Tuesday 10 July 2012

What happens when you go for a check-up?

In the past, I've tended to have about one check-up a week whilst undergoing treatment, but the frequency varied whilst in remission: It started at maybe once a week, but gradually the gap between check-ups increased, as the doctors gained confidence that I was on the right path.  When I recently relapsed, which was about eighteen months post-treatment, my check-ups were every twelve weeks.  So, as you can probably imagine, I've been for numerous check-ups over the last few years, hence by now I'm more than familiar with the routine; The routine is pretty simple though, as it essentially just involves a blood test, followed by getting weighed, and finally a chat with a doctor about how I am getting on - It probably comes as no surprise that there's a fair bit of waiting involved too.

The blood tests seem to be much more important during treatment than when you are in remission, as during treatment the chemotherapy affects the levels of various key components of your blood.  When in remission, the blood tests can show signs of relapse, but it seems the doctors rely more on the patient to mention any issues/symptoms etc.  Your weight is just monitored for any worrying trends.

It seems the blood components that are most closely monitored are:
  • Hemoglobin - It carries the oxygen that you breath-in for use around the body and the resulting carbon dioxide back to your lungs for you to breath-out, so if your level of hemoglobin falls too low you may have symptoms such as feeling weak/tired, out-of-breath on exertion, or trouble concentrating; You are considered anemic when it drops below a certain point (it varies based on age and gender) - A doctor can prescribe a red blood cell transfusion to increase your hemoglobin level.
  • White Cells & Neutrophils - They are both related to your immune system, so as they fall you become more and more prone to/at risk of infection; You are considered neutropenic (either mild, moderate or severe depending on the level) when the neutrophils, which constitute around 45-75% of the white cells, fall too low - You can have injections in the stomach to help raise these levels, and whilst undergoing chemotherapy they may be prescribed ahead of time as part of the treatment, as these levels are expected to drop, so this minimises the period where you are neutropenic.
  • Platelets - They are key to the forming of blood clots, i.e. if you cut yourself it is the platelets that stop you from continually bleeding, and if they fall too low can result in things like: becoming more prone to bruising, having nose bleeds, and red spots appearing on the skin (usually in the lower legs); You are considered thrombocytopenic when it drops below a certain point - A doctor can prescribe a platelet transfusion to increase your platelet level.

The chat with a doctor tends to involve a couple of things: The first usually starts with a fairly open question about how are you getting on, i.e. gives you an opportunity to raise any concerns - I have found that as I got to know some of the doctors it did also become a bit of an informal catch-up on life in general; The second is usually just a quick comment on your blood test results and weight, followed by arranging any medications, transfusions or further tests/procedures, and the next check-up or treatment.  During a check-up, the doctors have sometimes listened to my breathing, and had a quick check for any lumps too - I guess these tests could be specific to my diagnosis though, i.e. Hodgkin's Lymphoma (a type of cancer of the lymph nodes) in the chest.  Incidentally, that reminds me of the first time I was ever checked for lumps, as after the doctor felt the lymph nodes in my groin, under my arms and in my neck, he then not surprisingly washed his hands.  At this point, I was left thinking that perhaps that's not the best order, as now I feel like I should wash my neck!

In terms of the waiting, you can wait for up to thirty minutes (if things are really busy) for a nurse to take some blood samples to send for analysis; The analysis seems to take anywhere between about thirty minutes to an hour, during which time you get weighed and wait to see a doctor.  In the vast majority of cases, you don't see the doctor until the blood test results are back, and even then there is a queue of patients, so you can be waiting a while (especially if one or more doctors have been called away unexpectedly to treat patients).  In total, I think the quickest check-up I've ever had probably took about an hour, the longest maybe four hours, and typical being more like around two hours.

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