BMB and sedation ....

[annmonster]

Hi Everyone....

Just curious.....

Why isn't sedation used for bone marrow biopsy but is commonly used for colonoscopy ?? Also, is it common to have bmb in Dr.'s office, or as an out-patient procedure in a hospital ?? Is either preferable ??

Personally, I'd really rather not be conscious for my next bone marrow biopsy ......

Thoughts ???

Thanks !

Ann

[triumphe64]

I've had five. The first was in the hospital under sedation. The next was in the doctor's office and I was given a shot to relax me. I was not allowed to drive after it. The third was done by a different doctor from that same office but was done at the office of the urology group that they shared a CT scan machine with. I was given a Rx for a pill to relax me. Again I wasn't allowed to drive. The fourth was done at UCLA. Their practice was to give all adults locals and only sedate children. The last was at The Cleveland Clinic. They would have given me the shot to relax me, but I needed to take a bus to the on campus Guest House. They would not allow me to do that, so it was done with a local.

The bottom line - each location has its own rules. If you must have a local, try using a noise blocking headset (Bose type) if you can get one. Play music you like to distract you. I don't have one, but I have identified the exact song I want to use if I ever need to do it again.

[Greg H]

Hey Ann!

My BMBs done locally and at Wake Forest (a University hospital) were all done in a procedure room in the clinic, as opposed to the operating room. Ditto for the BMBs at NIH.

I think that may not be possible if you are looking for a general anesthetic for your next BMB, because you'd need to have an anesthetist involved. I'm guessing that would mean a same day surgery center instead of the doc's office.

Based on reading here on marrowforums, and conversations with other MDSers, I can tell you that folks have very different reactions to BMBs. Some folks find it excruciating and dread it; others find it less problematic than a trip to the dentist.

One option aside from anesthesia is a BMB power drill that some docs are beginning to use. I know, it sounds a little scary. But my roommate at NIH was terrified of his upcoming BMB. The tech who came into the room to do my roommate's BMB brought along the drill, which he was testing. I couldn't believe how fast that biopsy went.

In my experience, there are two primary types of pain in a BMB. One is the sharp burn when the liquid aspirate is drawn out of the marrow. The drill doesn't help with that. The other is the pressure and pain associated with drilling down into the bone for the solid marrow biopsy. This is where the drill comes in. No grinding, grinding, grinding. Just zip, zip, and you're done.

I'm not sure a lot of clinics are using these yet, but it might be worth asking if you want less pain without the risks of anesthesia.

Take care!

Greg

[cathybee1]

Ann, your question is so common sensical. That was the very same question that I asked when my husband was told it was "not possible" to have conscious sedation for his last bone marrow biopsy.

As Greg mentioned, bmb's are often done on the fly, so to speak, in a doctor's office, requiring no sedation.

Conscious sedation does require an IV be administered, which in the U.S. generally means it be done in an outpatient surgery unit. This requires advance scheduling, and is more costly.

I personally am receiving some very painful medical treatments. These are done in my doctor's office under sedation. There is no anesthesiologist involved. Rather, my doctor injects a mixture of Versed and Demerol into a vein in my hand (which btw works quickly and much more effectively for me than a Demerol tablet). When we asked my doctor about the reluctance of hematologists to use a similar kind of injection for a bmb, he said it might tie into what kind of insurance a particular doctor carries.

If you're like my husband and you're at the point where you can't really face another bmb without some kind of effective sedation, Marlene mentioned an idea for approaching the discussion that I'd like to try next time. That is: ask the doctor what they do in the case of children who need bmbs. If you're told that children are routinely sedated, and adults not, then why the difference? If the answer is to avoid trauma and pain for the child, then you should have a good starting place for negotiations.

[Chirley]

Hi, I've had 10 or so BMBs. I've had some with sedation and some without. Without sedation they are uncomfortable verging on painful and with sedation I feel nothing. Obviously, sedated is better. The ones I have had done while an inpatient in hospital were done without sedation....I have no idea why. The others have been done in a procedure room at the daycare centre.

My hematologist refuses to do a BMB without sedation. He says there is no reason why people should be in pain if there is no need. He also sedates for lumbar punctures for the same reason.

It's easy for the hematologists to use the procedure room at the daycare facility because they all have offices attached to daycare. It's a good idea, it means that if you have any problems during your treatment they can be there immediately. If they are working elsewhere or at the hospital the other hematologists in the building cover for them. It works out well.

Regards

[Marlene]

John will not have BMB without sedation either. You do have to plan ahead for it though. They can be done in the office or in the hospital.

[Mary4Mike]

Mike has had several biopsies. The first several were without sedation done in the doctor's office. The last few have been with sedation in the clinic. There is an anesthesiologist administering the sedation and monitoring the vitals. After Mike had a sedated BMB, he has never had another one without it and says he never will. He said he never feels a thing or remembers anything about it. Why put yourself though it if you don't have to. You do have to let them know ahead of time and you need a driver to get home - their rule - which I am sure is for your protection as well as theirs.

My question to others who have had this, how many have your spouse or significant other present during the biopsy? Has the clinic ever denied them being there? I have been present for all of Mike's. Only one doctor didn't really want me to be because the room was very small and I had to kneel in the corner of the room at his head. She wanted me to guarantee her that I would not pass out because there wasn't room or time to "deal" with me.

[Greg H]

Hi All!

After I mentioned the "drill" earlier, a helpful consultant from the company that makes it dropped me an email with a link to a website about it. I don't think my posting the link here would constitute advertising, since, after all, they don't sell a do-your-own-BMB kit. I found the animation of the procedure pretty interesting.

Here's the link.

Frankly, I'm not sure why more docs aren't using this thing. Even for my regular hematologist, a very fit 40-something, with a background in the military, grinding the awl into my very hard bones is a pretty good workout. This little device looks way easier -- and apt to produce a better biopsy sample.

As for having my spouse present at the event, she sat in on a couple of BMBs, and I think that was enough for her. She found it pretty gruesome. They don't encourage other folks to be in the room during the procedure at NIH. One of my regular nurses at the local same day surgery told me that one of her fellow nursing students fainted when the class was observing a BMB.

I tend not to mind the pain of a BMB (one NIH doc called me "stoic") as much as the after-effects of sedatives. I've never been much on painkillers, sedatives, or anesthesia, so I think I have a pretty low tolerance for fuzzyheadedness and a pretty high tolerance for pain.

However, if the prospect of a BMB made me anxious or filled me with dread, I'd ask for the drugs in a heartbeat.

Take care!

Greg

[annmonster]

Actually, a drill does make sense for this procedure ..... maybe I'll borrow one from my hubby's work bench !!! ( Totally kidding ! ) . Thanks for all of the info , Greg and everyone..... it's been super-helpful !!!

Ann

[Neil Cuadra]

Originally Posted by Mary4Mike

My question to others who have had this, how many have your spouse or significant other present during the biopsy? Has the clinic ever denied them being there? I have been present for all of Mike's. Only one doctor didn't really want me to be because the room was very small and I had to kneel in the corner of the room at his head. She wanted me to guarantee her that I would not pass out because there wasn't room or time to "deal" with me.

I have always been there for my wife's biopsy procedures. My advice to everyone is that if your spouse wants you there and the doctor tries to say otherwise, insist that they allow you there, and go over their head if necessary.

[Darice]

I have always been there for my husband's BMBs, and they have been numerous places . . . doctor's office, hospital procedure room, outpatient, whatever. Probably the most memorable was when he bent the needle . . . didn't bother Jens near as much as it did me & the doc. Hard bones. Never had sedation . . . it's over in a minute.

[squirrellypoo]

I'm one of those people for whom BMBs are excruciatingly painful. Unfortunately, my body seems to be incredibly good at processing a variety of anaesthetics (not just for BMBs) and so conscious sedation has almost zero affect on me. I feel everything, I remember everything, and the only difference is that the IV and extra attendants and the extra waiting time is a bigger PITA than just going straight home and under the covers afterwards.

For me, the biggest thing to ease BMBs is having my husband (then fiance) in the room with me. He squeezes my hand, tells me amusing stories about the cat, and pets my head. Above all, he distracts me. I must've had at least 20 BMB (thankfully, none since 2009!!), and the pain and time length involved varies greatly between doctors doing it. But I'd choose to have ten lumbar punctures in a row than a single BMB, hands down. They can numb the flesh, but once it hits bone, I feel everything.

(ugh even just writing about it is bringing back awful memories and working me into a cold sweat...)

[usaf1125]

You are the Boss. I told the doctor, in the hospital and no feeling. You are in charge.

[Nadia T]

These posts make me feel so much better. After my first BMB done in a doctor's office with nothing but some local anesthetic at the biopsy site (I supplied myself with some valium), I have insisted on sedation. At one point the healthcare facility I go to locally said they don't do that so I actually traveled 5 hours away to get it done as I wanted. With conscious sedation I felt and remembered nothing.

I am grateful to my primary care physician who told me to fight for what I wanted - it's my body and my experience, after all.

An alternative offered me at one place was some valium and a fentanyl lollipop, but I passed on that. I learned that doctors have to be in the room monitoring the biopsy when there's sedation if they are not performing it themselves. Otherwise they don't have to be present (or so I was told). This might be one reason for reluctance to OK the sedation.

At NIH they let my partner stay in the room but suggested she stay on the other side so she couldn't see much of what was happening, lest she pass out. (I have also heard of people -- health care workers-- fainting)

I have always had a high tolerance for pain and so was feeling like a wimp about this. Reading these posts has really helped.

[Neil Cuadra]

Remember that spouses, partners, and other caregivers can hold your hand and talk to you without having to watch the procedure. Watching might make some people squeamish but they can simply face the other way.

[usaf1125]

Never, never, feel like a wimp.Don't forget you are in charge, you are the boss. It is human nature not to want to feel pain of any degre. I have had onlt one bone marrow test and that was in 2003. I started getting blood in 2004. Since then I have recieved 280 units of packed red cells. I have had my crt levels drop to 25 I have seen them go to over 30. I get blood when I am under 29. It is a weird condition. You be the BOSS, you are in charge. I'll be 80 in 2 weeks and I never give up. I very rarely have a good day, some are just not has bad as others, the big Gorilla is being tired, so I rest, but I will not give in to ths D--- condition.I shovel my driveway, it might take 4 hours to do it, but I do, rest lot. I think I got off the subject, just remember that you are in charge.Stand up for what you want. Good Luck I hope it works out for you.From an average of 2 weeks, I have just gone 34 days without any Blood, I am getting 2 units on the 24th. It is a strange condition, don't lrt it run your life.

[Nadia T]

I decided to insist on sedation for any BMBs but I wonder if there are any longer-term effects from the sedation that I should consider. Does anyone know?
Thanks all.
Nadia T.

[usaf1125]

Never bothered me

[Chirley]

I've never had a problem. In fact I quite liked that post sedation feeling. My doctor said maybe I liked it a little too much.

Regards

[michellek]

I work in Interventional Radiology and we do BMB referred by hemotologist, little did I know I would become a pt. I had no reservations getting it done in IR because we do sedate. I don't remember anything. We can sedate because we have critical care nurses. We have one doctor that actually uses a mallet to get the needle to the bone marrow. Then I was referred to a University hospital and was surprised to find they don't sedate. My new doctor says he really needed to do it so he could do more studies on the samples so I gave in and had it without sedation. The needle going into the bone hurt. I would definately do it again WITH sedation. If I couldn't I would really reccommend bringing and ipod. I think that would have helped take my mind off what he was doing.

[Greg H]

A Mallet! OMG.

Friends and neighbors, whether or not you ask for sedation, I think we need to join together with our fellow bone marrow warriors and try to get docs to use the drill.

I asked my friendly medical device rep about the costs. She said the typical manual BMB kit costs about $10. The kit for the drill costs $80-$100. Now, I'm not the kind of guy who wants to increase to cost of medical care ten-fold. But the bill for my last BMB (which admittedly included a full Karyotype and FISH panel, plus FISH on an extra chromosome) was north of $12,000.

The extra $90 for the drill is three-quarters of one percent of that cost. And the chances of getting a good viable marrow sample out of the process is significantly enhanced.

I'm going to put the arm on my local hematologist to try the drill. (And, no, the company is not paying me to say this -- though maybe I should buy their stock!)

A mallet! Oy vey!

Greg

[Lbrown]

I have found it depends who is doing the BMB. Some doctors are really good at it while others - not so much. And it probably also depends on how hard your bones are. I don't have sedation, and I think I have a high pain threshold. But I have had them hurt like he**. When that happens, they usually put in more lidocaine (or whatever it is) and wait for it to sink in before continuing. It's not the most comfortable thing in the world for sure.

The thoughts of a mallet though - ew! Perish the thought!

Deb

[triumphe64]

Maybe he can use the mallet to hit you on the head real hard. A form of sedation we have not yet discussed.

[mausmish]

LOL - love your sense of humor!

[Lbrown]

Ha ha!