Billy Bob's Wild Ride: Fee Fi Fo Fum, I'll Grind yer Bones...

Wednesday, August 13, 2014

Fee Fi Fo Fum, I'll Grind yer Bones...

To obtain the necessary diagnostic information...

AS ALLWAYS, PLEASE CLICK ON IMAGES FOR FULL SIZE AND EFFECT

PLEASE CLICK ON IMAGES FOR FULL SIZE AND EFFECT

Notbillybob was at the "U" for the dreaded bone marrow biopsy yesterday.

PLEASE CLICK ON IMAGES FOR FULL SIZE AND EFFECT

He didn't publish this post then because of an exquisite little inconvenience known as... STINKFOOT !!! SCRATCH THAT, SCRATCH THAT!. Sorry, there's that Frank Zappa song again. I think it's from the album "Apostrophe". You really should check out Frank Zappa on this one. Seriously. Here's a link for you.
The real reason he wasn't around all day yesterday is a pill known as Flexerill. Or it.s generic term, Cyclobenzaprine,a mild muscle relaxer. This pre-medication was to used to relax the patient for the procedure. Whoa daddy! Relax is not really an accurate term. Howz about KNOCK OUT? Kids, don't try this at home. And by the way, what do they consider a strong muscle relaxer?? Oh, yeah, I remember detox. Valium's big brother, Librium could be called a strong muscle relaxer, but it would have anesthetized our guy before lunchtime, and left him unconscious.

As a result, the whole thing (day) is a blur, except for the part when the nurse practitioner took the bone sample. Here is an illustration which describes the event. A picture is worth a thousand words as they say...

But it's all done. Wow. There are brave people whom have had many of these! I cannot even imagine.
Let.s say that it is not something one ever wants to do again... EVER.

PLEASE CLICK ON IMAGES FOR FULL SIZE AND EFFECT
The upside in all this is that even though the procedure was done in a sterile fashion, Sharon was STILL allowed to sit next to and hold Notbillybob's hand. She scratched his goatee and talked about the cats and distracted him. Kudos, Sharon. You're the hero of the day.
And the NP and CNA They were excellent as all the staff here have been.

THANK YOU, SHARON!!

Anyone curious who wants to see the procedure on video, here is a link to a youtube video (not ours)
but do not watch if you don't want to, by all means. VIEWER DISCRETION IS ADVISED

P.S.
for thos who are interested iin CG, here is the red wax basemesh of himself that Notbillybob did with Zbrush...

PLEASE CLICK ON IMAGES FOR FULL SIZE AND EFFECT

exploded view of skeleton

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Solitary plasmacytoma

Solitary plasmacytoma is a large solitary focus of plasma cell proliferation.

This tumor has a median patient age of approximately 10 years younger than multiple myeloma.

Pain is the most common symptom. However, if the myeloma occurs in the spine, it will usually present with fast developing paraplegia and gibbous deformity due to the vertebral collapse.

Complete Information on this Tumor

Introduction and Definition:

Solitary plasmacytoma is a large solitary focus of plasma cell proliferation. This tumor is extremely rare and is found in the proximal femur, vertebral bodies, and pelvis in order of descending frequency. Solitary plasmacytoma occurs 70% of the time as an osseous lesion, and the rest of the cases are non-osseous lesions usually found in the upper respiratory tract. Approximately 70% of the patients with solitary plasmacytoma develop multiple myeloma.

Incidence and Demographics:

This tumor has a median patient age of approximately 10 years younger than multiple myeloma, and affects men more than women.

Symptoms and Presentation:

Pain is the most common symptom. However, if the myeloma occurs in the spine, it will usually present with fast developing paraplegia and gibbous deformity due to the vertebral collapse.

X-Ray Appearance and Advanced Imaging Findings:

Radiologically, solitary plasmacytoma appears identical to multiple myeloma.

Differential Diagnosis:

Most authors agree on a strict diagnostic criteria for solitary plasmacytoma. There may be no other radiological identifiable lesions, and bone marrow at another site must have no abnormal plasma cells. There may be no serum abnormalities and no Bence-Jones proteins in the urine. Some authors believe that the diagnosis can only be made if no other lesion is found for a period greater than 1 year.

Preferred Biopsy Technique for this Tumor:

Bone marrow biopsy

Histopathology findings:

Microscopically, solitary plasmacytoma appears as well to poorly differentiated sheets of plasma cells. These cells produce the same osteoclast stimulating factors found in multiple myeloma.

Treatment Options for this Tumor:

Treatment of solitary plasmacytoma includes radiation or en-bloc surgical resection. If abnormal serum or urine findings are present then the patient must be treated as if they have multiple myeloma with chemotherapy and bone marrow transplant 2.

Outcomes of Treatment and Prognosis:

Patients with solitary plasmacytoma have a better prognosis than patients with multiple myeloma, but 70% of solitary plasmacytoma patients develop multiple myeloma, and usually die within 5 years.

Graduation Day

LINAC U

You'd think that 25 radiation treatments wouldn't amount to much of anything. It doesn't sound like a lot.

...25 trips to the hospital. We were wrong. We started the week before Thanksgiving after a month long delay because of a bad bad flu like cold I developed. They wanted a commitment, with as few absences as possible, so we waited. The coughing up blood and fevers subsided, then we started, and got our groove. I say WE because Notbillybob's wife, Sharon drove most days. I was just along for the ride. Well, after 10 treatments, the tiredness set in. Especially for her. Like a new part time job. Notbillybob feeling like a roast ham most days. Kind of like a sun burn inside your guts. He made a big mistake in eating jalapenos one night. Ooh, the burn. So, they asked the doc if the stomach was getting radiation. They said "lets pull up your treatment plan... Yes, see here, inside this red line. The treatment plan showed that it was. The innermost red line is the most radiation, the outer one is the least. The green one is in the middle. A good part of the stomach is even inside the blue line.

The pain was accounted for. They told us that they were also concerned with his platelet count. It was going down again. Down to 37! (Low is 150) It has since stabilized at 40. The thing is that the white cells, red cells, hematocrit are all low. Way low. Bilirubin is elevated. INR is elevated. Not billybob began wearing a mask to treatments. Don't need cooties at a time like this.

Then the really cold weather set in. I know, I know- it doesn't really cause colds and "death of pneumonia" like our moms used to say, but when you have cancer of the immune cells, and then your white cell count goes in the toilet as well...

Notbillybob is going to stay a hermit for the foreseeable future.

But SMILE!

New Years eve was treatment number 25. Graduation day! Graduation from LINAC U!

(LINAC is a Linear Accelerator, an IMRT radiation therapy machine)