Today is another beautiful day here, it has been raining lightly all morning, with the weatherman saying it will be clearing late this afternoon. In this part of the country summer seems to be year around. Over the last several days, you would think that I didn’t even have CLL. I feel strong, did not lose my breath when walking, and even started digging in the garden to put new plants in the ground. My joints and muscles were not sore, and the pain in my ankles, which is always present, has been very little for over a week now. I have not taken my medicine for gout now for over a week, but after reading what is required before chemotherapy, to cleanse the body of uric acid, I will be taking it again. CLL cancer cells when being killed by T-cells, turn into uric acid in the body, and Allopurinol is excellent in moving the uric acid out of the body.

The weekend was uneventful, meaning all seems to be well here and with my family. Really though, how others are doing, is both physically and psychologically hard to ascertain for sure. One may look physically okay, but have serious internal problems, and those who look like they are very happy, may not be. Those who look to be capable of handling everything that is thrown at them, may be on the verge of a nervous breakdown. Those whose family unit looks like love is at the core of their family, may be at the break point of separation and divorce. With saying all of this, it is my sincere hope that none of these things are affecting any of my friends or family.

I thought I would list the Pretreatment evaluation of patients with Chronic Lymphocytic lymphoma

Tests to establish the diagnosis: 1)Complete blood count and differential count –  Always;  2)Immunophenotyping of lymphocytes – Always

Assessment before treatment: 1)History and physical, performance status – Always; 2)Complete blood count and differential – Always; 3)Marrow aspirate and biopsy – Desirable; 4)Serum chemistry, serum immunoglobulin, direct antiglobulin test – Always; 5)Chest radiograph – Always; 6)Infectious disease status – Always

Additional tests before treatment: 1)Cytogenetics (FISH) for del(13q), del(11q), del(17p), trisomy 12, del(6q) in the peripheral blood lymphocytes – Desirable; 2)IgVH mutational status, ZAP-70, and CD38 1.2 NGI – Always; 3)CT scan of chest, abdomen, and pelvis 3.5.2.2 NGI – Desirable; 4)MRI, lymphangiogram, gallium scan, PET scans – NGI; 5)Abdominal ultrasound – Possible.

I thought I would add this list also Recommendations regarding indications for treatment in CLL, as I am in Binet stage C, or Rai stage IV. What is Binet stage C, or Rai stage IV?  Stage C or IV – All patients who have Hb (red blood cells) less 100 g/l (10g/dl)(I am slightly anemic) and /or a platelet count less than 100 count, mine being 63, irrespective of organomegaly.

Treat with Rai stage 0 – NGI

Treat with Binet stage A – NGI

Treat with Binet stage B or Rai stage I or Rai stage II – Possible

Treat with Binet stage C or Rai stage III or Rai stage IV – Yes

Treatment of active/progressive disease – Yes

Treat without active/progressive disease – NGI

Okay, now on to Needs of Man

By using a structured hierarchy which ranks them according to their order of importance. This means that certain needs (higher in priority) must be met before others can be addressed (lower in priority). This ranking is based upon survival, that is, what is necessary to keep the person alive and well.

The physical needs for health are placed at the bottom of the hierarchy. We cannot continue to live without the proper nourishment of our bodies. Therefore, the most basic needs we have are those concerning our health. A man who is gasping for air or starving to death will simply not be concerned with personal worth issues. However, as the physical needs are met, then the personal needs begin to take priority in our lives. Likewise, when our personal needs are satisfied, our spiritual needs begin to take priority in our lives. This order is important. It cannot be reversed. Spiritual needs cannot be met until both physical and personal needs are met.

A husband and father who works hard to provide enough money for groceries, rent, gas, etc. may think that he has met the needs of his family. He brings home the paycheck expecting his wife and children to love and respect him for all that he has done. His unstated reasoning may be something like: “Because I have supported you with food and shelter, now you can at least, love and respect me enough to have dinner ready, and appreciate all that I have done for you.” Although Dad has met the physical needs of his family, he has overlooked the next level. He failed to understand his wife and children are more than physical beings. They have a set of personal needs that must be also met before they can exercise their spiritual need and give him any true love or respect. To make matters worse, Dad probably does not even realize he has a set of personal needs crying out to receive love and respect so loudly, that he is not really loving or respecting his family either. Dad must also have his personal needs met before he can exercise his spiritual need to love.

Perhaps the single biggest cause for family strife and turmoil is the failure to recognize the importance of personal need satisfaction in our everyday lives. With everyone needing personal worth to be satisfied before their spiritual need (to love others) can be satisfied, are we not in a “Catch 22” situation? If no one can truly love another before being loved, where does it begin?

Tomorrow, Lord willing:  Personal Needs

Advertisements