by George Taniwaki

The hematologist is concerned about my low white blood count (WBC) and has scheduled a bone marrow biopsy. A bone marrow biopsy will be invasive and painful, but certainly not as invasive or as painful as kidney donor surgery, which I’m already committed to. There is a possibility of complications, but again, the probabilities are much lower than for the surgery. (Yes, I know that the probabilities are cumulative not comparative.) Plus, I’m a bit intrigued by the opportunity to observe this procedure, though watching it on YouTube may be enough. Also, since the sample is taken from the posterior of the pelvic bone, I won’t actually be able to see my own sample taken.

What is it?

Bone marrow biopsy

Why is it needed?

Check for abnormalities (esp. cancer) in the core blood or bone marrow

How is it done?

A needle is inserted into the pelvic bone to extract a sample of bone marrow and liquid

Preparation None
Test time One hour
Risks

Rarely, can cause bleeding, infection, allergic reaction to medications

Discomfort

You have to pull down your pants. You will be given local anesthetics and oral pain meds, so cannot drive or travel alone after the sample is drawn. Even with meds, the test is rather painful

 

BoneMarrowBiopsyVideo

Bone marrow biopsy (not for the squeamish). Video from csmcd

The transplant coordinator at UWMC puts me in contact with a recent nondirected kidney donor who also had to undergo a bone marrow biopsy. She sent me an email with some excellent advice and ideas of what to expect, which is reproduced below.

“At first I was going to tough it out, just local and it shouldn’t be too bad. I mean, my son was 52 hours of labor with no meds – I managed that, right? But then I was thinking, ‘is there any reason to be in pain when there’s a relatively safe and easy way to not be?’ So I went for Local Plus, a combination of local surface and deep anesthesia plus fentanyl lollipops (really more like a giant Pez on a stick, but that’s what they call them).

“The person who did mine was Dr. Kelly Smith at SCCA. She did a really nice job, listened when I said I could feel what she was doing, gave me more anesthesia, as needed. I probably didn’t need all of the second lollipop, half would have been good, [but] one was not enough. Or maybe half to start, wait and the second half would have worked. I think I had to concentrate on breathing deeply for 2 or 3 minutes during the bone extraction, that’s about it. As it was, I pleasantly felt very little pain and I took a short nap when they were finished before getting up and going home. I did throw up on the way home, I think that was the second half of the second lollipop.

“The only lasting effect was hives from the dressing. My skin is really sensitive and I get hives at the drop of a hat, so I don’t know if you’ll get them too. [I took] lots of Benadryl for a few nights and they went away eventually. My hip was a little achy, but no activity limitations.

“It was nothing like Will Smith in 7 Pounds. Clearly he had no pain relief since he was punishing himself and it was a full on donation, not just a biopsy which is a much smaller extraction. I did find someone who posted [advice] on YouTube, which is how I decided to step up to the Local Plus pain relief.”

****

My bone marrow biopsy is scheduled for the morning. This will be my tenth appointment at UWMC. Actually, it will be at the Seattle Cancer Care Alliance, which is on the fifth floor of UWMC.

Based on the email message I received from the other donor, I’ve decided try to avoid nausea by not eating any solid food for dinner (just soup) the previous night and to not eat any breakfast (just juice) this morning. I will be sedated, so I’ll need to stay home for the rest of the day afterwards, meaning I’ll miss a day of work. (I’m a contractor, so I don’t get paid sick time.) Also because of the sedation, I can’t drive to my appointment. My wife is out-of-town, so a coworker has kindly volunteered to chauffeur me.

SCCA

Welcome to SCCA. Photo by George Taniwaki

The procedure goes smoothly. It starts with the doctor giving me the standard medical history interview. She takes my blood pressure which reads 125/85. That’s really high; it’s normally 110/70. Perhaps I’m a bit anxious.

A nurse then has me suck on a 200µg fentanyl lollipop. Once it is about one-third gone, he asks me to lay on my stomach with pants down. After covering me with a sheet and applying iodine disinfectant, the doctor injects lidocaine in the skin on my upper hip. After a couple of minutes she pushes the skin against my pelvic bone and injects lidocaine on the surface of the bone.

After a few more minutes, she inserts the biopsy needle. She asks me if I feel a dull pain or a sharp pain. My reply is, “Actually, I can’t feel anything.” She starts pushing hard and bores through the bone. I can hear the bone grinding away, but don’t feel anything. She removes the center of the needle, drives the needle deeper and takes a core sample and aspirate (liquid marrow). I feel a bit of a tingling pain, but not much else (and with the fentanyl, I don’t care). And then it is over. I still have some of the fentanyl lollipop left and spit it out. Overall, it wasn’t much worse than a trip to the dentist (except for the pants down thing).

BoneMarrowSamples

Core sample and aspirate. Photo by George Taniwaki

After a rest of about 30 minutes, they let me go. I could probably go to work, but decide it would be better to stay home. I don’t feel any pain for the rest of the day. However, as I lie down in bed for the night, when the needle spot on my hip touches the mattress, I feel intense pain, as if I had just fallen on my hip on an icy sidewalk. I immediately sit up. I have to sleep on my left side. I expect my hip will be sore for the next few days.

It will take a few days to get the test results. Obviously, I hope that I don’t have cancer. But after all this testing, what I really hope is that I can complete my donation scheduled for next Wednesday.

For more information on becoming a kidney donor, see my Kidney donor guide.

[Update1: Today (June 25), I receive a phone call from Elizabeth Kendrick, the transplant nephrologist. The biopsy results are not available yet. There isn’t enough time for a review, so my donor surgery has been postponed. See Jul 7 blog post for more details.]

[Update2: Added summary table.]

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