Drawing marrow and drawing near

It's funny how anxiety can sneak up on you. Today was Bone Marrow Biopsy (BMBx) day. This is the third time I have had this procedure done. The procedure itself is what I would call a non-event. They use a bit of lidocaine to numb the skin over the crest of the pelvic bone. Once that is done they go back in with more lidocaine and kind of soak the surface of the bone. The biopsy itself amounts to drilling a hole through the bony cortex and into the marrow space. This procedure is done with a specially designed instrument. 

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The instrument consists of a tube with a cutting edge on one end and a handle on the other end, allowing the operator to twist the blade through the cortical bone. Once the tube has been inserted to the proper depth, a central rod is  removed from the instrument, leaving a hollow canula, through which a sample of marrow tissue is withdrawn with a syringe. Michelle, the NP who did my biopsy today, said the sample looks like rich red blood, although she didn't go so far as to show me. Finally, a core of the cancellous (spongy) bone in the marrow space is withdrawn. (See below) 

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The whole procedure took about 30 minutes today. There was negligible discomfort, which I would not describe as pain. It was more like intermittent pressure. 

Now back to my comment about anxiety. Having been through BMBx on two previous occasions, I had no anxiety about the procedure itself. I think it is what it represents that brings on the anxiety. This procedure is essentially a test to see whether there is still cancer in my bone marrow. Now the first BMBx I had, when I was initially diagnosed with Acute Myeloid Leukemia (AML), caused little anxiety, because I expected it to show cancer. 

The second biopsy came after my initial stay in the hospital for chemotherapy. I expected it to show that the cancer was diminished, and that is exactly what it showed. I was pronounced "in remission." In other words, NO cancer was found. What was a surprise was that they found Systemic Mastocytosis: 

In systemic mastocytosis (SM), mast cells accumulate in internal organs such as the liver, spleen, bone marrow, and small intestines. The signs and symptoms vary based on which parts of the body are affected but may include:[1][2]

  • Anemia and bleeding disorders
  • Gastrointestinal symptoms such as abdominal pain, diarrhea, nausea, and/or vomiting
  • Itching, hives, and/or flushing of the skin
  • Anaphylactoid reactions
  • Enlarged liver (hepatomegaly), spleen (splenomegaly), and lymph nodes (lymphadenopathy)

Most cases of systemic mastocytosis are caused by somatic mutations in the KIT gene. This gene encodes a protein that helps control many important cellular processes such as cell growth and division; survival; and movement. This protein is also important for the development of certain types of cells, including mast cells (immune cells that are important for the inflammatory response). Mutations in the KIT gene can leads to an overproduction of mast cells, which then accumulate in internal organs and lead to the symptoms of this condition.*[5][2]

In my case, the aberration of the KIT gene was masked by the advanced state of the leukemia, so it didn't show up in the initial BMBx. The SM adds a layer of complexity to my case. 

So, now we come down to the real anxiety phase. I have been feeling so well and enjoying life so much for the last couple of weeks that the possibility that this BMBx could show some sign of the cancer or some sign that the KIT gene is still causing problems, gives me reason for concern.  Either of those developments will mean more medical treatments that are not likely to be a lot of fun. So, again I covet your prayers for complete remission of these problems. 

I continue to hang onto God's promises: 

Hebrews 4:16
Let us then with confidence draw near to the throne of grace, that we may receive mercy and find grace to help in time of need.

Romans 8:26       

Likewise the Spirit helps us in our weakness. For we do not know what to pray for as we ought, but the Spirit himself intercedes for us with groanings too deep for words.

I invite you to draw near to the throne of grace with me and call on the Holy Spirit to intercede with the prayers that will express the groanings of our hearts that are too deep for words. 

*https://rarediseases.info.nih.gov/diseases/8616/systemic-mastocytosis

 


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