I CONTINUED TO PURSUE A DEFINITIVE DIAGNOSIS

Initially, thinking it could only be insignificant benign tumors in my spleen, but my instinct as a physician, didn’t allow me to stop there because since a year ago, I also noticed my continued unexplainable weight loss totaling a loss of 11 kgs. From my previous weight of 86 kgs down to 75 kgs., in addition, I also have this continued and lingering unexplainable and uncontrollable generalized itching not relieved by any  anti-pruritic meds available in our clinic,  I also started to have easy fatigability on slight to moderate exertion, like climbing  the stairs and walking on short distance, more than regular night sweating, facial blushing and flushing, and unending skin bruising sprouting one after the other on both upper extremities.

With all these symptoms, the more I tried to pursue to find a definitive diagnosis to my problem. Again, I went back to my doctor and upon hearing all my symptoms I revealed to him, he suggested me to have a splenectomy (removal of my spleen) and he assured me that all my symptoms would disappear.  I hesitated, knowing the consequence of it. This means my immune system will be depleted and I will be very susceptible to infections, flu and malaria and my travel will be curtailed, I will be taking antibiotics for life, and I will have regular annual anti-flu vaccines and will have to take precautionary anti-malaria drugs while traveling to malaria-prone countries

I tolerated and carried the consequence of not having the surgery and suffered the effects of severe uncontrollable generalized itching and all those symptoms I mentioned for another two months until I can no longer tolerate it anymore as it made my life so miserable from uncontrollable scratching to sleepless nights. I used to tell my patients in the clinic not to scratch when itching starts and just tap it gently and take cold shower for relief. I used to laugh at them.  Not until I experienced it myself that I started to believe in them. Telling them not to scratch and take a cold shower to relieve itching? That’s baloney!

Do you know how I relieve my itching? I use hair dryer and hot compress to LITERALLY, burn my skin to relieve me of the itching. Initially, I will feel a very itching sensation which will later transform into burning pain and that’s the time I will switch places. Imagine burning my whole body twice at day time and twice early in the morning between 2-4 am? So practically, I never have a good night sleep daily. My stamina, my strength, my health and nutrition continued to deteriorate until I can’t bear it anymore and finally consented for splenectomy. Just as I was ready to submit for surgery, the surgeon did another work up and abdominal ultrasound and this time, aside from confirming the previous splenic tumors, abnormal para-aortic and supra-clavicular lymph nodes were noted with out any enlargement. A supra-clavicular  lymph node biopsy was done on the 2^nd week of July of 2012 and to my sigh of relief, the result was negative.  I could then relate my loss of weight to my DM. But three week after my biopsy, I suddenly palpated 2 enlarged bean-shaped lymph nodes measuring 2 cm on my right and one on my left inguinal areas. Immediately, another lymph node biopsy was done on my right inguinal area. The result came back initially as: Follicular B-cell Lymphoma but the pathologist couldn’t establish the grade, so the slides were sent to another pathologist and there was a conflicting report. The finding came back as: Atypical Lymphoid Hyperplasia.  Unconvinced, I borrowed the slides and brought to a cancer center – China Medical University Hospital, the best cancer center in Central Taichung, Taiwan and confirmed the initial diagnosis of: Follicular b-cell Lymphoma, grade 3. Still wanting for confirmation, I brought the slides to another cancer center – Taichung Veteran’s General Hosptial confirming the diagnosis of Follicular b-cell Lymphoma, grade 1-2.

My Oncologist ordered for a PET scan  (Positron Emission Tomography scan), a bone marrow biopsy and Stem cell harvest and culture plus a resting Ventricular Function Test in preparation for my chemotherapy.

My Whole Body PET scan revealed:

1. Multiple hypermetabolic lesions in the rt. inguinal region compatible with biopsy proven Follicular Lymphoma in the same region.
2. Multiple focal hypermetabolic lesions in all my lymph nodes – suggesting INTRA-NODAL involvement.
3. There are, apparently, increase focal uptake in the rt. 5^th intercostals rib, 1^st and 2^nd cervical vertebrae – suggesting   BONE involvement.
4.  There are multiple hypermetabolic lesions in the SPLEEN – suggesting EXTRA-NODAL involvement.

Bone Marrow Biopsy – negative.

Resting Ventricular Function Study – LV ejection fraction is 64% (normal)