Any Given Wednesday II: Bone Marrow Biopsy

The bone marrow biopsy is performed on me every 3-4 months. It is done to check to make sure there are not cancer cells in my bone marrow. And, just in case you're wondering, I remain in remission with a big fat ZERO leukemic cells. 18 months and not even a blip on the cancer radar screen.

Bone marrow is the spongy stuff found in the center of most of our bigger bones. For these biopsies, they usually take from the hip. They alternate between my left and right hip each time. For this procedure, I lie flat on my stomach.

Ready? Me neither.

Injecting the lidocaine actually creates a pocket of liquid under the skin (seen here). It burns a lot but obviously I can't imagine this procedure without it. They usually use a few syringes of it.

They insert anesthetic as deeply as possible. I can usually only feel the needle tap-tap-tapping on my pelvic bone as they numb the area.

Here, Adriana (my wonderful 7-months-preggers physician's assistant) is cutting a small slit into my skin. Apparently, this is her special trick to allow easier entry of the big needles. It also seems to allow the area to heal faster.

She leans her weight on this, twisting back and forth, and just bores down into the bone. This part hurts a bit; there is intense pressure.

Next is the worst part- they insert a needle within the "drill" and suck up an aspirate sample. There is this horrific jolt of sensation down my leg when this is done. Honestly, pain is so much easier to take than deep strange nerve reactions.

The marrow of me.

The drill just chillin' in me. I guess they all went for a coffee break or something.

Then, they do the actual biopsy, which is basically sucking up more marrow and bone, but it's done with a different needle. Where her thumb is pressing is the new needle going into the core.

This is the bits of marrow and bone from the 2nd needle.

Andres used to sing that Diana Ross song- "I'm coming out! I want the world to know, Got to let it show..." when he was done with a spinal tap or a bone marrow biopsy. The relief that the needle was coming out and it was over combined with his singing The Supremes in an Argentine accent usually had me laughing by the finish.

All done.

By the way, I've noticed bone marrow biopsies on House, Grey's Anatomy, and Scrubs and would like to dispel a little of the fear of pain they seem to exaggerate. This is not something I'd choose to do in my spare time or for kicks, but when this procedure could save the life of a bone marrow match, there's no question that it would be worth it. And you'd only have to get this done AFTER you'd already tested as a match for someone-- testing is a pain-free mouth swab. Have you been tested yet?

Any Given Wednesday

Since the day when I find myself most prostrate before god, the day I contemplate my mortality and pray most fervently is a different day than most Americans, I thought I'd invite you my sabbath. The reasons why Wednesdays find me feeling most small in the scheme of the cosmos and the fates is that I spend three to six hours every Hump Day in the cancer ward getting various treatments, usually simply liquid chemotherapy injected into my chest portal.

What kind of visuals does that meager description conjure for you? If I didn't know what it looked and felt like, I think I'd find it rather hard to imagine. So, for both your entertainment and education, I have, with the help of a few friends, photographed three of the procedures I may experience on any given Wednesday. Some people find me very strange and not a little morbid to be intrigued by needles entering my own body, but, personally, it makes me feel a little more in control. Also, if I leave it to my imagination, I've found that my idea of what must be causing that crazy pain is often scarier than the truth. The 3 photo "flip books" will be of 1) a lumbar puncture or spinal tap, 2) a bone marrow biopsy, and 3) a run-of-the-mill CBC and chemo injection. Here's numero uno:

Lumbar Puncture or Spinal Tap
August 22, 2007

These are the vials into which my cerebral spinal fluid will be collected. CSF is a clear fluid that circulates in the space surrounding the spinal cord and brain. It protects the brain and spinal cord from injury by acting like a liquid cushion.
I get spinal taps in order to both test my CSF and to put chemo medicine into my CSF. I used to get them very frequently, but my schedule for LPs now are every four months. These days, I rarely see results from my various tests and procedures to tell you the truth. Instead of celebrating every cancer-free test result, we just consider no news to be good news.

I sit on the side of a patient bed with my legs dangling and drape my body over a small adjustable table. I suppose the rounding of my lumbar region makes the vertebrae easier to delineate. After thoroughly cleaning the area, the doctor or physician's assistant will use their hands to feel deeply between my vertebrae, aligning with my waist, etc. A special plastic sheet is stuck to my back, I believe to prevent the various fluids involved from getting on my clothes. After a site is selected, they inject lots of lidocaine, the "pinch and burn" of which is really quite excruciating.

Needle is inserted into spinal column. This part can take several tries as they search for a good extraction place. When these occurred every few days or so during the initial induction phase in the hospital, I would have to get this done under fluoroscopy, to obtain real-time images of the internal structures.
This "hunt and stab" routine is my LEAST favorite part of all my treatments because sometimes the needle hits weird nerves or other places which cause jolts down my legs or shocks up my back. Everything in my body tells me that I should NOT be playing around with this vulnerable space, but what can I do?

After a juicy spot is found, the "plug" needle within the needle is removed to allow fluid to flow outward.

Collecting the precious nectar. Drip, drip, drip.

While they're there, chemotherapy is injected. You know, two birds with one stone.

Finished!

O Canada!

For those of you who have been following Jim and Jesse's incredible journey hiking from Mexico to Canada this summer, they have finally arrived! Here is their final update, including the total money raised for the Dana Farber Cancer Institute and the Cammy Lee Leukemia Foundation.

***

Our final post! (To see pictures associated with this post, please visit our blog: http://www.marrowtrek.org/blog.php.)

Hike Vitals
Miles hiked to date: 3000
Miles to go: 0
Days since hike started: 116
Location: Waterton Lakes, Alberta, Canada
Showers: 14

Fundraising Update
We raised nearly $35,000 from more than 200 people -- it was a moving display of support from our family, friends, and some whom we have never met. Thank you to all for the donations, care packages, and letters of suport we have received during our trek. We are very honored.

NOTE: For those that are supporting our charities through a per-mile pledge, we will be emailing you in the next few days with instructions on how to complete your donation.

Trek Update
We reached the 49th parallel marking the Canadian border on August 13th, 116 days and 3000 miles after leaving Mexico. We couldn't have scripted a better ending to our trip. Our week-long victory lap through Glacier National Park was some of the most majestic scenery either one of us had ever seen.

Our trek through Montana (and Idaho) did not begin with such promise. The first 500 miles of trail strictly (and often ridiculously) adhered to the divide, following jeep roads and ATV tracks as they meandered up and down (and up and down and up and down) the dry, rolling hills (labeled by another hiker as "PUDs", for "pointless ups and downs"). Thick haze from the summer's many fires often obscured views, and the lack of diversion and dimension caused the days to pass slowly.

Then we reached the Anaconda-Pintler wilderness, and we left behind the staid hills for more rugged terrain, rivers and lakes of alpine country. We continued to move quickly, weary of the rapidly growing fires in the north. Our fears proved well founded: By the time we reached our second to last resupply in Lincoln, fires had closed more than 100 miles of the remaining trail.

We settled on a route that preserved our long sought wilderness experience by tiptoeing around more minor fires on the western edges of the Bob Marshall Wildernes. During lunch one day, we sat on a high ridge and watched the dark, billowing smoke of trees bursting into flames a mile away.

Our detour extended into the southwestern corner of Glacier National Park where we left the fires behind (though not the smoke) and entered a glacially carved landscape of dramatic peaks, deep lakes, and beautiful tree-line passes. It was the type of scenery we had dreamed of on the CDT, but which had proven somewhat elusive. We swam in deep pools beneath towering waterfalls, ate trailside thimble berries, and took long lunchtime siestas. Mike Payne, our good friend from San Francisco, joined us for the last 50 miles, providing new perspectives and fodder for our daily trail banter. Jim's mom and her husband met us at trails end with food, comfortable beds and a welcomed ride home.

We are now spending our days working off our hard-won fitness as quickly as we can with a regimented diet of milkshakes, steaks, soft beds, and golf. Jesse will soon wake up to the imminent responsibilities of his September wedding, and Jim will face the challenges of finding a job and a place to live. But right now, it is time for another nap.

recalibrated, illustrated

Artineh's Bachelorette Party at Malibu Wines

I'm on a self-imposed mildly-unsuccessful non-drinking phase.

What a hard worker! (Jamie on her work cell while in Catalina.)

Newlyweds: Anai y Roberto

Anai, Uma, me, Marie, Erik (newly and happily divorced: uma y erik)

The Empire State Building.

Mom, Jaci, Andres y me at Katie's company (Rosenblum's) event.

Uncle Jimmy y me with Palace of Fine Arts & the bay behind.
(This is the actual view from their balcony!)

reCALIbrated

Almost two weeks in California are to blame primarily for this blag. That, plus I fear the clearer my mind becomes- as the fog of chemo continues to clear as I wean myself off various pills and peripheral medical agents- the less confidence I have that anyone reads this thing. During my trip, however, so many people cooed in ear that they do read my blog frequently that I am recommitted. Also, I think I need to stop this new budding concern about who's reading this- who cares! I'm going to use that old public speaking tool and imagine ya'll NAKED reading this. Ha ha, look! there's my professor letting it all hang out! and whoa- there's matt in his skivvies! and- oh snap, dude, uncle willy, please put something on!
My Mama has been printing out these elegantly-bound books of all these ramblings and comments, so I'll consider this my own private journal of "Two Years in (Ti)bed(t)" (sigh. without Brad Pitt) filled with lame jokes such as that, the likes of which make my sister wonder aloud how on earth we are even related...

what a preamble. jeez.

so, cali.
a luscious time was had. there need not be a reason to visit friends and family, but I planned this trip to attend a friend's bachelorette party. given that my sweet, just finished her PhD, about to marry her high school sweetheart, friend, Artineh, doesn't drink alcohol nor does she find the idea of strippers in the least bit tempting (who does?), we threw her a circus. a party with lots of junk food, games, and friends. then, we went for a picnic at this gorgeous winery in malibu under clear blue skies and giant oak trees. because i cannot miss certain treatments, I am unable to attend her actual wedding (which I'm pretty sure would have been more like an anthropological adventure to participate in a 400-person traditional Armenian wedding!) but want to wish her and Sev all the camaraderie, affection, and adventure their lives can handle. congratulations, Art!

one of the other special treats was going to Catalina Island with Jamie and Uma. It was Uma's "first slumber party", her first night spent away from John and home since the aneurysm. Catalina is a great place for an ice-cream cone and, if you're lucky (as I was in 1997), a swim with dolphins. So other than dumb-luck and mint-chip, why waste your time when you can go to Cinque Terre? or Baja even? Wonderful to spend time with Jamie and Uma, but I'll leave Catalina to those who like two-foot wide fake beaches and overpriced hotels...

takers? anyone?

another special occurrence this trip was getting to meet ROBERT, anna's elopemate. he's a sweetheart who seems to love my girl Anna with all his kungfu might- plus, he makes an awesome breakfast skillet (topping last night's bbq with over-easy huevos... mmmm). i can see why she always calls him her little panda bear.

as for other tall women with their little loves, Andres got to meet the Kwoks this weekend in San Francisco. For those of you who don't know yet, (have you been living under a rock?) Jaci is and has been for quite some time now, dating dr. andres sirulnik. if you've been paying attention, the name will be familiar because he is and has been for quite some time now, my oncologist. He was there that first night in the ER as every hemo-doc was paged in for what they feared was going to be a very bad and sad night for some girl with a off-the-charts white-blood-cell count. He was there (as they jammed a needle in my groin to begin immediate blood cycling to get those bastards out) at the head of my cot instructing me to look at him (not down at my thank-god-i-shaved lower half) and making me laugh despite the palpable fear and confusion all around. These days, he makes me laugh at the dinner table several nights a week when I visit him and Jaci in their cute apartment near Fenway. And now, he's even met my extended eccentric most-excellent family in San Fran. Naturally, his convivial personality and do-anything-to-make-Jaci-smile MO led to a wonderful weekend. He's been like family to me since I moved to Boston and it's nice to envelop him into ours on the w(b)est coast too.

and then there's the fact that if he wasn't the sparkle in my sister's eye, i'd probably have killed him by now for all the frickin misery his damn chemotherapy causes me. in L.A., I had severe back pain from "coming off the steroids"--which makes me sound like a Bondsian addict experiencing withdrawal symptoms-- that left me prostrate on jamie's bed while she converted from clark kent into super nurse. here's how it goes (or: All You Need To Know About Cancer Treatment):

benzene exposure
traumatic catalyst
leukemia
chemo
back pain
oxycodone (painkiller)
nausea (particularly jolly on a ferry boat)
constipation
constipation meds
you know what comes next
etc etc etc

anyway, now i'm back in boston enjoying a second-hand cigarette wafting up to my window from my neighbor. ha ha ha! i laugh in the face of nicotine and tar! i'm way ahead of you wusses!

boston has the funny quality of being very comfortable while you're here, but possessing few to no reasons to miss it when you're gone.

even so, it's good to be HOME.