Ron Smith

Lumbar Puncture.

a lumbar puncture (colloquially known as a spinal tap) is a diagnostic and at times therapeutic procedure that is performed in order to collect a sample of cerebrospinal fluid (CSF) for biochemical, microbiological, and cytological analysis, or very rarely as a treatment (”therapeutic lumbar puncture”) to relieve increased intracranial pressure.

So far in this round of chemotherapy I have had two lumbar punctures.  In both cases they were used for cytological analysis and to give me chemotherapy intrathecally.  First to determine what particular flavor of Leukemia is trying to kill me, and to find out what other damage the Leukemia may have done to my chromosomes.  This is where they determined that my brand of Leukemia was PH+ and that I had the Trisomy 8 marker.

In my case, the lumbar punctures were performed with me laying flat on my stomach with a CAT scan machine positioned over my lower back.  The doctor used the CAT scan to guide the needle in into my spine.  They then proceed to draw off 3cc of CSF and replace it with 3cc of intrathecal chemotherapy.

The first time through the procedure was  a piece of cake.  I was so out of it due to fatigue and the medications that I hardly noticed the procedure.  The second time was a whole different matter.  I’m not one to usually get anxious or worry about the uncomfortable nature of a procedure.  When you have little control of what happens next, you learn to accept with as little complaint as possible.

On the second go round, I was alert and very aware of the needle in my spine.   Throughout the procedure, you feel somewhat numb below the needle insertion point. I also had neglected to use the rest room before the procedure.  Note to anyone reading this and about to go through the procedure.  Use the bathroom first!  So there I lay with a needle in my back with the overwhelming urge to use the restroom. This caused me to start having a bit of anxiety and feel a bit nauseous.  The doctor would frequently ask me if I was OK.  My response, “hurry the hell up.”  To which he responded, “this stuff comes out very slow.”  I groaned.

He would count out cc as as he hit a new integer, taking what seemed an eternity to reach 3.  Then he quickly injected the chemotherapy and removed the long needle from my spine.  I was covered in a cold sweat and longed for a nap.  What was maybe a 10 minute procedure felt like a marathon.

Then the headache set in.  One of the common side effects of a lumbar puncture is a headache.  Which is not too surprising since they are sucking fluid from your brain and spine.  These headaches are likened to migraines, and that is a very accurate comparison.  A headache that lasts past a few hours of the puncture usually indicates of CSF leak at the puncture site.  This is commonly treated by a procedure called an epidural blood patch.  This is where they inject the patients blood around the puncture site, so that the pressure and clotting agents in the blood will patch up the leak.

Unfortunately for Leukemia patients, with low platelet count, and high risk of infection, this is not an option.  Lucky me.  So many days out now, I am still getting headaches which are being treated by Ultram and the occasional press of the button on my Hydromorphone loaded PCA.  The first few days in the hospital, my PCA became my best friend.  The means by which I could not escape my pain, but make it at least tolerable.  The headaches are thankfully decreasing in severity a strength and should be gone completely within a few more days.  It will be a  welcome relief from  one of my few remaining symptoms of this round of chemotherapy.

The doctor has indicated that I may be able to go home in about 6-7 days.  I am unsure how long I will be able to remain out of the hospital, as it probably depends on how quick and successful the donor search is, and how quickly I can move to Texas, albeit temporarily.  I’m hoping that I can stay out and enjoy life for a bit and then proceed to Texas for the next step in the process.  If I’m going to roll the dice, I am eager to get started.  When faced with a tough situation, I’m one to keep trudging along, waiting is not one of my strong suits.

When I go home, I want to have a nice weekend.  Invite over the dozens of family, friends, and rediscovered  friends to my house for a feast.  They fed my hopes, and in my best way of saying thank you, I want to feed their bellies.  I can’t wait.  And from the rumbling tummies I hear amongst my friends, they are overdue for a good home cooked meal.

In a doing a little bit of math using the statistics from my original post.

3,350 men affected by ALL in 2009

10.1% of those affected between the ages of 20-34

25% of those will have PH+ ALL

5% of those will have the Trisomy 8 marker

With a bit of quick math, that means there are a grand total of:

4.2 cases of my flavor of Leukemia in 2009

Juggle around some census numbers and you arrive at:

1 in 72,380,952 million chance of getting this disease.

I should have bought a damn lottery ticket instead.

Acute Lymphoblastic Leukemia, Hydromorphone, Leukemia Information, PCA, Personal Ramblings, PH+, Trisom, Ultram