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The Edge of the Ledge

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I had a CBC blood test done on May 30, the first since January. I had my last chemo in November. I opened the results today and found a few things that were marked as "High" and others that seemed to be on their way up. Specifically, the MPV and BUN creat ratio are high. Calcium has reached the high end of normal at 10.1. My whites are also higher than they've ever been but still in normal range at 8.2.

Does anyone know if elevation in these parameters are related to mets? I know high calcium can be. I'm just shy of 1 year since my mastectomy and am still getting Herceptin. Can Herceptin cause this kind of fluctuation on its own?

My APN/oncologist has not contacted me at all regarding these test results, but I do worry that since he sees me as "basically cured as far as he's concerned" (his own words) that he might fob something like this off? Or (and probably more likely) I'm reading into it too much.

Anyone with similar experience or knowledge?

Comments

  • kaynotrealname
    kaynotrealname Member Posts: 369
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    I don't have any experience with those test results being high specifically but if you weren't fasting then blood work can fluctuate quite a bit in relation to food. Sometimes it can fluctuate just because of dehydration. Anyway your calcium is still normal. If you weren't contacted then I imagine they aren't concerned. I have different things that will fluctuate sometimes but I think they're more concerned with patterns and want to see things get abnormally high before they worry about it.

  • jh40
    jh40 Member Posts: 140
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    Thanks for the reassurance. I’ve really gotta steel myself for this sort of thing. It sure didn’t take much to bring me right back to panic land.

  • moderators
    moderators Posts: 7,913
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    Hi @jh40,

    After a cancer diagnosis, it is normal to be anxious about test results, especially when one isn't sure what they may mean or how to interpret them. The best person to address your anxieties though would be your doctor, since they not only have the medical knowledge, but much more context for the test results. I know you said that you were worried that your oncologist sees you as essentially cured, but sharing your questions with him will allow him the opportunity explain his thought process/reasoning, which may provide you with comfort and reassurance in the long run. That said, if you have doubts, remember that you can always seek out a second opinion! We have an article about this here, with a few sub-articles that can be of assistance if you think this might be of interest to you:

  • melbo
    melbo Member Posts: 266
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    Almost every round of blood work I have had done since treatment has had at least one thing a little high or a little low. It’s really scary and frustrating and the first several times it sent me into a bit of a stress cycle. In each case though my MO was never bothered and she always reassured me that the numbers have to be really high or multiple numbers had to be pretty high over multiple tests before we got concerned. And in each case she was right, because the next test would show a different result and I never had anything that really stayed out of control.


    i know it’s hard, but try to remind yourself that numbers only a little high are probably just a normal fluctuation. Bodies are weird. My creatinine was high in one of my more recent tests and it turned out I was dehydrated. Naturally, despite several people telling me I was probably dehydrated, I still went a few too many searches down the Dr. Google rabbit hole and ended up stressing myself out. Sigh.

    after several cycles like that I have gotten to the point where I make a note of an odd number, but I don’t freak out about it.

  • jh40
    jh40 Member Posts: 140
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    thanks melbo. The worst of this was that my APN was out of the office on Friday when I saw the results, so I could get no clarification. My blood work was actually more normal during chemo and I think that’s what’s sent me into a spiral. I’m hoping that it is just fluctuation. Hoping very much that’s what it is.

  • melbo
    melbo Member Posts: 266
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    I had routine blood work done in December 2019 and everything was normal. My first blood work after I was diagnosed in July 2020 and at least half a dozen things were all out of whack. Whenever I get stressed about one or two odd reading, I go back to the results from July 2020 and remind myself what truly funky results look like. The other thing I remind myself is that if something were truly wrong then more than one number at a time would test abnormal and they would test significantly abnormal over the course of several months.


    Sometimes during the first two years after diagnosis I felt like cancer broke my brain and flushed all reasonable, rational thought down the drain. Now that I am almost 3 years out though, it’s easier to be a little more logical and I can talk myself off the ledge faster.

    I hope you can talk to someone soon. It doesn’t matter sometimes how rational we try to be — the fear gets down deep and we can’t just talk ourselves out of it.

  • jh40
    jh40 Member Posts: 140
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    melbo you're spot on. And I really appreciate you responding to me. My mind just will not cooperate with logic or reason at all. I've really struggled through the weekend trying to keep the anxiety under control. I can't get the thought out of my head that these latest results are pointing to the start of recurrence since all of them were more normal during chemo.

    I did put a call in to my oncologist's office this morning and they're so lovely there. They told me I'd hear back today from my APN and I'm hoping that will put my mind at ease.

  • specialk
    specialk Member Posts: 9,221
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    jh40 - several things to keep in mind - when labs are resulted out anything that is even a fraction above or below the range will be listed as "high" or "low" but that doen't mean that the result is actually considered high or low by your doctor. These labs are run by a machine with the range pre-programmed in and it can't make a judgement, only a report. This is why your doc needs to determine what is really high, or low, in regards to your diagnosis, and to you as an individual. Also, fluctuations within the range are still considered normal, even if they are higher or lower than a previous test. Most doctors look for trending info - does something continue to rise higher, or drop lower - this is usually what indicates a problem, or if a lab is radically higher or lower from the range. Your MPV being high can have several meanings. MPV stands for mean platelet volume and this result is looking at the size of your platelets. Platelets are the most volatile of your blood cells, and they have the shortest life span - literally days. If your CBC happened to be run on a day when your body was replenishing platelet cells, it could cause a slightly higher MPV result as brand new platelets tend to be larger than older ones. That you are producing new platelets is a good thing - they are responsible for the clotting of blood, and this may actually signal renewed blood cell health after chemo - it often takes a number of months for the bone marrow to produce healthy normal cells of all kinds. A slightly elevated WBC count can signal that you have a mild infection, or your body is in the process of fighting off something that is trying to make you sick. But if your WBC is still in the range, this is not alarming, even though this result may be slightly higher than your last test. Calcium also fluctuates - mine bounces all over the place and has been higher than your result, but also lower on the next test. Persistently higher than upper range should be looked at, but an upper end of the range doesn't necessarily mean anything. As melbo indicated above the BUN and creatinine levels are often mildly skewed if your lab required fasting, or if you were slightly dehydrated when the test was done as these are kidney function tests. A mild difference in this test does not usually cause concern for that reason - they are looking for a more dramatic rise/drop. I totally get the anxiety produced when you are confronted with a lab result that indicates a high or low result, particularly this soon after a diagnosis and while still in active treatment - I think that is pretty normal, right? Hoping your center got back to you and was able to put your mind at ease.

  • jh40
    jh40 Member Posts: 140
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    specialk - thank you as always for the excellent information and insight. The white counts were probably elevated because shortly after that blood work was done I tested positive for Covid. After 3 years of eluding it, it got me for a 2nd time.

    Yesterday I had my first mammogram and ultrasound on my remaining breast since my diagnosis. There was a small 5mm nodule that they classed as BI-RADS 3, and that had me terrified, but was assured that they are not concerned it’s cancer at all and just want to monitor it closely.

    Post diagnosis stuff ain’t for sissies, that’s for sure.