BMB Report

[andrewschorr]

I had a bone marrow biopsy Tuesday in san Diego. They use CT guided conscious sedation. One second the nurse said I am going to give you a little medicine. They next "second" she said we were all done. Wow! Much better that with a local. I know it's probably more expensive, but more humane for sure! Get results in a week or two. But doing well. First BMB in 4 years.

[Hidden]

On Monday, I had my second bone marrow aspiration with biopsy. A PA performed the procedure in my right hip. 10ccs of buffered lidocaine were used as a local anesthetic. The pain was when the lidocaine was administered - a quick sharp stinging pain. The procedure was not painful but an odd sensation. I expected to ache for the next several days when the lidocaine wore off, much to my relief I experienced no aching. I almost feel guilty. Last year when I had my first bone marrow aspiration with biopsy, I ached for several days after the procedure. The worst pain was when I would be sleeping and would roll on my back – ouch!

I am at a loss as to why I did not ache this time. One theory raised by my wife is that the first time I was very sick. My bone marrow was hyper cellular with 80% CCL involvement. After 12 cycles of ACP-196, my bone marrow was in better shape. Or maybe I got lucky and fewer nerves were hit?

The next time my "fear and loathing" will be less.

[E-Lynn in reply to Hidden]

I've had at least five BMB at the NIH in Bethesda MD and the key seemed to be using enough lidocaine plus the PA massaged it in. I never have had any pain during or after. For me, the sedation if I had it would be a bigger pain. But the PA at the NIH is their go-to person and she does many each day. Many are BMB phobic, so I try and spread the word that you don't need sedation to get through it. But whatever floats your boat ..

[kathyg in reply to E-Lynn]

I go to the NIH in Bethesda MD but I haven't had a BMB. I enrolled in a natural history study . As long as I am in w&w I will be in this study. Are you in a trial?

[E-Lynn in reply to kathyg]

Kathy, In 2010 I joined the wonderful natural history study of untreated CLL patients at the NIH .. isn't it amazing? I had a high WBC on entry, 263k, so I'm sure they thought I would be leaving for treatment soon so scheduled me six months after joining for a BMB. I was fortunate in that I felt great so it wasn't until 2012 that they decided I needed treatment. I joined the NIH PCI-32765 (now Imbruvica) trial in May, 2012. Unfortuantely, my first in trial CT scan showed a lung mass so I was bumped from the trial but treated with surgery at the NIH for lung cancer. (Four NIH/NCI surgeries 2012-2014). It is an amazing place and you are very lucky to be in that study. If you need treatment, most likely they will offer you a trial position if you are a match. BTW .. the wonderful trial docs allowed me back in after my first surgery, when it was thought my LC had been wiped out. When it returned, they had to bump me for good.

[kathyg in reply to E-Lynn]

I joined 2009 , stage 2 still on w&w . I get infections but still doing good. You are right the doctors are great. One of my doctors is Dr. Marti. Love him. I am sorry about your lung cancer. How are your doing?

[E-Lynn in reply to Hidden]

I vote that you had a more skilled technician doing the latest one. I was untreated with WBC > 300k for my first two BMB and had no pain then or now when my WBC is 5k.

[Hidden in reply to E-Lynn]

E-Lynn,

Thanks for the insight. I love this community in that it enables us to compare notes and gain a better understanding.

[KateEvaLen]

Lucky you Andrew to be in a place where you can access such medical advances. I'm facing my third BMB next month in less than two years and can look forward to just a local anaesthetic! But us Iridhwomen are made of strong stuff!!

[splashsplash]

Good to hear there are alternatives for BMB pain relief. I've had two BMBs both used a local anaesthetic but it didn't work for me and the pain was so intense I've refused to have any more.

I've concluded that people's pain thresholds are really different. Others have posted they only felt a tickle with a BMB and they don't know what all the fuss is about.

[splashsplash]

Andrew, I was wondering if you could tell us in more detail about your 'CT guided conscious sedation' treatment?

[Fenway]

What is CT guided sedation? I found the two bone marrow biopsies I had to be the most painful experience of my life. I asked when scheduling for sedation and they said numbing locally would be enough and it wasn't. Thanks for any advice on what to ask for. And where was this done?

[gardening-girl]

In my experience the pain associated with BMB depends on the skill of the person administering it as well as the gauge of the needle used. When my own oncologist administers a BMB with only a local it is totally painless. When new residents do with the same gauge needle, it it is excruciating. I also have had a CT-guided biopsy where I requested only a local because I wanted to remember what I could see on the monitor during the procedure, only to change my mind during the procedure. Fortunately an IV was already hooked up so it was easy to administer the additional medication. My oncologist prefers the CT-guided biopsy because of the more representative sample that can be collected with a 12 gauge needle that is used in that protocol instead of the 14 or 16 gauge needle that he uses in his office.

[gardening-girl]

Correction: My CT-guided BMB was done using an 8 gauge needle!

[MsLockYourPosts Passed Volunteer in reply to gardening-girl]

Interesting. I had no pain after my first two BMBs with just laidocaine, but felt the third one - just twinges - for about three days afterwards. I was out for that one. I assumed that the person doing the procedure, perhaps, didn't have to be as careful because he didn't have a panicked patient on the table. Needle size makes more sense.

[SouthFloridaLady]

IMHO, everyone should be informed by their doctor that they have the choice to have a bone marrow biopsy performed under MAC (Monitored Anesthesia Care) sedation using Propofol, or pharmacological choice; this is NOT general anesthesia. It is the same sedation given when you have a colonoscopy. You are out like a light, unaware of everything, completely drugged, gonzo, you will not be aware of anything. There is enough pain with cancer, emotional and otherwise, why not eliminate all discomfort that is within our power!!!