hematologist

“I want to be a hematologist. That’s a blood doctor. Well not a blood doctor, exactly. But a doctor that finds cures for blood diseases.”
“How’d you decide on that?”
“We were dissecting frogs in class and learning about how the blood flows through the body. And I went home that night and wrote an essay. And it wasn’t like any other essay I’d ever done. Normally when I write essays, it takes me a long time, but this was the fastest essay I ever wrote. So the next day I was asking the teacher mad questions, and she was like, ‘You know you can get a job in this.’ And she pulled it up on the internet, and was showing me all about hematologists.”

I am a flake

I can’t write consistently mostly because I got a new puppy that I can’t leave alone so I can go to my room and write. So I apologize. I’ll try to condense the last month in the most concise and accurate way as possible. 

My hematologist appointment I was nervous about went really well. As of right now I am not positive for major genetic predispositions to blood clotting. I do have something called a double mutation in one of my genes which is probably what was aggravated by the BC. So basically, thats that. And also when the gene is mutated it also causes your body to not be able to do something with B vitamins and folic acid. 

Verdict, regime of B6, B12 & folic acid to see if I can get those up (since they were low) AND here’s the big one - probably only one year of Coumadin! 

AOOOOWWWWWWWWWWW

So I have another appoint in the beginning of May to check up how the vitamins faired in my body. And he also needs to screen for one more genetic blood disease that I came out borderline for. BUT he said that the numbers could be skewed by the low B’s and Folic Acid. I am hoping that is the case. 

In the meanwhile, for the last 5 weeks I finally have my INR under control. 

About fucking time. 

It has ranged anywhere from a 2.1 - 3. 

More importantly I feel amazing. For the last 3 weeks I have been to gym frequently. I need to lose some of the excess weight that I gained from being so low activity. For the first time in a really long time, I feel like myself. 

And for a little while, I kinda forgot what it felt like. Its liberating and I have an insatiable urge to LIVE.  I am really excited for the CT scan in a couple weeks to see if the blood clots in my lungs are gone.

Cause I think they are. 

L

Dr Cagle, The Woodlands and Houston, Tx, Hematologist

I developed a post-partum clot which, despite my complaints at the hospital re the pain (that’s a separate entry for the hospital!), moved to my lung.  After a stay in the hospital, I was referred to Dr Carol Cagle working out of a clinic in the Woodlands but with offices in Kingwood and Houston.  Dr Cagle could barely be bothered to look at me or do a proper exam, had to be begged to run specific (protocol for PEs) tests and told me every visit “If you weren’t fat, this wouldn’t have happened”.  He rarely checked my INRs and said “just do what the nurse says” and kept me on blood thinners for far longer than necessary.  I finally found a new hematologist my insurance would accept and told her about the treatment and she was horrified mainly because of his misinformation and his willingness to let me be on potentially life threatening medication because he was too disgusted by my body to do a proper exam or work up.  I found out later that several other fat women I know have had equally negative experiences with him and his staff.

3 weeks have passed

Since I last had the guts or energy, time, patience …etc etc to update you. But now, I’ve screwed us both cause not only do I have to freaking write another book because I didn’t update you - you have to now read it. 

forgive me?

A week after posting last, my next INR check was at a 2.2.

Finallllyyyyyyyyyyyyyyyyyyy.

I felt like for once, maybe this dosage was right. That I didn’t have to continuously, every week return to the doctor. I know its bad cause I don’t even have to check in at the front anymore, they just pull up my charts as soon as they see me walk in. 

The week after, we are looking for a stable INR of 2.2 or even higher. If I match the previous week’s INR, I could keep my dosage of a 8.5mg everyday. My INR turned out to be a 1.7

Oh f off coumadin. 

Baffled again, doctors and nurses who crowd around the nurse’s station to see my results are heartbroken. I get bombarded with a million questions about my diet and what I am doing.

Because basically anything that is green in color has Vitamin K. I was told specifically to not eat massive amounts of greens. I was cleared by multiple doctors I was going to be able to consume small small amounts if I chose. And we’re talking like less than a half a cup of greens for the whole week. 

If anyone has ever been told not to do something or eat something, you know what comes next.

The incredible urge to do it.

Now I am not saying I went into every restaurant and ordered every salad on the menu and shoved it in my mouth. But if I wanted a little lettuce on a sandwich or burger, I had it. When I explained this to the doctor, she agreed with me that such a small amount of the greens should not be affecting me this much, but to nonetheless pay more attention to my consumption to absolutely make sure that it is not the greens. My dosage was increased to a 9.0mg everyday. 

Last week, once again - hoping for something good. I was once again disappointed by an INR of 1.9. At this point, the doctor feels like raising my dosage everyday might be too much and to alternate dosages. 

Now she suggested this to me in the beginning and I HATED the idea that my medicine wasn’t going to be consistent and that I would now have to be 1000% vigilant of what my dosage was going to be every night. This time around, I feel like I have no choice. It’s already been about 8 weeks of hell. 

My dosage is now 9mg for 5 days out of the week and 2 days 10mg. 

More importantly, on Tuesday the 8th, I went and saw a Hematologist ( a blood doctor ). I had been waiting for this appointment for over 2 months. I had a series of blood work ups done to let me know if my blood clotting is genetic. This is extremely important to know since this will probably be the answer to the question I’ve had since the beginning of this whole mess. 

Will I have to take blood thinners for the rest of my life? 

My Hematologist was amazing. He was so incredibly smart and gave me a good pre-prognosis concerning the meds. He basically said pending the results of the additional blood tests, since it was an induced pulmonary embolism, he wouldn’t suggest me on blood thinners forever! 

BUUUUT 

this is all pre-blood test speaking. If the results come back for positive genetic susceptibility to blood clots - then we’ll have to revisit the idea of a blood thinning regime . . for forever. I have a follow up on Tuesday, I’ll make sure to update appropriately. 

Hopefully. 

Which finally brings us to Wednesday. My weekly INR check up! I was super excited about it because I felt like the raise in the Coumadin would definitely throw me over the 2.0 range. 

1.9

Yes, I said it. 1.9 

AGAIN, did not even change a bit. So the doctor suggested this week, to not have any greens AT ALL. Not even a bite, a taste, a lick - NOTHING. It seems that my body must be extremely sensitive and that my minimal greens intake is just affecting it to the point where its totally stunting the medicine. 

a kid’s dream diet.

So thats that. I promise not to write any books of this sort anymore because it must be long and laborious for you to read as it is for me to go back into my memory and type. 

I guess, I’ll just update in a few days. Or maybe I’ll sneak in a non-related medical post tomorrow about my puppy, Chewie. 

maybe.

L

I talk a lot of ish bout only having a job just to support my spending habits. But at the end of the day all I really want is to have a fat 401k, a home with two kids, and to eat as much ice cream as I want, whenever I want 😔🍦 #basiclifegoals #hematologist

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What makes an oncologist hematologist a truly inevitable medical professional?

Hematology can be described as a branch of science that deals with the study of blood. Hematologists treat basically treat two types of blood disorders and they include anemia and hemophilia. Oncology can be described as the study of cancers that causes uncontrollable growth of cells. Though these two specialties are separate, they are closely connected and experts of these two branches work closely to offer integrated care for the cancer patients. People will not have to collect expert opinion from two different sources if they can find an oncologist hematologist and this professional will be competent enough to handle both these branches with utmost efficiency.

An oncologist hematologist will be specialized in the diagnosis, treatment and prevention of cancers and blood diseases like anemia, hemophilia, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, sickle-cell disease, leukemia and multiple myelomas. These professionals do not normally treat cancers like prostate cancer (operable) and they will focus on treating solid tumors as well. 

Cancer treatments always demand great expertise in the fields of blood and cancer and that is exactly where the importance of an oncologist hematologist comes in. For example; bone marrow transplants can be described as blood related and some cancers are being treated using these transplants. Blood tests are also being employed to diagnose some forms of cancer. In such a situation, primary-care provider will refer the patient to an oncologist hematologist for specialized care.

Hematologist oncologists work closely with other departments like surgery, radiology and pathology to make the treatment extremely effective and some other associated specialties are pain medicine, psychology and infectious disease as well. Cancer treatment definitely needs an integrated method of approach and an oncologist hematologist can be described as the pivot on which the entire treatment revolves around. Some of these professionals will convert to the field of stem cell transplantation as well. 

Raw Diets and Bloodwork Results: Should you be concerned?

For almost two decades, the veterinary community has debated the effects of raw diets on laboratory blood and urine results. Unfortunately, the debate has not been definitively resolved and is now sending confusing mixed messages to companion animal parents. I want to give my conclusive opinion, based upon published results and personal experience.

Blood is my thing.

I am by training a veterinary hematologist and immunologist. After graduation from veterinary school, I was a Research Scientist with the New York State Health Department and began comparative studies of animals with inherited and acquired bleeding diseases. Eventually, my position culminated as Chief, Laboratory of Hematology, Wadsworth Center. In 1980, I also became Executive Director, New York State Council on Human Blood and Transfusion Services before moving to Southern California to start Hemopet, a non-profit, closed colony blood bank for dogs, greyhound rescue and veterinary specialty diagnostic program.

So, when you hear me go on about antibodies (produced in the blood) and the NutriScan test, adverse reactions to vaccines such as IMHA (anemia), or the importance of thyroid reference ranges (measured through blood), you can rest assure it is backed with my over 50 years of clinical research.

Bloodwork Analysis

The beauty of initial bloodwork results (known as CBC and Chemistries) is that it reveals and detects the potential presence of many conditions including the effects of vitamin and mineral deficiencies or excesses, or diseases such as infections, diabetes, bowel, liver, kidney and adrenal conditions, and even leukemia. Different, additional bloodwork or other tests probe further to confirm, to deny or to point the medical professional in another direction. However, a comparative baseline or reference range for the species and each patient needs to be applied for accurate diagnosis. Human bloodwork results are sorted on numerous variables like sex, age, weight, medications, menstrual cycle, etc. Based on years of research, this is how epidemiologists can extrapolate and determine which lifestyle choices lead to ill or optimal health. Similar features should be applied to animal diagnostics.

Depending on the laboratory running the test, a companion animal’s initial bloodwork analysis generally includes the variables above and breed. (Mind you, most laboratories do not use reference ranges that are specific for the breed type and age when screening for the presence of thyroid disease in companion animals. Hemopet’s Hemolife Diagnostics does apply these specific thyroid reference ranges for dogs, cats and horses. But, that’s a different article altogether.)

Wynn/Dodds Study on Raw-Fed Dogs

Approximately 10 years ago, Susan Wynn, DVM and I conducted a two-part study:

1. Blood reference range differences in raw-fed dogs vs. kibble-fed dogs

2. The potential presence of increased protein in urine based on Part 1 of the study

Study Part 1: Bloodwork reference ranges

1. Sample Size
87 Dogs – Fed a classically biologically appropriate raw food (BARF) diet
46 Dogs – Fed a popular raw diet 
94 Dogs – Fed other custom raw diets

2. Control Group
75 Healthy Adult Dogs – Fed a commercial kibble diet

3. Length
9 Months

4. Findings
Comparisons of bloodwork results were essentially the same for the raw and kibble diets with a few exceptions.
Hematocrit – Higher in all raw diet fed groups.
Blood urea nitrogen (BUN) – Higher in all raw diet fed groups.
Creatinine level – Only higher in one raw diet group.

5. Conclusion
Dr. Wynn and I concluded that the normal blood reference ranges for raw-fed dogs need to be revised and differentiated from kibble-based diets.

This is significant. Let’s step back and compare to human diets. We all know we need iron to prevent anemia. High iron foods include beef, dark leafy greens (spinach), nuts and dark chocolate. While iron is better absorbed from meat sources, plant iron is better regulated and causes less damage to the body. We also know that we should not have a diet with too much beef. Once or twice per month, you may eat beef in the form of steak or hamburger, and indulge in a little dark chocolate. You may have a handful of nuts as a snack occasionally. The rest of the month, you may have a dark leafy green salad, but sometimes opt for steamed spinach or kale. If your stove broke, you may microwave some canned spinach but you know that fresh, steamed spinach is better for you because of processing. Hence, you are fulfilling your body’s need for iron through raw or cooked sources and different processing methods. In essence, human reference ranges include food variety. On top of that, research is deeply funded and robust for human health to steer us to the right food choices.

So, if fresh, whole foods for humans are preferred over highly processed foods, why not apply the same logic to our companion animals? When dogs and people started co-habiting thousands of years ago, the dogs ate what we ate. At the turn of the 20th Century, kibble diets were brought to the market as a convenience for companion caregivers. So, the majority of caregivers started feeding only kibble diets with little variety in the ingredients. Then veterinary research really took off. Hence, decades of reference ranges were formed by kibble diets, which exclude variety and are not species appropriate diets.  

However, Dr. Wynn and I made special note of the elevated BUN and Creatinine levels in the raw fed groups. Part 2 of the study was then conducted for more information.

Part 2: Potential Presence of Increased Protein in Urine

“Blood urea nitrogen” test sounds more complicated than it is. The phrase refers to a process that goes on inside the body. The liver produces the waste product, urea, when it breaks down protein. Urea leaves the liver through the blood, circulates, ends up in the kidneys, mixes with other waste products and water, and then passes as urine. Nitrogen in the blood comes from urea. If urea nitrogen in the blood is elevated, it could just be an indication that the nutrients from the bowel have not yet been assimilated, or, the kidneys are not removing urea nitrogen from the blood normally or efficiently, and may could even be a sign of early kidney failure – if the creatinine, discussed below, is also high.

Creatinine comes from creatine. Creatine forms when food is metabolized or changed into energy. Creatine breaks down to creatinine, which is passed from the blood to the kidneys and is disposed of through urine. If the kidneys are damaged, the amount of creatinine in urine goes down while its level in the blood rises.

As you are probably imagining, BUN and Creatinine tests are the primary tests used to check how well the kidneys are able to filter waste from the blood. The two are often expressed as a ratio of BUN-to-creatinine.  An increased ratio may be due to a condition called albuminuria or proteinuria, which is the presence of too much protein in the urine. This is a spillage that could be due to high dietary protein intake and/or increased leaking of protein through the glomerular kidney filtration system. Eventually, albuminuria can lead to kidney failure.

1. Sample Size
37 healthy adult dogs of all sizes fed raw diets for one or more years

2. Comparison
Urine was compared to Heska’s historical database for dogs fed standard commercial diets (presumably kibble).

3. Findings
5 out of the 37 dogs tested positive for microalbuminuria. 

4. Conclusion
A diet of raw ingredients does not appear to cause leakage of albumin into the urine in most of the dogs tested. Of the 37 dogs screened, 32 were negative for microalbuminuria, and five were positive (two low and three medium positive). Two of the five positive dogs had medical reasons relevant to the finding of microalbuminuria. Follow up testing of these two dogs were negative, after their low-grade urinary tract infections resolved. The reason for the positive reaction in the other three dogs is unclear as there was no identifiable abnormality in their health history or on recent physical examination; they were lost to follow up.

My thoughts on Raw Diets for Dogs and Cats

Am I an advocate of raw diets? Yes. Dogs and cats shine with health and vigor on raw diets.

Are raw diets always appropriate? No. For the dogs that tested positive for albuminuria, I would suggest a home cooked diet. I would also suggest home cooked meals for dogs with significant liver, kidney and bowel conditions. Raw diets can be a little bit too much for their bodies to handle and they need the food to be slightly broken down through light cooking or steaming.

W. Jean Dodds, DVM
Hemopet / NutriScan
11561 Salinaz Avenue
Garden Grove, CA 92843

References

“Albuminuria.” The National Kidney Foundation, 12 Aug. 2014. Web. 06 Dec. 2015. <https://www.kidney.org/atoz/content/albuminuria>.

“Blood Urea Nitrogen.” Lab Tests Online. AACC, n.d. Web. 06 Dec. 2015. <https://labtestsonline.org/understanding/analytes/bun/tab/faq/>.

“Blood Urea Nitrogen.” WebMD, n.d. Web. 06 Dec. 2015. <http://www.webmd.com/a-to-z-guides/blood-urea-nitrogen>.

“Creatinine and Creatinine Clearance.” WebMD, n.d. Web. 06 Dec. 2015. <http://www.webmd.com/a-to-z-guides/creatinine-and-creatinine-clearance>.

Dodds, Jean, DVM, and Diana Laverdure, MS. Canine Nutrigenomics: The New Science of Feeding Your Dog for Optimum Health. Wenatchee: Dogwise, 2015. Print.

Dodds, W. Jean, DVM. “Understanding Your Pet’s Blood, Tissue & Urine Laboratory Results.” Dr. Jean Dodds’ Pet Health Resource Blog, 18 Apr. 2015. Web. 06 Dec. 2015. <http://drjeandoddspethealthresource.tumblr.com/post/116836320986/pet-laboratory-results#.VkDqz7erTIV>.

Dodds, W. Jean, DVM, and Susan Wynn, DVM. “Updated Second Progress Report: Study of Microalbuminuria in Dogs Fed Raw Food Diets.” Dr. Jean Dodds’ Pet Health Resource Blog, 12 Nov. 2012. Web. 06 Dec. 2015. <http://drjeandoddspethealthresource.tumblr.com/post/35814186848/raw-diet-affect-on-dog-urine-kidney-renal#.VkDrX7erTIV>.

Whitbread, Daisy, MSc. “Top 10 Foods Highest in Iron.” HealthAliciousNess, n.d. Web. 06 Dec. 2015. <http://www.healthaliciousness.com/articles/food-sources-of-iron.php>.

Great Debates and Updates in Hematologic Malignancies

NEW YORK, NY, November 21, 2011 – Imedex, LLC would like to present the Great Debates and Updates in Hematologic Malignancies meeting occurring on April 27-28, 2012 in New York, New York.  This oncology continuing medical education (CME) activity has a target audience of academic and community hematologists, oncologists, oncology nurses and other healthcare professionals involved and/or interested in the treatment of patients with hematologic malignancies

 

This oncology CME conference will focus on controversial areas in the management of hematologic malignancies and will also cover a broad curriculum of hematologic malignancies, from lymphoma to leukemia to myeloma to myeloproliferative disorders.  The format of this oncology CME conference will include didactic presentations, in conjunction with lively and interactive debates.  During this oncology CME meeting, discussions between the faculty and audience members will be encouraged with a focus on how new information fits into current community practice, as attendees will have the chance to really engage themselves with an insightful look at more than one side of a question. Discussions will focus on how the new data fits into current community practice of hematology, and will be aimed at facilitating rapid incorporation of important new advances in treatment into the registrant’s current practice.

 

Upon successful completion of this continuing medical education opportunity, attendees should be able to:

 

•       Have increased awareness of recent challenges to the standards of frontline and salvage therapy for hematologic malignancies 

•       Have increased confidence in their ability to use novel tools to predict patient outcomes and guide treatment planning for hematologic malignancies 

•       Have increased confidence in their ability to evaluate potential benefits and risks of maintenance therapy for hematologic malignancies

•       Have increased confidence in their ability to recommend specific treatment strategies for elderly versus younger patients with hematologic malignancies

•       Have increased confidence in their ability to manage comorbidities and treatment side effects in patients with hematologic malignancies

•       Be more likely to incorporate new data from recent clinical studies into therapeutic decision-making for hematologic malignancies

 

For more information and to register for the Great Debates and Updates in Hematologic Malignancies meeting on April 27-28, 2012 in New York, New York please contact us:

 

E-mail us at registration@imedex.com

Call us toll-free at 1-855-276-6855

or

Register Online at http://www.greatdebatesinhematologicmalignancies.com/2012/index.asp

This Is What It Feels Like to Have Cancer at 20 Years Old

“In some ways, what you have is treatable—though we don’t really use the term ‘cure,’” sighed the hematologist. “'Remission’ is much more appropriate.”

There I was, listening to my consultant ramble on about semantics, waiting to hear whether or not I was going to die. I was another 20-year-old winner of the cancer lottery, one of the seven young people diagnosed with cancer in the UK every day. This was my day. What had previously been a statistic on a GP’s waiting room wall had become my reality. My frankly very disappointing reality.

Aside from the whole life-threatening disease thing, everything had actually been going pretty well for me. I’d been in my first serious relationship for three-and-a-half months and had settled happily into British life as an exchange student, over from my native France.

In retrospect, this probably made the news slightly harder to stomach. For the first time I had someone whose happiness I valued over my own, compounding the anxiety I was already feeling. I also had an inkling that the impending treatment might put the stoppers on my usual regime of going to house parties and generally having fun without having to think about what was coming the next morning—whether it would involve a needle in my arm or a scalpel or a massive machine making loud clicking noises while I laid inside, acutely aware of my own mortality.

And to think of how I’d ended up there: first, it was the swelling of a lymph node on the first day of summer. Then the local GP failing to acknowledge that something was wrong. Twice.

Then I did the sensible thing and tried to diagnose myself on the internet. For once, what I read was reassuring: nine times out of ten, said faceless strangers on a forum, swelling is just a symptom of a benign infection. However, just for peace of mind, I thought I’d pay one last visit to my GP to check that Dr. Google wasn’t bullshitting me—that there really wasn’t anything wrong with this ugly growth that had started to annex my neck.

I was eventually referred to A&E, where I underwent a couple of infection-related tests. A fortnight later, a phone call summoned me to the hospital. The results were negative. Serious causes would have to be considered. To properly consider these serious causes, it transpired, I’d have to spend extended periods of time under anesthetic/wearing ass-revealing hospital gowns/having bits of tissue cut out of me.

External image
The author after a biopsy on his swollen lymph node

Weeks later, after being referred to a specialist in France, I was finally told what I could never resign myself to face, despite the fact the idea had been pawing away at the back of my mind for some time.

“It appears we have found abnormal cells during the biopsy. These are called Non-Hodgkin lymphoma cells. There are many different types of lymphoma. Yours is called diffuse large B-Cell.”

The C word was dropped, uneasily.

Continue

2

Since it’s a selfie day apparently, I decided to do a much needed bump update. 

Currently right about 37 weeks along!

 Since around week 34 my legs/feet/ankles have transitioned from being actual limbs to sacks of water hanging from my body. >.< We’re talking several inches of swelling. 

Contractions and various pains abound. Still, I really need her to stay in there til due date. Or, at the very least, until the 29th when I see the hematologist again. 

Update

saw my oncologist / hematologist yesterday
besides very bad dehydration, sleep deprivation, and starvation, apparently some of my medications including my chemo was to blame for why I’ve been feeling so horrible
CT scan showed the cancer grew / mild increases in activity

we’re changing my chemo regiment on Monday, stopping for now so I can get back to myself
also having an MRI of my brain in two weeks just to make sure there’s nothing there too just to be safe

I hope you all are doing much better than I am, love you all so much. Stay strong. 💕❤️💕

Honestly

Our rent is due on Friday and we’re $300 short and Alex keeps missing work because he’s sick and has swollen lymph nodes and can’t go to the hematologist/(+oncologist? is what the doctors recommended) to get help and figure out what’s wrong because he doesn’t have insurance so if you could please donate to our paypal dockter13@gmail.com and signal boost this that would be appreciated 

Serving up some 1970s casual chic #hospitalglam at the hematologist.   Want to give praise one last time to the fierce artist Karolyn Gehrig ( hospitalglam ) for her inspiration.  Thank you for showing me how something as simple as a selfie can transform an all too often dehumanizing (and drab) experience.  It has been encouraging me to take up space in a fabulous way, has given me something to focus on other than my fear and is providing some positivity for this upcoming medical journey. 

//So, I have an appointment with my hematologist today, which will hopefully end in good news since the treatments he’s been giving me seem to be working and my blood work seems to be in a much better place than it was 2 years ago. (No more transfusions, yay!) I’m hoping that means I’ll be back soonish and won’t have to worry about this anymore, but we’ll see what happens, so wish me luck!

megameatloafcake  asked:

Hiya Dandy!!! I was wondering what made you decide that you wanna be a lawyer? I'm awkward and curious and nosey, sorry 😅

okay so, it’s story time: i started off as a chemistry major, and i was three years into a chemistry degree when i decided that it didn’t interest me anymore. i wanted to be a hematologist, but once i had worked as a pharmacy tech for two years and had to deal with all of those doctors, i decided that being a doctor wasn’t for me. so i had to figure out something else to do with my life. so i was sitting in my organic chemistry class and it just hit me: i want to be a lawyer. i don’t know where it came from, i don’t know what made me think of it, but i just knew. that was it. so i changed my major that day and i am SO glad i did because law is infinitely more interesting to me than diagramming molecules all day. i honestly feel like that’s my calling in life, and i just wish i had realized it sooner before i logged all those chem lab hours.