When Irish Eyes Are Aspirating...

Ask, and ye shall receive!  Late yesterday a NW scheduler phoned that Dr. John Galvin offered to perform Steve's bone marrow biopsy.  He may have been coerced.  Regardless, it was show time, and Steve was apprehensive last evening.  Dr. Tim Huyck had done 3 of them, Galvin 1, and The Jerk did one.  Steve hadn't napped the past two days, feeling that by stretching himself energy-wise, he might improve the quality and consistency of his sleep.  It is not unusual for him to fall asleep at 10, sleep well until 1, then lie awake until 5 or 6 a.m...then passes out again, gets into a deep sleep and wakes up in a fog.  The past two weeks he had not improved in lab numbers, more like a holding pattern over O'Hare during a storm.  You are hoping the storm passes and you can land safely, but there is always a chance of diversion.  We don't want to land at Mitchell.

He had a rough evening Tuesday, very emotional, very down, gaunt, and tired.  All of a sudden he looked at me, and said, "you know what?  I think I feel a lot better all of a sudden."  (Be creeped out.)  He went to bed and had the best night's sleep in months!  He was rather chipper this morning, was PLEASANT, almost happy (okay, let's not get carried away) and we grabbed a McD breakfast on the way to the clinic.

Here's one of those things that hits me every week.  I look at this sign and try to imagine how much worse it could be, and I try to be grateful for an illness that has a hope for cure and physicians and nurses that are working toward that goal.  Steve has never needed surgery for his cancer.  I have seen people on the 21st Floor in Galter that are beyond description.  Twisted, deformed, pasty-skinned people that look just like Nazi concentration camp prisoners, but these images are in color today.

Steve and I walked in to see Dr. Galvin waiting in the hall.  He is "black Irish," and has a twinkle in his eye that makes you feel everything will be alright.  I realized I had never stood up next to him before (I was always sitting in the hospital, always...) and he was taller and more athletic than I realized, and was wearing a green plaid shirt and jeans instead of his lab coat and dress pants.  I gave him an obligatory bazinga! about Notre Dame's awful football team (he has an undergrad degree in English from ND) and we were off to the races.  

I have come to realize that many of this blog's readers are very interested in my photos and in learning about "the process."  Well, medical junkies, here you are, an early Thanksgiving feast for the eyes.   

The glass slides are all prepared ahead of time, and labeled by hand with Steve's name and, I think, hospital ID number.  The med tech's job reminds me of a baseball outfielder.  She waits for the pitch, sees the ball hit, and gets into position for the catch.  The ball (Steve's aspirate or marrow) is delivered into her glove and she makes the play for home.  She quickly takes the samples, smears, rubs, shakes tubes, etc. and gets it all to the lab for both basic and  high-level testing.

 

The first photo is of Steve's aspirate, no wait, his butt isn't showing, is it?  Gotcha.  The aspirate is the "juice" that is extracted from the bone cavity and is semi-liquid marrow, much like the goo from a ham bone.  It can tell us the type and quantity of cells in the marrow.

Dr. Galvin at work, doing a top-drawer job of aspirating and controlling any and all pain or discomfort during the procedure.  iPod selection was a mix from the group Boston, which Galvin deemed "most worthy biopsy music."

We had really great conversation with him, and talked about a shift in medical school training and thinking that seeks students with a broader, more liberal arts background pre-med.  As is often found in "teaching hospitals," Dr. Galvin explained (and smoothed some waters) about how practitioners are trained at Northwestern.

The pièce de résistance, the bone marrow!  This allows the doctors to examine the "architecture" of all cellular structure.  A gender-typing test was ordered to determine the presence of XX (female) in the cells, providing proof that Mary's stem cells had taken up housekeeping and Steve's body was producing new cells.  At this point I get very confused.  I don't know if I need to guard my mascara and Chanel perfume or not (?? YIKES ??)...we are going to get a LOT of mileage in the joke department with this one.  

Dr. Altman told us after the biopsy that there WAS evidence of XX genes on August 28, the date of his last marrow biopsy, and that a tech communication disconnect kept her from knowing and telling us.  THAT means that the FIRST transplant on August 13 DID WORK, it was NOT a failed transplant!!!  Another huge, huge sign of improvement....she mentioned for the first time the *thought* of pulling his PICC line.  Unbelievable. 

Meds stay the same from a week ago.  His Tacro dosage got bumped up twice since the last visit, and now all signs of GVHD rash are all but gone on his lower legs and forearms.  I asked about his high ferratin level, and the ball started rolling to get his Exjade prescription filled.  Did you know there is such thing as "the specialty pharmacy?"  Oh sure, there is!!  Yes, kiddies, guess where the Exjade comes from?  Might take a week or two.  I just rolled my eyes at the thought of Blue Cross paying for that....muah ah ah, I'll find a way!!!!

Returned home to the dog spazzing out with badly infected ears, called our vet, and $123 later (that Blue Cross for sure won't cover), I came home to hear that Dr. Altman called with today's FABULOUS lab results....here we go, and let's hope this party is starting:  

WBCs 2.1  (what what?)

ANCs 1.0 (sweet!! I'm not cleaning anymore)

Hemoglobin 7.2 (she lowered transfusions to <6.8!)

Platelets...drumroll.....79!!  Go sharpen the lawnmower blade!!

Goodnight all!