Quick Run Down of a BMAC Stem Cell Procedure

So we have Ms. Kirk Rangel who's here today for a bone marrow aspirate stem cell harvesting with a hip injection into the hip joint today. So what we're going to be doing today is I'm going to walk you through the process from start to finish. The goal here is to make this as least anxiety ridden as possible. A lot of times going into procedures like this, anxiety is our biggest worry. You know, patients get very, the unknown is very scary. Sure. I'm going to walk you through start to finish and then also as we're doing the procedure, I'm going to be walking you through step by step telling you everything I do before I do it. I don't want any surprises or shocks for my patients. So the first thing we're going to be doing is getting you into the room, laying you on your stomach and making sure that you're comfortable, covering up your legs with the blanket to keep you warm because it is a little chilly in the room. Then I'm going to be using my hands and I'm going to also use my skin marker to draw out some areas on your back. I need to be able to know where your bony landmarks are. Then I'm going to use the ultrasound to find the exact spot that I'm going to be working on. Now I'm going to mark that area with the skin marker. Then I'm going to clean off the skin and I'm going to numb up that area. I use a little vibration tool to try to help distract the nerve. So the burn from the numbing medicine is not as bad. I'm going to numb that area up really well. And as we talked about with you being fair skinned, sometimes those of us who have the fair skin, our bodies go through numbing medicine very quickly. And so if we will have lots of extra on standby if we need to at any point in the process, add more numbing medicine. Okay. Then I'm going to take a needle with the ultrasound again and I'm going to find the bone, numb up the area of the bone really well and all of the tissues in between. And then we're going to let that set for a minute and let it, give it time to do its job. We're going to clean the skin as we would for any surgical procedure and we're going to drape the area out with sterile drapes. And then again I'm going to use the ultrasound and another needle. A sterile needle. Well, the other one's sterile, but this is in the. On the procedure Find that spot again, mark the skin where I'm going to cut, make sure it's numb. Again, make a small incision. It's usually about one to two millimeters, very small. And then I use a metal instrument that's a hollow tube to go down, and it's going to touch the bone. It's called a trocar. And so I'll tell you, this is the trocar. You'll feel some pressure as it goes through the tissues, but again, should not be any pain. I'm going to tap it with my finger so you feel the vibration. And then after confirming that you're numb, I'm going to use a small mallet with a little hammer. It's really about this big. And tap, tap, tap, to get through that top layer of bone. And again, like we talked about, you can sometimes feel a little jerk. Your leg will kind of react. But nobody yet has told me it hurts. In fact, some people giggle because they weren't. It's not what they expect. You can feel that vibration, and as it spreads across the bone, sometimes you'll feel it in your stomach, down your leg. But again, it shouldn't be painful. And if it is, you tell me. We stop, we numb you up some more. Okay. Then we take the little centerpiece out and we've got the hollow tube. We connect a syringe, and we start to aspirate out the bone marrow. When this happens, you'll feel an odd sensation, but again, it should not be painful. We try to go slow. We're going to get a total of 60cc's or milliliters of your bone marrow. And we do that with six tubes, so six 10cc tubes to reduce the pressure that you feel. Once we've gotten the first three, we're actually going to move that metal piece over a little bit to a different spot of the bone so that we get a good mix of cells out of the. Out of the bone. And again, finger tap, tap, mallet, tap, tap. And then we aspirate the rest of the bone marrow. When we're done, I tell you I'm going to pull the instrument out, I clean you off, and I either glue it shut or suture, whichever I need to do. To make sure that we get the wound closed, put a waterproof dressing on. That will stay on for about two to three days. And then we'll slowly help you stand up and turn around. And then we'll seat you in that same chair where you'll stay for about 20 minutes while we spin the bone marrow down to separate out all of the stem cells. We'll come back into the room. You'll still be there, but we'll come back in. We'll get this area cleaned up here for your hip. I'll use the ultrasound again to find the exact spot. We'll use a needle to go down and inject it. And all you should feel, besides the little needle stick, is some pressure. And then when we're done, we put a band aid on it. When you get home, you're going to put heat on the front. You're going to put ice on your backside. You'll feel kind of a bruise sensation back there for a few days, but other than that, everything should go well.

How long do I use the heat and the ice?

The heat? Up to a couple of weeks, just kind of, because that's going to help accelerate the cellular activity. Help helps everything feel better. You're going to want to use heat for about a week or two and then the ice couple of days. Okay.

Couple of days for the ice heat. Couple of weeks.

Yep. And you're going to want to make sure, too, that you take your Celebrex that we're sending to the pharmacy. Take that every day. You want to avoid ibuprofen, Aleve or aspirin, but you can take Tylenol.

Oh, okay.

Okay. So you'll take your Celebrex every day, and then if you need anything else for pain, you take Tylenol.

And like when I'm using the heat and the ice, how long each time?

A few minutes each. Five to ten minutes. Oh, really?

But several times a day.

The ice particularly is as needed. So if after the first day or two you don't need it, then you don't have to do it anymore. But we do want you to keep using the heat. Okay?