Wednesday, May 27, 2015

The Story of a Needle Biopsy: Part 1

An interventional radiologist (I.R.) did an out-patient procedure on my lung called a needle biopsy.  Since a few of the nodes in my lungs were just over a centimeter across, my oncologist, and the I.R. believed that obtaining a biopsy via "puncture" was possible.  It would be far less invasive than the alternatives: open thoracic surgery, or lung wedge surgery, both of which require hospitalization.  I was all for it;  I wanted to settle the question of what was growing in my lungs.

Excerpts from a blast-o-gram below:

Sent:  Oct 31, 2014 7:10 AM

I have another procedure to share with you. If you ever need a lung biopsy, it's pretty likely that it won't hurt at all.  That's what they told me anyway.

They were only mostly right.

I was greeted by a nurse in the radiology department. Vitals were taken, then she needed to start an I.V., "just in case".  Unfortunately for me, she was not immediately successful.  She blew a vein on the first try (ow!).  The interventional radiologist came in to witness the next try, which also resulted in a blown vein (ow! again!).  On the third try, the goal was achieved. Woo!  She taped it down extra, super tight, which felt like over-compensation to me.  Thank you. Now please go away.
The doc pulled up a wheel-y stool next to where I was, and opened up a laptop computer.  Familiar images of my lungs appeared on the screen.  He introduced himself then, and explained what he was planning do, which was to collect some lung tissue using a giant needle-like instrument.  He showed us on the screen the nodule of choice (I knew it as Casamina).  He assured me that I would be completely numb, and that I would probably only feel the first needle, which would administer the anesthetic.
They wheeled me to an adjoining room where the now-familiar CT machine waited.  No contrast for me this time (hurray!).  I was told to lie down in "Superman position".  Right.  That would be face down, with both arms above my head.

The I.R. came in and announced that he had changed his mind.  He'd be going for a nodule on the left instead.  (Jorge!)  He would still approach through the back, so "no need to reposition".  He started with lidocaine in a big needle and began numbing all the layers of…me.

I thought I'd be offered demerol or some other calming potion, but no.  Nothing.

The doctor had me practice taking a "scan breath".  The goal of this type of inspiration is to fill the lungs to the same volume each time.  "Moving targets," he said, "are hard to hit."  If my lungs were filled to the same volume each time, it would help him to predict the location of the nodule he was trying to biopsy.  There was no camera involved; no live-video.

He placed a small, radio-opaque grid on my back, and got a scan of my lungs + grid so he knew where to position his instruments.  He drew a target on my back with a marker, and disinfected a wide area around where he would be making an incision.  Sterile sheets were draped.  I was not able to see or feel what was happening, which was fine with me.

During the forty minutes that I was on the table, the machine would move me into and out of the scanner many, many times.  Sometimes a recorded voice would direct me with an instruction to "Hold your breath", and after a few seconds it would command, "Breathe,"  just as happened during every other scan I've had.  These times, I assume, were for alignment.  Other times the doctor himself would say, "Take a breath like for a scan," and then he'd take a sample.  Sometimes—and this was unsettling—he'd say "Stop breathing…now!," but never at a predictable moment.  I was to remain silent and completely still, breathing as directed.  I could do that.

Every time he collected a sample, the instrument made a loud clicking noise, but I felt no pain.  I could feel a slight, grisly jostling though.  He's pushing a gigantic hollow needle into my lung! Ack! Sometimes he would say, "Let's get a photo of that," and I'd be sent into the scanner again.

Three samples were taken without incident.  The fourth and final one though, was a different story.  I remained still and silent but suddenly I was thrown into torment.  Fiery pain shot up my left side, seared its way to my left shoulder, and traveled all the way to and across my jaw--with every breath.  I stayed still.  Silent tears escaped from my tightly closed eyes.  Then--even though my eyes were closed--everything went completely dark.

The next thing I knew, the doctor was bent over my ear proclaiming, "This biopsy is OVER!"  I was sent into the scanner one last time.

Part 2 here.

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