Bone Marrow Aspiration

I again woke up took the fastest shower I could, I needed to be with Presley. Paul always does the night shifts at the hospital. What a blessing for me. I don't sleep through all the hospital commotion, Paul does. He can wake up, unplug the IV pole, disconnect the glow light (pulse ox),  get her to the potty with his eyes shut and fall back asleep before the nurse knows the pulse ox was unplugged! He just cuddles up next to her and sleeps all night. She slept so good that night. She needed that. I got to the hospital at 8:30am. She was getting her hospital gown on for the procedure. They were going to do the BMA at 9am. WHOO big huge relief. Keeping her NPO (no food) until 1pm was going to be a big task. I didn't have the energy for that. I'm so thankful we could get in and get this BMA done. It was so very hard today to put her down on the procedure bed after putting her out with the white med (propaval). We gave her big kisses and cried as we walked away. Oh that is so hard. Very hard today. We knew that results from this procedure would give us the news we needed. I cried. I listened to the song...Blessings while she was under. 

oh those puppy dog eye! The nurses saves her a cute purse from all the holiday toys. She was so excited. They must know she loves her purses!

Mama and baby girl...tired and sick eyes. 

This is the room we left our little girl and shut the door behind us.

Waiting to be called back as she wakes up. 

BMA is a short procedure where:

An aspirate needle is inserted through the skin using manual pressure and force until it abuts the bone. Then, with a twisting motion of the doctors hand and wrist, the needle is advanced through the bony cortex (the hard outer layer of the bone) and into the marrow cavity. Once the needle is in the marrow cavity, a syringe is attached and used to aspirate ("suck out") liquid bone marrow. A twisting motion is performed during the aspiration to avoid excess content of blood in the sample. A different, larger needle is inserted and anchored in the bony cortex. The needle is then advanced with a twisting motion and rotated to obtain a solid piece of bone marrow. This piece is then removed along with the needle. The entire procedure, once preparation is cocomplete, typically takes 10–15 minutes.

That part only take about 10-15 minutes. We saw the doctors as they came out and said she did good. So we waited for a while for her to wake up. It wasn't long before she was stirring. 
We took her back to to ICS (4th floor) and waited for results.

On our way back to the 4th floor. Hungry baby just wanted french toast and it was not coming fast enough. So fruit  loop

This time we know...if the whole team plus the social worker walks in we know the results would most likely be positive for leukemia. If it was just Doc Fluchel we would know the results 
were not as concerning.

Doc Green left her the cutest cupcake set. Prefect addition to her play kitchen she got from Santa

Thumbs up!

What would we do without the Ipad? I really don't know. Watched her favorite movie over and over. 

Since I can't go back in the procedure room,
here is the site where the BMA was done.
She was not happy for the large back band- aid. 

This is how she keeps entertained! Something fun to ride to go potty! Where is her Strider?

At about noon Doc Fluchel peeked his head into the window. My heart was was calm. He came to share with us that the "smears" of her bone marrow under the microscope looked clean. He said "cells are looking promising and only showing healthy blasts or cells". He then said that they were still waiting on the flow cytematry test to come back before we would know the final results. We knew we couldn't let our guard down yet but felt some relief at that moment. I knew in my heart that Doc Fluchel would not have shared that if he was a little hesitant about the smears. At this point no leukemia was showing up in her blood from the slides yesterday and no leukemia was showing on the smears of her bone marrow. Everything was pointing toward good news. The room seemed to lighten up. So thankful even though Doc Fluchel was not the in-patient doctor or at clinic that he was involved with today's events. I could tell there was less worry in his face. Mark (Doc Fluchel) told us that he wanted to just keep us updated on the results as he saw them knowing the results could possible be very upsetting. Again so thankful for that. Some doctors could have just left the in-patient doctor in charge. As Mark says..its hard not to have emotional attachment to Presley. He said last night was hard and that it was his Birthday yesterday (the day we had the CBC in clinic) and he keep thinking...All I want for my birthday is for her to have clean slide and smears.
At 3:00pm the final results came. Again it was just Mark when he walked into that hospital room. Room 4422, just two doors down from the room we heard the new on March 12.
"The flow is clean" meaning no leukemia was found in the flow cytometry test.
This test they send the cells individually down a tube, straining the cells looking for different proteins. There are certain proteins that are absent on leukemia cells. He said its  pretty clear when leukemia is present. Black and white.
We were given a miracle that day. I know the Lord was watching over us. I knew our little family was struggling so much already that we needed good news. I think I might have taken the deepest breath of relief. We cheered, we gave high fives, we cried. It was a celebration. Presley said "take that cancer"!
Mark then went on to say that there are two possible reasons why such a dive in her WBC, RBC and platelets. The first being a viral suppression. Presley has had a bad cough and so we know that is part of the equation. The second part is her current chemo treatment. She is currently taking only 6mp,methotrexate and vincristine.The chemos she is given and the amounts should not cause her numbers to be this low. She is in maintenance. Most kids in maintenance never need blood product transfusions after the front line chemo treatment (first 6-10 months of treatment). Presley was in real need of blood and platelets (hoping those will go back on their own). They placed Presley on a "chemo hold", no chemo until her next appointment where they will start her on 25% or 50% of the dose and see how her body handles the chemo. Her little body needs a break. The viral infection and the chemo has really hit her hard.
Mark Fluchel also said they are going to do some genetic testing to see if she is more sensitive to the drug 6mp. I remember back in May when she was on 6mp, her counts were very low also. I hear this test takes a while to come back and so they will move forward thinking she is sensitive to this drug. About 10% of child and adults have a hard time metabolizing this drug and others like Presley metabolize at a 
higher rate.

Presley called down to the RTU to share the news with the RTU nurses. Becky and Wendy came to the 4th floor and brought her a slushie and a little beanie baby. All of the doctors and fellows involved today  came to give a Presley a high five and her favorite clinic nurse came to give her a big hug too! So thankful for these special people in our life!

I'm still numb, when you world is turned upside down you self medicate to be numb. Its an easier state to be in but very hard at the same time. I could feel through that numbness the Lords hand in all this. I'm so very thankful for the news we received today. 
Thank you so much for each one of you who texted, called, brought meals, cried and prayed. Your prayers were heard. Thank you. It's a very special feeling to know so many are praying and pulling for our little girl. We did it! Still cancer free. That is a very reassuring feeling.