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Doctors Lounge - Oncology Answers
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| Lisa K, RN
- Fri May 20, 2005 10:41 am |
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 Hello all, I'm new here :-)
I had some bloodwork done recently (cbc, lytes, kidney, liver, cholesterol, fasting bg, thyroid)....it came back showing I'm a little oversupplemented w/ my thyroid med (synthroid)...TSH too low, Free T4 a little elevated...doc's office called to inform me they'd call in Rx for lower dose Synthroid. I was surprised because if anything, I've been feeling more tired lately, suspected maybe my dose needed to be upped!
I had clinic fax me my results so I could see for myself (I'm an RN).
What caught my attention was the differential. My lymphocyte count is right at the high end of the normal range. Mine is 3.3 (range here is 0.5 to 3.3). WCB count, although it's normal, is close to the high end of the range, too: mine is 9.9 (range here is 4.0-11.0).
My RBC count great, platelets good too. Neutrophils good @ 5.6 (normal range here is 2.0 to 9.0). Nothing else in CBC is concerning to me. I did notice, too....my monocyte count is close to the high end of the normal range. Mine is 0.8 (range here is 0.0-1.0)
I am concerned about my lymph count. I have an appt this afternoon to discuss w/ my doc...I'm sure she'll say that as long as it's within the normal range that I have nothing to worry about. I'm going to ask to see what it's been in the past, to compare..to see if it's slowly been increasing.
My concern is this: is it on it's way up slowly? If so, why? I will ask to have it repeated in 3 months for sure.......but isn't this something we should be keeping an eye on?
I have NO infections of any kind (viral or bacterial). I've received no live vaccines within the last year or more. I have not travelled overseas. I understand lymphocytes can be elevated when the body is trying to fight off a viral or bacterial infection. No UTI, no bronchitis, no dental infection, no nothing.
I've read, also, that lymphocytes can be elevated w/ lymphocytic leukemia. Now obviously I wouldn't be concerned about acute L.L......but I guess my concern is about Chronic Lymphocytic Leukemia. Now I understand the Staging for same.....it starts out @ Stage 0 - in which there's elevated lymphocytes but no other involvement/no enlarged lymph nodes..............but maybe I'm slowly on my way there, that is my concern.
I have autoimmune thyroiditis, and wonder if my near-elevated lymphs could somehow be related to that....can people w/ autoimmune diseases have any kind of elevation in lymphs?
I just feel that it wouldn't have taken much for me to be "over" the normal range........and because I'm at where I'm at, shouldn't this be closely monitored?
Is it true, too, that you can often see elevated lymphs if a tumor is present somewhere? If that were the case, my first concern would be breast tumor or lung cancer (I've stupidly smoked for 17 yrs). 2 yrs ago I had 3 lumps biopsied (benign)..I have very lumpy breasts and I always worry that one day, in amongst the benign lumps, there might be something that isn't benign...and it will be overlooked.
I'm nearly 38.
Any thoughts?
My doc will do any testing I ask for...but I'm not even sure what to ask for today......just repeat CBC/diff in 3 months and see where we're at? I think it would be a little extreme to request a bone marrow biopsy at this stage? Should I at least ask for a CXR? sputum cytology? (my nagging fear/guilt about smoking for so many years - though I never get bronchitis or URIs).
I have felt more tired the past few months.....but I attributed it initially to my job which is very stressful. Then I attributed it to maybe being hypothyroid and needing my Synthroid increased....but then when I learned my TSH was so low (0.09 - normal range here is 0.20 to 6.00) and Free T4 slightly elevated (mine: 23.7, normal range here: 8-22)..I figured maybe I was feeling slightly hyper, which can ALSo cause one to feel tired.
Thoughts? Suggestions? Thanks so much.
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| Dr. Wafaa Abdel-Hadi
- Fri May 20, 2005 2:34 pm |
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Dear Canadian_RN,
well , i think you have already answered your own questions...as long as your counts are within the normal range..please don't panic like that....autoimmune thyroiditis should be monitored ....and i think your doctor is doing a good job ....so don't worry about that.
in your case if you wanna exclude CLL ....then you should do a bone marrow biopsy from both iliac crests.... but if you went with your normal counts and asked for on ethey will refuse...because it's not an indication for a biopsy.
as for your breast lumps... you can do a mammography and breast ultrasonography as well...to see if your lumps are benign....CXR if you want .
don't trouble trouble...until troubles trouble you... got what i mean :wink:
if there was something bad about your counts and since you've mentioned your concerns to your doctor , i am sure he'll do his best to prove to you that there is nothing to worry about.
on the other hand...a repeated CBC with differential count would be very good for follow up after 3 months...don't bother about previous CBCs ,as long as they were in the normal range as well then it's allright.
Keep me updated,
best regards
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| Lisa K, RN
- Fri May 20, 2005 6:15 pm |
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Hello,
Thanks for taking the time to respond :-)
I saw my doc today, shared my concerns. I asked for another CBC/diff in 3 months, along with ESR and although she didn't think I needed to worry, she gladly obliged. I asked her if it was possible that my lymph count was on the high end of normal due to the fact that i have autoimmune thyroiditis - which would seem possible to me, and she said she never thought of it but it did make sense.
She's sending me for a CXR, re: my concerns about having smoked for so many years. I asked about sputum/cytology and she said that unless I was bothered by a frequent very productive cough, the bit of sputum I might be able to produce wouldn't likely show much (has to be from deeper down in the lungs).
As for the continued breast lumps, I asked for another Mammogram and she agreed. It's difficult with so many lumps to know for certain that they're all benign. I realize I'm young and a mammo might not show too much but it's better than nothing.
Thanks a lot for your response...I'll let you know what my ESR and lymph count is come August.
;-)
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| Dr. Wafaa Abdel-Hadi
- Sat May 21, 2005 3:28 am |
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Dear Canadian_RN
a mammogram in a dense/firm breast...is difficult indeed,that's why we ask for a complementary Ultrasound with it. are you married?
if you have multiple lumps...and ultrasound or mammo, revealed that it's query, then ask for an Ultrasound guided biopsy called (FNAC=fine needle aspiration cytology) just to know it's nature and to exclude malignancy,ok?
keep me updated,best regards :) ,
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| Lisa K, RN
- Sat May 21, 2005 7:49 am |
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Hello Dr Abdel-Hadi,
You see, I've gone down this "lump" road before. Back in Sept 2002, I found my first lump...and then a couple more, in my LT breast. My family doc did an exam and told me it was likely just fibrocystic disease. I wasn't content with that, I asked for an Ultrasound - that was done...along with a Mammogram. I was sent to a specialist. He assured me I had nothing to worry about but I told him that unless he could prove to me completely "what" these lumps were, I couldn't just let it rest. Several months later I got in for biopsies of these 3 lumps...all came back benign. I guess I just have to accept the fact that I have lumpy breasts. My only concern is.............with so many lumps, what if a non-benign lump develops.....and I assume it's just benign. I also can't go running to doctor for every lump I have :)
I will ask about having an ultrasound done first, though. Thanks. I'll keep you posted.
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| Dr. Wafaa Abdel-Hadi
- Sat May 21, 2005 3:24 pm |
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Dear Canadian_RN,
You have all the right to be concerned...I am with you...so what we should do ...is monitor your lumpy breast...with serial Ultrasounds....say every 6 months-12 months.
Fibrocystic disease is very common...and i guess you've already read tons of papers on it...and you know it's benign and all that stuff...so what we should do ....is forget about it BUT monitor it,ok? I don't want you living in continuous stress... ! just live normally... and put your every 6 months or yearly mammography/ultrasound in your calendar. That's the smartest way to deal with it... at least from my point of view :wink:
Best regards :)
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