Biopsy

• Hemoglobin 13.2 (normal 14.0-17.3)
• Absolute neutrophil count 2.2 (normal 1.4-7.5) — NORMAL
  
• White blood cell count 3.1 (normal 4-10)
• Platelet count 200 (normal 150-450) — NORMAL

Yesterday I had my followup bone marrow biopsy, or "BMB," as they call it around the Cancer Center. I'll get the results on Friday, or Monday at the latest. They'll tell me whether I've had a CR (complete remission, with no evidence of disease even at the molecular level), a GPR (good partial remission, with up to 1 percent hairy cells visible on flow cytometry), a PR (partial remission, up to 5 percent hairy cells), or — worst case, very rare — no real remission at all.

Dr. B's assistant, Ms. I, did the biopsy. Not quite as easy as last time, partly because she was teaching a student to do the job.

First Ms. I injected lidocaine deep into the upper part of my hipbone, just above the waistline on the right side of the back. This is the worst part, because you can feel the needle. (I don't really understand how a needle can penetrate bone, but it does.) The lidocaine burns like the fires of hell, but in a few seconds you're numb.

Next came the aspiration (narrow needle, for pulling out a fluid sample). Pressure, probing, pain, but not too awful. I just kept on breathing, trying to stay Zen. At the first biopsy in October, they couldn't aspirate at all, even though they tried three times, because the matrix of hairy cells was too thick. This time, it went well, and Ms. I had no trouble sucking out a cubic centimeter of fluid.

After that came the core sample (thick needle, takes out a 1.5 centimeter, narrow, circular core of bone plus bone marrow). These really f-ing hurt. This time Ms. I showed the student how to do it, guiding her hands. The night before I'd heard a doctor friend talk about learning to do this 25 years ago. Now it was my turn to sacrifice my body for the good of the profession. They have to learn somehow.

The student's unconfident, tentative pushing and wiggling actually hurt much more than Ms. I's firm, expert tapping and pressing — but at least she didn't push right on through to sample my kidney instead. Her lack of expertise showed up when they looked at the sample; she'd broken it in half, making it unusable. So Ms. I had to take another core. That's still better than last time, when they did three tries at an aspiration and two core samples — five stabs in all.

Today I feel like I've been kicked in the back with a steel-toed boot. Fortunately it's like a bad bruise, only hurts when I sit down wrong or try to twist too much.

Had more blood tests, too. Results are mixed. Hemoglobin and red cells are still climbing nicely. According to UM standards my hemoglobin's even normal now (at 13.2), since they use 13.0 as the bottom of the range. But the WHO standard for normal hemoglobin in men is 14.0, so I'm hoping it'll climb a bit more (and it should since my red cell count is still slightly low). Around mid-March I expect it'll all flatten out.

On the other hand, my white count is subnormal again. Not terrible, but still low. Could be (said Ms. I) because I've got a cold right now; tends to bring the white counts down. She didn't see a reason to worry about it. So I won't. Or at least I'll try.

Waiting for Friday's test results now... nervous but hopeful.