When I don’t understand something, I must trust the experts

Everything was going well. My new-to-me car responded well to the steering wheel, and the brakes were nice and tight. I’d left my house in Alabama and was heading west to visit my oldest daughter in Texas. Suddenly, it felt like my back tires ran over three small branches on the road. Thump, thump, thump!

Next, the engine stopped working, although I still had steering, brakes, and electricity. I pulled over to a safe place and got out and looked at the car. No smoke, no burning smell, tires all good. I got back in and turned on the car. All the warning lights lit up and the center display said, “Engine overheated.” So I waited awhile, tried again, and got the same message.

I called a local repair place. They had the same results, so they hooked up a diagnostic iPad. A module under the hood on the left side of the engine turned out to be the faulty component. That’s when the mechanics said, “Dealer.”

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January 16, 2020 Health Insights by Emily Malcolm, PhD

How to Prepare for a Bone Marrow Biopsy When you Have Cold Agglutinin Disease

I have no clue what’s going on with my car. When others, mostly my dear husband, Mike, try to explain engines to me, my eyes glaze over and my brain cells go on strike. I just nod and go along with their expert information. I don’t speak car mechanics at all.

I also don’t speak bone marrow biopsy, meaning I don’t understand it at all. I just nod and agree with my doctors. But since I recently had one done, I decided to investigate a little more.

A bone marrow biopsy serves the same function as the mechanics’ diagnostic tests. Their iPad provided a deep dive into the workings of my car engine, while the biopsy allowed my doctors to examine the bone marrow in my hip and understand how my blood cells are forming there.

What a biopsy analyzes

Many cold agglutinin disease (CAD) patients like me undergo this procedure for at least two reasons. First, it can be used to evaluate the production of reticulocytes, or immature red blood cells, and neutrophils, a type of white blood cell. Both counts tend to be elevated in CAD patients.

Another reason for the biopsy is to determine whether there’s an underlying disease, such as blood cancer, that may be causing a person’s CAD. In my case, CAD is secondary to Waldenström macroglobulinemia, a type of lymphoma. For some, the disease may be caused by leukemia, while others may have primary CAD, in which there is no underlying malignancy. Knowing if someone has another disease besides CAD helps the medical team decide on a course of treatment.

I endured a bone marrow biopsy in 2016 and again last month on July 9. I confess, I’m squeamish about things that pierce my skin. I don’t like shots, and I don’t like blood draws. I especially don’t like hand-held augers drilling into my bones.

In my quest to gain more insight, I learned that four main components are studied in a bone marrow analysis: the core biopsy, the touch imprint, the aspirate smear, and the clot particle. Each specimen type is assessed individually, but together, they offer a more complete picture of a person’s bone marrow.

As I read terms such as “morphology,” “phenotyping,” and “megakaryocytes,” I wished I’d paid more attention in high school biology. By the time I reached “morphologic dysplasia,” my eyes glazed over and my brain cells went on strike.

My lack of understanding

On Saturday night, I called Mike, who’s at our overseas home in Indonesia. My description of what the mechanics had told me was this: The radiator and all the hoses need to be replaced. The oil something-or-other leaks sufficiently that there is a puddle of oil at the bottom of the something-else. They wondered that I didn’t smell it. I did not. And there was a third something, which I’ve now forgotten.

Mike had more questions, for which I had no answers. I don’t speak car, and so confusion abounds.

I’m trained in music, which means I can analyze a Beethoven sonata. But what’s going on in my car — and in my bone marrow — is beyond me. In both cases, I must trust the experts.

Note: Cold Agglutinin Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Cold Agglutinin Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to cold agglutinin disease.