Diagnosing Multiple Myeloma: What Is a Bone Marrow Biopsy and Does It Hurt?
BY LIZZY SMITH What is a bone marrow biopsy and does it hurt? I am not going to sugarcoat... A bone marrow biopsy is not like a day at the spa. That said, it isn't the most painful thing I've ever endured either. I think I can speak with authority since just this morning, I had my seventh biopsy since diagnosis in January 2012, and I haven't yet had anything more powerful than topical lidocaine. What is a bone marrow biopsy? From the Mayo Clinic:
Bone marrow biopsy and bone marrow aspiration are procedures to collect and examine bone marrow — the spongy tissue inside some of your larger bones. Bone marrow biopsy and aspiration can show whether your bone marrow is healthy and making normal amounts of blood cells. Doctors use these procedures to diagnose and monitor blood and marrow diseases, including some cancers, as well as fevers of unknown origin. Bone marrow has a fluid portion and a more solid portion. In bone marrow biopsy, your doctor uses a needle to withdraw a sample of the solid portion. In bone marrow aspiration, a needle is used to withdraw a sample of the fluid portion. Bone marrow biopsy and bone marrow aspiration are often done at the same time. Together, these procedures may be called a bone marrow exam.
Bone marrow biopsies are typically done in your oncologist's office or even in a hospital setting. The procedure goes like this: 1. You show up at your appointment time. If you request a local anesthetic or conscious sedation, discuss this with your doctor prior so if there are food and water restrictions prior to the procedure, you know beforehand. You may also ask for anti-anxiety medication or something else to relax you. Personally, I prefer to go cold-turkey because I want the rest of the day to myself-- I don't want to feel tired and groggy. But the choice is yours. 2. You lie down on the bed face down, sort of like getting massage, except not really. I don't change clothes or even take off my shoes, the Physician's Assistant who does the procedure simply lifts up my top and tugs down my pants enough to have full access to my back pelvic area. I usually ask for warm blankets because that relaxes me more. 3. My PA cleans off my skin and injects lidocaine (a topical numbing medication) into the area and the surface of my bone. A special needle is inserted into the bone. The needle has a tube attached to it, which creates suction. A small sample of bone marrow fluid flows into the tube. This is the part that hurts (if you're awake, like me). It feels like a reverberating electrical shock in your entire back and pelvic area. But... it lasts just a VERY LONG second or two. This is done perhaps three times to get enough sample. Each time, I want to scream but by the time I'm ready, it's over. The needle is then removed. 4. Pressure and a bandage is applied to the skin. I am told that, while I can shower immediately, no bathing or swimming for 48 hours. Watch for bleeding through the bandage or unnecessary pain because infection is possible (though not highly likely). 5. The bone marrow samples are then sent to a lab to be examined. This will let your doctor know how many myeloma cells are lurking in your bone marrow. The first time I got a bone marrow biopsy, I had no idea what it was or that I would be getting one at all. The doctor gave me my diagnosis: "You have multiple myeloma. But there are so many treatments available, that you'll be around for a long time." (Relief! In an odd way when you're are just told you have cancer.) Then "We need to get a bone marrow biopsy really quick." (Oh my gosh what is happening to me!) The second time I got a biopsy, just a month later, I almost had a panic attack. I knew what it entailed and I was petrified. My PA talked me into going without sedation so it wouldn't ruin the rest of my day. She was nice and talked me through the whole thing. She was terrific and I did it! These days, you need another biopsy? Fine. I don't even think about it until I'm on the table. And then I concentrate on other parts of my body that aren't being touched. It helps. Today, I complained because they put me in a different room and I hated the table. But I treated myself to new shoes afterwards so, hey, that was kind of cool. Plus my dad drove me to my procedure so we had time for some daddy-daughter time in the car, chatting and catching up. Right now, the site is a bit sore, the numbness is wearing off, but it's all good. Not to say that others don't have a tougher go of it. If you think this might be you, it's ok to get sedation. I just talked to my partner of this Myeloma Crowd site, Jenny Ahlstrom, and she gets sedation. It's all good, no excuses to anyone for the choice you make. Wow, I can't believe I just wrote an article where parts of it are talking about the positives of my bone marrow biopsy. This myeloma journey is an odd one. I can find good in a biopsy? Ok, well, then I will.