Bone Marrow Biopsy

I've been getting e-mails asking to describe the bone marrow biopsy I had this afternoon, so I thought that I would elaborate now that I am out of my drug-induced stupor.

The bone-marrow biopsy is the most useful test for determining presence of amyloid in a person. By obtaining a sample of the bone marrow, doctors can accurately ascertain whether a person has amyloidosis, as well as how far it has progressed in the marrow. It is performed at your first pre-admittance evaluation, then performed at your six-month evaluation. The biopsy at the six-month evaluation is the first real indicator used by doctors to determine whether a person is in "complete remission". I may be able to tell you this information about me as early as tomorrow.

Although the procedure is quite invasive, it is rather routine, and can be causally performed in a doctor's office. Usually there are two medical staff in the procedure, one typically in a learning capacity. Before the procedure you can take a relaxation drug (Ativan is my tonic of choice), which will make things go smoother.

You pull down your pants a bit to reveal the rear of your pelvis, and lay down facing away from the doctors in the fetal position. This is actually quite convenient, as after the procedure is done you probably will want to be wrapped up in a ball.

The doctor then gives you a local anesthetic, which helps when they shove the big needle through your skin and muscle. Note that this shot doesn't numb any feeling when the needle breaks into your bone, so I feel that this shot is given out of pity.

Once the doctor "numbs" you up, he non-chalantly pushes the needle to your bone (to find it). You relax a bit, as this part doesn't hurt too bad. I try to think happy thoughts. Lots of light, fluffy happy thoughts and all is peaceful. Exhale....

Then the doctor jams the needle into the center of your bone. I can't relay the pain that is caused from this action, but I would probably compare it to how it would feel to cut your arm off with a bottle of alcohol and a hacksaw. It is a deep, very sharp pain that sends quivers of pain down your legs. I can imagine that a person could pass out if they went through a number of repeated attempts.

But wait, there's more. Once the needle is in fully, and you are swearing at a top of your lungs, he removes the top of the needle, jiggles the needle that is stuck in your bone to extract marrow from the bone. It is an amazing experience, mostly because that just when you didn't think the pain could get any worse, it does. While this is happening, the staff have a causal chat with each other if they are in a good place and are ready to extract a sample. And you are like, "TAKE THE G*DDAMN F***ING THING OUT OF ME YOU M*****F**KER!!!" After a minute of this, while grimacing in pain and trying not to pass out, they will decide to do the extraction of the needle to determine whether they were able to get a good sample. And then the needle is out, and silence as they examine the sample to see if it is good. And you are praying to whatever God you believe in hoping that they got what they needed and they don't have to do it again.

Usually they will say "well we got a small sample, but to be safe we're going to go in one more time just to be sure. Is this ok with you?"

It is important to note that should you be in this situation, I do not advocate aggressive violence against the doctor performing the procedure. Instead, I recommend that you laugh nervously and resume the fetal position. You'll be wrapped up there for a while.

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It was not bad today. They got what they wanted after 2 attempts, which is average. They place a bandage over the wound, and send you on your way. I am on Tylenol to deal with the pain, which is moderate, and expect the wound to be healed in a day or two.