when I go for my clinic appointment, it becomes a wasted trip and I would have to reschedule. I guess it is all about saving the HMO money (isn’t that what HMOs are all about?), but I’ll wager the amount they save withers in comparison to what it costs me in time, money, and inconvenience. Oh well. I plan to appeal to someone at the HMO, but have very low expectations about the odds of any satisfaction. I guess I’m lucky to be around and healthy enough to be irritated.
Love,
Justin
3 Comments:
Hello Justin,
I just found your blog and am very interested in reading about your past 300+ days. I am a few days 'older' than you! I had my mini-allo at City of Hope, CA for Non Hodgkins Lymphoma on 8/17/04.
Sorry- I just had to write before reading your posts, it'll be interesting to see how you did compared to what I remember about my experince.
Take care,
Sandra
This comment has been removed by a blog administrator.
Sandra,
I'd be delighted if my blog is any help to you at all. I'd also be interested to hear any comments or experiences you'd like to share.
Justin
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