Wednesday, March 14, 2012

Bone Marrow Biopsy

On 3/22/10, I went into Providence Hospital for a bone marrow biopsy. This is done in order to collect and examine bone marrow — the spongy tissue inside some of your larger bones. Doctors use this to diagnose and monitor blood and marrow diseases, such as Waldenströms and myeloma.

Bone marrow has a fluid portion and a more solid portion. In bone marrow aspiration, your doctor uses a needle to withdraw a sample of the liquid. In a bone marrow biopsy, a larger needle is used to take a sample of the solid part. In my case, both procedures were done at the same time.

These procedures aren’t terribly risky; rarely, complications may result such as breaking of needles within the bone, which may cause infection or bleeding, long-lasting discomfort at the biopsy site or issues related to sedation, such as an allergic reaction, nausea or irregular heartbeats.  I tend to be timid; lucky for me, the docs here believe in conscious sedation for this procedure. My dad has had it done twice, in the office with local anesthetic, but his pain threshold is of family legend.

Leading up to the day, I had some mixed feelings; I was anxious about the procedure itself; I was concerned about the results; I wanted to get it over with. My subdued but mixed emotions lasted until we got to the second floor of the hospital to Infusion where I began to feel dismay. The rooms and equipment immediately took me back to sitting with my dad while he endured whatever treatment the doctors prescribed. Once we were checked in and in our own room, I was feeling a bit overwhelmed. The nurse asked me if I have a living will, which is something I suppose I need to think about. They found that I was missing a CBC within the last 14 days and had to redo it, which added another 45 minutes to our wait.

My husband is a great caregiver; he kept me entertained and encouraged as we waited. It makes me cry to think about leaving him. I thank God that he is a believer in salvation through Jesus Christ and that whatever happens to him or to me, we will be together in eternity.

Finally they took us down to the procedure floor. I met the doctor who was to perform the biopsy. I liked him a lot; he carefully explained each and every step he’d be taking in simple, brief language. Basically, they administer the conscious sedation; the area where the doctor will insert the needle is confirmed using x-rays, then marked and cleaned. The bone marrow fluid and tissue sample were to be collected from the top ridge of the back of my left hipbone (posterior iliac crest).

In the procedure room, the team members were gentle and efficient as they moved me over to the table. I had to flip to my stomach-the procedure table is long, but very thin. Once they started the sedative, I was out cold and didn’t feel a thing. Next thing I knew I was waking up, back on the second floor, with my husband nearby. The sedative caused some loopiness and nausea, but nothing severe. In fact, the loopiness may be innate. When they released me, I walked out to the parking garage on my own steam.

At home I went straight to bed to sleep off the sedative. After that I treated the discomfort with ice packs and Tylenol. It’s no worse than a common back ache-even for a pain weenie like me. Just a heads up; if you go through this and decide that watching a nice movie would be just the thing to take your mind off the heavies-don’t watch “Up”. It is a lovely animated film, but the preamble is a fast forward zoom through the life of a loving married couple that ends with the death of the wife. Who knew?
Scripture Reference: Romans 10:9-10

Thursday, March 1, 2012

Hematologic Oncology

On 3/12/10 I went to the hematologist for the first time. I’d already received the results of the Immunofixation blood test he had requested: “IGM KAPPA MONOCLONAL PROTEIN DETECTED.” That was not good news. IgM Kappa is a marker for Waldenströms. My husband took off from work to drive me over and went in with me. His support was such a blessing to me.

While we were waiting at the Cancer Center, I watched as lovely women came and left with all sorts of headdresses covering their baldness. I had to fight back the tears-so much bravery in such a small room. The nurse took us back, checked my vitals. The doctor came in to speak with us then examined me. I think he was looking for bone pain, spleen or liver pain and neuropathy or weakness.

He ordered more blood drawn to determine the level of IgM in the blood. The diagnosis can’t be made with certainty from blood tests, so we scheduled a bone biopsy in 10 days. If inconclusive, then a skeletal survey (x-rays of the skeleton) would be taken to help distinguish between WM and a similar plasma cell cancer, multiple myeloma.  MM would be a worse diagnosis. The best case is MGUS: monoclonal gammopathy of undetermined significance-a benign condition in which there is a higher-than-normal level of IgM protein in the blood. Patients with MGUS do not have cancer, but are at an increased risk of developing cancer. This would be the diagnosis if tests do not prove either WM or myeloma.

As we left the Cancer Center, I was drained. It is a lot to process. Does it get easier or harder to handle? Once home, I began the phone calls. I called my girls, my parents, my brothers, to let them know about the appointment and the next steps. How hard it was to tell them! My dad feels guilty; although it is no fault of his if I received some genetic predisposition to this. What could he have done differently? I know he can’t help feeling this way, I will feel the same if it shows up in my girls. My mom is fragile; it was harder to tell her. She took it bravely but was struggling. My brother has a tender heart, and he was caught off guard. His concern made me feel loved.

My latest lab results came through while I was on the phone. The test “Immunoglobulins A-G-M” showed: “IgM, Serum 2016 Normal is: 48 - 271 mg/dL” Seems pretty high. At this point, it would be a relief to find out I have WM and not myeloma. My husband found an article dated 5 months ago that cites a recent study that found “only 21% of patients with asymptomatic WM eventually required therapy with a median follow up of 8 years. “ (Clinical Advances in Hematology and Oncology; Volume 7, Issue 10 October 2009; page 680.) That sounds very encouraging.

My thoughts were tumultuous. What will it mean if I have cancer? What else has God prepared for me to do here, before I go? What is the best use of my time? How much time do I have?  How will it affect my loved ones? I have a husband with serious health issues; will I be able to take care of him? I have a daughter in Texas; I have a daughter, son-in-law and granddaughter in North Carolina. I have elderly parents 2500 miles away. Will I still be able to travel to see all of them? Will I get to see my daughter married? Will I get to see my granddaughter grow up?

How can I help to prepare them so that they see my going as something to be desired and anticipated? How can I help to prepare them to feel the same way when it is their time? This world is not our home; we are strangers here. When we get to heaven, then we will be home. God says that the great heroes of our faith considered themselves foreigners on earth and desired not their own country but rather a better one, a heavenly one. Therefore He is not ashamed to be called their God, because He has prepared a city for them. I’m asking God to give me a longing for my heavenly home.
Scripture reference: Hebrews 11:12-16