Thank-you to all of you who’ve shared your concerns and prayers both through the comments and by email. Your support has helped calm our spirits.
Here’s where things are now. The most common cause of swollen lymph nodes in a kid is “mono” – a viral infection. The problem is, with Arman, there is enough that is not consistent with mono that the doctors were immediately concerned. The spleen can get big in mono, but Arman’s spleen is huge, which is not typical. Mono usually comes with a fever, which Arman has not had. And, no sore throat. His white blood cells don’t show signs of an infection either. So, the concern about lymphoma. Luckily, not everything is consistent with lymphoma either. Foremost, he hasn’t been experiencing weight loss, weakness, fatigue, or any of the other constitutional signs of cancers. He’s a pretty active healthy-looking six year old boy with an unexplained enlargement of his lymph nodes and spleen.
So, last week we drew blood to test for mono. The problem is, because we live on a remote island in the Pacific, there are no facilities here to perform a mono test. The blood has to be sent to Hawaii. It will take a week or so for the results.
Some of the doctors have felt that because it’s not typical for mono, we should quickly remove the lymph node, and send it for analysis. The problem: it would be a big operation, splaying Arman’s neck open. The danger in waiting: if it is lymphoma, it could grow quickly and cause severe problems.
My thinking has been that since it hasn’t grown over the past week, we should be okay to wait for the results of the mono tests. If they’re positive, then we have a diagnosis. We can relax and just wait for the mono to get better. We're off this hellish ride. If the mono tests are negative, then we can go ahead with the biopsy.
So, the pediatric oncologist in San Diego (with whom Arman’s doctors at CHC have been consulting via telephone) recommended getting a test for uric acid. Uric acid comes from the breakdown of cells. If there is a large tumor, or a rapidly expanding one (what’s called "large tumor load") then the uric acid will be high. If the uric acid is high, then the likelihood of mono is low, and we need to move immediately to biopsy. If the uric acid is normal, then there isn’t a large tumor load (even though there may still be a tumor). In that case, we can wait for the mono test results instead of moving urgently to biopsy. The uric acid test was run here on Saipan, and the level was normal. So, if there is tumor, it’s not rapidly expanding. So we're safe to put off the biopsy for now and wait for the mono test results. Our hopes are high.
The mono test results should be back by Friday. Right now, it’s just a matter of waiting.
In the meantime, the great thing about Arman is his general obliviousness to all of this. He’s unaware of our concerns and worries. He’s happy playing. He feels fine. He knows that he’s got a lump on his neck and that we’re trying to figure out what it is, but from his perspective, it’s just another minor annoyance like an ear infection. What a great perspective to have in the midst of all of this.