Saturday, January 05, 2008

Bone Marrow Biopsies, Step By Step

Hey, everyone. My bone marrow biopsy—which helps determine how effective chemo was—happens Monday, and there's been some concern over the procedure. As I've already been through two of them, I thought I'd explain how they work and how they weren't really painful.

Getting at bone marrow is pretty straightforward: the doctor gets a long needle and drills it into your bone until it breaks through to the marrow within.

The procedure can be done on a hospital bed. My first one went into the iliac bone, so I lay in a semi-fetal position on my left side. The doctor administers a local anaesthetic, then inserts the needle. Once the needle hits the bone, the doctor starts turning it like a screw so it can drill in. (Paraphrased conversation—doc, clearly making an effort: "You have really strong bones." Me: "It was you guys that told me to drink my milk from when I was a kid. So I did. Now you give me grief?") Once it breaks through the draining proceeds; the needle is extracted; and a bandage applied.

Sounds painful, right? The thing is, there are no nerve endings involved in most of this process. The few that are are deadened by the anaesthetic.

But here's the thing: the nerves of the surrounding tissue do a great job of conveying the sensation of the needle passing through your flesh, the screwing motion, and the resistance your bone puts up. It doesn't hurt, but you know what's going on. For example, I didn't know the needle was going to be screwed in until I felt it.

The real danger is a psychological one—if you start freaking out because you realize someone's drilling into your body and into your bone, you'll likely tense up and start to experience pain because your mind expects it, not because there actually is any.

When I had my first bone marrow biopsy, the nurse's ID card was at my eye level, so I distracted myself by factoring the five-digit part of her ID number in my head. When she had to go assist the doctor (those hard bones!) I started thinking about a great family outing to the beach in Jamaica in the summer of 2002. When the doctor applied the bandage (commenting, "You are a most patient patient") I was surprised that it was over. Knowing how easy it was, I spent part of the second biopsy talking about the book I was reading, and started to nod off after that.

So, honestly, the worst part of the biopsy is afterward; the entry point stays sore for almost a week after.

And that's it for now.



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