Wednesday, April 22, 2009

Day 84 - Bone Marrow

Day 84 marks the last SCCA bone marrow aspiration for Tyler's protocol, so we were excited to tick off yet another item from our list of things to do before we leave them. Tyler always gets sedation with his bone marrow draws, so he had to fast for 8 hours before the procedure. As he is starting to feel hunger again, this was actually the most challenging part of the procedure.

For today's procedure, they were actually taking a bone marrow biopsy, a bone marrow aspiration, and a skin biopsy. I've posted photos below to help paint the pictures.

As shown in the photo below, they lay Tyler on his side for this procedure to allow them to access the pelvic bone. As far as we can tell, bone marrow aspirates are done in either the breast bone (center of your chest) or the pelvic bone. SCCA seems to prefer the pelvic bone for their procedures.

They start the sedation and get Tyler feeling kind of sleepy. He's technically awake, but acts as if he is asleep during the procedure. In fact, I've heard him snoring during more than one procedure. Yet, if you call him by name, he will wake up long enough to respond to you.

After numbing his skin with a local anesthetic, they insert a needle through the skin and into his bone. The nurse in the photo below is actually twisting a handle to insert the needle.

When they think they have a good spot, they draw a small sample out. When Tyler did this procedure without the sedation, this was the part that hurt the most. And he actually remembered the vacuum feeling for days afterward.

The sample in an aspirate looks like blood, which I never would have expected based on my understanding of marrow before this procedure. The tech swirls the sample around in a petri dish to see if it is a good marrow sample or mostly blood. If you look closely at the photo below, you can see a few granules in the petri dish from Tyler's 3rd sample. The presence of these granules indicate that they have drawn a good sample. Ideally, they would like to have more than are shown in the photo below, but decided that this sample was good enough.

Next, they used a bigger needle to draw out the bone marrow biopsy. They take a narrow core of spongy part of the marrow to be able to look at it as well. We'd not had a biopsy until he came to the SCCA family, but it isn't so very different in the patient portion of the procedure.

For the Day 84 procedure, they also took a small slice of Tyler's skin to check for any signs of GVHD under a microscope. This was a new procedure for us too, but as they took the sample from the same location while he was still under anesthetic, it didn't cause us any difficulty at all.

After the 20-30 minute procedure, Tyler had to stay laying down while he recovers from the poke (laying down applies pressure to the site) and the anesthesia began to wear off. During this time, he was finally allowed to eat and drink again.

My apologies if the photos were too graphic for anyone, but I thought that learning more about this procedure that I have been seeing for the last two years was absolutely fascinating. Some of you may be interested to see more about this as well.

Thanks for the great responses to Tyler's last post! It's fun to "hear" his voice again, isn't it?


1 comment:

  1. The photos were fantastic and really capture the fight as it is. I'm grateful for this post.