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Two routine days, except for another bone marrow biopsy

Day 1:  I'm such a veteran of managing this lymphoplasmacytic lymphoma that I should have known better.  For many, this would be no ordinary day at Dana Farber Cancer Institute.   I don't like bone marrow biopsies.  Nobody does. There's a secret code amongst cancer patients.  Don't talk about it or write about bone marrow biopsies.  This is the only medical procedure that even nurses and doctors say ewe, oh no, or yikes, patient-speak. They too think, "poor bastard". Ouch.  This is my eighth bone marrow biopsy.  

Too bad they don't give some kind of award, perhaps a lollipop that you can hang somewhere for all to see.  Why so many?  We'll it's not that many compared to what some Multiple Myeloma patients experience. These bone marrow biopsies (bmb) are the one part of the Clinical Trial that I wish I could bypass.  But as this is a cancer of the bone marrow, the factory floor that makes blood, this biopsy is needed to see what's going on in there rather than out there in the blood system and lymphatic glands.  The only way in is through a bone, your bone.  Which bone?  The pelvic/hip bone.  

Do yourself a favor.  Don't research this procedure and don't watch those YouTube videos unless you are absolutely sure you don't have cancer and you will never get cancer.  Then you too can say, poor bastard. You just don't want to use this information as the basis to visualize what's going on back there. I did and I regret it.  I've so many bmb's that I can accurately visualize what's happening every inch of the way (pun intended). I won't break the pledge to be silent about the actual bmb procedure except as follows.

There are actually two popular bone marrow sample procedures for blood cancer patients.  If you're lucky, you'll get only an aspiration which yields semi-liquid bone marrow.  You've seen marrow when you break open a chicken bone for example.  There is also an actual biopsy, a trephine biopsy which yields a narrow cylindrical shape,a  solid piece of bone marrow which looks like a broken toothpick, each sample is about 4/5 of an inch long.  I looked. Every time I get a bmb, I make sure to donate an ample sample for the team in the research labs.  I don't do this for any altruistic reason, I do it because the more info the researchers have, the better, the more likely the achieve success. Waldenstrom's lymphoplasmacytic cells have a limited shelf life and I'd sure rather they be looking a my little cancer bastards than something else, like a mouse.

So what did I learn on this day?  I started the day with a scheduled CT scan.  A Computer Tomography scan is a series of X-ray views taken from many different angles and computer processing that creates a cross-sectional images of your bones and soft tissues in your body.  It's like looking at a loaf of bread, one slice at a time. So imagine a tumor the size of a marble inside that loaf of bread.  One slice might show only the edge of the marble while another will show the widest circumference of the marble, perhaps a half inch wide.  It's a great way to visualize all body parts and a tumor for example with a three dimensional image. That is probably why you often hear, the tumor was the size of a pea or a grapefruit.  Much better than exploratory surgery.  It helps identify bone fractures, splinters, tumors, inflammation and more.  And this won't hurt a bit.  Well, just a tiny bit if you get an intravenous needle to facilitate receiving contrast.  You can also be given some contrast liquid to drink slowly for about two hours before you receive a scan.   More on this later.  

I learned it's not a good idea to get a CT scan (or CAT) before the bone marrow biopsy.   I drank that liquid after having no food and only clear drink for the previous 12 hours.   So after the CT scan when getting ready for the bmb, I had the urge "to go".  Well, everyone wants to go and not get the bmb, but I'm talking, you know, "I gotta go".  Needless to say, I made it fine, but next time I'll know better.  You're probably not in the right frame of mind to want to get the CT scan or other procedures after the bmb, so book it the next day if possible.  

Day two:  I don't know a cancer patient that doesn't breath a sign of relief when getting good news subsequent to a CT scan.  I've heard some patients say they can't function waiting for the news.  It seems to me there should be a better way to delivery the news more quickly, especially for women wondering if that lump she feels (a very common occurrence) is cancerous or benign.  When I get the confirmation I want, I think, well of course.  

This is a relatively routine day for me at DFCI, blood work at 6;40AM.  I like the early appointment to beat the traffic and to try to have as much of the blood chemistry reports completed as possible before my appointment with my oncologist. The more info she has, the better.  Being Dr. Irene's first patient of the day doesn't subject me to other patient tardiness or an unexpected change in her schedule.   Also, before the rush of the day begins, we get quiet time to talk, seriously talk and laugh too.  I come prepared with a list of questions. I think physicians prefer to work with informed patients that bring them thoughtful, meaningful questions that indicate you care about yourself and you care about your physician's valuable time.  Don't ask why you have dry skin on your elbows.  Do ask, are there any symptoms for which I should be looking?  Other routine tests include blood pressure, a key indicator, blood oxygen level and weight and on this day a series of EKGs just to check out the old ticker.  In fact these EKG's are a mandatory recurring test required as part of my current clinical trial.  Makes me wonder.  

I'll get the bmb test results in the mail.  These indicate progression, improvement or no change.

Got results, no change in % involvement in bone marrow, call this Progression Free Survival, whew!

Love that Clinical Trial.


From Ted Hitchenson | On October 05, 2012 @03:08 pm
Jack, poor bastard, very funny.

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