The Bone Marrow Biopsy

The bone marrow biopsy hurt like a bitch (pardon my language but there is no other word emphatic enough to describe it). The nurse took me into an exam room where a biopsy kit was laid out – think slides, tubes, and containers – a little overwhelming to look at. Originally the nurse positioned me on my left hand side for the biopsy but it was too tricky – I had to keep my left leg completely straight, my right leg bent up towards my chest like I was doing a cannonball, and my torso tilted down towards the table hugging the side. It wasn’t comfortable. After trying to maneuver me at an angle that would work the doctor and nurse decided it would be easier for me to just lay on my stomach. I laid down on my stomach with my legs extended and my face turned to the side for the entirety of the procedure.

Before I get into the logistics of the procedure, I think some background knowledge would be useful. I have two very different, very effective, ways of dealing with pain.

When the pain is emotional in nature (i.e. feeling anxious, overwhelmed, scared, depressed, etc.) I cry. A good, long cry is so therapeutic. It makes me feel like the pain is washing away. When that doesn’t work, listening to sad music does the trick. It seems counter-intuitive, but for me, listening to happy music when I’m sad is never the answer. When I’m sad I want to wallow and be sad for a little bit. I don’t want to try to force myself to skip over the grieving/healing.

When the pain is physical in nature I tend to swear, make weird noises/sound effects, threaten those around me, and use sarcasm and humor as a shield. I also react the same way when I’m stressed or really angry. Just to help drill my point home, here are a few examples of phrases I have been known to utter in times of physical pain or extreme stress and during fits of rage:

“I hate you and everything you stand for”
“I’ll kill you”
“You’re the devil”
“You’re dead to me”
“I’m gonna punch you in the face”
“I’m dead inside”
“I’m gonna cut off your face and wear it as a mask” (okay, so this one is more of an inside joke than anything else, but I did get mad enough to say it once)

Now back to the procedure! The nurse had ocean sounds playing on a sound machine and held my hand during the painful parts. In a way it reminded me of when I got my ears pierced when I was younger because the nurse and doctor asked if I’d rather have a countdown or be surprised and I had the same response I had years ago at a mall kiosk – I would rather just have a casual conversation – it is a nice distraction. The nurse and I talked about my husband and about my parents’ dog while the doctor injected the local anesthetic. He said it would feel like a slight pinch as the needle went in and then a burning sensation. He wasn’t kidding. It felt a lot like the Cortisone shots I used to get in the heels of my feet for my plantar fasciitis. My lower hip started to go numb and the doctor got ready for the biopsy. I spent the next ten minutes or so resisting the urge to swear and rotating between “I hate you” and “I’m dead inside”. Luckily the doctor and I have a pretty good rapport and he knows I was just kidding around.

I was unable to control the noises I was making as a subconscious response to the pain and the doctor started to get nervous that he was hurting me. The pressure of the needle was intense since it has to break through skin, tissue, & bone to extract marrow. Though the skin was numbed, there is no way to numb the bone. As he was pushing I kept grunting “ahhh” and he kept stopping because he was afraid the anesthetic wasn’t strong enough or that I needed more. I kept telling him “no, no pain – just pressure” but he asked all three times I made a noise. The noise was involuntary. I make strange noises all the time. Every time my husband drives through Manhattan he makes me nap because otherwise I gasp anytime he gets close to another car. It freaks him out every time. I understand why the doctor was concerned but by the third time, no need to ask! Every time he asked he paused and then had to reapply the pressure. It made it worse somehow. I even told him “if it hurts, I will tell you”, but he continued to ask anyways. I think he just cares SO much that he wanted to make sure he wasn’t causing me any pain. I suppose that’s not such a bad thing!

I don’t know how to describe the pain of the biopsy without analogies. It left like someone was pogoing on my lower back. Whatever tool/needle/corkscrew he was using just kept pushing on my bone repeatedly and felt springloaded. Though the skin was numbed, I could feel when the needle penetrated the bone – a super strange and terrifying feeling. I hope I never have to get another bone marrow biopsy. The sheer level of pressure and discomfort was awful. The good news is the doctor said he got a great sample and it was one of his best he’s ever obtained. Whew!

He made up a bunch of slides and packaged the kit to be sent out for testing. In the meantime the nurse applied pressure to the biopsy site to stop the bleeding. She then used a 4×4 gauze square and medical tape to patch it up and said to leave that on until tomorrow. She brought me an apple juice and helped me flip over and button my pants back up. I was then instructed to remain lying down for 20 mins.

During the biopsy I had mentioned to the nurse and doctor that I noticed a handful of little bruises on my chest (all very small, about six of them, varying stages of yellow/purple) when I woke up this morning. The doctor asked the nurse to take a finger prick after the biopsy was done and run the blood to check my platelets. Since he just checked them yesterday he didn’t expect much of a change. While I was lying on my back for 20 minutes, she did the finger prick and ran the numbers. When she returned to the exam room she had an empty vial with her and a needle. She said that my platelets were at 42 and she wanted to run it again with a better sample. The second sample showed my platelets at 38, meaning they dropped 21,000 overnight.

The doctor wants me to come back on Monday for a platelet check again. He originally was going to have me come in later next week to ensure he had the echo results and the preliminary biopsy results before meeting with me, but the low platelet count caused him to move up my appointment time.

Now that I’m home I’m just sore. It’s been 8 hrs since the procedure and I haven’t needed any Oxycodone or Percocet, just Tylenol! It’s a little uncomfortable, but it doesn’t hurt. I was afraid it would be more of a sharp pain, but it’s dull and achy if anything. The thing that has been the biggest problem is that I keep vividly picturing/reliving the pain of the procedure for no apparent reason. I can’t seem to distract myself long enough to forget what it felt like to feel something move around inside of my bone. Hopefully the flashbacks end soon. I’m not trying to sound dramatic – it was literally that awful.