health matters

Living with CML

Learning that you have a blood disorder can be the most challenging part or situation in your life.

Just last month, I had my bone marrow test done due to the elevated white blood cell  count when I had my CBC on June. Alarmed that it reached up to 100,000 , my mom and I decided to seek a hematologist as recommended by my other doctor.

The bone marrow aspiration/biopsy test result revealed what I had and it’s CML or what we call chronic myelogenous leukemia/chronic myeloid leukemia. Never expected to have this kind of serious condition other than my thyroid problem.

To be honest, I had no clue as to how and where I got this illness and to be exact, my white blood cell count started to elevate just last year, but this case has been always ruled out until such time I had my bone marrow test done that it confirmed that I have this blood problem.

I didn’t even know if this CML is what had caused my on and off fever as well as difficulty in breathing last month which also led to my hospitalization.

So ,  I and my parents started to process the requirements and papers needed for the O.A.T.H (Organized Assistance to Treatment and Healthcare) program to avail of the medicines I was prescribed to take. We visited Can-Care Adxto in Makati and Vanguard Screening Solutions, Inc. in Ortigas to submit the requirements that we had. I just hope and pray that the one in charge of these would approve of my request . The trip was quite tiring but we had to finish what needed to be done.

I’ve been battling this blood problem or cancer this year for a month (since July 25) . At first, I didn’t want to think that this is really a cancer or a serious illness since the day I’ve been diagnosed. I was in denial at first since I’ve never had one in my family member with leukemia but then, family history plays no role in this type of chronic illness (or so I thought – please correct me if I am wrong).

I just really hope and pray that by the time I get back home from the province, I’ll be able to avail of the donated medicine from the Novartis oncology, with the help of the PCSO and the O.A.T.H program.

Just then, I had this on and off fever again last Tuesday– September 6,2016, the day I was about to travel to my mom’s province. I thought to myself that maybe this wasn’t the Lord’s plan yet to let me travel as He doesn’t want me to be harmed or even get too tired. Dark, red spots would start to appear on both my left and right hand, increasing as they would. This might either be a symptom of my illness , or a side effect of the medications I’m taking for my chronic myeloid leukemia.

 

 

 

 

 

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book review

The Fault In Our Stars – John Green (Chapter Summary)

Chapter 1:

A sixteen year old cancer patient, Hazel Grace Lancaster, narrates about her life and how it is like living with a thyroid cancer.  She resents being forced to attend a cancer support group  where she finds herself surrounded by fellow cancer patients or survivors. Hazel describes this as a hellish experience.

However, she meets a friend, Augustus Waters, a fellow cancer patient who has been dealing with osteosarcoma.

Unknown words in this chapter:

1) improbable : not probable or not likely to happen  (page 6)
2) cannula: a tubular instrument of any one of several types introduced into a body cavity  or tube,especially to permit drainage or irrigation. (page 8)

3) osteosarcoma: a sarcoma derived from bone or containing bone tissue . Osteo = “bone” ; sarcoma =“tumor” (page 11)

4) hamartia: the error of judgment or tragic flaw in the character of the hero of an ancient Greek tragedy. (page 19)

Chapter 2:

As days go by, Hazel and Augustus seem to like each other’s company. They trade books with each other, watch movie and talk about the diagnosis of their illness.

Unknown words in this chapter:
1) enchiladas: a tortilla rolled around a filling of meat, cheese, peppers, etc. , served with a peppery sauce.  (page 27)

2) toroidal: of or having to do with, or characteristic of a toroid (page 30)

Chapter 3:

Hazel faces the next day like a normal day, unaware and unexcited to celebrate her thirty third and a half birthday. She would usually focus on reading a book while her friend, Kaitlyn, shops for shoes.

Unknown words in this chapter:
1) herpes: any one of various virus diseases causing spreading blister-like blotches on the skin or mucous
membrane, such as shingles and cold sores. (page 39)

2) fraught: a burden or load (page 41)

3) dysmorphia: deformity or abnormality in the shape or size of a specified part of the body. (page 44)

Chapter 4:

Hazel spends her time in bed, reading a book written by her favorite author, Peter Van Houten, who doesn’t know about her existence. She had written letters to him regarding what happens to the other characters which however remains unanswered.

Meanwhile, she pays a visit to Augustus’ house, only to find him consoling his best friend, Isaac, who has been recently dumped by his girlfriend who can’t seem to handle his dilemma or situation.

Unknown words in this chapter:
1) perpetuity: the condition of being perpetual; existing forever (page 50)

2) gargantuan: enormous/gigantic/huge (page 56)

3) bereft: deprived or bereaved (page 58)

Chapter 5:

Augustus shares to Hazel the email he received from her favorite author, Peter Van Houten, through the care of his assistant, Lidewij Vliegenthart. Unable to believe her ears, Hazel asks for the email address of his assistant and starts writing, sharing her disappointments that Peter didn’t fully finish the book.

Augustus and Hazel also plan to visit Amsterdam through Lidewij’s invitation and without Peter’s knowledge. Augustus pays for their trip ticket in going to Amsterdam.

Unknown words in this chapter:
1) sobriquet: a nickname (page 64)

2) insipid: without any particular flavor; lacking interest or spirit; dull (page 68)

3) bacchanalia: a wild, noisy party; drunken revelry (page 68)

4) insidious: seeking to entrap or ensnare; wily or sly (page 86)

Chapter 6:

Hazel grows curious about Caroline Mathers and views her page, only to find thousands of condolence messages for her and learn that Caroline had died of a brain cancer a year ago. She felt jealous upon finding Augustus’ message and a photo of him with her but then shook the feeling off.

Hazel thought of Augustus Waters and felt that she might hurt him every time they are together and decides whether to avoid him or not.

Unknown words in this chapter:
1) oncologist: a person who studies, or knows much about, oncology (page 92)

2) vernacular: a native language;  language used by people of a certain country or place (page 93)

3) pre-emption: the act or right of purchasing before others or in preference to others (page 95)

4) lascivious: inclined to or feeling lust (page 95)

Chapter 7:

Just the night before their trip to Amsterdam, Hazel suffers from a headache and pleural effusion which caused her another trip to the hospital. She woke up only to find herself in the ICU, feeling alone as her parents were not allowed to stay with her inside the intensive care unit for the whole time.

Unknown words in this chapter:
1) coterie: a set or circle of close acquaintances; group of people who often meet socially (page 109)

2) sarcophagus: a stone coffin, especially one ornamented with scriptures or bearing inscriptions (page 112)

3) digress: to turn aside from the main subject in talking or writing (page 113)

Chapter 8:

A cancer team meeting was led by Dr. Maria to discuss about Hazel’s cancer situation and decide whether to let her travel to Amsterdam or not as this may pose another risk to her health.

During that meeting, Hazel recalls the time she almost or was about to die from her cancer. She saw how her parents were worried and suffering with her and hated the feeling of having to hurt them. The doctors were hesitant at first in letting her go to Amsterdam without any medical assurance that it will be safe for her to travel.

Unknown words in this chapter:
edema: an abnormal accumulation of watery fluid in the tissues or cavities of the body, often causing visible swelling (page 115)

Chapter 9:

Hazel went back to the Support Group before she travels with Augustus to Amsterdam. One of their fellow cancer patient, Michael, had passed away after battling with leukemia while the rest of them either had a relapse or had gone NEC (no evidence of cancer).

Isaac invites Hazel over to play with him and talks about the game and his relationship with his ex-girlfriend, Monica. Hazel reprimands Isaac about what he did to Monica, i.e. going blind.

Unknown words in this chapter:
1) leukemic: of or having to do with leukemia (page 129)

2) relapse: to have a return of the symptoms of an illness following convalescence. (page 129)

3) remission: a decrease by lowering or lessening, as of pain, force or labor (page 131)

Chapter 10:

Hazel and her mom prepare for their trip to Amsterdam together with Augustus and drove over to his house to pick him up. Hazel and Augustus spend their time watching movies and reading a poem while on board the plane.

Augustus then confesses his true feelings to Hazel , who then dismisses the thought of him falling in love with her as she didn’t want to hurt him in the end.

Unknown words in this chapter:
1) stubbly: bristly ; like stubble (page 138)

2) ludicrous: absurd but amusing, causing derisive laughter (page 145)

3) homebody: a person who prefers the pleasures of his home and family to outside attractions. (page 146)

4)  flummoxed: confounded or bewildered (page 146)

Chapter 11:

Upon arrival to Amsterdam, Hazel, her mom and Augustus were driven to their hotel which is the Hotel Filosoof. Hazel and Augustus later on spend their dinner at Oranjee which was set up by Lidewij Vliegenthart. They continue talking about each other’s cancer situation and what would their death outfit be in their funeral.

Unknown words in this chapter:
1) ubiquitous: present everywhere (page 156)

2) midriff: the diaphragm separating the chest cavity from the abdomen ; the middle portion of the human body (page 160)

3) gnocchi: dumplings (page 165)

4) narcissist: a person characterized by narcissism or has an excessive love or admiration of oneself (page 170)

Chapter 12:

Hazel prepares for the day she will be meeting her favorite author, Peter Van Houten, together with Augustus. She felt nervous at the first place that they would never find his house as all the houses in Amsterdam almost looked the same and that they’d never find their way back to their hotel in case they get lost.

Together, Hazel and Augustus set off to Peter Van Houten’s house. Much to their surprise, Peter Van Houten is not the man they expect him to be. He turns out to be a miserly old man who spends his life drinking alcoholic drinks. Aghast by his rude behavior, Hazel and Augustus ended up arguing with Peter Van Houten, especially when he insulted Hazel’s medical condition and refused to give answers to her questions regarding his novel’s ending.

Wanting to make up for their spoiled trip, Lidewij takes Hazel and Augustus to Anne Frank Museum.

Unknown words in this chapter:
1) reedy: sounding like a reed instrument (page 180)

2) ontologically: philosophically dealing with nature of reality (page 182)

3) douche: an obnoxious and contemptible person, typically a man (page 184)

4) putrid: thoroughly corrupt or depraved; extremely bad (page 190)

5) addled: muddled; confused (page 191)

6) vermouth: a white wine, either dry (pale yellow) or sweet (usually reddish-brown), flavored with wormwood or other herbs and used as liqueur or in cocktails (page 194)

7) fetish: anything regarded with unreasoning reverence or blind devotion (page 207)

Chapter 13:

Hazel, her mom and Augustus spent their last full day in Amsterdam strolling and exploring other places they haven’t visited yet. While in the middle of the middle of their strolling, Augustus opens up to Hazel about his relapsed cancer, stating that it had returned before the time Hazel went to the ICU.  He, however, reassures her that he will fight against his illness.

Augustus also confessed that he was supposed to have chemotherapy treatment but he gave it up for the sake of going to Amsterdam even though it would make his parents furious.

Unknown words in this chapter:
1) bluster: to talk noisily and violently; a noisy and stormy commotion (page 210)

2) machismo: manly self-assurance; masculine drive (page 210)

3) hunker(ed): to squat on one’s haunches, or with the haunches brought near the heels (page 213)

4) paisley: a soft, woolen cloth with a very elaborate and colorful pattern (page 213)

5) palliative: useful to lessen or soften; mitigating (page 215)

Chapter 14:

Upon returning home from their trip to Amsterdam, Hazel discusses with her dad that Gus’s cancer had recurred, to which he admits being told by Gus’s parents and apologizing for it. Her dad also admits reading An Imperial Affliction while they were away and wished the same thing as Hazel.

Hazel drops by her friend’s, Augustus, house, to check on how he’s doing only to find out that he was asleep on the living room couch , with the medicine pumped through his body.

Unknown words in this chapter:
1) recurrence: an occurrence again ; repetition; return (page 222)

2) oncogene: a tumor-producing gene (page 224)

3) barf: to vomit (page 224)

Chapter 15:

Augustus was rushed to the ER for his chest pain a week after having dinner with Hazel’s parents over his house and was admitted overnight. Hazel drove over to the Memorial after having heard about the news. Emily, Augustus’ mom, tells Hazel that she can visit her friend but not at the moment when they needed to be a family.

Two weeks later after Gus had been released from the hospital, Hazel drove him to the Funky Bones where they once hang out. Augustus opens up to Hazel about imagining himself to be the skeleton, which signifies that he is close to dying.

Unknown words in this chapter:
1) nostalgic: feeling or showing nostalgia; homesick (page 231)

2) prematorium: common hall (page 231)

3) goading: anything that drives or urges one on; inciting (page 233)

Chapter 16:

Augustus Water’s condition gets worse as his cancer progresses to the last stage. He shares with Hazel his pre-Van Houten analysis of An Imperial Affliction. He promises as well to write a sequel for her but couldn’t as he’s tired all the time.

Downstairs, Gus and Hazel play a video game he would always play with Isaac.

Unknown words in this chapter:
1) memoir: a biography, now especially a relatively short or limited one; biographical note (page 235)

2) eponymous: giving one’s name to a nation, tribe or place (page 237)

Chapter 17:

Hazel drops by Gus Water’s house to check on him, only to find her friend writhing in pain and she calls her parents for help. In the middle of their game, Augustus opens up once again, talking about death and mentions about having an obituary written about him.

This makes Hazel get a bit frustrated with Gus, offended that Gus thinks he doesn’t mean anything to her as a friend and that he won’t make it to write a eulogy about her.

Unknown words in this chapter:
1) excruciating: causing great suffering; torturing (page 239)

2) mortified: ashamed, humiliated (page 240)

3) obituary: a notice of death, often with a brief account of a person’s life; necrology (page 240)

Chapter 18:

Hazel receives  a call from Gus, asking for help and saying that he’s at the gas station. Sensing that something is wrong, Hazel dresses up and switches her BiPAP with her cannula, heading off to the gas station that Gus had mentioned.

Upon reaching the gas station, Hazel rushes over to her friend’s side to see what’s wrong and finds him covered up in his own vomit and that the skin of his abdomen is warm and bright red, signifying an infection. She immediately calls up 911 for emergency.

Augustus Waters breaks down and keeps telling to himself that he wants to die so as to end the suffering.

Unknown words in this chapter:
1) annihilated: destroyed completely; confused (page 242)

2) waiver: to give up; relinquish (page 245)

Chapter 19:

A few days later, Gus Waters was discharged from the hospital and was permanently moved upstairs to the living room. He was, however, deprived of all his ambitions and put under more medications to alleviate the pain.

Gus and his family, together with Hazel, went out for Gus to enjoy and have some fresh air.

Unknown words in this chapter:
1) irrevocably: irreversibly; unalterably (page 248)

2) fleece: a fabric with a soft, silky material, used for lining outer garments.

Chapter 20:

Hazel gets a day off from visiting Augustus as she herself wasn’t feeling well and a bit tired. However, she receives a call from Gus, asking her to be at the Support Group and prepare a eulogy for him. Hazel hesitates at first, but then gives in to his request.

While preparing to go, Hazel gets in a heated argument with her parents for the first time, stating that they were the ones in the first place who asked her to get a life outside instead of being just a homebody.

Hazel meets up with Gus and Isaac at the Support Group room, with her eulogy prepared. Gus told her that he thought of arranging a pre-funeral service. Isaac was the first one to eulogize, describing how Augustus Waters is as a friend to him, then followed by Hazel who breaks down almost in the end of her eulogy.

Unknown words in this chapter:
1) inexorable: not influenced by prayers or entreaties; relentless (page 253)

2) eulogy: a speech or writing in praise of a person or thing, especially as a set oration in honor of a deceased person (page 254)

3) self-aggrandizing: aggrandizing or magnifying oneself; the act or practice of enhancing one’s own importance, power or reputation (page 257)

4) lectern: a stand that serves as support for the notes or books of a speaker

Chapter 21:

Augustus Waters, or simply called ‘Gus’ , passes away just a few days later after his pre-funeral. This news leaves Hazel shocked and devastated.

She checks on her friend’s wall page and reads the condolence messages written by other people and receives a call from his parents regarding his funeral that will be held for five days.

Unknown words in this chapter:
clarion: clear and shrill (page 263)

Chapter 22:

Gus Water’s funeral was held at the Support Group’s chapel or church where a lot of people visited and took a close look at him in his casket.

Peter Van Houten shows up at Gus Water’s funeral, much to Hazel’s surprise. Later in the middle of the funeral, each of Gus Water’s family member and friends gave a eulogy about him. Hazel was still pissed at Peter Van Houten’s arrival and didn’t like the idea of him showing up right after what he did during their meeting in Amsterdam like nothing happened and hitching a ride with them after Gus was buried.

Unknown words in this chapter:
1) casket: a coffin (page 269)

2) lanky: awkwardly long and thin; tall and ungraceful (page 269)

3) pulpit: a platform or structure in a church from which the minister preaches (page 271)

4) rotundity: roundness or plumpness

5) titter: the act of tittering or laughing in a restrained manner (page 272)

6) pall-bearer: one of the men who walks with or carries the coffin at a funeral, so called from the old custom of holding up the corners or edges of the pall carried over the coffin. (page 274)

7) infernal: of the lower world (page 275)

8) precocious: developed earlier than usual in knowledge (page 276)

9) booze: an intoxicating liquor; a drinking bout (page 277)

Chapter 23:

A couple of days later after Gus Water’s burial, Hazel drops by Isaac’s house to play a video game with him and talked about how they were coping up with their friend’s death. Isaac also mentions about Gus writing a sequel about Hazel’s favorite book An Imperial Affliction.

Hazel hurriedly rushes to her car , though she was aghast to see Peter Van Houten in the backseat, wearing the same suit he had worn during her friend’s funeral. From there, Peter Van Houten opens up to Hazel that he wrote the book in memory of his deceased daughter who died from leukemia.

After realizing this, Hazel decides to forgive the old man and after Peter Van Houten gets off from the car, she drops by Gus Water’s house to search for his written sequel but finds nothing, to her dismay.

Unknown words in this chapter:
1) labyrinthine: of or forming a labyrinth (page 279)

2) depraved: having very bad morals; corrupt (page 281)

3) beatified: made supremely happy or blessed; declared to be among the blessed and entitled to a specific religious honor (page 285)

4) leukemia: a rare , usually fatal disease characterized by a large excess of white blood cells; any of several cancers of the bone marrow that prevent the normal manufacture of red and white blood cells and platelets, resulting in anemia, increased susceptibility to infection and impaired blood clotting (page 285)

Chapter 24:

Hazel receives a call from Gus Water’s dad regarding a black Moleskin notebook where Gus used to write his sequel or eulogy for her. She hurriedly drives over to Isaac’s house to pick him up and headed to the Support Group before their session with Patrick begins. She kept looking for the torn pages from the notebook around the room but couldn’t find it.

She spends the rest of her time listening to Patrick’s testimonial about living with cancer, feeling bored like she usually does. She feels out of the mood to share her memory of Augustus to the group and wishes that she would just die. At home, she watches her favorite TV show with her parents while eating dinner.

Unknown words in this chapter:
1) hover: to stay in or near one place; wait nearby (page 296)

2) revile: to call bad names; abuse with words (page 299)

3) fumbled: felt or groped about clumsily; searched awkwardly (page 299)

Chapter 25:

Hazel writes a correspondence to Peter Van Houten’s former assistant to ask if she had, by any chance seen the letter or sequel that Gus wrote for her to which Lidewij (Van Houten’s former assistant) responds to later in the afternoon, indicating that she hadn’t seen any but will try to find it and apologizes as well when she heard the news from Hazel that Gus Water s died.

Right after checking her email, Hazel spends time with her family by having picnic in commemoration of the Bastille Day and visiting Gus Water’s grave at the Crown Hill Cemetery.

Upon reaching home, Hazel receives another email from Lidewij Vliegenthart, notifying her about what happened when she visited her former boss’s house . She (Hazel) reads the attached files which included Gus Water’s letter to Peter Van Houten days before he died. It was his eulogy for her.

Unknown words in this chapter:
1) unconscionable: not influenced or guided by conscience (page 301)

2) monolith: a single large block of stone, especially one forming a monument or used for building or sculpture (page 305)

3) voracious: very eager; unable to be satisfied (page 305)

4) indefatigable: never getting tired or giving up (page 307)

5) mercenary: a soldier serving for pay in a foreign army (page 307)

6) bequeathing: giving or leaving by means of a will when one dies (page 310)

 

 

health matters

Health Talk: Chronic Myelogenous Leukemia

 

Normal blood vs. Leukemia
Normal blood vs. Leukemia

What Chronic Myelogenous Leukemia Is

Chronic Myelogenous Leukemia or CML is a type of a cancer affecting one’s blood cells and bone marrow. This condition is also called chronic myeloid or chronic granulocytic leukemia. Chronic myelogenous leukemia is an uncommon type of cancer of the blood cells, which progresses more slowly than acute forms of leukemia and affects older adults.

There are 3 phases of chronic myelogenous leukemia:
1) Chronic phase – this is the earliest phase which generally has the best response to treatment.

2) Accelerated phase – this is a transitional phase wherein the disease or condition gets aggressive.

3) Blastic phase  – this type of phase is the most severe and can be life-threatening.

How Is CML being diagnosed?

A series of laboratory tests is being performed to determine if a patient has CML. These tests are: 1) blood tests (complete blood count), 2) physical exam, 3) tests to look for Philadelphia chromosomes and 4) bone marrow tests (bone marrow biopsy and bone marrow aspiration).

What Are the Symptoms of Chronic Myelogenous Leukemia?

CML signs and symptoms may include the following: 1) fatigue , 2) weight loss, 3) loss of appetite, 4) pale skin, 5) night sweats, 6) fever , 7) easy bleeding and 8) pain or fullness below the ribs on the left side.

What Causes Chronic Myelogenous Leukemia?

There are several factors that possibly cause this type of condition: 1) development of an abnormal chromosome, 2) genetic mutation of abnormal chromosomes, 3) diseased blood cells created by the new gene

A human cell normally contains 23 pairs of chromosomes which hold the DNA that contains the instructions in controlling the cells in the body. In CML patients, chromosomes in the blood cells swap sections with each other wherein a section of chromosome 9 switch places with a section of chromosome 22, creating an extra short chromosome 22 (Philadelphia chromosome) and an extra long chromosome 9.

This Philadelphia chromosome then creates a new gene called BCR-ABL from the genes of chromosome 9 combined with genes from chromosome 22. This new gene contains instructions that command the abnormal blood cell to produce too much of a protein which we call tyrosine kinase, thus promoting cancer by allowing certain blood cells to go out of control.

A human blood cell originates in the bone marrow (a spongy material inside the bones). When a bone marrow functions normally, it produces immature cells in a controlled manner. These blood stem cells then mature and specialize into various types of blood cells circulating in a human body – red blood cells, white blood cells and platelets. In CML, this doesn’t work properly as the tyrosine kinase caused by BCR-ABL gene produces too many white blood cells which most, or all, contain the abnormal Philadelphia chromosome. The diseased white blood cells would build up in huge numbers, crowding out the healthy white blood cells and damaging the bone marrow.

Who  are at risk of CML?

There are 3 risk factors having this condition: 1) older age , 2) being a male, 3) exposure to radiation (e.g. radiation therapy) . Family history is certainly not a risk factor of this .

What Are Or Maybe The Possible Complications?

When left untreated, Chronic Myelogenous Leukemia may cause a variety of complications such as: 1) pain (bone or joint), 2) infection, 3) fatigue, 4) enlarged spleen and 5) death.

Treatment

CML treatments such as Dasatinib (Sprycel), Imatinib (Gleevec), Ponatinib (Iclusig), Nilotinib (Tasigna) and Bosutinib (Bosulif) are designed to attack cancer by focusing on a specific type of cancer cells that allow them to grow and multiply. In CML, the target or goal of these drugs is the tyrosine kinase , a protein produced by the BCR-ABL gene.

Aside from these targeted drugs, there are also different treatments for CML like chemotherapy, biological therapy, blood stem cell transplant, clinical trials and even alternative medicines such as relaxation techniques, aromatherapy, massage, meditation and acupuncture

Image Source:

http://cancerhawk.com/2012/10/19/got-chronic-myelogenous-leukemia-get-to-the-national-cml-society/