This test measures the numbers of plasma cells in the bone marrow and once diagnosed you may end up having quite a few. To date I’ve had 5 over a year! I didn’t want to reinvent the wheel so I’ve looked for patient info leaflets and thought the Royal Free Hospital’s one was as good as any. See links section – go to their home page and just search for bone marrow biopsy.
Different hospitals have different procedures with this test. I have discovered that although mine used to offer no pain relief as standard apart from local anaesthetic, it does now and most hospitals offer sedation or gas and air as routine. If you are really worried I guess you could ask for pain relief even if they don’t offer it. Having talked to my consultant, she said some people don’t really find it painful and others do – this possibly depends on your reaction to pain, but also I’ve discovered that it feels a bit different every time. Sometimes they struggle a bit to get a good sample and so that may prolong things. But on the whole it’s not really that bad and it’s over pretty quickly – just a bit ouchy in a few short bursts. I think I have been lucky. Gas and air makes me feel sick, so I just go without.
The actual procedure goes like this (from the Royal Free description)
- The bone marrow will be taken from the back of your hip bone. This is very safe.
- You will be asked to lie on your side with your knees tucked into your chest.
- The area will be cleaned and local anaesthetic injected into the skin and surface of the bone. Local anaesthetic takes away the pain, however you may feel some mild discomfort (a light pressure or pushing sensation). A syringe is attached to the needle and a sample of bone marrow sucked into the syringe. This part can be painful for a few seconds, as the local anaesthetic cannot be injected into the bone cavity.
- It is also necessary to obtain a ‘trephine biopsy’. This is the removal of a tiny core of marrow. You experience further slight discomfort as the sample is obtained using a ‘screwing action. This sample allows for further important diagnostic examination.
- Once the procedure is completed a small dressing is placed over the site and pressure applied to prevent bruising.
Me again. That all sounds very simple and probably less painful than it is, but it does take a little while (possibly 10/15 mins actual procedure on average?) to do. Really you get little bits of pain, bits of pushing and pulling and resting bits where the doctor is smearing samples on slides etc. They put quite a bit of local anaesthetic in which is a bit scratchy, but they can’t anaethetise the actual bone cavity . Then you get strange pushing sensations and sometimes as the needle goes into the cavity it jolts a bit which is slightly startling (like DIY drilling when the drill gets through to the other side). You can get strange feelings down your leg. There is a short bit of pain as they withdraw the fluids, which they then smear onto slides. I find the core sample a bit trickier as they have to push to get it and you have to brace against it – which is counter-intuitive as it hurts a bit just for a few seconds. You should have a nurse in with you and they can help to brace you. I find breathing deeply can really help. And then they just pull it out and it’s over!
If you’re not squeamish, ask to see the samples and the little core – it’s interesting to see them!
Afterwards, if they are a good hospital, they should offer you a cup of tea and a rest for 30 mins! You might feel a bit shaky. I usually feel sore at the site for a few days afterwards, but nothing major. The scars are still there – just very small ones. I have three on one hip and now I’m getting them to do the other side.
One tip – if they use iodine – don’t wear light underwear!
Update. I recently had another bone marrow and they had a lot of difficulty getting a sample. I ended up having to turn over to try the other side, which after a major episode of pushing and pulling managed to provide a core sample. Given that other people seem to sometimes have this problem I did ask about the reason. What I was told was that firstly the Zometa may have hardened up my bones quite a bit. Secondly I think that the myeloma can thicken the bone marrow and makes you ‘dry’. Whether these are the explanations, or there are others, I don’t know. Apparently if there are major problems they can extract from other areas such as the sternum – though I guess that may be tricky. They don’t like doing them.
The other good thing was that although the last bone marrow was quite a trial and I was really sore and stiff after for days, the actual procedure seemed less painful. They seem to be injecting more anaesthetic into the bone at the start – there are nerves running along it apparently. Maybe it was my imagination, but it seemed better than before. This isn’t very technical, so don’t take my word for it!!