BMBx (No it's not a thermonuclear device!)

Sometimes, you just have to wait. I last met with Dr. Waugh, my oncologist, on November 8, 2021. That was the day I checked out of Club Sunnyside for the final time after completing all of my HiDAC chemotherapy rounds. On December 4th, I had a consultation with Dr. Cook, the oncologist who specializes in bone marrow transplants (BMT) at OHSU. At that appointment, we learned that a suitable donor for BMT was not found in the worldwide database. Dr. Cook told us that day that she would consult with Dr. Waugh about where to go next with my treatment. 

Well, today was the day we had a consultation with Dr. Waugh to discuss the way forward. Unfortunately, due to current Covid19 protocols, Jill was not able to accompany me into the meeting, be she was able to be part of the festivities via phone. Dr. Waugh had some good news and some other news. Whether or not the other news turns out to be good, bad or indifferent will have to wait until after I have another bone marrow biopsy (BMBx). The good news is that my blood counts are doing very well. She is pleased. Also, there was a genetic marker in my original BMBx called KIT16. That marker did not show up in my second BMBx, which was done after the induction round of chemotherapy that kept me in the hospital for 26 days. In addition, that second BMBx showed no sign of the leukemia cells. In other words,  I was in remission. That was good news.

So, the next step is another BMBx. The outcome of that procedure will indicate what needs to be done next. If the KIT16 shows up again, it will indicate I need to take some chemotherapeutic medicine on a regular basis to keep that at bay. If there are any leukemic cells present, I will need a different maintenance chemotherapy. If neither of these problems shows up, I will not need to go on further medication, at least for the time being. 

There is already good news regarding the BMBx, it is scheduled for Thursday, two days from now. It will be 7-10 business days before we get the pathology report. Then we will know what was found. Sometimes, you just have to wait. 

Other good news about BMBx is that the procedure is simple and fairly quick. As I recall, it takes about 20 minutes. I will be sedated, but awake, and some local anesthetic will be used at an area overlying my pelvis on my lower back. There is little to no discomfort and just some mild tenderness in the area afterward; no need for pain medication. 

Dr. Waugh also said that my blood counts are doing so well that I only need one blood draw every two weeks, although I will still have go to the medical office weekly for a dressing change on my PICC line. She also said that I can have the PICC line removed and even offered to have me go upstairs to the nurse treatment center today and have it removed. After further discussion, we decided that we would leave the PICC line in place until the results are in for the BMBx, just in case it may be needed. Sometimes, you just have to wait. 

Now, why would the PICC line still be needed? One of the chemotherapeutic agents that I would need to take, should the BMBx show that there is still a problem with my marrow, can have some side effects, including low platelet levels that could necessitate a transfusion. In that case the PICC line would come in handy. So, I am crossing my fingers that I could be relieved of the PICC line, with its attendant inconveniences, such as needing to have the dressing changed weekly and needing to wear a waterproof sleeve over the whole assembly whenever I shower; or, and this is the worst for me, not being allowed to lift over 10 lbs. with my right arm. Do you know how hard it is for me to exercise my arms, if I can only lift 10 lbs.?

So, IF there is no sign of leukemia on my biopsy, I can have the PICC line removed. But sometimes, you just have to wait. If you are a praying person, I covet your prayers that the BMBx will come out negative on all counts, and that I won't need to be on long term medications with their attendant side effects and inconveniences. 

I will, of course, report the results of the biopsy and any necessary treatments that I will need based on that information. But in the meantime, you'll just have to wait. 

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In case you are not familiar with what a PICC line is or looks like, I have included a photo. 

The green caps cover the threads on the clear plastic hubs, through which fluids can be introduced into my veins and blood can be withdrawn for laboratory analysis. This is where the chemotherapy was introduced into my body via tubing from an IV bag. The two purple tubes from the hubs join together at a purple, plastic Y joint near the top of the picture. The tubing from the other end of the Y joint has a divider in it so it works like two tubes in one. The other end of that tube enters my arm through the skin under the pale blue circle. It is routed up my arm through the veins that lead to my heart, and it terminates just above my heart. (See diagram below)

The blue disc and the puncture where the tubing enters my body are covered with a clear plastic material to protect against microbes getting into my veins through the skin opening. The whitish, spotted material around the clear plastic is the part of the dressing that adheres to my skin, like a band aid. The tubing needs to be flushed weekly to make sure that no blood components are forming a blockage, and the dressing needs to be replaced weekly to ensure that the area around the opening in my skin remains sterile. 

In a previous post, I wrote "your PICC line is your pal." It provides easy access to the blood vessels in order to simplify the giving of medications and transfusion of blood products and the withdrawal of blood samples for monitoring progress. When those things are happening multiple times daily, the PICC line eliminates the need for lots of needle sticks, too. Nevertheless, it comes with it's own drawbacks, most of which are issues of inconvenience, although there is an ever present concern about the possibility of infection entering the blood stream. That is the big negative. Perhaps, you can understand why the prospect of being free of a PICC line is appealing.