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BLOOD CANCER & BONE MARROW BIOPSIES

eew... "harvesting" iheartxrays.com/iliaccrest it is so very sad a thing to be envious of a cartoon waistline... hey! guess which part of the picture is the iliac crest?!

Since my very first bone marrow biopsy, I’ve been aching to watch the procedure. It’s not often that a metal spike bores into your body with little more sensation than grinding pressure–and I wanted to see it happen.

“You want to see? No, you don’t,” said Dr. Paul Coty, Maui’s only hematologist, when I asked if there was some sort of mirror I could use.

It was the morning of November 2nd, 2009, and I’d just spent the night at Maui Memorial Medical Center, having been admitted there on no-notice.  The very next day I turned the other cheek for Dr. H. Nguyen at Kaiser Monanalua on Oahu; and having not had the chance to prepare for that either, did not have the luxury of watching.

So, scheduled for a third biopsy this last Monday, I came packing: a huge, handled mirror, wrapped in a towel, tucked carefully into my journo-savvy Duluth Pack. But to my disappointment, Dr. Coty decided it’s best to postpone until after the New Year.

My disappointment did not last long, as yesterday I got the call that Doc has changed his mind and they’d like to go for it. Today. An hour ago. All pau.

And yes, with three uncommon occasions presented to me, the third time was the charm.

i vant to suck your blood ... Georgetown University Hospital, Washington, D.C. (Dec. 4, 2002) -- Surgeon Dr. Hans Janovich performs a bone marrow harvest operation on Aviation Electronics Technician 1st Class Michael Griffioen. The procedure consists of inserting a large-gauge syringe into an area of the hip and extracting the bone marrow.  It is transfused into the recipient, and helps to recreate and replenish T-cells and the white and red blood cells killed while undergoing chemotherapy. Griffioen is assigned to the Pre-commissioning Unit Ronald Reagan (CVN 76) and was matched with an anonymous cancer patient through the Department of Defense Marrow Donor Program.  U.S. Navy photo by Photographers Mate 2nd Class Chad McNeeley.  (RELEASED)

Watching was more enjoyable than I had anticipated! Witnessing the disconnect between actually seeing the procedure vs. imagining it, via the doctor’s step by step explanation–thus being able to recognize how little you were feeling comparative to what was happening–was an unexpected treat.

The effect was the dissipation of any mild discomfort experienced during the process (other than that initial “pinch and burn,” from the lidocaine, a local anesthetic … ah, how I’ve come to love lidocaine … oh, and the stabbing pain in your butt cheek as they suck out a vial of blood from the bone)

My experiences thus, I encouraged Dr. Coty to recommend to other patients the option of watching–so they too might enjoy the intrigue and pain-reducing disconnect.

He begged to differ, saying that when it’s done from the front, it can be very traumatic for patients.  My curiosity abundantly evident, he then recommended I go into medicine… Bleh! Being a nosy journo, unafraid of a little blood (and after having seen gallons upon gallons of it sucked out or pumped into me these last six weeks, if I wasn’t squeamish before, I’m certainly not now), suits me just fine.

Besides, I might not pass out while watching a metal rod get jammed into my iliac crest and blood and a bit of bone sucked out, but I certainly would hit the floor if forced to perform said-stabbing on someone else!

I'm really hoping it's obvious that none of these photos are mine... just scooped up from "the Internets." My doc wore an aloha shirt and purple sterile gloves ;-)

Ok. So I’ve watched on one of three occasions and have seen it performed several times, but I’m still going to enlist the help our friends at the Mayo Clinic online, to help explain just what exactly a bone marrow biopsy is:

“Bone marrow biopsy and bone marrow aspiration are procedures to collect and examine bone marrow — the spongy tissue inside some of your larger bones. Bone marrow biopsy and bone marrow aspiration can show whether your bone marrow is healthy and making normal amounts of blood cells. Doctors use bone marrow biopsy and aspiration to diagnose and monitor blood and marrow diseases, including some cancers.”

this is what leuk looks like! i spy a smiley face rather pretty, I think

As for me and my reasons, there are many names for the same kind of shizzle: Acute promyleocytic leukemia. Acute progranulocytic leukemia. APL. AML with t(15;17)(q22;q12). t(15;17). PML-RAR and varients. AB subtype M3 and M3 variant.

{NOTE: My favorite way to say it is t(15;17), representing the chromosomal translocation of the 15th and 17th chromosomes during mitosis (a freak error during cell division where genetic material between the aforementioned chromosomes is improperly traded–that the very thing that created that first leukemia cell, which created all the others). Hmm… t(15;17). Don’t you think that’d make a swell tattoo? PAU NOTE}

One cool thing is that the whole shebang takes about 30 minutes–from its start with sanitizing the work space (my backside) with cool alcohols and iodine, to crumpling up and tossing away all the disposable blue sheets, swabs and tools.

After the aforementioned lidocaine, a small incision is made. Then, more lidocaine, and finally, “[a] hollow needle is inserted through the bone and into the bone marrow. You might feel a deep ache as the needle is fully inserted.

Using a syringe attached to the needle, the doctor pulls back on the plunger to draw a sample of the liquid portion of the bone marrow into the needle. You may feel a brief sharp pain or a stinging, sucking or pulling sensation, which may travel down your leg, depending on the location of the aspiration needle. The aspiration takes only a few minutes. Several samples may be taken.”

As much as it wounds my pride to do so, I’ll admit that the aspiration hurts a little. But just a little and then it’s over.

Next is the marrow extraction itself, which is easy peasy lemon squeasy [oh, and on the topic of squished fruit, afterward, Doc poured me a glass of apple apple juice (saying, "this is a little ritual of mine"), then held my hand as he walked me to the waiting room to rest. Nice.]

“In a bone marrow biopsy, a sample of solid bone marrow tissue is taken. (A bone marrow biopsy isn’t the same as a bone biopsy — a bone biopsy takes a sample of actual bone.) For a bone marrow biopsy, your doctor uses a different type of needle than is used for aspiration. The larger biopsy needle is specially designed to collect a core (cylindrical sample) of bone marrow.”

That “larger biopsy needle” is really a huge needle with a T-shaped blue handle. with manually applied pressure, breaks into your bone. If you’re not jabbering too much (as I often am), you can hear a subtle crunching sound. Then, to detach and remove the sample, the doctor twists the blue-handled aparatus–which strangely feel like exactly that! Twisting! Then, whoop! Out pops the little piece of spongy marrow–the size and look of a bloody maggot–as it’s dropped into a little jar of solution.

Again, thank you friends at Mayo Clinic, for helping me describe all that. Hey, maybe you can help me out with this one too: What’s the whole Mayo vs. Miracle Whip preference thing about I hear about, in your home state Minnesota?

CLOSING NOTES:

Well, by now you’re either bored or disgusted. That likely being the case–if you’re still reading at all–I think this is a good place to stop. I’ll leave you with a few interesting tidbits from the results of my first biopsy (reports kindly printed up for me by Dr. Coty’s nurse):

From a Clinical Labs of Hawaii report for Maui Memorial Medical Center, taken 11/2/09:

Hematopathology Report:

Diagnosis:

A, B. Left Iliac Crst, Bone Marrow Core Biopsy, Aspiration and Clot Section:

1. ACUTE MYELOID LEUKEMIA WITH t(15;17) (Acute promyelocytic leukemia ML -M3)

2. MARKEDLY DECREASED MARROW STAINABLE IRON.

Peripheral Blood:

1. INCREASED PROMYELOCYTES WITH RARE AUER RODS, CONSISTEN WITH ACUTE MYELOID LEUKEMIA (Acute promyelocytic leukemia)

2. NORMOCYTIC-NORMOCHROMIC ANEMIA

3. MARKED THROMBOCYTOPENIA

Excerpts from “Microscopic Description” (with my own parenthetical comments/clarification):

Bone marrow: Many promyelocytes have multiple Auer rods and pink globular material… The bone marrow differential is as follows:

NORMAL % / (DESCRIPTION) / PATIENT

0-1% / Blasts / 1%

1-5% / Promyelocytes / 77% (Yikes!)

5-15% / Myelocytes, neutrophilic / 2%

10-15% / Metamyelocytes, neutrophilic /1%

5-15% / Lymphocytes / 12%

16-35% / Erythroids / 7%

Excerpts from “Immunophenotyping Diagnosis”:

Bone Marrow: Abnormal population of granulocytic cells present, and constitues 86% of total cells (probable Type III blasts)…

Comments: Recommend FISH studies for t(15;17) to difinitively exclude M3…

{NOTE: FISH studies? Dr. Coty explained it stands for fluorescent in situ hybridization, and that “scientists think theyhave a sense of humor. Since the test is looking or fishing for something, and the acronym happens to spell fish, the name stuck. Clever! PAU NOTE}