My Experience with a Bone Biopsy

Hello everyone!

Well these are getting harder and harder to write! And it’s not for lack of inspiration but more lack of having a coherent theme or object of one post when I have about 8 floating around in my head. I am also struggling with the egocentric nature of blogging... so I apologize with the delay!

Last week I was able to share some amazing news with everyone and the response has once again been overwhelming. It was also the first day I truly cried! And I cried for about 5 minutes which is a really long time for me. I was so overwhelmed with a sense of relief and joy that it poured out of me in big gobby tear drops and a gushing nose! I genuinely hate crying... I feel very “uncomposed” that even if I start crying I control it very quickly so five minutes is an extremely long time for me to cry. The other more interesting reaction I had was a sudden onset of extreme back pain in the area of the biopsy.  Man did it hurt! My best guess is that this was a psychosomatic release of stress and tension as the first time I allowed myself to be “exposed” enough to acknowledge the discomfort the biopsy had caused. It took about 4-5 hours for the pain to start to go away, but the reaction was real and marked and therefore very interesting.

A lot of people have asked me what the biopsy was like. So I shall tell you the tale. J

I had a CT scan done which showed something suspicious in my spine.  Because I have copies of most of my images and a really awesome friend who showed me how to use the viewing program I can show you the suspicious area which is pretty cool. So the image that you see below is a side view of my mid section. The top of the image is my neck and the bottom of the image is my torso. Disregard all the organs and tissue and look for the spine.  Once you locate the spine start at the top vertebrae and count down.  It is the third whole vertebrae from the top. As you may notice all of the other vertebrae look pretty white where the 3^rd from the top has a big “grey cloud”. That grey cloud is the suspicious area.  It turns out that it is just a bunch of inflamed tissue. Now I know your next question. Why do you have that much inflamed tissue? The answer is I don’t know but am interested to find out. However, I blame my inability to stay on horses and or the inability to always stay out of their way when on the ground. LOL! In short, I’ve never been so happy to say I was schmucked into by a horse in flight in January, and then I “gracefully” took an unscheduled dismount in February, got conked in the head without my helmet on later in February  etc etc etc J  

This is the real image of my actual spine. All other images are googled and are not actually me!

Anyways when the doctors looked at this image and my understanding of what they said is that it was very likely cancer but they wouldn’t discuss what that means until it is confirmed due to the nature of that discussion. Then the next thing they said is that the location of the tumor (yes they called it a tumor) was very difficult to access and they would need to discuss the best plan of accessing it. They then brought me my scheduled biopsy time told me to take my painkillers before and after (I had permission to take the strong stuff J) and I was on my way.

So the night before my biopsy I packed my “hospital bag” found my missing kindle and then started stressing about not being able to eat or drink anything because clearly that is the most important thing in this situation(oi!).  But in reality it actually was a pretty big deal. You see, I wasn’t going into this biopsy at the top of my game.  As you may remember Wednesday we had to decide whether or not to continue ahead with treatment due to the delay it may cause my “if the biopsy was positive treatment” and we decided to go ahead. Then Friday was a bit of a gong show because my blood counts were lowish and they cancelled and rescheduled my chemo for Monday, and after all of that (about 1.5 past my treatment time) I ended up going ahead with the treatment on Friday.

Another thing we decided on Wednesday is that I wasn’t going to take my anti-nausea drugs to see if they were triggering my migraines as I suspected. Therefore my only line of defense against the nausea was to drink an obscene amount of water (4 Litres) and always have food in my stomach. Therefore not being able to eat or drink after midnight was in my opinion a rough deal but I promised myself I could eat by lunch. HAH! I was so wrong. So feeling pretty thirsty and hungry I loaded into the car with my pit crew (Steve, Mom and Dad) and we headed to the hospital. We got there went up to admitting  and was then sent to Medical Imaging where they promptly re-directed us up to day surgery (dear lean system... room for improvement). I got to day surgery and they gave me a bed to lay down in which was lovely because at this point I was pretty green around the gills. My biopsy was scheduled for 10 am however you are supposed to arrive by 8:30 am so I had plenty of time to get comfortable. The nurses explained to me as best as possible what was going to happen which included waiting 2 hours with nothing to eat or drink after the procedure.

So we got comfortable and settled in to wait for my turn. The day surgery room I was in had 3 beds. The gentleman in the first bed was quickly whisked away for his appointment. Shortly after an absolutely adorable senior citizen came in with his wife. They were pretty sweet but he got to eat right away and him and his wife discussed his toast and coffee for what felt like at least a half hour which along with the smell of his coffee and toast was my own special kind of torture. It seems silly, I understand, but really I was hungry and thirsty and really nauseas. So 10 am (my appointment time) came, 10 am went. 10:30 came, the nurse popped in to tell me that they were a bit behind. I said not to worry! I know that it’s a good thing to be the person who get’s bumped or delayed because that means you are not the person with the most imminent need.  Due to the nature of my diagnosis I know I have bumped to pretty high on the list myself so it felt good to push over and let someone in front of me! It’s a give and take. Then 11:00 came and went. At this point the nurse brought me a few sips of water because I was getting increasingly nauseous and thirsty.

 Finally around noon someone came to get me and I took a tour on one of the hospital beds down to the CT scan room. It was pretty busy down there. There were 3 beds and a lady in a wheel chair in the waiting room. One of the techs came out and told mom, dad and Steve that they should wait in the main lobby as it was pretty crowded in the CT waiting room. Steve stayed anyways and mom and dad went on their way. Then a guy came in with some EMT’s and had to wait with us shortly after his arrival so at this point the room was more than “pretty crowded”. Then one of the rooms opened up and with some fancy manouvers on those steering the beds there was a clean exit and entrance of the emerg patient into the lab.   Suddenly it was my turn... eek! At this point I will admit I wasn’t feeling too hot but remember thinking... at least I’m not the guy on the stretcher!

The tech that brought us in this time said that Steve could come in to the room with me for a while which was nice. So he came in and explained to me what was going to happen and that the doc would come in and answer any questions and sign consent. At this point I asked if there would be general ( knock you out) or local anaesthetic (like dental freezing). Because up until this point I had no idea whether I was going to be conscious or not.  You see I had decided for this treatment I was going to roll with the punches because, well truth be told... thus far having a mental plan was turning out to be more stressful because the plans kept changing and for a type A control freak thats pretty stressful. SO I was going in blind, hoping that would be less stressful. I found out that there would just be local anaesthetic which was a relief that at least that way the anaesthetic wouldn’t make me more nauseas after waking up.  I wasn’t sure how much more nausea I could take without keeping it together, or more importantly in. Then we met the doctor. I have to say I was impressed. He was very honest, to the point and professional.  Here is what he told us from my perspective.

•           Due to the location of the tumor this is going to be very tricky. In fact we may not be able to go ahead.
•           If we have to cancel I am pretty much SOL, they could try the surgery but the chance of a successful surgery was just as likely.
•       They had to come in from above and down at an angle to get into the vertebral body.
•       The vertebrae rests beside the lung, so there was a chance my lung could be punctured or damaged, this would not be good. But I am in a hospital and they are well equipped and prepared to deal with that event. 
•       They had to go through a  forest of  nerve to get there so there was a risk of nerve damage.
•       There is a chance that the biopsy process can crack the vertebrae. Which as you can assume, is also not very good. 
•       This procedure would take about 30 minutes to get set up and another hour to complete. 
•        He explained that at any point they may have to “abort the mission” but this is my best chance and he would do his best to make this happen for me.

I signed consent then we discussed the use of local aneasthetic. I told him that my experience in the past month leads me to believe I seem to absorb lidocaine like a sponge and I suggested he use as much as possible. He explained that lidocaine was hard on my heart; I explained how I could feel the last half of my first biopsy and felt the stitches going in on the PICC line. We discussed the difference between feeling pressure and feeling the procedure.  We also discussed him taking as many samples as he felt he needed. The more the merrier for me. As I had to do my breast biopsy twice (not due to lack of samples but damaged samples) and would like to avoid doing this one twice.

I then hopped off the bed and onto the table. I am a pretty narrow person so I fit on the table fine! This is a perk because I remember thinking... this is one small table! The cushion on the table is also not really designed for long term comfort. Its a 2 inch mat and I don’t provide much padding myself.  I laid on my stomach and they put a wedge pad under my forehead so my head was perched about 4 inches higher than the bed. Then myself and the tech’s mcguivered some blankets to provide some neck support for me as that wasn’t a position I could hold for an hour and guarantee I wouldn’t cramp up or move. We then tried to figure out what to do with my arms and determined the best place was to have them over my head and crossed sort of like a relaxed diving position and we were ready to roll.

They prepped me for the procedure. And I got another one of those aweful fake tans the health region keeps giving me J. They use a cleaning stick that dyes your skin orange (sort of like betadine for my horsey friends). Then they took the prelim image and did the landmarking where they wanted to go. The Doctor then showed me the image of the vertebrae, where he wanted to go, how he had to get there and just how close he was working to my lung. Let’s just say, I had a lot of trust in this doctor! He gets 10+ points for building rapport in 5 minutes!  

These are not my images. But the black blobs are the lungs. The needle is pretty obvious and the light bulb shaped thing the needle is in is the vertebrae. The angle on mine was a bit different but this gives you an idea.

Another image that shows where they had to go. 

The most painful part of the whole procedure was the freezing going in. And that is because as I have expressed before, I have hypersensitive everything strangely combined with a high pain tolerance. So when it is your job to tell the doctor if you feel any discomfort I have a hard time discerning what is normal and what is bad. You are lying on the table face down and feel a needle traveling through your shoulder and into your vertebrae and then when it gets there you started to feel some discomfort below your neck. And you lay there thinking do I say something or do I not. You don’t want to be a baby, but  he is working blind with a needle in your spine, he can’t see where in my neck the needle is... do you say something? He said to say something? But what do you say... it doesn’t hurt per say but with your neck cocked back and towels surrounding your face and neck conversation is limited. What do you say... ummmm “owe”. Doctor freezes, “what do you feel?”, discomfort right below the spine, more ache, not sharp”. He says “thats just the freezing going in.” And you say “Ok sounds good”. All the while thinking damn I was a baby and said owe when I didn’t need to. Ugh!

 So we moved on. And that my friends was the most painful part. Now I can only describe what I felt as I didn’t see what was going on, my face being buried in wedge pad and a blanket and such not. But I think what happened next was they took a really sharp really strong metal straw and put it in my spine into the location that they were trying to access and it stuck out of my back what I can guess was at least a couple inches. Although there was no pain, it was a little nerve racking as he was pushing through bone so it wasn’t a gentle process. I found myself wiggling my fingers and toes periodically just to ensure they hadn’t cracked the vertebrae and I was paralyzed.  Throughout the entire procedure the doctor stopped and CT scanned to check his location etc. I knew I was in competent and experienced hands. Once “the straw” was in it was pretty smooth sailing for me mentally. I still had lungs and I could wiggle my toes. Win!  

This was what it would have looked like to a spectator, except I was laying face down. The big Donut is the CT. They take a picture to check location. Pull you out. Do procedure. then put you back in to check . Do procedure... etc etc

Inserting the "Straw"

So the next step is to insert what felt like a mini hand auger but I have no idea what it actually was. And voila the first sample was extracted. The doctor was pleased to inform me that we had 1 sample! He asked if I minded going in for another sample.

Ready to extract a sample... I have no idea if this is the equipment they used... but it "felt" like this. I found these images after writing this blog.

bone biopsy sample.(Not mine)

 By this point I was getting pretty sea sick! You see everytime the CT was taken they had to move the table into and out of the CT machine. I am sure that if I was not on Day 4 post chemo which is one of more nauseas days and had I been able to take my medication or eat or drink water I would have been fine. But, alas that was not the case and this was the hardest part of the process. I felt like I was being rammed in and out of the machine with reckless abandon! Is this fair, probably not. But to all my friends who work in the health region, please note that if some one is coming in nauseas those beds are like hell! Lol! It’s kind of funny that the most uncomfortable part of a spine biopsy was the rides in and out of the CT but it was the truth in my case.   That aside a “heck yes take as many samples as you can” was muffled through my neck roll. A few minutes later he happily informed me he had an additional 2 samples from me taking him to 3! At this point he asked if I was okay to continue on for a fourth so that they could test for non cancer stuff as well. I said most definitely.At this point I was pretty relaxed! Honestly I was, no sedatives or anything.Things had gone so well, the doctor was clearly very skilled and it was the first procedure I have been to where there wasn’t any pain involved so I was a happy camper.  The doctor took his 4 ^th sample just as a slow ache was returning to my back, so however much freezing he used was perfect.  Then the extraction proceeded a few more trips in and out of the CT to ensure my lungs were good to go and voila. I got to move. I sat up and had a bad case of the shakes. I seem to get the shakes when I have lidocaine. It’s funny because I think I always look worse than I feel. I moved over to the hospital bed and was whisked off to XRay. We ran into a friend in the medical imaging que and chatted with them for a bit before heading in for another chest XRay. I passed muster and was sent back to my bed and waited for a porter to take me back up to our room. I was able to meet one of Steve’s work friends who I had never met before and he was so kind as to wait with us and chat. I know how busy their days are so really appreciated it!

Another room with view!

It was back up to day surgery for me and I was pretty excited to see that I had the room to myself.  Even better news was that I was allowed to eat and drink relatively shortly after arriving as it had been long enough after his orders. Let me tell you apple juice and toast have never tasted so good! I then spent the next while resting and texting my family and friends letting them know I was okay.

never far from my phone!

Around 4:00 I was given the nod to go home so I stood up to get dressed. And promptly re-seated myself. I stood up again... and decided to reseat myself again. At which point we tried adding some fluids in me (more apple juice! Woot woot!). Unfortunately that wasn’t enough and I was still wobbly like a newborn foal. So Steve ran and fetched one of the wheel chairs to transport me.

Sitting up ready to go home!!!

 I was pretty annoyed but at the same time realized that it was a necessary thing as I knew i wasn’t going to make it all the way to the parking lot without going down. And lets be  realistic, falling after having metal rods jammed through your spine and  4 chunks of bone removed is not an ideal situation. So I had my first trip through the hospital in a wheelchair.

What’s interesting is that although I am bald and was rolling through the hospital in a wheel chair I don’t feel like a “sick person”. I am sure I looked like a sick person but I feel strong and healthy and ready for battle just a little banged up from the lidocaine.

After a few days of “bed rest” ie) me sleeping for awhile and then my parents chasing me around the house trying to get me to sit or lay down I was back at it. The pain in my back was minimal. It wasn’t until a few days later that I remembered I was supposed to be taking advil and Tylenol and whatever pain meds I needed. I had forgot to take them the day of the biopsy and then completely forgot afer the fact. There was a bit of muscle twitching in my shoulder, and my back still aches if I sit or stand for too long, and driving along our beautiful Saskatoon spring roads caused a certain degree of torture but other wise it wasn’t too bad. That said my first biopsy(breast)  had me travelling across the world  and then I spent the day battling the winds at the helm of  40 ft boat.... so.... relatively I was doing a grand job of resting.

My feelings on bone biopsy is that they are another miracle of science! It is amazing what medicine can do! Thanks to the Doctor, and all of the staff at RUH involved in my biopsy, you were all fabulous and made the experience much better!

To top it off, as you know the results came back clear! Which means I do not have cancer in my spine. So I get another kick at the can :D I am now happy we went ahead with the 4^th biopsy sample as it will help determine what is causing the inflamed tissue.

In conclusion the biopsy was much better than I expected and I came out no worse for wear!

Celebrating the good news with the most delicious coconut cheesecake in existence at Alexanders!

So till next time,

Left Foot , Right Foot!

Alyssa & Steve