A Whole Lot of Tests

Roy’s My Chart from Houston Methodist has started populating with test results, a whole lot of test results. Two handfuls of vials worth of blood drawn are starting to yield their secrets. Deciphering what they mean may take a bit longer. Some are easy enough to understand — “Hepatitis B: negative” is pretty clear to most of us laypeople — but others are going to need medical expertise to interpret.

Before we dive into what’s populating the medical feed, Roy did get his results from last week’s guided biopsy of his axillary (arm pit) lymph nodes this morning – they do not show signs of cancer and the nurse wrote “This is good news” in case there was any fogginess. The current plan is for there to be follow-up on his Y-90 treatment in June; this will be imaging to determine if the liver mass “responded to treatment.” This is a very positive outcome – we don’t want the cancer to meander out into the body.

Back to that list of tests. Here’s what’s on the results list so far, in no particular order:

• Basic Metabolic Panel – we all know this one
• Hepatic Function Panel (standard for liver disease)
• Lipid Panel – again, one most of us have seen on our own records
• Lipoprotein A
• GGT
• Total Iron Binding Capacity, Percent Transferrin Saturation, and Iron Level
• Ferritin Level
• Magnesium Level
• Phosphorus Level
• Vitamin D 25 Hydroxy Level
• Cystatin C with EGFR
• Thyroid Stimulating Hormone
• Antinuclear Antibodies (ANA) with Reflex to Titer and Pattern, Immunofluorescence
• Cytomegalovirus AB, IGG
• Cytomegalovirus AB, IGM
• Hemoglobin A1C
• Hepatitis A Antibody Total
• Hepatitis A Antibody IGM
• Hepatitis B Surface Antigen
• Hepatitis B Surface Antibody
• Hepatitis B Core Antibody Total
• Hepatitis C Virus (HCV) Antibody with Reflex to PCR
• Toxoplasma Gondii Antibody, IGG
• Varicella Zoster Virus AB, IGG
• Stronglyloides AB IGG ELISA
• Glucose-6-Phosphate Dehydrogenase Level
• Measles/Mumps/Rubella/Varicella (MMR/VZV) IGG Antibodies, Quantitative
• Anti-Mitochondrial Antibodies (AMA), Immunofluorescence
• Smooth Muscle Antibodies with Reflex to Titer, IFA
• CBC with Platelet and Differential
• Prothrombin Time with INR
• Partial Thromboplastin Time (PTT)
• ABORH – Transplant
• Alcohol Level, Blood
• Cancer Antigen 19-9
• Alpha-1 Antitrypsin Level
• Ceruloplasmin Level
• Fibrinogen
• TB T-Spot
• C-Reactive Protein
• PreAlbumin Level
• Zinc Level, Serum
• Phosphatidylethanol, Blood
• Estimated GFR
• Smooth Muscle Antibodies Titer
• Epstein-Barr Virus Antibody Panel
• Nicotine and Cotinine, Serum
• Arterial Blood Gas, Pulmonary Func Dept

And this is why, in part, I cannot tell you, if you ask me, if his results are good, bad, or indifferent. Some of these are familiar parts of labs that he’s had over the years because they are very specific to liver disease and/or kidney function monitoring, but others are absolutely new to me. Some appear to be measuring the presence or impact of potentially problematic viruses: Hepatitis A, B, C, Epstein-Barr, Varicella Zoster, Tuberculosis, etc. Others are testing for traces of alcohol or drug use or are being used to assess his general nutrition or wellbeing.

His other results are related to consultations or imaging that were done during the evaluation. For example, the XR Panorex showed them that he has had fillings, has no current cavities and his jaw does not have any concerning lesions. The NM Bone Scan Whole Body indicated that he has no suggestions of metastatic disease but maybe some degenerative conditions in his shoulders, clavicle, feet and right hip. The echocardiogram has a laundry list of measurements of the various parts of his heart and notes any slight variances from “normal” and some estimations of blood pressure at various points. The PV Carotid Duplex summary states “no evidence of plaque or occlusive disease” which sounds like a good result.

Essentially, the science folks are doing the science and he is the source of the data that they will analyze and compare and conjecture. This is why, in spite of our impatience to have things moving forward where we can see progress, we have to wait and let them do their thing. The Medical Review Board will expect each person to be able to tell them how his imaging or their discussions with him or these test results compare to what they need for a successful transplant match, a successful transplant process, and a successful transplant outcome. It’s maddening, of course, to wait, but it is necessary. We want them to be sure of the facts when they make their decision.

I am choosing not to dig deeper on these tests at the moment. If I need to know more about a specific one, I suspect it will appear again on the menu, or in the medical team’s guidance later on. And then, then, I will dig so I understand the parts I need to understand more fully. For the moment, I am (and he is) trying to catch my breath and breathe and see things other than test results around us. An iris bloomed in the yard today. I planted a coreopsis. There were cardinals at the feeder. I heard an ice cream truck making its rounds. George and the rest of our oaks leafed out into their full glory and there are volunteer sunflowers popping up in odd spots. This is what we know right now and it is enough.