Bone Marrow Biopsy
 

Hi everyone,

I'm due to have a bone marrow biopsy done at the end of the month with only local anaesthetic. I am really nervous about it, I have not had one for ten years and the last one I had I was only 14 so they put me under general anaesthetic. Can anyone give me any advice on what it will be like as a procedure and what to expect? I'm not sure if I should ask for some sort of sedation or not.

Thanks,
Carolyn

The last two I had were local from two different people. If they are experienced it should not be bad. Try to get something to distract you like an iPod. The last one I had they had a special person to engage me in conversation.

The problem is that you won't know how it's going to be until they are doing it. Some feel nothing while others have a completely different experience. My husband will ask for sedation if he ever needs another one.

I have had many BMB and all at various levels of sedation to wide awake. I ALWAYS ask for sedation now. I won't ever let them do it again without sedation. I would personally just ask for sedation, don't let them talk you out of it, in my experiences some places make you feel guilty for asking for sedation for BMB. But are they going through it? No, they aren't, and why go through the nerves and be all anxious when you can go in with a peace of mind because you know you will be asleep!

Laura

Some people feel more pain than others and I don't know if that's because of the choice of painkillers, the skill of the surgeon, the thickness of a patient's bone, or an individual's pain threshold.

After a number of bone marrow biopsies, my wife and I learned an important lesson: always ask for conscious sedation for bone marrow biopsies. With conscious sedation they use a drug like propofol (alias Diprivan) to knock you out just enough for the procedure. This method requires an anesthesiologist so it's more trouble to schedule but it avoids the pain and the anticipation of pain. I don't know for sure, but maybe having a properly sedated patient will help the doctor get a better biopsy sample since the patient isn't tensing muscles or "fighting back" during the procedure.

Being anesthetized carries a small risk so it's an individual decision (assuming you have the choice). In our case, it was definitely worth it.

Only some treatment centers offer conscious sedation and only some insurance plans cover it, but I would take the trouble to find out, and then tell them what you want. I recently asked a doctor if conscious sedation is available for bone marrow biopsies at his treatment center. He said it is but only if you know to ask for it.

I think this is an area where pain management and anxiety management should be taken more seriously by treatment centers. Under they do, I recommend that patients be their own advocate and let their treatment centers know they want this option to be available, for them and for other patients.

Another perspective
 

Hi Carolyn,

I just get Lidocaine (a local anesthetic) for my BMB's. I think they bother the doctor more than they bother me. My pain tolerance is probably higher than average. For me, it feels a little uncomfortable when he injects the anesthetic. I'll SCREAM for about 1 second while he takes a core sample, and about 2 seconds while he does the aspirate (the most painful part). But that's it. It's over quick. I'll take a BMB over major dental work any day!

Thanks
 

Thanks everyone, you've given me some food for thought! at the moment i think i'm going to ask for some kind of conscious sedation...i'll see how that goes.

Thanks again,

Carolyn

I just had my Day 100 BMB yesterday, I think it's my 7th or 8th one now (not counting the couple I had as a kid). I'm one of those people who REALLY finds them painful. I get anxious, stressed, and really upset before them, and I consider them to be pretty much the pinnacle of pain.

But I don't get sedation. I had it once - they told me it would give me amnesia and I'd forget everything that happened and it would be less painful. But all it did was make me feel worse beforehand because I wasn't allowed to eat, so I was lightheaded and woozy on top of the usual stress and anxiety. And I had zero amnesia - the procedure was just as bad as it was without sedation, only I was forced to stay at the hospital for two hours afterwards instead of being able to go home right away and crawl under the duvet with a cup of tea like I wanted to.

But the absolute worst thing about sedation is that they wouldn't allow my fiance to be in the room with me, to hold my hand, pat my head, and - most importantly - talk to me continuously throughout the entire procedure to distract me. I cannot stress enough how much having him there helps me through it!

So for me, I just don't think sedation is worth the extra hassle, even though BMBs are absolutely the worst procedures ever IMHO.

(and Carolyn - Kings do not do the sort of anaesthetics Neil is talking about that require an anaesthesiologist. The only sedation they offer is the "amnesia" one that didn't work for me, though others seem to opt for it)

I called Kings today to find out if I could have some sort of sedation for my BMB and they said no because they can only sedate 2 people per day and there are already two having the sedation next Tuesday , so it looks like I'll just have to be tough and deal with the pain,my husband has taken the day off so at least he'll be there to hold my hand!
Thanks everyone for all your advice,

Carolyn

BMB
 

Carolyn,
I'm hoping that you will be among one of the many patients for which the procedure is not extremely painful. Everybody is different and I think it depends on everybody's individual tolerance for pain and also somewhat on your individual bone marrow and whether your doctor is good at it. But just to reassure you , I too , was extremely anxious about my first bone marrow. The anticipation I think was worse than the procedure itself which lasts less than 15 minutes. I took a Valium the night before and the morning of the procedure and I think this helped me relax a lot more. It was not as bad as I was anticipating. It feels somewhat like a steady pressure in the bone with occasional twinges of pain when they aspirate and when they get the bone core biopsy. It doesn't lasts long. Good luck. tytd

Hi, I've had BMB done with and without sedation. Sure, with the sedation it's a breeze but without sedation it's not that bad either. I have very tough bone and the doctors always comment on the difficulty in doing the procedure, they also have trouble doing an aspiration so that takes a bit more fiddling than normal.

I find that just when you're starting to think "ouch" it's over. I also find that mentally going to my favorite place is very relaxing. I imagine myself lying on the grass under a weeping willow tree by a rippling stream. From there I add little bits in. e.g. an ant biting me, what kind of bird can I hear in the next tree, what can I see in the shape of the cloud going over etc. This is very distracting and next thing you know, it's all over.

Give it a go, it works for me.

Best of luck.

Chirley

I agree, I hope you are one of the people that it isn't bad. In my case, I know I have a high pain tolerance. I have broken my femur and had two spinal taps along with some other injuries from the horses........those were all easy compared to BMB's (had 6 in 1 1/2 yrs). BUT my doctor believes that I have very hard bones, therefore what I experience is typcially worse than the norm. They don't knock me out, but they have come up with a cocktail for me that makes it more tolerable.

I have met people who are not bothered by a BMB in the least and others not so lucky.

Good luck,

Lynn

Biopsy
 

I have had two - the first one they Dr. hit a nerve, so it was tender for about 4 days after. The second I felt no pain at all after. I did do conscious sedation for both, and would recommend it.

I've had two BMBs and was extremely nervous about the first, expecting a lot of pain and trauma. However, I had no real difficulty with either. They numbed me with a liberal amount of Lidocaine beforehand in each case but no other sedative or anaesthesia. During the biopsy itself, I felt uncomfortable pressure and felt like the muscles in my back were about to cramp from the tension but I was okay. It was over quickly with no lingering pain, even after the Lidocaine wore off. I have my third coming up soon and continue to be nervous because of the horror stories I've heard from others.

BMB
 

Hi Karen,
You know if you have myelofibrosis as I have the doctor can't aspirate bone marrow. It is the aspiration that hurts. I have had 4 BMBs without any pain at all because of my severe fibrosis.
Kind regards
Birgitta-A

I find them uncomfortable but really not that bad. The freezing helps a lot. I am 45 and my bones aren't really hard. I have one upcoming on Thursday. 18 yrs ago I had about 8 done, before they used disposable needles (!) Now THEY were painful, because the needles got blunt, and I've had morphine/valium and they still hurt. Now that they use disposable needles, they are sharper and hurt WAY less.

Deb

I have myelofibrosis too Grade 3/4 and every BMB I have had has been extremely painful. I have had various injuries over the years and never considered myself to be a wimp until the BMB. Luckily my doc gives me a bunch of meds before them, now it isn't as bad although still very painful.