-Shirley Cox

"Neutropenia Support Association Inc., Volume 9, Winter 1997"


A very painfully invasive procedure which is absolutely necessary.

For Neutropenia patients receiving Neupogen treatment, according to the protocol of the drug, a bone marrow procedure must be performed each 12 months. This test is absolutely necessary in order to detect any changes in your blood, either good or bad.

The procedure for an adult is far more involved than for a child as an adult’s bones are mature and firm, whereas a child’s bones are in the younger years still in growth and development stages and are relatively soft. Regardless of age the most important factor is to find the doctor, whom by recommendation has the "best and most experience hands." The bone Marrow procedure stress and pain can be kept to a minimum with the skill of the doctor with the best track record in your hospital. Do not be afraid to ask the nurses whom they recommend.

Adult - The procedure is usually done in the area of the middle lower back near the hips. The area is frozen to eliminate the pain of the procedure in the skin area. There is no way to freeze the bone itself. A small finger drill is used on the bone to actually drill a hole into the bone so that the marrow can be removed. The whole procedure should be in the neighborhood of a minute or so with additional time spent in prep time for freezing etc. Once the drilling and marrow is removed, the pressure is removed and so is the intense part of the pain. The area will remain tender but not a source of pain.

Child - Since the bones are still developing they are safe enough to pierce with a procedure needle and depending on the age of the child the procedure may be conducted in several different ways.

Infant - Instead of the trauma of two needles, the first being the freezing of the surface skin and the waiting for the effect to take place, you may elect to forgo all freezing and just do the procedure, keeping in mind that the pain is only whilst the pressure is put on the bone itself. This procedure will take less time and in the hands of an experienced doctor like mine, I would guesstimate that he has performed it in under 10 seconds. My child was fine once out of the procedure room and never complained.

Toddler - (old enough to remember the last bone marrow procedure) Freezing of the skin and or a mild sedation may be recommended so that they have no recall. This is a conscious sedation - child will be wobbly but awake; lights on but nobody home sort of thing.

Older child - If the child is old enough and knows what is coming, and the conscious sedation route is meeting with stress, tension, apprehension then you may wish to make arrangements for the child or teen to be sedated.

Keeping things in perspective

It would take you longer to recite your full name, address and telephone number than it would to have a bone marrow procedure.

Remember what your life was like before Neupogen - I guarantee that a few seconds of pain far outweighs the fevers, infections, pain, and constant fighting for your life that you used to endure. How soon we forget.

Testing for Osteoporosis

Some persons have been found to be dealing with a depletion of their bone density whilst taking Neupogen. This is a common condition of osteoporosis, a weakening of the bones. With proper exercise, diet and rest you can win the fight against osteoporosis if you are diagnosed in the early stages.

The testing is very specialized and a hospital, usually a women’s hospital, is the only likely source of a bone density scanning bed. In Toronto, Ontario, the closest hospital to Sick Children’s that have this xray machine is at The Toronto General. The testing is non-invasive, you are gowned and lay on a flat bed like table for 5 minutes while a large arm xray "jumps" back and forth overtop of you. This is a full body xray and the only requirement is that you remain still.