Tag Archives: Leukemia

Medical Microfiction: Remission

The Plague Cicadas

They came flying over the sea: horse-sized insects in battle armor. Eyes like red coals and hungry jaws. They chewed through our trees, our homes, our bodies. Anything the touched, they consumed, heedless of our misery.

But we drove them back in the end.

Victory! We have stacked and burned the bodies of the strange invaders. We have buried our dead and made songs for our heroes.

It’s time to put these dark days behind us. Tonight we celebrate victory.

Apart from the rest of us, one old warrior stands at the ocean’s edge, scanning the horizon with doubtful eyes.

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Cicada
Cicada (Photo credit: plounsbury)

You’ve heard the word remission before, probably in association with cancer. Remission means the subsiding or diminishing of a disease. Full remission is distinct from a cure because while the disease is no longer detectable, there’s always a chance it could reoccur. This is true of many types of cancer, and of some types of bowel disease. Still, even with that distinction, in cases of chronic or incurable diseases remission is great news indeed.

Today I’m happy to report that my wonderful friend, who has been battling acute leukemia since November, got news a few days ago that the leukemia’s completely undetectable in her body for the first time since the battle began. Full remission! And the timing couldn’t be better. Today she’s entering the hospital to begin prepping for her bone marrow transplant next week. There is no better time to do a transplant than when the disease has been so thoroughly beaten into the ground.

The cool thing about bone marrow transplants? When successful, they can actually cure leukemia. Not just put it into full remission; cure it. That’s why I’m so enthusiastic about the bone marrow registry and highly encourage you to consider joining it, or the branch in the country you live in.

I think cicadas make for a good metaphor for remission. Cicadas have a unique life cycle. They spend years and years living underground and only emerge to mate, lay eggs, and die. Then their grubs go underground for up to 17 years before they emerge again. As with any incurable disease, they’re likely to reappear after being completely gone for years and years.

This year marked the return of one cicada brood up and down the East Coast of the United States. They’re remarkable insects, cicadas. Check out this gorgeous video for a real treat. Make it big, and set it to HD for best enjoyment:

Beautiful. Have you ever witnessed a brood of cicadas emerge? I wanted to drive around and look for one this year, but just barely missed the window!

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Medical Microfiction: Graft-Versus-Host Disease

S.C.A.T

Ernie strolled into the captain’s office with something lumpy tucked under his arm. “Hey Captain, I bagged another one!”

Captain Jackson was afraid to look. Ernie had been guilty of occasional… misunderstandings… ever since he’d been hired to the Supernatural Creature Annihilation Team. Warily, he asked, “Whatcha got there, Ernie?”

“Werewolf.” Ernie shoved the severed head of Cindy Reeves into Jackson’s hands. Startled, Jackson gagged and dropped the thing. “I caught her right after she changed back into a girl. There was hair everywhere. Definitely a werewolf.”

Jackson smacked Ernie upside the head. “Ernie, you moron! Cindy’s a hair stylist!

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modern straight hairstyles for women
Werewolf, or hairstylist?

If you’re like me, perhaps you first heard about Graft-Versus-Host Disease, or GVHD, through the TV show Arrested Development. For those of you who’ve missed out, on the show a bald man named Tobias gets hair plugs. Unfortunately, his hair transplant begins “rejecting” his body. As his new hair grows more and more luxurious, the rest of Tobias wastes away until all he can do is limply sit in a wheelchair.

In reality, hair plugs don’t cause GVHD, but the Arrested Development parody is a pretty good analogy to explain how it works. With most transplants (such as organs or skin grafts), the patient’s body needs to accept the new part. If the body sees the new kidney or liver as foreign, the immune system will attack the invader and attempt to destroy it.

This is all well and good, but what if the thing you’re transplanting into the patient is a new immune system? This is where GVHD comes in. It’s a common concern with leukemia patients receiving bone marrow donations. As we’ve discussed in previous posts, leukemia is a cancer of the white blood cells which make up your body’s police force or military. To cure leukemia, doctors must wipe out the patient’s existing bone marrow and give her new marrow from a donor. If the new marrow views the body as foreign, it will attack the body and try to destroy it.

Keystone Cop Paddy Wagon
Here come the Keystone Cops!

Think of GVHD like hiring a new police officer who for some reason views all the citizens as criminals and starts attacking them. If you’re Ernie, you see werewolves where you should see hair stylists.

So what’s the cure? Generally speaking, the goal’s to get the disease manageable. Patients take medicine that somewhat suppresses the overactive immune system. This is a tricky thing, because obviously you want cancer survivors to have an immune system to fight cancer if it returns, and to fight other common sicknesses that we all get.

We can’t just fire Ernie. We’ve got to teach that moron the difference between a werewolf and a person. If you see him coming, better to run for cover. Just to be sure.

Pledging My Axe to the Fight Against Cancer

Whoa hey! Guess what I got in the mail today? My genetic testing kit for joining the National Marrow Donor Program, that’s what! I’m taking a break from flash fiction today to tell you more about the experience. I’ve discussed leukemia and bone marrow donation in the past, and am very excited to invite you along for the ride.

I like to think of it like that scene in Fellowship of the Ring where Gimli, Legolas, and Aragorn pledge their weapons to fight Sauron. The Fellowship of the Ring is a fellowship to destroy the Ring. In the same way, becoming a donor is a pledge fight the Enemy with the sword or ax that is your own immune system. Dear Fellowship of Leukemia, you can count me in on that fight.

Check out all the science swag! I got a few pages of directions, two packs of GIANT cotton swabs, and a nifty mailer for sending my DNA in for testing. Collecting my cell sample was very easy. You stick each cotton swab into the inside of your cheek and scrub for 10 seconds. This process rubs off buccal cells, or cheek cells, onto the swab. Repeat it three more times, and you’re done! Here is my completed set of DNA samples, all ready to mail:

DSCN0471

At this point, my part in the process is over. The swabs will go to a laboratory to get tested for protein markers. Those markers will be associated with my donor ID in the donor database. After that, I just go about my life. I may never get called on to donate, but my sample will be on file in case I happen to match someone.

So what happens if I match someone? Bone marrow donation comes in two flavors. The first and most common version is called PBSC donation, which stands for “peripheral blood stem cells”. If this is what the sick person needs, then I’ll receive five days of injections to prep for the donation. The injections will cause my bone marrow to produce an army of extra hematopoeitic or blood-forming stem cells. Think of these cells as raw recruits, able to take on any role necessary in your blood.

After five days, I’ll go into the doctor’s office and go through a procedure called apheresis. This is very similar to giving blood at the Red Cross, except instead of just giving a pint of blood, they’ll run my blood through a machine to separate out all the hematopoeitic stem cells and give me back the rest of my blood. Those of you who’ve participated in a blood drive may have experienced apheresis yourselves; the Red Cross uses this same procedure for plasma and red blood cell donation.

An illustration of bone marrow cells.
An illustration of bone marrow cells. (Photo credit: Wikipedia)

The second type of bone marrow donation is to extract bone marrow straight from a bone.   If I get asked to do this type of donation, I’ll go into the doctor’s office, receive anesthesia, and then the doctor will use a needle to extract liquid marrow from the iliac crest of my os coxae, or hip bone. If you feel the prominent wings of your hip bones just above your thighs, near your waistband, that’s where the donation comes from. The missing bone marrow will grow back before a month’s past, because the skeletal system is awesome like that.

I’ve noticed that people get a little freaked out when we talk about procedures involving our bones. I think it’s because we’re used to thinking about our bones as something inorganic, sort of like the chassis of a car. If your car gets in an accident, you can get it repaired but it’ll never be the same again. Its structural integrity’s damaged forever. Fortunately, our bones are nothing like that. The human skeletal system is resilient and alive as long as you are. Right at this very moment, your bones are being dissolved and rebuilt to better adapt your body to its daily stresses. Bone remodeling is a fascinating physiological topic, and I plan to discuss it in more depth later this week.

So there you have it: I can now say I am actively doing something about cancer. Who else is fighting cancer? DC Comics superheroes! Check out this heartwarming video on what one hospital is doing to help children with leukemia going through chemotherapy. Warning: it might cause your eyes to sweat.

Hopefully this post has helped clear up some of your questions about bone marrow donation. If I’ve inspired you, click right here and join the registry yourself. Now that Batman’s involved, you’ll be in good company! If you’re already a donor or thinking about signing up, give yourself a shout-out in the comments below, because you are awesome.

Medical Microfiction: Leukocytes

“The Charge of the White Brigade”

“Rodgers, stand down!” I commanded.

Behind his gun, Rodgers sneered. An army of clones swarmed behind him. “Screw that. I don’t take orders anymore. The universe is mine. Surrender.”

I touched my insignia. Meaningless. I’d lost my whole army fighting Rodgers. “The clone multiplication’s destabilized the universe. Your rebellion’s destroying it. We won’t survive the next radioactive shockwave.”

“You’re bluffing.” Rodgers took aim. “Die.”

The universe spoke. Its booming voice threw us to our knees: One more round of chemo. Then the marrow transplant.

I understood. For the universe’s sake, the faithful and corrupt must perish alike. “Rodgers. Please… proceed.”

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Fighting Rodgers
Fighting Rodgers (Photo credit: Wikipedia)

Leukocytes (white blood cells) are your body’s military, responsible for defending the homeland against invaders. Leukemia is a cancer where immature white blood cells proliferate much too rapidly to the point where they crowd out other important cells. It’s a particularly vicious form of cancer. It’s a military coup, if you will. Rodgers is trying to call the shots, and the General’s outgunned.

Fortunately, many forms of leukemia can be treated with a bone marrow transplant. Leukocytes originate in the bone marrow, so if you can replace the marrow, you can stop the abnormal multiplication. It’s like doing a hard reset on your immune system. You nuke all the bone marrow in your body–the good with the bad–and receive bone marrow from a donor, which will regrow and return your leukocytes to factory settings.

There’s something inherently tragic about cancer treatments, in that they’re invariably destructive rather than constructive. Cancer’s hard for your body to fight because from your body’s perspective, the cancer cells look like they belong there. They contain the same identity markers as the other cells produced in your body. Treatments like chemotherapy kill off a lot of harmless cells with the harmful ones. This is why chemo often causes hair loss. The weapon that harms Rodgers also harms his neighbors.

From left to right: erythrocyte, thrombocyte, ...
From left to right: erythrocyte, thrombocyte, leukocyte (Photo credit: Wikipedia)

Today’s story is an homage to these innocent bystanders in the fight against cancer. Faithful, loyal, sticking to their jobs until the bitter end, these cells must die that the universe be saved. But their sacrifice is not forgotten.

A dear friend of mine will soon be undergoing another round of chemo for her leukemia while she waits for an update on a possible bone marrow match. This is cool: the doctors think they might have a match with someone on another continent! Amazing, huh? I never knew the network extended so far!

I recently joined the National Bone Marrow Donor Program. Please consider joining the registry too, if you meet the requirements. Leukemia is a terrible disease. Somewhere in the world, a much-loved man, woman, or child may be battling Rodgers, and reinforcements from your personal army might be the key to his defeat.

The odds of two people matching is roughly 1 in 20,000, which is why it’s so incredibly important to have lots people on the registry. If you’re between the ages of 18 and 44, the process is 100% free. Just click the link, fill out a short survey about your health, and they’ll mail you some cheek swabs to collect a few of your cells. After that, your data stays on file in case someone who matches you gets sick.

Donation is ridiculously safe and easy. It’s not often that we have the opportunity to help fight cancer in such a tangible way. This will help! Let’s join forces and fight off Rodgers.

If you or someone you know has dealt with/is dealing with cancer, I’d love to hear your story. Let me know in the comments section below!