The word leukemia has dire connotations in the public’s eye and perception. This is not so, if we know the details. Indeed, the devil is in the detail. Those details can be conveniently summarized in stories and examples. A recent encounter provides such an example which, by no means, is an anecdote. A few months ago, I saw a young patient who is highly educated and a professional educator himself. He came seeking our professional advice about a low blood count discovered through routine bloodwork for his annual physical examination. I found that he, indeed, has low white blood count and low platelets in addition to an obviously enlarged spleen. Looking at his blood under the microscope I suspected that he has a rare form of leukemia (hairy cell leukemia). It is not an easy task to tell a young, healthy-looking man (I’ll call Mr. T) that he has leukemia at the first visit, but honesty is a critical part of medical care. Sugar-coating bad news can only serve its false sweetness for few minutes or hours, at best. Often, the delivery of bad news, when it comes to health and sickness, is to mix the bad with some good news and hope. If I was wrong in my first impression, the alternative diagnosis would be liver disease which is not only as bad, but actually worse. This presented to me an opportunity to deliver the bad news in a positive way. I told Mr. T, “I hope that I am right in my impression that you have hairy cell leukemia and I equally wish that you don’t have liver disease instead of the leukemia.” I still don’t know what went through his mind at that moment. Needless to say, he was in awe. Of course, my duty was not to let him think too much before I was done talking. I explained that I can cure hairy cell leukemia. But, to cure liver disease? Forget it, short of liver transplantation. As it turned out Mr. T did have this very rare form of leukemia that a busy cancer specialist, like me, would see one case every 3-4 years. The following week we started him on a brief, 5 day chemotherapy regimen administered as an outpatient without any complications. Three months later, a repeat bone marrow biopsy confirmed that he is leukemia free and, most likely, cured. Remarkably, he adjusted his work schedule and did not miss a single day of work while receiving his chemotherapy. There are more than a dozen different kinds of leukemia, many curable and many more not so. Fortunately, Mr. T’s hairy cell leukemia is a highly-curable disease with simple chemotherapy that is safe, if properly delivered and supervised. Know your enemy; in a hundred battles, you will not peril.
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