Questions on Blood Tests

Hi. I am already getting lost in the maze of diagnosis and treatments. So frustrating. I have been diagnosed with B Cell Follicular Lymphoma and am just starting all the tests that can further refine the diagnosis. The hope is that it is an isolated occurence on my scalp.
Waiting for insurance company authorization to get the scan. It has only been a couple of days but it seems like forever.
Blood tests came back but I have not been able to able to talk to the doctor and get help interpreting them. I asked them to be sent to me. CBC results were given the day of my appointment - they were normal and doctor said that is good.
However, in the blood test report I just recived, I am scared by the notation that there are elevated Immunoglobulin M (366 vs. range of 56-352). Anybody know what that means?
Confused and concerned.

Isue-
Immunoglobulins are antibodies in the blood that kill foreign things. I don't know how many there are, but M is one of them. And I'm sure the reason you're worried is because you did a search for elevated levels of this protein and found it was associated with lymphoplasmacytic lymphoma, aka Waldenstrom’s, a rare NHL that causes your blood to be really thick.

But
A) it seems you're barely outside the normal range;
B) your doc said you were good
C) elevated antibodies can mean lots of things, it's an immune system response to a bacterial invasion;
D) lymphoma diagnoses are broad-based, they don't rely on one level, and although there are some minor blood markers that can hint at some lymphomas, ultimately a CBC can't remotely come close to dx'ing lymphoma.

I can understand why you're concerned, but try not to get worked up over something like this. I'm the first person to accuse the medical profession of ongoing elitism in the face of the information age, but all the information can be so, so misleading and cause you to worry unnecessarily. To ease your mind, call your doc and demand an explanation for the elevated levels, but keep it at that and try to move forward.

Ross

Ross,
As usual, your advice and information is so, so helpful. You are truly a gift to the this board and to me personally. I followed your advice and spoke to the doctor. He confirmed what you wrote - blood tests did not reveal anything of concern.
Also, my beloved brother is a doctor (dermatologist) who has been far away since all this began. He has returned and is also a huge source of comfort, basically confirming everything that you and doc have said. He said that he sees these cutaneous lymphomas only a couple of times a year so he is far from an expert....but when they do present, they are usually isolated and treated with radiation.
Fingers crossed.

Ross: I need your take, I just finished chemo on 20 july this year my doctor called me at work it was after normal working hours. He heard the interruptions them he realised that I am like assistant to the financial contoller. He has warn me that its too early for so much stress and suggest I take 2 weeks off the island and away from office or I can get very sick is this true? Somehow I seem to be taking longer to recover from chemo 12. What do you think? I love my job but I must admit am tired.

Yes it is too early for you to be working, I asked my Oncologist how long and he said 1 month, I waited the month and now I work (in a stressful job) per his restrictions 1/2 time for 1 month. I thought I could go back sooner and have learned 1/2 time is plenty for now. You still need extra rest and to take care of you!

rascal makes a point, that your body has been through a very serious ordeal and that ideally some rest would be preferred. Now, not everyone has that luxury. Furthermore, there are people who work right through chemo and radiation, never missing a day. there's no once-size-fits-all response.

that said, if your doctor is urging you to take some rest, you should at least give him or her the benefit of the doubt.

THAT said, even though this is an NHL board, you had Hodgkin's correct? I don't know what regimen you had but if I had to guess I would say ABVD. If you had had an NHL and that chemo regimen included an immunological agent like Rituxan, then going to a crowded workplace might be risky simply because rituxan kills lymphocytes expressing CD20, healthy or cancerous, so your immune system would be more compromised than it already had been.

But since no such agent is in use against HL that I know of, you aren't facing that direct threat to your health. Is it fair to think your immune system has nonetheless been compromised by treatment? Yes, but to what degree, who knows. Maybe none.

It seems like your doc listed stress as being the reason you should rest a little. Well i think the notion here is a connect-the-dots: a variety of pre-clinical studies (mouse studies) and some questionable clinical trials suggest that stress affects the immune system, i.e. it minimizes its efficacy and leaves people vulnerable to infection. This may or may not be true, this may or may not apply to you. Maybe you thrive at your job, maybe you don't think you stress as much as you do, only you know. But I think there's a reasonable amount of indirect evidence to suggest that you're more prone to catching an infection now than you will be in a couple weeks or a month. Unfortunately, that infection could be minor in the rest of us, but a monster in you if you are in fact compromised.

And not just from stress, but think of all the **** people are touching in the workplace that you're touching, think of the recycled air-- unless you work in a sterile environment, the potential is there for infectious crap to be afloat everywhere you go. Tack on the stress, tack on your body in rebound, and you might be a sitting duck for some moderately opportunistic infection.

All that said, there's nothing that going back to work is going to do to impact the efficacy of your anti-cancer treatment regimen. Either treatment knocked it out or it didn't.