I'm a doctor, and now it seems I'm likely to have leukemia.
First things first, it's an early diagnosis, but the lab results seem highly suggestive of a leukemia/lymphoma variant. I want to write to arrange my thoughts, and if possible, share experiences and get words of support.
Second, I feel fine physically, and better mentally right now.
I'm a 37-year-old doctor, not in the US. My main specialty is cardiac anesthesiology. I work in one of the biggest government hospitals in the country. My workplace has a rule that a smidgen of a salary raise depends on whether we get a health check-up or not, so everyone gets a blood test every year.
This year, I'm actually in very good health. I started doing Pilates a year ago and felt the best ever. I aimed to get good lab results to buy good health insurance. However, my CBC in January showed mild thrombocytopenia (around 120, last year it was 180).
Initially, I did not mind it much. It can be a temporary drop in infection, except I thought now I can't submit these labs to the insurance company. Maybe next year.
I also always have very thin skin. Even when my platelets are 300-400, I get petechiae easily from a scratch. But one day, I noticed very small petechiae on my forearms and jokingly showed it to my junior, showing her how thin my skin is, and told her my last platelet count was 120.
She insisted I do the blood test again, very insistent until I relented (and I will forever be grateful to her). So I redid my CBC again. This time, my platelet count was 100k. Whelp. I consulted the hematologist. Initially, we agreed I might have early SLE or ITP. The age range is typically not the leukemia age range.
My ANA is negative, then the follow-up lab started to show mild anemia (32-35), which I never had before, and an increase in monocytes in the automated CBC.
I'm an Asian doctor, who can work a grueling schedule of 60-90 hours a week, so at first, the hematologist still suspected it could be underproduction from lack of sleep. However, the bone marrow biopsy started be a suggestion. I was the one who postponed it due to my very conflicted schedule. The CBC stayed roughly the same for four months, until earlier this month, when my CBC showed a few metamyelocytes and atypical lymphocytes.
As a doctor who is not a hematologist and works in an operating room, I'll tell you I last heard about metamyelocytes is 18 years ago 😂. My monocyte count has reached 2600. My ANC is 1300. I have (mild) pancytopenia.
Now we're getting serious, and everything is moving fast. I had a bone marrow biopsy, NGS, and flow cytometry. Lots of tests I'm not familiar with. With high monocytes, the initial likely diagnosis is CMML, which is 1) atypical for my age but possible, and 2) compared to other types of leukemia, has a poor prognosis and no targeted therapy except for some rare subtypes.
I cried for a week, waiting in a limbo of the worst possible outcome. I started lingering in these subs, and I do think everyone here has very good knowledge, much better than mine. I have to say you all here are amazing to even have the courage to share your experience, good or bad. It means a lot that while everybody's experience is different, you are not alone.
Last week, the lab that ran my blood cytometry for the acute leukemia panel notified that the flow suggested decreased monocytes but increased B lymphocytes, and asked to further do the non-Hodgkin lymphoma panel.
Today, the cytometry suggests hairy cell leukemia, a rare type that correlates with the clinical picture. The initially increased monocytes were an automated CBC error. (My country lacks technicians to really look into individual blood smears, and sometimes it's easier to just send the advanced test.) The markers override the CBC. There are still other possible types I could have, but mostly still better than I thought. Anesthesiologists are usually trained to be pessimistic and expected the worst outcome.
I currently feel a lot better. After a lot of consideration, I realized I have a good standing. Accidentally finds while healthy, with no B-symptoms. My diagnosis was much faster than for other people who are not healthcare workers. It can take years of you start from abnormal health check up.
I still need further tests to determine the exact type, progression, etc. But I have a start now, and I do feel better than being in limbo yesterday.
I do know it will be bad again, but right now I want to record that I'm hopeful. This is the beginning of my journey as a patient (I have never been admitted due to sickness in my life, which is surreal that I will be a patient for THIS).
Thank you for reading. Hope today you have a good day.