I recently noticed that one of the most active discussions in the Myeloma Beacon forums is one about experiences with bone marrow biopsies. I haven’t read of anyone who really was neutral to having that procedure done.

Whether it’s done under local anesthetics or with the help of a sedative, it is somewhat dreaded because it helps diagnose, confirm and stage multiple myeloma. However, most of us patients consent to the procedure because of the information it can yield.

When I had an initial appointment with my oncologist to review the results of various blood tests, I had been advised that a bone marrow biopsy might be done at that time.

Sure enough, after getting the unwelcome news that my blood held a high amount of monoclonal (M) protein, my oncologist suggested that I have the bone marrow biopsy that day. Otherwise, I would have had to make another appointment, which would have further delayed the definite myeloma diagnosis. I was anxious to start treatment as soon as possible, if I indeed had multiple myeloma.

In preparation for the procedure, a local anesthetic was injected into my left hip area. This reminded me of trips to the dentist, when I had needed ‘freezing’ for dental procedures.

As I waited nervously for the freezing to take hold, the attending nurses wheeled in a cart containing all of the items needed for the biopsy: two large needles with syringes, test tubes, a paper sterile drape, iodine swabs, a scalpel, frosted glass slides, gauze sponges, a large adhesive bandage, and test tubes. I looked at this cart with some apprehension, as I realized I was about to have a minor surgery and wasn't sure what that would be like.

The three nurses attending that morning had calm, soothing demeanors and reassured me that the procedure would be quick.

My doctor came in, and the procedure began. The first needle was used to remove a small sample of the bone marrow, the ‘aspirate,’ and the second was used to collect an actual sample of the bone, the ‘bone biopsy.’

I have to admit that I was not as calm as I should have been. The nurses told me to wiggle my toes and complimented me on my pink-flowered socks. They squeezed both of my hands tightly, and in return, I hope I did not bruise their hands with the pressure of my hand holding.

The feeling of pressure and pain as the doctor inserted the first needle did not last very long, but I did feel a slight crunching sensation as he took a small sample of bone with the second needle.

At the time, I barely noticed that the staff were preparing smears on the glass slides, which were sent off to a pathology lab for examination.

My next appointment with the doctor to discuss the results of the biopsy was not for another couple of weeks. In the meantime, I read up a little on the procedure because I wanted to know why we would need an invasive test such as the biopsy, with all the sophisticated blood tests available now.

I found that the bone marrow biopsy is meant to examine the actual bone to see how much the cancer has infiltrated into the bone.

I also learned that another very important aspect of bone marrow testing is to look for chromosomal abnormalities, which frequently occur in multiple myeloma. That testing was done on my bone marrow the second time I had the test.

Still hoping that my bone marrow test would come back normal, my husband and I returned for my next appointment. We found out that, alas, I really did have myeloma, and my treatments commenced soon after that.

I started induction therapy with Velcade ^[1] (bortezomib) plus dexamethasone ^[2] (Decadron) in August of 2010, and after four cycles, I achieved a very good partial response. I felt so much better. The tumor burden was lifted, my fractures were healing, and I had more energy too. I was back to walking about three kilometers a day.

In November 2010, I started the stem cell transplantation process, which my doctor recommended as a follow-up to the initial therapy. I needed to go through a lot of testing to determine that I could withstand that procedure. Those tests included heart, lung, more blood tests, and another bone marrow biopsy.

This time, I decided to take the easy way out and opted for sedation. An injection of midazolam (Versed) put me into a sort of half awake state, a state in which I definitely didn’t feel any pain. Quite a contrast from the first time.

Midazolam can make one really chatty and uninhibited too, but I don't remember much of it. To my complete relief, my biopsy showed very positive results, matching the blood and other tests.

I had a third biopsy after the stem cell transplant, in March of 2010.

At that point, I had a ‘central line’ catheter, which had been inserted before the transplant. So it was through the central line that the sedative was infused.

This time, I actually fell asleep before the procedure and must have slept right through it, for when I awoke, the nurses were tidying up the instrument cart and had several test tubes full of samples (I had donated a tube of aspirate for research).

I was grateful that one of my daughters had been patiently waiting for me outside the examining room, ready to drive me home. I could not have done it myself, and actually would not have been allowed to do so, because when you take the sedative, you are legally impaired for a day.

As you can see, my experiences with bone marrow biopsies have been mixed so far. I would say the first one was the one that had the most discomfort associated with it.

So I am somewhat relieved that I have not been scheduled for any more yet.

What has your experience been with bone marrow biopsies?

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The quotation for this month is from Soren Kierkegaard (1813-1855), a Danish philosopher, theologian, and poet, who wrote "Life can only be understood backward, but it must be lived forward."