The bone marrow biopsy. What a dilemma. This is what could be considered the most physically painful experience in Leukaemia treatment.
The bone marrow biopsy is done by a haematological (blood) doctor to determine how many cancer cells there are in the bone marrow. Cancer cells are very sneaky because they don't show their true colors in the blood. They all live in the marrow and they stay there. The only evidence of Leukaemia is because of low blood counts and an increased amount of immature white blood cells.
Why do white cells multiply when Leukaemia kills blood cells? I'm glad you asked. Leukaemia somehow tricks the white cells in leaving the marrow while they are still immature. Therefore, they cannot fight infections, hence, you develop fevers, etc.. It's like telling a 4 year old boy to teach college. The reason the white cells increase so much is that they know there is infection in the blood but they cannot kill it.
The following is a very graphic portrayal of a bone marrow biopsy. Do not go any further if you are sensitive to graphic detail.
The biopsy can be a very difficult process. The procedure is as follows:
The doctor swabs the back of the hip bone above one of the cheeks with alcohol.
Next, he inserts a needle that contains the local anaesthetic to deaden the pain.
He waits for about 2 minutes and starts to tap on the part with the anaesthetic to see if the patient can feel it. The doctor asks if it is noticeable, if not, he proceeds.
Next, he makes a small incision with a scalpel to make an opening for the marrow extracting needle to go into. This is still painless.
Then comes the big fella. The marrow extracting needle is about 6 inches long with a hard, plastic, unscrewable T handle on the end of it. The doctor lines this up in the hole and starts to push it into the bone. Now this is all fine on the outside of the bone, but when he gets inside, that's when it starts to hurt. Bone is covered on the outside and the inside with a very thin membrane. This mebrane is full of nerves. The anaesthetic works on the outside part of the bone, but there is no way to anaesthitise the inside. The feeling is something like going to the dentist without anaesthetic. Once he has pushed the needle in, he unscrews the T handle and screws on a plunger so as to suck out the marrow. Marrow is very thick and it takes a little time to get enough of it.
This procedure lasts for approximately 20 minutes. It goes this long because the doctor has to get enough marrow to cover 8 slides. Once it has finished, he simply puts a band aid on the cut and you are forced to lie on your back for about 1 hour to stop any marrow from leaking out of the hole the doctor made.
The very first biopsy a Leukaemia patient gets is the toughest because the doctor has to pull off a piece of bone out of the back of the hip. THIS IS NOT PLEASANT!!! Sometimes it is done from the sternum which is located right in the centre of the chest. When the doctor chips off the piece of bone, it actually feels like an asteroid hits you there and you can feel the crater forming. This is done to check the consistency of the bone.
Now, for all you people wondering why they don't put you to sleep for this, it's because general anaesthetic is a very strong anaesthetic and a marrow biopsy is not a major operation. But, there is a wonderful drug called Medazzalam. This does not put you to sleep but arrests your short term memory totally for about 3 hours. What this means is that the patient feels everything but the mind is not really there. Once it wears off, you begin to wonder if the doctor has even started. But this is not a sleep agent. You are conscious throughout the entire procedure, but you have no memory of it when the drug wears off and you have no conscious control of what you say. A few swear words came out of my mouth, I can assure you. When I came out of it, the nurses told me what I had said with 7 other patients in the same room. It is a totally safe drug with no long term side effects. The only short term side effect is short term memory loss and the occassional bit of swearing while they do the procedure.
Of course, it is best to perform this procedure without any kind of drugs because the doctor can lose concentration with possible false statements the patient may make while under the influence of this drug.
And the feeling of this drug is truly amazing. As soon as it gets injected, it feels wonderful. It affects the brain and makes you feel all drowsy and funky. As if you have been spinning around for 5 minutes but you don't feel sick. You just feel really comfortable. It's very hard to explain but that is the best I can do.
The marrow biopsy is necessary because it tells the doctor everything about what you have. There are different treatments for different Leukaemia's. Lymphatic Leukaemia for example, requires regular lumbar punctures, (injections in the spinal cord and fluid extraction with chemo injection. Yes, the spinal chord has a clear fluid running through the middle of it. This lubricates the brain). That is not a pretty sight. I haven't had one done to me but I have seen one done and it looks very painful.
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