The bone marrow biopsy experience

Last week I had my after-chemo PET scan done. The hope for that scan was that I would get the news that all the active cancer had been kicked out of my body. Unfortunately there was a spot still lit up on the PET scan. Specifically my left illiac, the upper wing of the pelvis, lit up with possible cancer. Due to this spot my oncologist wanted to do a bone marrow biopsy in orderto find out if this is in fact active cancer, or is something else. In this post I will share my bone marrow biopsy experience.

Just as with any surgery, I started the day by not eating or drinking anything after midnight the night prior. I really didn’t have a problem doing this. The only reason I mention this is because my well-meaning wife decided to skip breakfast as well so she wouldn’t be eating in front of me. This of course made her very hungry later on in the day and I fear her blood sugar may have gotten too low. The stress of my going through this probably didn’t help her disposition either. Hopefully in the future I will be able to talk her into eating breakfast when/if I go through something like this again. Oops, I’m off topic already; back to this post…

The plan

Before the procedure I was able to meet with the oncologist. She explained what would be done. There was actually two possible plans for getting the bone marrow biopsy samples. The first plan was for her to do the procedure and taking a bone marrow biopsy and a bone marrow aspiration. Here is what the Mayo website has to say about these two procedures:

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.

My oncologist went on to explain she would be doing this with a needle to punch through the outer layer of the bone in order to get these samples. She would apply a local anesthesia. This procedure was not expected to take very long.

The backup plan

In the event my oncologist was not able to get a sample of bone marrow there was a backup plan. The imaging doctor would be on standby and perform the bone marrow biopsy in the CT scan room. If this were to happen he would also grab a sample of bone along with the two types of bone marrow samples. Spoiler alert, the plan B option does happen. I remember wondering how a procedure could be done by CT scan since there is so little room in the CT machine for me, much less room for someone trying to do a procedure on me. I find out later.

My port worked!

During the last couple rounds of chemo my port only worked in one direction. The port would allow liquid into my body, but would not allow blood to be drawn. A catheter retraction was the root cause of this. When the nurse accessed my port for this procedure she was able to get a good blood draw. It was the hopes of the surgeon that the port catheter would straighten itself out; and it appears that actually happened. Hopefully I won’t have any more port issues going forward! Oops, off topic again…

The first attempt at a bone marrow biopsy

I was wheeled into the procedure room. After getting everything set up and hooking me up to monitoring machines I was told it was time for the procedure. First the oncologist would apply a local anesthesia where she would be performing the biopsy. I was warned this would feel similar to when a dentist applies a local anesthesia with a needle. She is right that the experience is similar feeling, but there was no initial pain like there is when the dentist does it in the mouth. That was one pleasant surprise!

The oncologist then went on to perform the biopsy. I should mention I was laying on my right side with my knees as close to my chest as possible. While this fetal-like position was quite uncomfortable, it gave the oncologist the clearest possible access to my pelvis. The procedure room tech warned me I would feel some “pressure” when the needle was put in. If the pressure became too much, or if that pressure turned into pain, I was told more local anesthesia could be applied. When the oncologist actually put the needle into me I really didn’t feel anything at first. I felt kind of a light and sharp pressure just as I had been warned about. Then the major pressure occurred.

As she was trying to punch through the bone the pressure turned into extreme pain. Of course I didn’t come out and say it like that. Instead I just said “ow, I feel a lot of pressure”. The oncologist backed off and gave me more local anesthesia. She tried two more times to punch through the outer layer of the bone. Each time the pressure/pain got worse. She tried one more time with a different size of needle. This final attempt gave me one of the most extreme pains I remember feeling. Again I didn’t actually come out and say how badly it hurt in plain language. Instead I just loudly said “ow, I am feeling MAJOR pressure!”. At the same time there were tears coming out of the corner of my eyes. The oncologist and tech in the room determined I was actually in a lot of pain from this procedure.

I can’t remember if it was the procedure tech or the oncologist, but one of them mentioned that this procedure is not normally done on someone as young as myself. It felt kind of good being called young at age 45. Normally it is much older patients having a bone marrow biopsy done in this manner. Apparently the outer layer of the bone gets much softer as we get older and much easier to punch through with a needle. The oncologist apologized for the pain she had caused me. All I said was “no worries, it is what it is”.

Looking back I think this procedure must have been pretty bloody. The oncologist apologized to the procedure room tech for the mess she had made and later on my wife saw a lot of blood on me and my gown. This blood had caused my wife quite a bit of anxiety. I think all I said to my wife was something like “no worries, it’s only blood”.

Time to implement Plan B

Sine the original bone marrow biopsy didn’t work, plan B had to implemented. After about a half hour I was wheeled down to the CT scan room. Here I was rolled onto the CT scan table/bed and once again hooked up to machines. During this procedure I had to lay on my stomach the whole time. Looking back I think my only complaint about the plan B is my having to lay on my stomach the whole time. I am a large person and it is very uncomfortable to lay on my stomach for any amount of time, especially for the hour this ended up taking.

Once the staff started taking pictures of the area I was told not to move if at all possible. They especially didn’t want me to move my hip at all. That small instruction became harder as time went on… It seemed to take forever for anything to happen after they took the images. As time when on the pain in my back from being in this position got worse.

After about 20 or 30 minutes the imaging doctor visited me. He apologized for taking so long. The problem they were having is trying to determine just where to take the biopsy sample. The CT scan was not showing any signs of lesions or anything to match up with what the PET scan showed. They had spent the last twenty minutes planning out just where to take the bone marrow sample and the best path to take. At this point I really didn’t care about all these details, I just wanted the whole ordeal done. Looking back I realize I should have been more happy to hear there was no sign of anything in the CT scan, it may be a sign that no active cancer is actually present in my pelvis.

During this procedure the imaging doctor used a local anesthesia as the first procedure had. But he also had me lightly sedated as well. I was not put to sleep, but I was definitely feeling light-headed. When the imaging doctor started the procedure all I felt was a light pressure, there was no pain at all. This was definitely much better than how Plan A went! To ensure the needle was going to the right location the imaging doctor constantly had the tech put me back into the CT machine to take an image. I would then be taken right out and he would continue the procedure. Earlier I had wondered how the doctor could perform a procedure with the in the machine, and I now had that answer. I remember thinking I felt like the bird in the coo-coo clock constantly going in and out of the machine.

At one point I heard the imaging doctor ask for a hammer. Someone in the room then inquired whether he wanted the big or small hammer. The doctor said the small hammer would be sufficient. In retrospect I wondered what the two different hammers looked like. This all happened behind my back so I was unable to see what was going on. It was a weird feeling when the doctor started to use the hammer to break through my bone. It didn’t actually hurt at all. I could just feel a weird vibration going through my bones. And of course I could also hear him hammering. My bones must in much better shape than I though they were since it actually seem to take him a while to break through.

After breaking through the bone I remember going in an out of the CT machine quite a few times. I think this was done so he could get samples in various places within my pelvis. Other than the discomfort from being on my stomach, I don’t remember any pain during this part of the biopsy. After the procedure was done I remember the doctor pressing hard against my back where he had just put a bandage. He told me I had to lay down on my back for three hours before I could go home. At that point I was looking forward to getting off my stomach and was looking forward to laying on my back!

Recovery

Finally I was able to go back to the recovery room. I was so happy to be wheeled back on the bed, since it meant I was once again on my back instead of laying on my stomach. Shortly after arriving my wife was brought into the room. She looked like she had been through more than I had. It is easy to forget that these procedures can be emotionally taxing on loved ones who are waiting what feels like forever as the procedure goes on. And in my case the first procedure had problems and I had to go on to plan B. That whole time she had to sit there wondering what went wrong and why this whole thing was taking so long. I think it took over two and a half hours for me to get through both procedures, an eternity to someone sitting in the waiting room.

Recovery itself went pretty easy. I did eat a small cheeseburger. The nurse offered multiple times to order other food. But honestly eating while laying flat on my back is hard enough and I really didn’t want to eat more until I got out of the hospital. After three hours I was getting kind of tired of being on back, but I just kept in mind this was much better than laying on my back!

When I finally was able to get up the nurse and my wife looked at the dressing. Apparently the area is quite bruised and there is a large blister just under one corner of the bandage. The nurse said to watch that blister when the dressing is removed, as it may come open. There wasn’t a lot of blood in the bandage. But it was apparent to the nurse and my wife that multiple wound sites existed under the bandage.

After getting the normal discharge instructions I was finally free to go. We had been there from 9:30 am to 4:00 pm. A very long day! One I hope not to repeat any time soon.

Now it is time to wait again

During recovery the oncologist had come by to speak with me and apologize for the first procedure not working. I again just said “no worries, it was what it was”. She said it would likely take a week for all the biopsy results to come in and she would see me next Wednesday. The samples would be sent to the lab in Sioux Falls. She also noted some of the samples would go to Mayo Clinic. It was her hope that no active cancer would be found in the samples. It is possible the PET scan showed extra activity in my pelvis because it was recovering from chemo. In researching PET scans I have found it is quite common to get false positives for a variety of reasons. She also reiterated the fact that the PET scan showed no activity in the rest of my body. If this biopsy comes back good I am free of any actual active cancer. Now I just have to wait a week to find out the biopsy results!

Getting the port installed in my chest

21810462Yesterday I blogged about learning just how widespread my lymphoma cancer was. My body seemed to look like a fireworks display in the PET scan. Due to the widespread nature of the cancer and other factors it was decided it would start chemo soon. As I continue documenting my cancer experience it is time to write about getting a port installed in my chest to facilitate chemo.

Wednesday, September 5, was the day I had a PET scan performed and was able to see the fireworks. The oncologist said a surgeon would be calling me soon to hopefully get a port installed in my chest on Friday. She explained the port would allow the chemo drugs to go directly into a major vein. If that is installed and if insurance pre-approves the chemo drugs she hoped to start my treatments the next Monday.

On Thursday I got a call from the clinic to set up a consultation appointment with a surgeon late Friday morning. I took the fact that this was a consultation appointment to mean that I would not likely get the port installed on Friday. This kind of annoyed me. But then I should mention at this point everything was annoying me; and my family can probably attest to that fact. My breathing had continued to deteriorate. Even simple things as getting out of a chair or walking across a room were leaving me breathless. The inhalers I had been using to improve my breathing were basically useless at this point.

On Friday morning, prior to my appointment with the surgeon, my oncologist called to ask how I was doing and the status of my port. I let her know I had an appointment later that morning. She said she would work with the surgeon to come up with a plan. Part of me was annoyed she didn’t know the current status; but another part of me was happy with the fact a doctor was calling me instead of having a staff member do it.

The consultation with the surgeon went very well. He is a very likable guy and I could relate with him right away. One thing he did that nobody had done to that point was ask my wife and I “has it hit you yet?” We had to admit it really hadn’t. It seemed everything was going so fast.

During the appointment, the surgeon took the time to explain to me what exactly a port is and why it was important to be installed. Since the chemo drugs have to be injected into the bloodstream intravenously he explained a port makes the whole treatment process go smoother. Receiving chemo drugs the traditional method is very rough on the veins in the arms. As each treatment passes it may be harder for staff to get a good vein.

In order to facilitate the chemo treatment process a port can be surgically installed into the chest, the surgeon explained. What he planned to do was perform a surgery from the front of my shoulder (I believe he said left at the time, I could be remembering wrong.) He would insert a catheter into a vein in my shoulder, which would run to a small device inserted just under the skin in my chest. He would use his finger to actually create a small cavity the port could rest in. When the procedure was complete I would be able to receive injections (or even blood draws) by putting a special needle through my skin into the port. Since the port was always connected to a vein it mean oncology staff wouldn’t have to fight with find a vein every time I had chemo. He showed the type of port he would be installing, it was about the size of a quarter. The type of port I had installed can be viewed on this website.

After explaining the process the surgeon answered all of the question that my wife and I had. Actually he made sure this was something I wanted before proceeding. The he said he will work to figure out when the surgery could be done. Usually he does surgeries on Tuesday, but he understood from talking to the oncologist that we wanted the port on Monday. The surgeon let me know him and his staff would figure out a way to get the port installed on Monday morning and that I would get a call in the afternoon.

That afternoon I did get a call from the hospital to set up the appointment for my surgery early Monday morning. They were able to schedule an operating room with a bit of shuffling. As with most surgeries I was told to fast the morning of the surgery. I was also told not to take any ibuprofen that weekend. It is good that was mentioned. I’ve never really had a lot of surgeries before and I had no idea that ibuprofen is a blood thinner. My back aches so much that taking ibuprofen is almost second nature to me by this point.

The night before the procedure I remember looking forward to getting surgery. I didn’t care about the port at this point. Really all I wanted was to be knocked out so I didn’t have to worry about my breathing problems anymore. By this time I was getting very little sleep and any amount of activity, including talking, would leave me breathless.

In the morning my wife took me to the hospital and I went through the normal check-in process. Before surgery I remember speaking briefly with the surgeon. I also remember being wheeled into the operating room and the surgeon joking around with the OR staff using a quote from The Waterboy (I love that movie). That is the last thing I remember from before the surgery. Those knockout drugs are amazing!

When I woke up I remember speaking to my wife about the procedure. She had been worried during the surgery because it took a lot longer than had been planned. The surgeon had run into multiple problems. He first tried to connect to a vein in one of my shoulders. But there were so many lymph nodes and they were so rock hard that he could not get a clear path. He tried to access a vein from the other shoulder and he ran into the same problem. The front of my two shoulders show the multiple attempts me made to find a vein. It looks like a little mine field had exploded.

Since the surgeon was unable to access a vein from my shoulder he had to access a vein in my neck. The port was installed on my right chest and the catheter runs under my skin to about half way up my neck. The catheter was then surgically installed into a vein running through my neck. The path of the tube can be seen since it is just under my skin. He also said the port is not inserted as deeply as he usually likes due to the problems he ran into. When looking at my chest there is a lump that is actually caused by the port. But even with the problems the port was installed and was ready for use.

After the surgery my wife said the surgeon and the oncologist met with her for about a half hour. They talked about the procedure and what would happen going forward. I really appreciate the fact both doctors took time to speak with her and keep her informed. It was then my wife found out chemo might not happen that day since the insurance had yet to pre-approve all of the chemo drugs. But that is a story for the next post.

At discharge I was given a prescription for some of the good painkillers, which I only used for a day. I really don’t like the way those painkiller make me feel so I use them only as necessary. I was also told not to lift anything for a few days and to take it easy.  Since I still had my  breathing problems I found it unlikely I would have the urge to do anything stupid like lift heavy objects.

I’ll end this part of my cancer documentation here. In this post I blogged about meeting the surgeon and getting a port installed in my chest. I’m thankful I had a surgeon that was good enough to deal with unexpected barriers and come up with alternatives in order to get my port installed. In the next post I will blog about my chemo experience, which I was starting to get nervous about.