Physical Check-list

[Guest guest]

Hi everyone:

I have a question regarding my upcoming physical, to

coincide with turning 40. I was dx with CLL in August 2009

and have been on w/w since. I probably had it back in 2005,

however. I am excellent shape and feel great, with some

palpable nodes and wbc around 50,000. When I go for more

physical, are there are specific tests I should order? any

specific blood panels, etc? I want this to be pretty

thorough.

I'd also be interested to hear any general advice younger

patients get from their doctors with respect to routine

healthcare.

Thanks in advance and thanks for the great service this list

provides.

Regards,

[Guest guest]

Hi ,

Am presuming you have had the basic diagnostic and

prognostic tests for CLL. The results of these are fairly

stable, and would likely be checked again only just before

beginning treatment: FISH, flow cytometry, possible CT for

internal nodes baseline, B-cell IGVH gene mutation status.

Bone marrow biopsy (BMB) is generally not an early test. It

can be useful, though, in measuring treatment results, and

in diagnosing CLL-mediated, autoimmune, or idiopathic

cytopenias or anemias.

Here is a list of tests you might ask for. The early part

of the list relates to general health and wellness, the

middle pertains to CLL-specific assays, and the latter part

covers some other contingencies. This list does not take

any account of the cumulative cost of the listed tests: if

you had them all, the bill would be quite high. And the

list is not comprehensive; you may have pre-existing

comorbidities or show signs that lead your doctor to order

other tests.

Blood tests: complete blood count (CBC) with differentials

and platelets, comprehensive metabolic panel (CMP), and

lipid panel to measure your cholesterol/triglyceride levels.

These three tests will provide your doctor with good

indications of your general health and health risks, immune

system health, and may point up anomalies associated with or

in addition to CLL, if any, that may need further inquiry.

Examples include anemia of different possible origins, or

thrombocytopenia, and kidney and liver function.

Additional blood tests might include a Vitamin D panel, and

a T-lymphocyte panel to measure ratios and absolute levels

of CD4+ and CD8+ T-cells.

An electrocardiograph - ECG or EKG - will indicate general

heart health. If abnormalities in the ECG or other heart

measurements (e.g., blood pressure, unusual sounds through

the stethescope) then an electrocardiogram (sonograpy) may

be appropriate, or other cardiac and cardiovascular function

tests may be necessary, conducted by a cardiologist.

CLL-specific tests in addition to the initial work up:

Lactate dehydrogenase (LDH), and beta 2 microglobulin (B2M)

can give a sense of disease stage and aggressiveness, and

are prognostic.

Quantitative immunoglobulins; IgA, IgG, and IgM. Most

CLL'ers will become hypoglobulinemic at some point, from the

disease and/or treatment. This test helps measure health

and fitness of one part of the adaptive immune system to

fight off invasive infections.

CLL (and treatment) is inherently damaging to the immune

system. As a result, the cancer surveillance and cancer

suppressive functions of the immune system are compromised.

For that reason, secondary cancers are more common among

CLL'ers than the general population. Some doctors know

this, some don't. Three cancers in particular are easy to

screen for, at least to determine the need for further

evaluation:

Skin cancers are many times more common among CLL'ers: have

a careful, whole-body visual scan for lesions of melanoma,

squamous cell carcinoma, or basal cell carcinoma. Learn how

to do this yourself, as well, repeat every 6 months.

Colorectal cancer. Occult fecal blood test. Possible

colonoscopy.

Prostate cancer. Digital rectal exam (DRE). Prostate

specific antigen (PSA) assay should be taken. A value over

2.5 ng/mL indicates a need to monitor and perhaps consult a

urologist, more than 4.0, sustained, is an alarm bell.

A careful physical exam and personal history taken by the

examining physician can pick up many conditions at an early,

treatable/curable stage. This seemingly unsophisticated,

" hands-on " exam is in fact a gold mine of information for

the doctor. Encourage the doctor to be thorough, and assist

him or her to be so.

Regards,

Tim Klug

[Guest guest]

Tim,

Very nice summary.

I might quibble over a few other points, and I would add PAP

and mammo where appropriate, and get up to date on all your

" killed " vaccines ASAP, but your thoughtful note should be

highlighted in the archives.

/message/15112

Thank you