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Should I Start Treatment Now Or Wait Despite Rising WBC Levels?
Posted on
Fri, 13 Mar 2020
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Fri, 13 Mar 2020
Answered on
23 hours ago
Last reviewed on
Question : sir
WBC level again increased in one month from 79000 to 95000 but Platlates and RBC &Haemoglobin is ok .Again LDH increased from 390 to 450.
No fever ;No weight loss No other symptoms.
DR telling treatment can start but it is up to you
Not immediate but required
What your opinion?
Whether I wait more
Up to what level WBC increased I will not worried if other parameters ok
WBC level again increased in one month from 79000 to 95000 but Platlates and RBC &Haemoglobin is ok .Again LDH increased from 390 to 450.
No fever ;No weight loss No other symptoms.
DR telling treatment can start but it is up to you
Not immediate but required
What your opinion?
Whether I wait more
Up to what level WBC increased I will not worried if other parameters ok
Brief Answer:
Treatment can wait
Detailed Answer:
Hello,
I am not sure if this much rise in 1 month is correct or not. But even then, it's not mandatory to start treatment right now.
You may repeat another count in 1 month and see. As your doctor has correctly said, it's not absolutely necessary to start treatment now. But yes, we will need it in near future. Unfortunately there's no criteria of WBC count to start treatment so I can't answer that.
Hope this helps.
Regards
Treatment can wait
Detailed Answer:
Hello,
I am not sure if this much rise in 1 month is correct or not. But even then, it's not mandatory to start treatment right now.
You may repeat another count in 1 month and see. As your doctor has correctly said, it's not absolutely necessary to start treatment now. But yes, we will need it in near future. Unfortunately there's no criteria of WBC count to start treatment so I can't answer that.
Hope this helps.
Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
Sir
Thanks lot
I understand there is no way except chemotherapy. I want also delay because once the treatment start life may horrible due to mainly side effect and other complication.
My only pray to avoid chemotherapy as possible.
But what precautions I should take not to increase level rapidly .How to stop infections .I do not know what is inside going on.
Nowadays I am facing dry mouth problem.
Whether I will do ESR test and CRP .
So many queries and doubt arises in mind
If possible please suggest.
Thanks lot
I understand there is no way except chemotherapy. I want also delay because once the treatment start life may horrible due to mainly side effect and other complication.
My only pray to avoid chemotherapy as possible.
But what precautions I should take not to increase level rapidly .How to stop infections .I do not know what is inside going on.
Nowadays I am facing dry mouth problem.
Whether I will do ESR test and CRP .
So many queries and doubt arises in mind
If possible please suggest.
Brief Answer:
ESR and CRP won't help
Detailed Answer:
Hello,
Dry mouth is also likely unrelated to this problem.
There is no such precaution to limit the increase in WBC. At this stage, you don't need preventive medicines to stop infections. You can consult your doctor regarding influenza and pneumonia vaccination as those are helpful in this scenario.
Regards
ESR and CRP won't help
Detailed Answer:
Hello,
Dry mouth is also likely unrelated to this problem.
There is no such precaution to limit the increase in WBC. At this stage, you don't need preventive medicines to stop infections. You can consult your doctor regarding influenza and pneumonia vaccination as those are helpful in this scenario.
Regards
Above answer was peer-reviewed by :
Dr. Kampana
local dr suggested to carried out FISH for Cyclin & uric acid.After report he will suggest.I do not understand why this test required again as FISH test already carried out which comes negative. He worried about high level of WBC AND told treatment may be required.
PLEASE SEND YOUR VALUABLE ADVICE.
PLEASE SEND YOUR VALUABLE ADVICE.
Brief Answer:
If cyclin D1 negative no need to do it again
Detailed Answer:
Hello,
WBC count is worrisome, but as I said no criteria to start treatment on its basis. I personally do not start treatment if absolutely no symptoms.
Regards
If cyclin D1 negative no need to do it again
Detailed Answer:
Hello,
WBC count is worrisome, but as I said no criteria to start treatment on its basis. I personally do not start treatment if absolutely no symptoms.
Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
As per prescription of Dr, what test Dr suggested? . Already pdf file loaded.
Blood collection wala told me that FISH cyclin D1 test will be done by block. I have to arrange from where biopsy has done before 3 years
I totally confused what he want to say
Blood collection wala told me that FISH cyclin D1 test will be done by block. I have to arrange from where biopsy has done before 3 years
I totally confused what he want to say
Brief Answer:
Yes, fish have done on a block
Detailed Answer:
Hello,
He has advised uric acid in blood and FISH for cyclin D1 on the block.
For that, you need original biopsy block. But if it's done already then I think there's no need. Maybe you can share the results with him.
Regards
Yes, fish have done on a block
Detailed Answer:
Hello,
He has advised uric acid in blood and FISH for cyclin D1 on the block.
For that, you need original biopsy block. But if it's done already then I think there's no need. Maybe you can share the results with him.
Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Sir
I attached 4 numbers FISH reports . Two reports at the time of biopsy and two are current .Is earlier two reports, FISH for cyclin D1 on the block.
Currently I checked my weight reduced two kg within 15 days. NO fever No nausea . Appetite ok .
Due to lockdown I can not go anywhere .Can you suggest how weight will increase. Any protein supplementary ? .Please advice some protein supplementary .
I attached 4 numbers FISH reports . Two reports at the time of biopsy and two are current .Is earlier two reports, FISH for cyclin D1 on the block.
Currently I checked my weight reduced two kg within 15 days. NO fever No nausea . Appetite ok .
Due to lockdown I can not go anywhere .Can you suggest how weight will increase. Any protein supplementary ? .Please advice some protein supplementary .
Brief Answer:
After lockdown is lifted, you can start the treatment
Detailed Answer:
Hi,
Weight loss is not too much but most probably this indicates need for treatment. After corona situation improves you can start it.
The first FISH was done on bone marrow while second one on blood. That is adequate. I don't think any further FISH is required.
We give supplements to many. For diabetic patients sometimes we give Ensure diabetes.
Hope this helps.
Regards
After lockdown is lifted, you can start the treatment
Detailed Answer:
Hi,
Weight loss is not too much but most probably this indicates need for treatment. After corona situation improves you can start it.
The first FISH was done on bone marrow while second one on blood. That is adequate. I don't think any further FISH is required.
We give supplements to many. For diabetic patients sometimes we give Ensure diabetes.
Hope this helps.
Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks sir
After going through your valuable answer few queries and tension in my mind.
. 1. How much I can delay treatment . Immediate after lock down or 1st week of May or later on. How much emergency.
2. If treatment required from where I will start as presently I am in Bhuvaneshwar.
3. If the chemo is required once in month then I can take in Kolkata from any big hospital and come back to Bhuvaneshwar after 2-3 days .
4. OR it is better to take chemo in Bhuvaneshwar itself so that any complications arises due to side effects then immediate rush to Dr.
5. What will be the dose of BR chemo .
6 What are the precautions I will take before and after chemo.
7. So many confusions and fear
sir I am taking Ensure diabetic care once in day.
sir waiting for your valuable advice
After going through your valuable answer few queries and tension in my mind.
. 1. How much I can delay treatment . Immediate after lock down or 1st week of May or later on. How much emergency.
2. If treatment required from where I will start as presently I am in Bhuvaneshwar.
3. If the chemo is required once in month then I can take in Kolkata from any big hospital and come back to Bhuvaneshwar after 2-3 days .
4. OR it is better to take chemo in Bhuvaneshwar itself so that any complications arises due to side effects then immediate rush to Dr.
5. What will be the dose of BR chemo .
6 What are the precautions I will take before and after chemo.
7. So many confusions and fear
sir I am taking Ensure diabetic care once in day.
sir waiting for your valuable advice
Brief Answer:
Can be delayed by a month
Detailed Answer:
Hi,
Thanks for following up.
Surely it can be delayed by a month or so. Better to take in Bhuvaneshwar as travel should be avoided in these times.
Dose can't be specified without examining the patient in-person. Your treating Oncologist should be able to fix it. General precautions are to avoid contact with other persons, maintain personal and food hygiene. In case of any complications, it's advisable to notify the treating oncologist urgently.
I am sure you will do well with treatment.
Regards
Can be delayed by a month
Detailed Answer:
Hi,
Thanks for following up.
Surely it can be delayed by a month or so. Better to take in Bhuvaneshwar as travel should be avoided in these times.
Dose can't be specified without examining the patient in-person. Your treating Oncologist should be able to fix it. General precautions are to avoid contact with other persons, maintain personal and food hygiene. In case of any complications, it's advisable to notify the treating oncologist urgently.
I am sure you will do well with treatment.
Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Sir
As per your advice Today I could visit local Dr. Dr suggested to take following medicine as lockdown going on and further test not possible now so start oral therapy
1.cap Ibrunat 140 mg x 3 cap once a day
2. Liquid Alkasol 10 ml thrice
3. Liquid Ranidom _O
4. Cap SanQ 10 forte
Advice some more test after taking medicine
II could not ask in details due to emergency call for Dr
Now my question whether anticancer medicine have side effects
If yes what will be and for that what medicine prescribed.
Weight loss 2 kg within one month observed
I am facing weakness and both legs cramping
Please advice
As per your advice Today I could visit local Dr. Dr suggested to take following medicine as lockdown going on and further test not possible now so start oral therapy
1.cap Ibrunat 140 mg x 3 cap once a day
2. Liquid Alkasol 10 ml thrice
3. Liquid Ranidom _O
4. Cap SanQ 10 forte
Advice some more test after taking medicine
II could not ask in details due to emergency call for Dr
Now my question whether anticancer medicine have side effects
If yes what will be and for that what medicine prescribed.
Weight loss 2 kg within one month observed
I am facing weakness and both legs cramping
Please advice
Brief Answer:
Ok to start ibrutinib
Detailed Answer:
Hello,
Ibrutinib is a good drug considering present situation. It's common to have side effects like nausea, diarrhea, low blood counts with ibrutinib. Mostly manageable. If serious problem, doctor may reduce the dose.
Nothing to worry regarding muscle cramps. Drink plenty of fluids.
Hope for the best results.
Regards
Ok to start ibrutinib
Detailed Answer:
Hello,
Ibrutinib is a good drug considering present situation. It's common to have side effects like nausea, diarrhea, low blood counts with ibrutinib. Mostly manageable. If serious problem, doctor may reduce the dose.
Nothing to worry regarding muscle cramps. Drink plenty of fluids.
Hope for the best results.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Sir
Many many thanks
From starting you are giving moral support and valuable advice. Once You have check me in Kolkata apollo.
Sir except nonveg any other food items restricted with this medicine.
I don't know what will be the good effects on my health and worried for side effects.
Sir you are my moral booster
Thanks sir again. Remotely you are doing lot of help.
Many many thanks
From starting you are giving moral support and valuable advice. Once You have check me in Kolkata apollo.
Sir except nonveg any other food items restricted with this medicine.
I don't know what will be the good effects on my health and worried for side effects.
Sir you are my moral booster
Thanks sir again. Remotely you are doing lot of help.
Brief Answer:
No food is restricted
Detailed Answer:
Hello,
It has no interaction with any food, including non veg.
Don't worry about side effects too much. If something unusual happens, do contact your doctor.
Regards
No food is restricted
Detailed Answer:
Hello,
It has no interaction with any food, including non veg.
Don't worry about side effects too much. If something unusual happens, do contact your doctor.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Sir Good morning
6 days over. Going on ok till date.
Today my body temperature was low at 5am.Pulse rate was 63 as per Oxymeter and spo2 98%..Temperature measure found 95.7..Body skin feel cool. Other things ok.
At 1130 am. BP was 130/80pulse rate 70 temperature 96.7
Little worried.
Medicine Ibrunat taken as per prescription.
6 days over. Going on ok till date.
Today my body temperature was low at 5am.Pulse rate was 63 as per Oxymeter and spo2 98%..Temperature measure found 95.7..Body skin feel cool. Other things ok.
At 1130 am. BP was 130/80pulse rate 70 temperature 96.7
Little worried.
Medicine Ibrunat taken as per prescription.
Brief Answer:
Unlikely to be sure to ibrutinib
Detailed Answer:
Hello,
Temp was bit low but ibrutinib doesn't cause it. So I don't think it was due to ibrutinib.
Monitor temp regularly. Get warm sunlight. Most likely it will improve soon. If problem persists then you may need to visit the hospital.
Regards
Unlikely to be sure to ibrutinib
Detailed Answer:
Hello,
Temp was bit low but ibrutinib doesn't cause it. So I don't think it was due to ibrutinib.
Monitor temp regularly. Get warm sunlight. Most likely it will improve soon. If problem persists then you may need to visit the hospital.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sir
attached new reports .
WBC LEVEL INCREASED
Hgb and PLT reduced
Capsule IBRUNAT taken 19 days
Observation-
Before medicine
WBC--83900
Hgb--13.6
PLT-1.43 LAC
RBC-5.08
After medicine
WBC--99500
Hgb--11.8
PLT-86000
RBC-4.51
Problems observed
Body temperature always remain in between 95to 96.6
PR remain in between 65 TO 68
PRESSURE--115/72
QUERIES
1.WHATS THE REPORT INDICATING?
2. Will parameters will increased initially and then reduced due to capsule IBRUNATE characters
3. How long IBRUNAT(Targeted Therapy Drugs) WILL TAKE or medicine required to change.
4. Why body temp and PR remains low ( Thyroid test ok )
attached new reports .
WBC LEVEL INCREASED
Hgb and PLT reduced
Capsule IBRUNAT taken 19 days
Observation-
Before medicine
WBC--83900
Hgb--13.6
PLT-1.43 LAC
RBC-5.08
After medicine
WBC--99500
Hgb--11.8
PLT-86000
RBC-4.51
Problems observed
Body temperature always remain in between 95to 96.6
PR remain in between 65 TO 68
PRESSURE--115/72
QUERIES
1.WHATS THE REPORT INDICATING?
2. Will parameters will increased initially and then reduced due to capsule IBRUNATE characters
3. How long IBRUNAT(Targeted Therapy Drugs) WILL TAKE or medicine required to change.
4. Why body temp and PR remains low ( Thyroid test ok )
Brief Answer:
Nothing much to worry
Detailed Answer:
Hello,
As I can see that WBC was 101000. Also, so it has not increased. Some variation may be there between labs so the value of 83000 can be explained by that. It may take some time to act. At least 2 months should be given to see the effect. If still no effect, can think of chemo.
Platelet count is low because of ibrutinib. If it falls below 50000 we may have to stop.
Body temp can't be explained by ibrutinib or the disease. I think this is normal for you. Heart rate is also acceptable. You can do one ECG just to make sure everything is normal.
Overall, there is nothing much to worry at this time, as WBC count is stable and not increasing as fast as before.
Regards
Nothing much to worry
Detailed Answer:
Hello,
As I can see that WBC was 101000. Also, so it has not increased. Some variation may be there between labs so the value of 83000 can be explained by that. It may take some time to act. At least 2 months should be given to see the effect. If still no effect, can think of chemo.
Platelet count is low because of ibrutinib. If it falls below 50000 we may have to stop.
Body temp can't be explained by ibrutinib or the disease. I think this is normal for you. Heart rate is also acceptable. You can do one ECG just to make sure everything is normal.
Overall, there is nothing much to worry at this time, as WBC count is stable and not increasing as fast as before.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Thanks sir
Yesterday I COULD not upload all reports.Today uploaded all reports.
Observation-
1.Before taking medicine-
Hgb-13.6,TLC-83900,PLT-1.43 LAC,RBC-5.08,Neutrophil-18,Lymphocytes-66
2.After taking medicine 18 days
Hgb-11.8,TLC-99500,PLT-0.86 LAC,RBC4.51,Neutrophil-10,Lymphocytes-90
3. CT SCAN REPORT
Multiple enlarged retroperitoneal lymphnodes
Few enlarged pelvic lymphnodes
4. CT THORAX REPORT
Tinny calcification in right middle lobe of lung
Few mlildly enlarged lymphnodes
5. 2D ECHO WITH DOPPLER
ALL NORMAL
6. ECG REPORT
Low T WAVE (V5,V6)
Abnormal Q WAVE (III,VI)
PROLONGED P WAVE
7. Weight--63 kg ,slightly increased
8. Body temperature --95 to 97F
9. PULSE RATE--63 TO 68
10. ( THYROID TEST NORMAL)
11. LFT & LIPID PROFILE NORMAL
12. SUGER UNDER CONTROL
PROBLEMS
1. BODY FEEL COOL ( THYROID TEST NORMAL)
2. MOUTH AND LIPS DRYNESS
QUERIES
1. WHAT THE REPORTS INDICATE? Specially CT SCAN
2. Whether this target tharephy drugs will continue? --I got answer perhaps
3. Why some times body skin feels cool?
4. Is ultimately BR treatment required which I don't want in present COVID situation .
5. your valuable advice overall.
As per local dr prescription continued medicine till FISH Cyclin D1 test result on blood comes out.Next review 15th May
Thanks & regard
Yesterday I COULD not upload all reports.Today uploaded all reports.
Observation-
1.Before taking medicine-
Hgb-13.6,TLC-83900,PLT-1.43 LAC,RBC-5.08,Neutrophil-18,Lymphocytes-66
2.After taking medicine 18 days
Hgb-11.8,TLC-99500,PLT-0.86 LAC,RBC4.51,Neutrophil-10,Lymphocytes-90
3. CT SCAN REPORT
Multiple enlarged retroperitoneal lymphnodes
Few enlarged pelvic lymphnodes
4. CT THORAX REPORT
Tinny calcification in right middle lobe of lung
Few mlildly enlarged lymphnodes
5. 2D ECHO WITH DOPPLER
ALL NORMAL
6. ECG REPORT
Low T WAVE (V5,V6)
Abnormal Q WAVE (III,VI)
PROLONGED P WAVE
7. Weight--63 kg ,slightly increased
8. Body temperature --95 to 97F
9. PULSE RATE--63 TO 68
10. ( THYROID TEST NORMAL)
11. LFT & LIPID PROFILE NORMAL
12. SUGER UNDER CONTROL
PROBLEMS
1. BODY FEEL COOL ( THYROID TEST NORMAL)
2. MOUTH AND LIPS DRYNESS
QUERIES
1. WHAT THE REPORTS INDICATE? Specially CT SCAN
2. Whether this target tharephy drugs will continue? --I got answer perhaps
3. Why some times body skin feels cool?
4. Is ultimately BR treatment required which I don't want in present COVID situation .
5. your valuable advice overall.
As per local dr prescription continued medicine till FISH Cyclin D1 test result on blood comes out.Next review 15th May
Thanks & regard
Brief Answer:
CT is as expected
Detailed Answer:
Hello,
CT scan shows few lymph nodes which is very much expected. echocardiogram totally normal though ecg showed some changes. Better to consult a cardiologist. Surely ibrutinib to continue for now. If ibrutinib fails then BR.
Regards
CT is as expected
Detailed Answer:
Hello,
CT scan shows few lymph nodes which is very much expected. echocardiogram totally normal though ecg showed some changes. Better to consult a cardiologist. Surely ibrutinib to continue for now. If ibrutinib fails then BR.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Sir
Many many thanks for your evergreen advice.
I am worried about chemotherapy which I don't want immediately due to current situation but local Dr told that all will depends upon the results of FISH cycling D1 test.
Sir will drug Ibrunat give some positive results in future. What's your experience telling.
Before starting this drugs I could manage to contact with Dr M B Agrawal. Asper him need not hurry to start chemotherapy so you can continue this target therapy drugs till no side effects.
Many many thanks for your evergreen advice.
I am worried about chemotherapy which I don't want immediately due to current situation but local Dr told that all will depends upon the results of FISH cycling D1 test.
Sir will drug Ibrunat give some positive results in future. What's your experience telling.
Before starting this drugs I could manage to contact with Dr M B Agrawal. Asper him need not hurry to start chemotherapy so you can continue this target therapy drugs till no side effects.
Brief Answer:
Yes, there is no hurry
Detailed Answer:
Hello,
As I said, ibrutinib takes time to act, so it's not the time to judge its efficacy. It can very well give good results.
So at present ibrutinib can continue.
Regards
Yes, there is no hurry
Detailed Answer:
Hello,
As I said, ibrutinib takes time to act, so it's not the time to judge its efficacy. It can very well give good results.
So at present ibrutinib can continue.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
What's report telling of FISH just upload
Brief Answer:
It's negative
Detailed Answer:
Hello,
FISH is negative for cyclin D1 translocation. So it's a good result. Nothing to worry.
Regards
It's negative
Detailed Answer:
Hello,
FISH is negative for cyclin D1 translocation. So it's a good result. Nothing to worry.
Regards
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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