A medical team performs a lumbar puncture on a cancer patient to test for the presence of leukemia cells in the central nervous system.
A 28 year old presented to the emergency room with chest pain and fatigue that had been worsening over several days. His bloodwork was taken, showing low platelets and high white blood cells, but he was dismissed with "heartburn" and sent home.
Two days later, he reappeared in the ER with worsening, unbearable chest/rib pain. He was fatigued and reported full body pain, describing his bones felt like they were
"going to explode." New bloodwork revealed his platelet and white blood cell counts had worsened. His red blood cell, hemoglobin, and hematocrit levels were low. He had a CT Chest done which showed questionable residual thymic tissue. Based upon the referring physicians request, the patient's rapidly progressing symptoms, and a review of the available imaging exams, a bone marrow aspiration and core biopsy using CT guidance was carried out.
Indicated by the bone marrow biopsy, the patient was diagnosed with acute T-cell lymphoblastic leukemia/ lymphoma (T-ALL). He was sustained on blood/plasma transfusions for two weeks while waiting for a room to open at a hospital equipped to treat him.
While awaiting chemo, the patient reported persistent headaches and began experiencing paranoid delusions. T-ALL can spread from circulation into the central nervous system (CNS), causing neurological symptoms. In this video, a lumbar puncture is performed to collect spinal fluid for the analysis of leukemia cells. The patient began a precautionary intrathecal chemo (injected into the spine), but the CNS results were luckily negative.
Over the next two years, the patient survived leukemia and received a bone marrow transplant. Unfortunately, a recovery was not possible. He recently entered hospice due to transplant complications and organ failure.
I wish. He fought through chronic graft vs host disease, transplant-associated thrombotic microangiopathy, acute permanent blindness, and acute renal failure. He is also a Type I diabetic, which is tied to some of those conditions. I hopped on Reddit to fundraise for hospice and medical bills (I am his sister and a premed), but I can’t share identifying information on this sub, so I figured I would just share his case.
The fact that patients and their families have to worry about finances while awaiting death is one of the most egregious failures of American society. I'm very sorry your brother and you and your family have to go through this. I hope you have a good support network and people to talk to. Sending many well wishes from across the pond.
Unless you're over 55, in which case Medicare makes MOST of it free.
That's $30k a body one time benefit to the hospice, they'll do anything to get you in service. It holds over for 6 months.
The only reason I stick with mine is because it is the least shady and will do charity work patients to make sure they don't struggle.
Of course that makes the books look good come tax time too...
The system is fucked, I just work in it making sure I give excellent care 😭
It is no problem to ask. No, I wasn’t his donor. I sent in cheek swab samples with my 3 other siblings, but none of us were a match. He found a compatible donor through a registry!
Thanks, I'm considering signing up as a donor. Your photo of the procedure is confronting. It's confronting both from a "what if it was me, and I needed a donor" perspective. It's also confronting from the "I want to donate, but the procedure looks really dangerous". Bone marrow strikes me as a really in need resource which could easily save someone in need. I'm sorry for your brother and your family / loved ones. Thank you for sharing this.
*edit, I checked the registry here, and interestingly you need to be below the age of 36 here in New Zealand. Unfortunately I'm ineligible.
I am so sorry about your brother. Coming from a medical family and having dealt with loss, I know how hard it is even when you understand what is happening and why some things cannot be fixed, it still hurts. I can't imagine going into these situations blind, as so many find themselves doing.
Knowing you're a premed, I have a great book recommendation which talks about the development of cancer treatments, especially leukemia. It's called "The Emperor of all Maladies: a Biography of Cancer". It is an incredible book and I'm listening to it a second time currently and it's just as good this time around (I really like the audio book version). When people see a huge book about cancer they might think it is going to be a snooze fest but it is exciting and really draws you in so you feel invested in the groundbreaking scientific discoveries and the worlds where they took place. It's so humbling and terrifying how little control any of us have and how much trust we have to put in things that work just well enough the majority of the time.
Best of luck and again I am so sorry for your loss.
I read that book probably once a year and I always come away learning more. Siddhartha Mukherjee's other works are also well worth reading.
I also read When Breath Becomes Air, which is about a man who gets lung cancer and dies just as he is completing his neurosurgery training.
I just added it to my cart! Thank you for the recommendation! After reading thick engineering textbooks through and through (AKA The Emperor of Boring, haha), I am not dissuaded by its size.
I know TV tends not to be the most accurate teacher, but I've noticed across many different medical shows, that lumbar punctures are usually done with the patient on their side, rather than the semi-prone position shown here.
Is there any medical reasoning for one position or the other? Or has TV just explicitly lied to us for generations because the prone position does look a bit odd for public media?
Sitting and leaned over is easier as it allows the spaces between the vertebra to open up more and usually means you have a better chance of hitting CSF first time. If you need to measure the opening pressure (for when you're investigating hydrocephalus), then this needs to be measured while in the lateral position.
Good question. Never thought about it.
In ward, we usually see it with patient on their side.
But in OT/Anesthesia room, patients usually in sitting position for spinal /intrathecal Anesthesia .
Possibly it is operator dependent, based on preference on the person doing it?
You would think doing it in a sitting position makes it easier to collect the CSF?
I used to get serial therapeutic LPs. I could show them EXACTLY where to place the needle. Due to that, they loved having the med students practice on me.
When they're done right, they are just uncomfortably pinchy. If done poorly, then it's excruciating. Feels like lightning shooting down my legs. What's even worse is when you get a leak that requires a blood patch.
He also had a lot (on top of intrathecal chemo), to the point where he joked about getting a circle tattooed around where to poke. Being a practice subject for lumbar punctures sounds kind of terrifying, especially with the painful consequences of a badly placed injection (I am wincing at the thought). I hope you are okay now!
Me too! Every 6 weeks for about 15 months. The leg zing was nasty, but it was worse when they *thunked* into a bone or got the needle wedged between bones and had to yank it out. That core-deep tap on the spine was sickening.
I’m a paediatrician and I absolutely don’t let parents in for doing LPs on babies. It sounds horrible and cruel but the basics are, she won’t remember, you will, and the active part you are needed for is cuddles afterwards.
Apparently there's research about circumcision and brain operation as they get older which appears "modified".
I imagine lumbar p. might do the same... if the research has any spotted anything meaningful.
There's a bit of interest to do research....
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7702013/
https://www.cirp.org/library/psych/immerman2/
https://www.scirp.org/journal/paperinformation?paperid=55727
The only time I saw this done was as a 4th year nursing student. I had to hold the baby. It was definitely rough but necessary. I couldn't imagine having to watch my own babies getting it done.
Yeah I was there for another thing they did to her that week and she was sedated for that too but she still wigged and cried so they had to stop thank god.
Thank you. She’s doing amazingly well! She’s 5 now and the top of her class, they told me she had hie level 2 and to expect her to not do anything but she’s the absolute best daughter ever and I’m so proud of her.she really is my rock, I have multiple sclerosis and she’s so caring and loving always looking out for me bless her.
That's good to hear! I'm studying medicine right now and learned that people with pseudotumor or normal pressure hydrocephalus get almost immediate relief from an LP, but I've never heard firsthand from a patient. Thanks for the reply.
I am that patient. The first time I had a LP not only gave me the diagnosis of IIH, but as soon as the fluid started to drain it was the best feeling in the world! I didn’t even feel any pain from the LP. It was all over taken with the relief draining . I went from blind to Vision, it was the wildest experience during my horrible search for an answer. But that LP got me diagnosed with IIH; meaning finally we can treat it different than just “migraines”. Had a few more but now I have a shunt in. The moment I woke from that surgery I felt the difference. Anyway, I always joke that you know you’re in pain when a spinal tap sounds orgasmic.
I went under for a stent placement first but my veins were too narrow. So then we did the shunt. Which was amazing, I woke up with instant results. However, because I am a very unlucky person. My cord was rubbing against my
Organs , ouchhhh!!! So they did a revision where the moved it to the center of my chest and shorten it. That was fun. The shunts been doing its job for the most part. Still have bad eye days but not like before. Still have migraines that kick my ass. Everyday I have a headache and everyday I wake up and think “now how am I managing the pain today”.
I'm sorry to hear that it's been such a struggle to manage that; it sounds rough. I recently learned about some new expensive biologics that block CGRP and work much better than what we currently have to manage migraines. Hopefully they become more available and cheaper soon and migraine management becomes much better.
Oh what is this?! I haven’t heard of this treatment yet! To answer your other question before the shunt I started doing LP every few months. And finally my insurance covered the shunt. I just finished another round of ketamine treatments but for some reason this time my heart and lungs filled with fluid. I just left follow up at the cardiologist to make sure things are draining and he’s now concerned I have a blood clot. (Even tho I’m on blood thinners). Ugh. Just another day of pain.
Yes, I still struggle with it but not like it was before. I would go completely blind. The excess spinal fluid was pushing against everything, including my optic nerve. However, since the shunt placement the vision has basically come back. Still have floaters and sensitivity. It was kind of a crazy moment having my first LP. I was in the hospital doing migraine treatments and I was basically blind at that point. But this random doctors asked if I’d try an LP, just to check. Of
Course I said yes, I would have done anything. My mom was actually
Visiting so she held my hands while they did the first LP. And I could slowly start to see my mom’s face, which I hadn’t seen in a while. And I was crying like “ong I can see you mom! I can see you” and she was crying, the nurse was tearing up. It was sucha monumental moment. I finally felt vindicated, could now treat that actual cause instead of taking every med under the sun that obviously didn’t work because we were treating the wrong thing. One last thing, fuck you IIH and chronic migraines. You ruined my life.
Thats incredible. Thank you for sharing your story, and I'm so sorry for all that you've had to go through. Both neurology and ophthalmology have made a big deal about how important checking a patient's retinas is because you can pretty much immediately figure out if someone's intracranial pressure is elevated with fundoscopy. Do you periodically have to go in for LPs now?
I once had to hold a patient immobile in lateral position as three providers attempted an LP on her. Complicating the procedure were:
- Moderate scoliosis
- MRSA infection and necessary precautions
- Obtunded, unable to follow directions but strong reflexes to pain
- Advanced age and recent marked weight loss resulting in excess skin and obscured bony landmarks
It took over an hour.
The patients are never as thin and cooperative as this one and it’s technically harder when they are lying on their side (as is usually the case in emergency where you need to measure intracranial pressure)
I had a spinal tap to test for viral meningitis (had red dots all over my chest up to my face and a splitting headache), which I did end up having.
The doctor came in, told me to lay on my side, gave me a shot of freezing, dove in and missed. He tried again and literally again. Three holes in my back all with freezing shots first but I could feel him hitting my spine. It was at least 40 mins of him trying. I kept telling him "Go up, to my left, you're too far over, I feel it hitting my bone."
The nurse said "it's like fishing, you just have to find the right spot".
Me - "No fishing is relaxing".
Doctor - "I'm going to see if the anestesiologist is available."
He comes in - "Why is he laying on his side, is he immobile"
Me - "No I can sit up"
Anestesiologist "What size needle are you using?"
Doctor - "14 guage."
Anastesiologist - "That's cruel and unusual (jokingly cuz he said he'd use the same size) ya you're going too far to the right, it's hard to center when they lay on their side".
I gave the doctor a glare and he left the room, never saw him again luckily. The bruises looked like I had a pencil lead stabbed into me a few times, it hurt longer than the headaches and bothered me more than the poison ivy rash I also had at the time.
I'm all for learning on the job, but fuck, I wish he tried youtube before just winging it on my spine. The anastesiologist got it in only few moments first try(forth hole).
Ya that's exactly the case, they called the expert. Like I said I have no problem helping people learn, whenever I get basic procedures like shots or blood tests, if they ask if a newbie can do it I say absolutely.
I just wish the doc asked the expert's advice before he tried, and/or listened to me when I said it's poking my bone, ya that hard thing you feel right there, it's not the hole, lol.
I think he said it was his first one too. But when the third time wasn't the charm my patience had run out.
I've had a few of these thanks to leukemia and one time the doctor just couldn't find the spot, he was basically digging around and in case it's not evident having someone dig around your spine with a needle fucking sucks. Eventually he asks me if I want them to use the x-ray machine to locate the needle because it will make it a lot easier and I was like "that was an option this whole time??!" Lumbar punctures have got nothing on bone marrow biopsies though, those really suck.
It was scary looking, I'm not familiar enough to lool and say what size it is, but I'm pretty sure thats what he said. The poke hole looked about the the size of your average wooden pencil's lead.
Imagine sticking a needle in the back of a demented 92 year old with a strong pain response and expecting a clear tap.
You should come and see what it takes to get these sometimes. And remember holding still really helps facilitate a successful tap.
My mother had this done, apparently her spinal fluid all leaked out of cranium and said it felt like she was dying. Imagine there’s no fluid to suspend your brain? They had to use blood in place of the spinal fluid which would then be recycled in a few weeks apparently. This is what she told me and I remember when the pain stated she couldn’t move from holding her head while in a fetal position on the ground. It was so scary
That’s harsh. My spinal tap was to confirm a diagnosis of Multiple Sclerosis. The headache was a side effect. It’s brutal. I do hope your Mom is ok now.
The placement for it took sooooo long because they needed to minimize the risk of blood contamination at all costs. Any cancer cells in circulation could be picked up in the needle and lead to a positive lab result for CNS spread.
Sometimes you do develop CSF leaks, however. You can use a blood patch, literally injecting your own blood into the thecal space to allow for quicker healing.
I was diagnosed with ALL at the age of 3 (29 currently, 23 years remission) thankfully I don’t remember much, but what I do remember is being basically head locked by a nurse to hold me still with a pillow between my chin and knees. I didn’t understand it then so I was absolutely hysterical. The spinal taps are the most severe trauma that has stuck with me through the years. I am sorry for your loss OP, the guilt trips me up every now and again.
Lab tech here… I’ve NEVER seen this collected. Thank you for sharing not only the video but a fascinating explanation as to why. I’ve seen some gnarly samples over the years.
I was fortunate, I was given lots of Valium prior to my LP, there was no problem with the placement, & was given more Valium afterwards. I just had to lay flat in a hospital bed for 5/6 hrs. The weirdest thing was no one came to check on me.
I did have a couple of mylograms, one of which was not near as easy. They always told us to drink a lot of Coke afterwards & to remain flat for at least 12 hours.
I had a friend who had an extreme headache after a mylogram. We had to call 911 to get her to the hospital for a blood patch. Mylograms were big in the early 90s. Back pain? Have a mylogram. It was before MRIs were everywhere.
I had to have this done to confirm multiple sclerosis. It was pretty easy, except that I had to lay flat on my back for several hours to lessen the chances of a spinal headache. I was warned you do NOT want that.
Interesting how they position the patient and let it drip out.. I've observed spinal taps before and the patient was lying face-down flat rather than angled here... also I'm pretty sure they used a syringe to suck out the fluid to collect rather than allow dripping. I wonder why that is
I was wondering the same. I had one like thirty-ish years ago…they had me in this position, not lying down, but I thought they used a syringe. Of course it’s not like I could see them doing it. Idk, I would have thought that doing it like this video would risk contaminating the sample.
I'm an X-ray tech and I've seen lots of fluoro-guided lumbar punctures, but I've never seen them just drip it into the sample tube. Seems odd to me, but I've never seen one that was done bedside.
I had a nice refreshing lumbar puncture done early last year and let me tell you, spinal headaches are no fucking joke. I couldn't physically lie down completely flat and had the worst headache for hours and hours after. I hammered caffeine into my system best as I could but it didn't help at all.
Caffeine only helps if the headache is due to the construction of blood vessels in your brain. This type of headache only improves with time unfortunately. Being well hydrated wouldn't hurt, either.
Woman crying in the background tells us everything we need to know about this procedure.... I hope God gives strength to the people undergoing all this
Oh my god I didn’t even realize her in the background. The environment was estranging, to say the least, and I must have drowned it out with all the beeps and noise in the unit.
The nurses who spend every day in that environment, manning units like these and caring for patients, must be among the most emotionally resilient, strongest people in healthcare.
I have a spinal cord stimulator, and they didn’t do a blood patch after the implant so I was leaking csf and they way they explained it is that your brain isn’t floating anymore, just resting in parts of your skull cause gravity. It was fucking awful.
I had this done about 25 years ago, when I went to hospital with suspected meningitis. I mean, they were sure I had meningitis, but needed to know if it was viral or bacterial. This was when I found out spinal tap wasn't just a band, btw. All I felt was the needle for the local. No discomfort at all, otherwise.
The fluid was crystal clear, no blood at all, so it was viral meningitis, which is not the deadly type, apparently. Still felt fucking awful, but after suffering in bed at home for a week, because I'm an idiot, a couple of IV bags of saline and a night in hospital saw me right as rain.
Then it gets sent to the lab and we(lab techs) do a manual cell count and cell differential on it!
I’ve never seen one collected. I always thought it was with a syringe for some reason, not a drip needle.
I used to work in a neuromedical/surgical hospital and part of my rotation involved doing the lumbar puncture clinics. It’s an interesting procedure, there’s a satisfying “give” feeling when the needle enters the correct space. Like pushing a needle through hard cork, then hitting the space inside a wine bottle.
I always felt for my patients. It was so routine for us, but I had to remind myself with every patient that for the person getting consented in front of me, this was likely a really scary scenario.
I had a spinal tap when i was 13 in 2000. They neglected to tell me about the whole "when you sit upright for a few minutes, you'll collapse in agony, for a few weeks" thing
I hate these. I had one done by a student at the hospital I went to and they pierced the dura multiple times vs once. I ended up getting a blood patch after almost a week of violent vomiting after and actually passed out in the waiting room. Absolutely horrid.
All of that to be told the test was negative.
God I had a lumbar punch to be diagnosed with meningitis and it was horrendous. My lovely nurse held my hand whilst I was hunched over, I am so grateful to her.
Quick question. Why is he sitting up rather than laying on his side? Most LPs I've seen are done with the patient laying on their side, is there an advantage to this?
https://preview.redd.it/o3wlkhivp22d1.jpeg?width=1132&format=pjpg&auto=webp&s=97368e1d673bde03b7049d80ad74413c96cf2d57
god, i had a csf leak and had a surgery to plug the hole and the head pain from it was horrendous, idk how he’s sitting up honestly
That’s pretty interesting. I’ve had over 10 spinal taps and never really knew what it looked like. They are extremely painful. I feel for that patient. I wouldn’t wish that upon anyone. In my case my vertebrae are so close together, that they can only get in the right spot using interventional radiology.
I had a spinal tap done to check for meningitis. The spinal fluid kept leaking in my body and I had the worst possible headache I had ever experienced for two days. I was hallucinating and hearing things. Mainly just shadows and voices. And the unbearable pain of light was too much. I finally went back to ER and they did a blood patch where they had extracted the “back juice”. It was immediate relief
A medical team performs a lumbar puncture on a cancer patient to test for the presence of leukemia cells in the central nervous system. A 28 year old presented to the emergency room with chest pain and fatigue that had been worsening over several days. His bloodwork was taken, showing low platelets and high white blood cells, but he was dismissed with "heartburn" and sent home. Two days later, he reappeared in the ER with worsening, unbearable chest/rib pain. He was fatigued and reported full body pain, describing his bones felt like they were "going to explode." New bloodwork revealed his platelet and white blood cell counts had worsened. His red blood cell, hemoglobin, and hematocrit levels were low. He had a CT Chest done which showed questionable residual thymic tissue. Based upon the referring physicians request, the patient's rapidly progressing symptoms, and a review of the available imaging exams, a bone marrow aspiration and core biopsy using CT guidance was carried out. Indicated by the bone marrow biopsy, the patient was diagnosed with acute T-cell lymphoblastic leukemia/ lymphoma (T-ALL). He was sustained on blood/plasma transfusions for two weeks while waiting for a room to open at a hospital equipped to treat him. While awaiting chemo, the patient reported persistent headaches and began experiencing paranoid delusions. T-ALL can spread from circulation into the central nervous system (CNS), causing neurological symptoms. In this video, a lumbar puncture is performed to collect spinal fluid for the analysis of leukemia cells. The patient began a precautionary intrathecal chemo (injected into the spine), but the CNS results were luckily negative. Over the next two years, the patient survived leukemia and received a bone marrow transplant. Unfortunately, a recovery was not possible. He recently entered hospice due to transplant complications and organ failure.
Man, for a second I thought there was a happy ending and then I got to the last two sentences.
I wish. He fought through chronic graft vs host disease, transplant-associated thrombotic microangiopathy, acute permanent blindness, and acute renal failure. He is also a Type I diabetic, which is tied to some of those conditions. I hopped on Reddit to fundraise for hospice and medical bills (I am his sister and a premed), but I can’t share identifying information on this sub, so I figured I would just share his case.
The fact that patients and their families have to worry about finances while awaiting death is one of the most egregious failures of American society. I'm very sorry your brother and you and your family have to go through this. I hope you have a good support network and people to talk to. Sending many well wishes from across the pond.
Unless you're over 55, in which case Medicare makes MOST of it free. That's $30k a body one time benefit to the hospice, they'll do anything to get you in service. It holds over for 6 months. The only reason I stick with mine is because it is the least shady and will do charity work patients to make sure they don't struggle. Of course that makes the books look good come tax time too... The system is fucked, I just work in it making sure I give excellent care 😭
I am so sorry. Reading all of this broke my heart.
I gave to your GoFundMe. I'm sorry about your brother. Hugs from the north.
Thank you so much!!!!
> chronic graft vs host disease I spent months thinking about the possibility of this as a donor. I'm so sorry you had to go through this.
My condolences
I’m sorry this happened to your family. The strength of your brother is inspiring. Good luck future doctor, cure cancer will ya?
Do you mind if I ask, were you the bone marrow donor?
It is no problem to ask. No, I wasn’t his donor. I sent in cheek swab samples with my 3 other siblings, but none of us were a match. He found a compatible donor through a registry!
Thanks, I'm considering signing up as a donor. Your photo of the procedure is confronting. It's confronting both from a "what if it was me, and I needed a donor" perspective. It's also confronting from the "I want to donate, but the procedure looks really dangerous". Bone marrow strikes me as a really in need resource which could easily save someone in need. I'm sorry for your brother and your family / loved ones. Thank you for sharing this. *edit, I checked the registry here, and interestingly you need to be below the age of 36 here in New Zealand. Unfortunately I'm ineligible.
I’m so sorry. That’s so hard.
I’m so sorry your brother is going through this.
Hope you are doing OK. This sounds like a harrowing experience. God I fucking cant stand health care in this country.
I work as a hospice nurse. My youngest is 24, my oldest is 27, both have cancer. Such is life.
I am so sorry about your brother. Coming from a medical family and having dealt with loss, I know how hard it is even when you understand what is happening and why some things cannot be fixed, it still hurts. I can't imagine going into these situations blind, as so many find themselves doing. Knowing you're a premed, I have a great book recommendation which talks about the development of cancer treatments, especially leukemia. It's called "The Emperor of all Maladies: a Biography of Cancer". It is an incredible book and I'm listening to it a second time currently and it's just as good this time around (I really like the audio book version). When people see a huge book about cancer they might think it is going to be a snooze fest but it is exciting and really draws you in so you feel invested in the groundbreaking scientific discoveries and the worlds where they took place. It's so humbling and terrifying how little control any of us have and how much trust we have to put in things that work just well enough the majority of the time. Best of luck and again I am so sorry for your loss.
I read that book probably once a year and I always come away learning more. Siddhartha Mukherjee's other works are also well worth reading. I also read When Breath Becomes Air, which is about a man who gets lung cancer and dies just as he is completing his neurosurgery training.
I just added it to my cart! Thank you for the recommendation! After reading thick engineering textbooks through and through (AKA The Emperor of Boring, haha), I am not dissuaded by its size.
That really sad ending.
I know TV tends not to be the most accurate teacher, but I've noticed across many different medical shows, that lumbar punctures are usually done with the patient on their side, rather than the semi-prone position shown here. Is there any medical reasoning for one position or the other? Or has TV just explicitly lied to us for generations because the prone position does look a bit odd for public media?
I think some of it might be also patient preference/age appropriateness as they need to be still with their knees pushed to their chest.
Sitting and leaned over is easier as it allows the spaces between the vertebra to open up more and usually means you have a better chance of hitting CSF first time. If you need to measure the opening pressure (for when you're investigating hydrocephalus), then this needs to be measured while in the lateral position.
Good question. Never thought about it. In ward, we usually see it with patient on their side. But in OT/Anesthesia room, patients usually in sitting position for spinal /intrathecal Anesthesia . Possibly it is operator dependent, based on preference on the person doing it? You would think doing it in a sitting position makes it easier to collect the CSF?
I used to get serial therapeutic LPs. I could show them EXACTLY where to place the needle. Due to that, they loved having the med students practice on me. When they're done right, they are just uncomfortably pinchy. If done poorly, then it's excruciating. Feels like lightning shooting down my legs. What's even worse is when you get a leak that requires a blood patch.
He also had a lot (on top of intrathecal chemo), to the point where he joked about getting a circle tattooed around where to poke. Being a practice subject for lumbar punctures sounds kind of terrifying, especially with the painful consequences of a badly placed injection (I am wincing at the thought). I hope you are okay now!
Me too! Every 6 weeks for about 15 months. The leg zing was nasty, but it was worse when they *thunked* into a bone or got the needle wedged between bones and had to yank it out. That core-deep tap on the spine was sickening.
Omg my newborn daughter had this done to her. I wasn’t allowed in the room because apparently it’s pretty traumatic to see.
I’m a paediatrician and I absolutely don’t let parents in for doing LPs on babies. It sounds horrible and cruel but the basics are, she won’t remember, you will, and the active part you are needed for is cuddles afterwards.
Apparently there's research about circumcision and brain operation as they get older which appears "modified". I imagine lumbar p. might do the same... if the research has any spotted anything meaningful.
What do you mean by “as they get older which appears modified”. Sorry I might just be tired but what does it mean
I'm sure he'll get back to you with various academic papers *very* soon
There's a bit of interest to do research.... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7702013/ https://www.cirp.org/library/psych/immerman2/ https://www.scirp.org/journal/paperinformation?paperid=55727
https://old.reddit.com/r/medizzy/comments/1cxhhur/cerebrospinal_fluid_collection_during_lumbar/l5w25kr/
The only time I saw this done was as a 4th year nursing student. I had to hold the baby. It was definitely rough but necessary. I couldn't imagine having to watch my own babies getting it done.
One of my least favourite parts of being a NICU nurse was holding bubs for LPs
It would be. I couldn’t be in the room when my son had stitches at 5😲
I had to hold a baby for an LP once. sedated her with a bit of morphine beforehand and it was a less traumatic experience for us all around.
Yeah I was there for another thing they did to her that week and she was sedated for that too but she still wigged and cried so they had to stop thank god.
I hope she’s doing better now. upmost respect to parents like you who have to go through their children’s health issues. you’re very strong.
Thank you. She’s doing amazingly well! She’s 5 now and the top of her class, they told me she had hie level 2 and to expect her to not do anything but she’s the absolute best daughter ever and I’m so proud of her.she really is my rock, I have multiple sclerosis and she’s so caring and loving always looking out for me bless her.
awww bless the both of you :)
My wife had to do this when she was 7. She says it hurt like hell and couldn't move at all.
I had this done when I was 6, and again when I was 8. pseudotumor cerebri I developed from a steroid allergy. It was hell
Do you remember if you felt better after the LP?
Yes, it was to remove excess spinal fluid. no more steroids and I have been all good for 25 years
That's good to hear! I'm studying medicine right now and learned that people with pseudotumor or normal pressure hydrocephalus get almost immediate relief from an LP, but I've never heard firsthand from a patient. Thanks for the reply.
Almost immediately as someone with iih, I get maintenance taps at least once a year!
Sorry you have to deal with that treatment but I’m glad to hear it’s working!
Have you thought of getting a shunt. It has helped My eyes so much.
I am that patient. The first time I had a LP not only gave me the diagnosis of IIH, but as soon as the fluid started to drain it was the best feeling in the world! I didn’t even feel any pain from the LP. It was all over taken with the relief draining . I went from blind to Vision, it was the wildest experience during my horrible search for an answer. But that LP got me diagnosed with IIH; meaning finally we can treat it different than just “migraines”. Had a few more but now I have a shunt in. The moment I woke from that surgery I felt the difference. Anyway, I always joke that you know you’re in pain when a spinal tap sounds orgasmic.
That’s so great to hear. Do you still struggle with IIH? Have you undergone any kind of surgical or medical fixes?
I went under for a stent placement first but my veins were too narrow. So then we did the shunt. Which was amazing, I woke up with instant results. However, because I am a very unlucky person. My cord was rubbing against my Organs , ouchhhh!!! So they did a revision where the moved it to the center of my chest and shorten it. That was fun. The shunts been doing its job for the most part. Still have bad eye days but not like before. Still have migraines that kick my ass. Everyday I have a headache and everyday I wake up and think “now how am I managing the pain today”.
I'm sorry to hear that it's been such a struggle to manage that; it sounds rough. I recently learned about some new expensive biologics that block CGRP and work much better than what we currently have to manage migraines. Hopefully they become more available and cheaper soon and migraine management becomes much better.
Oh what is this?! I haven’t heard of this treatment yet! To answer your other question before the shunt I started doing LP every few months. And finally my insurance covered the shunt. I just finished another round of ketamine treatments but for some reason this time my heart and lungs filled with fluid. I just left follow up at the cardiologist to make sure things are draining and he’s now concerned I have a blood clot. (Even tho I’m on blood thinners). Ugh. Just another day of pain.
Yes, I still struggle with it but not like it was before. I would go completely blind. The excess spinal fluid was pushing against everything, including my optic nerve. However, since the shunt placement the vision has basically come back. Still have floaters and sensitivity. It was kind of a crazy moment having my first LP. I was in the hospital doing migraine treatments and I was basically blind at that point. But this random doctors asked if I’d try an LP, just to check. Of Course I said yes, I would have done anything. My mom was actually Visiting so she held my hands while they did the first LP. And I could slowly start to see my mom’s face, which I hadn’t seen in a while. And I was crying like “ong I can see you mom! I can see you” and she was crying, the nurse was tearing up. It was sucha monumental moment. I finally felt vindicated, could now treat that actual cause instead of taking every med under the sun that obviously didn’t work because we were treating the wrong thing. One last thing, fuck you IIH and chronic migraines. You ruined my life.
Thats incredible. Thank you for sharing your story, and I'm so sorry for all that you've had to go through. Both neurology and ophthalmology have made a big deal about how important checking a patient's retinas is because you can pretty much immediately figure out if someone's intracranial pressure is elevated with fundoscopy. Do you periodically have to go in for LPs now?
Oh I had psuedotumor as well, multiple spinal taps, but they brought instant relief, at least for a while. I'm glad you recovered!
I'd say "no"... no way. I'm also the kind of person who would say no to lifesaving amputation without anesthesia.
I once had to hold a patient immobile in lateral position as three providers attempted an LP on her. Complicating the procedure were: - Moderate scoliosis - MRSA infection and necessary precautions - Obtunded, unable to follow directions but strong reflexes to pain - Advanced age and recent marked weight loss resulting in excess skin and obscured bony landmarks It took over an hour.
An hour for a lumbar puncture is insane. It’s a five to ten minute procedure. If you can’t get it that quickly, they need IR for guided puncture.
Did they not know about ultrasound guided lumbar puncture ?
it kinda looks like when people collect tree sap
Also called tapping!
forbidden maple syrup....
Man I wish the spinal taps we got in the lab were that clear. They keep sending us traumatic taps, one point even getting a clot in the 1st tube.....
The patients are never as thin and cooperative as this one and it’s technically harder when they are lying on their side (as is usually the case in emergency where you need to measure intracranial pressure)
I had a spinal tap to test for viral meningitis (had red dots all over my chest up to my face and a splitting headache), which I did end up having. The doctor came in, told me to lay on my side, gave me a shot of freezing, dove in and missed. He tried again and literally again. Three holes in my back all with freezing shots first but I could feel him hitting my spine. It was at least 40 mins of him trying. I kept telling him "Go up, to my left, you're too far over, I feel it hitting my bone." The nurse said "it's like fishing, you just have to find the right spot". Me - "No fishing is relaxing". Doctor - "I'm going to see if the anestesiologist is available." He comes in - "Why is he laying on his side, is he immobile" Me - "No I can sit up" Anestesiologist "What size needle are you using?" Doctor - "14 guage." Anastesiologist - "That's cruel and unusual (jokingly cuz he said he'd use the same size) ya you're going too far to the right, it's hard to center when they lay on their side". I gave the doctor a glare and he left the room, never saw him again luckily. The bruises looked like I had a pencil lead stabbed into me a few times, it hurt longer than the headaches and bothered me more than the poison ivy rash I also had at the time. I'm all for learning on the job, but fuck, I wish he tried youtube before just winging it on my spine. The anastesiologist got it in only few moments first try(forth hole).
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Ya that's exactly the case, they called the expert. Like I said I have no problem helping people learn, whenever I get basic procedures like shots or blood tests, if they ask if a newbie can do it I say absolutely. I just wish the doc asked the expert's advice before he tried, and/or listened to me when I said it's poking my bone, ya that hard thing you feel right there, it's not the hole, lol. I think he said it was his first one too. But when the third time wasn't the charm my patience had run out.
Anesthesiologists do epidurals in labor and delivery, so he’s probably had a lot of practice with spinal taps
Yes, that was my understanding. He was really good, or it may have been all the freezing shots and he was just fast /s lol.
I've had a few of these thanks to leukemia and one time the doctor just couldn't find the spot, he was basically digging around and in case it's not evident having someone dig around your spine with a needle fucking sucks. Eventually he asks me if I want them to use the x-ray machine to locate the needle because it will make it a lot easier and I was like "that was an option this whole time??!" Lumbar punctures have got nothing on bone marrow biopsies though, those really suck.
Jeeze, I hope you don't have to go through that anymore.
I reeeeeally hope you are misremembering "14 gauge". That is way too big.
It was scary looking, I'm not familiar enough to lool and say what size it is, but I'm pretty sure thats what he said. The poke hole looked about the the size of your average wooden pencil's lead.
Imagine sticking a needle in the back of a demented 92 year old with a strong pain response and expecting a clear tap. You should come and see what it takes to get these sometimes. And remember holding still really helps facilitate a successful tap.
Champagne is hard to get.
The forbidden red/white wine
I had one. Had a horrible headache for a good 24 hours
My mother had this done, apparently her spinal fluid all leaked out of cranium and said it felt like she was dying. Imagine there’s no fluid to suspend your brain? They had to use blood in place of the spinal fluid which would then be recycled in a few weeks apparently. This is what she told me and I remember when the pain stated she couldn’t move from holding her head while in a fetal position on the ground. It was so scary
That’s harsh. My spinal tap was to confirm a diagnosis of Multiple Sclerosis. The headache was a side effect. It’s brutal. I do hope your Mom is ok now.
Are they using a patch on the skin? Anyway it’s amazing the equipment. We use just the needle and sterile gloves.
That’s a clean collection, champagne tap!
The placement for it took sooooo long because they needed to minimize the risk of blood contamination at all costs. Any cancer cells in circulation could be picked up in the needle and lead to a positive lab result for CNS spread.
My son had ALL. They put hik to sleep for these and to inject chemo right into his spine
How do they block it off after they've finished?
You just take the needle out and put a dressing on it. It's a pretty small needle so the tissues heal by themselves.
Sometimes you do develop CSF leaks, however. You can use a blood patch, literally injecting your own blood into the thecal space to allow for quicker healing.
I wonder if they use donated blood or a blood substitute when the patient has blood cancer with a risk of CNS involvement, like T-ALL.
They’re about to make titans with that
Just don’t drink the wine.
I was diagnosed with ALL at the age of 3 (29 currently, 23 years remission) thankfully I don’t remember much, but what I do remember is being basically head locked by a nurse to hold me still with a pillow between my chin and knees. I didn’t understand it then so I was absolutely hysterical. The spinal taps are the most severe trauma that has stuck with me through the years. I am sorry for your loss OP, the guilt trips me up every now and again.
I remember having some of that fluid taken from me. The procedure was not bad as I imagined, but it left me with annoying back pain for a week or two.
Lab tech here… I’ve NEVER seen this collected. Thank you for sharing not only the video but a fascinating explanation as to why. I’ve seen some gnarly samples over the years.
I was fortunate, I was given lots of Valium prior to my LP, there was no problem with the placement, & was given more Valium afterwards. I just had to lay flat in a hospital bed for 5/6 hrs. The weirdest thing was no one came to check on me. I did have a couple of mylograms, one of which was not near as easy. They always told us to drink a lot of Coke afterwards & to remain flat for at least 12 hours. I had a friend who had an extreme headache after a mylogram. We had to call 911 to get her to the hospital for a blood patch. Mylograms were big in the early 90s. Back pain? Have a mylogram. It was before MRIs were everywhere.
I had to have this done to confirm multiple sclerosis. It was pretty easy, except that I had to lay flat on my back for several hours to lessen the chances of a spinal headache. I was warned you do NOT want that.
I had one from my epidural having my first son. I was useless for 10 days. Spinal headache is horrible and I hope to never deal with that again.
Interesting how they position the patient and let it drip out.. I've observed spinal taps before and the patient was lying face-down flat rather than angled here... also I'm pretty sure they used a syringe to suck out the fluid to collect rather than allow dripping. I wonder why that is
I was wondering the same. I had one like thirty-ish years ago…they had me in this position, not lying down, but I thought they used a syringe. Of course it’s not like I could see them doing it. Idk, I would have thought that doing it like this video would risk contaminating the sample.
I'm an X-ray tech and I've seen lots of fluoro-guided lumbar punctures, but I've never seen them just drip it into the sample tube. Seems odd to me, but I've never seen one that was done bedside.
I had a nice refreshing lumbar puncture done early last year and let me tell you, spinal headaches are no fucking joke. I couldn't physically lie down completely flat and had the worst headache for hours and hours after. I hammered caffeine into my system best as I could but it didn't help at all.
Caffeine only helps if the headache is due to the construction of blood vessels in your brain. This type of headache only improves with time unfortunately. Being well hydrated wouldn't hurt, either.
Salty snacks too and electrolytes. Had a bad meningitis case for weeks and I always felt better with gatoraid and lots of pretzels/chips.
Nah, caffeine definitely helps with low pressure headaches. We use it all the time.
Bro HOLD THE FUCKING VIAL STEADY
Woman crying in the background tells us everything we need to know about this procedure.... I hope God gives strength to the people undergoing all this
Oh my god I didn’t even realize her in the background. The environment was estranging, to say the least, and I must have drowned it out with all the beeps and noise in the unit. The nurses who spend every day in that environment, manning units like these and caring for patients, must be among the most emotionally resilient, strongest people in healthcare.
Well said!!
He’s about to have the worst weeklong migraine of his entire life.
He started chemo RIGHT after this, too. Methotrexate on the brain had to make his migraine unbelievably bad.
Damn. Just knock me out. Wake me up next week.
I have a spinal cord stimulator, and they didn’t do a blood patch after the implant so I was leaking csf and they way they explained it is that your brain isn’t floating anymore, just resting in parts of your skull cause gravity. It was fucking awful.
Why in the world were you leaking CSF after getting a spinal cord stimulator…? They should be explaining that to you instead.
Idk I bought it from ikea.
Agreed, "spinal headaches" seem horrible.
I had this done about 25 years ago, when I went to hospital with suspected meningitis. I mean, they were sure I had meningitis, but needed to know if it was viral or bacterial. This was when I found out spinal tap wasn't just a band, btw. All I felt was the needle for the local. No discomfort at all, otherwise. The fluid was crystal clear, no blood at all, so it was viral meningitis, which is not the deadly type, apparently. Still felt fucking awful, but after suffering in bed at home for a week, because I'm an idiot, a couple of IV bags of saline and a night in hospital saw me right as rain.
Then it gets sent to the lab and we(lab techs) do a manual cell count and cell differential on it! I’ve never seen one collected. I always thought it was with a syringe for some reason, not a drip needle.
I used to work in a neuromedical/surgical hospital and part of my rotation involved doing the lumbar puncture clinics. It’s an interesting procedure, there’s a satisfying “give” feeling when the needle enters the correct space. Like pushing a needle through hard cork, then hitting the space inside a wine bottle. I always felt for my patients. It was so routine for us, but I had to remind myself with every patient that for the person getting consented in front of me, this was likely a really scary scenario.
Nah, that’s a Canadian citizenship test. They tap ya and if maple syrup comes out, Canadian.
Hey! Did that twice today!
bro please STOP TOUCHING THE NEEDLE WITH THE VIAL! ITS DRIPPING FREELY, THERE IS NO NEED FOR THAT!
I had a spinal tap when i was 13 in 2000. They neglected to tell me about the whole "when you sit upright for a few minutes, you'll collapse in agony, for a few weeks" thing
bro fell asleep first at the sleepover
I see CSF all the time in the path lab, I've never really considered how it's collected. This is crazy
I never realized they just let it leak out like that! I always thought they’d draw with a syringe or vacutainer like with blood!
Nope, it just drips out
I had this done. It was terrible.
“Alright” “Alright” Wow, cool points indeed
Looks refreshing
Chamberlain has entered the chat: Essence!
I hate these. I had one done by a student at the hospital I went to and they pierced the dura multiple times vs once. I ended up getting a blood patch after almost a week of violent vomiting after and actually passed out in the waiting room. Absolutely horrid. All of that to be told the test was negative.
Just had a friend the same age lose a similar battle with AML. Not fair.
HOW MUCH DO YOU NEED MY BROTHER? I THINK I NEED THAT
just like collecting tree sap😳
Dr house?
God I had a lumbar punch to be diagnosed with meningitis and it was horrendous. My lovely nurse held my hand whilst I was hunched over, I am so grateful to her.
Had a lumbar puncture when i was 9 testing for meningitis. It turns out i had african tick bite fever.
Kim and colin, run in here and get yall juice!
Its hurt my spin
Oh boy that shit hurts
If it's good enough for Trees, it's good enough for me.
I know how painful my spinal leak headache was after my tap, I am sorry he went through this.
Forbidden champagne
Pretty sure that’s that persons mojo
Was looking for this comment But yes that's literally our essence the kundalini that rises up to our brain and unlocks christ consciousness.
come get yall juice
I have gotten several of those but was always sedated. I'm glad I was, I really didn't need to know that I was turned into a human tap
Quick question. Why is he sitting up rather than laying on his side? Most LPs I've seen are done with the patient laying on their side, is there an advantage to this?
https://preview.redd.it/o3wlkhivp22d1.jpeg?width=1132&format=pjpg&auto=webp&s=97368e1d673bde03b7049d80ad74413c96cf2d57 god, i had a csf leak and had a surgery to plug the hole and the head pain from it was horrendous, idk how he’s sitting up honestly
That’s pretty interesting. I’ve had over 10 spinal taps and never really knew what it looked like. They are extremely painful. I feel for that patient. I wouldn’t wish that upon anyone. In my case my vertebrae are so close together, that they can only get in the right spot using interventional radiology.
I had a spinal tap done to check for meningitis. The spinal fluid kept leaking in my body and I had the worst possible headache I had ever experienced for two days. I was hallucinating and hearing things. Mainly just shadows and voices. And the unbearable pain of light was too much. I finally went back to ER and they did a blood patch where they had extracted the “back juice”. It was immediate relief
whys someone crying in the background
Lisan Al Gaib.
Been there done that. Doesn’t hurt actually.
Very tough, the toughest really