Bone Marrow Biopsy

[Chris Guerra]

My husband Tony has MDS (RARS). Tony has had MDS for 7 years and now it is time for another bone marrow biopsy. Tony is a patient at Stanford Cancer Ctr. would like to have the biopsy done under conscious sedation, Stanford is not able to provide this. Does anyone know any place in the bay area that uses conscious sedation for BMBs.
Thank you,
Chris Guerra

[Neil Cuadra]

Is the problem really that the Stanford Center doesn't ever use conscious sedation, or is it an issue of their "standard" practices, or even of your husband's insurance coverage?

[Wendy Beltrami]

I am not exactly sure what you mean by conscious sedation, but I will tell you that my son Grant had a BMA & B at Stanford for which he was put "out" for very very short period of time- maybe 15 minutes max using "gas". He woke up quickly and had no pain. I'm sorry I am completely drawing a blank on the name of the sedation med and can't locate it in my notes right at the moment. Might have been propophol or versed or maybe both(?) He wakes up, has some crackers, sits around for 45 min or so and away we go.

He has had 6 BMA & Bs since his dx in 1998 at 3 different hospitals and has never, EVER had any pain or difficulty. A tiny bandaid and maybe a slight soreness at the site afterwards for which he does not even require any Tylenol.

Yes, he is a pediatric patient but I do not understand why anyone would ever undergo this procedure any other way. What is the benefit of not doing it this way? I hear of adults who describe a horrendous painful ordeal. I don't get it.

Wendy/mom to Grant
age 15 1/2
dx 12/4/98 AA

[Chris Guerra]

Tony and I have talked to patient relations and Dr. Robert Negrin Div. Chief for Oncology and Hemotology at Stanford. Stanford does not provide conscious sedation to their patients. Dr. Negrin said the Cancer Ctr. is not set up to provide this service. Our insurance does cover it, but Dr. Negrin said that some insurance companies do not.
After reading Wendy's post apparently concious sedation is provided at the Children's Hospital. Wendy, it's good that the Children's Hospital provides this service, my husband has told me that a BMB is a very uncomfortable procedure.
My own feelings are that as patients (myself included, as I am breast cancer patient) we have enough uncomfortable procedures perfomed on us. I would hope that these procedures could be performed with the least amount of pain and anxiety as possible.
Chris Guerra

[Ruth Cuadra]

I'm very surprised to hear that Stanford has told you that they do not provide conscious sedation for their patients. The Stanford website contains numerous mentions of conscious sedation. For example,

• an update for medical staff from the Chief of Staff says:
  
  "Similar [informed consent] rules apply for conscious sedation. We must document that we have given appropriate information whenever we consciously sedate our patients. Physicians should read the new policy. It is available at nursing stations. In essence, the policy requires us to explain to patients not only the risks and possible complications of conscious sedation, but also the alternatives to using sedation for the procedure."

• a page on Interventional Radiology Information for Physicians says:
  
  "...patients who need long-term chemotherapy may be candidates for chest ports or arm ports. These subcutaneous infusion ports can be easily placed under radiological guidance under conscious sedation."

• a page that lists Important Dated Departmental Memos for the Department of Surgery has an entry titled "Invasive Procedures & Conscious Sedation Forms 7-21-06". This page requires a login, but does indicate that someone, somewhere at the Stanford Medical Center is performing conscious sedation.

I've had bone marrow biopsies done with no sedation, with versed/demerol, and with conscious sedation. There is absolutely no question that I would never have another one without conscious sedation. I urge you not to accept the answer you've been given without pressing for more information. Stanford clearly does conscious sedation so the question for them should be how to arrange for it to be used during a bone marrow biopsy.

Hope this helps.

Ruth Cuadra

[Chris Guerra]

Ruth,
Tony's nurse has tried to arrange for the BMB to be done in the main hospital. The hospital is the place where conscious sedation is available. She was told no they would not make available an operating room for this procedure.
I have spoken with patient relations at the main hopital and at the Cancer Ctr. and as I previously stated the Div. Chief of Oncology and Hemotology at the Cancer Ctr.
So at this point Tony is willing to go outside of Stanford to get the BMB using conscious sedation.
Chris

[Ruth Cuadra]

Hi, Chris.

When I had conscious sedation for bone marrow biopsies at City of Hope, they were always done in the outpatient clinic. An anthesiologist is required, but not necessarily an operating room, which would be a lot of overhead for a 10-minute procedure. Maybe Stanford just needs to take lessons from their fellow institution to the south!

Hope you can find a way to get Tony what he needs!

Regards,
Ruth

[Chris Guerra]

Hi Ruth,
I contacted City of Hope today and registered Tony as a new patient. We are going to try to go there for the BMB.
Thanks for you help,
Chris

[Neece]

Originally Posted by Chris Guerra

My husband Tony has MDS (RARS). Tony has had MDS for 7 years and now it is time for another bone marrow biopsy. Tony is a patient at Stanford Cancer Ctr. would like to have the biopsy done under conscious sedation, Stanford is not able to provide this. Does anyone know any place in the bay area that uses conscious sedation for BMBs.
Thank you,
Chris Guerra

As far as BMB pain. I have had several BMBs since my diagnosis in 1999. I have them every few months. I have previously had them with different doctors. I know everyone's pain tolerence is different but so is every doctor's BMB techniques. I truely believe that it can be done with minimal discomfort. Fortuneately for me, my doctor has this ability and good technique. Lanocaine is used prior and the only pain I feel is the first injection of the lanociane. Then the rest is mainly pressure. Afterwards there is some discomfort that usually Tylenol takes care of. Hopefully you can find the right doctor who can do this procedure.
Neece

[Steve Kessler]

I've had a couple of BMBs without sedation and don't need to show such hubris any more. My docs give me a lollipop sedative and lidocaine at the site. Not too bad, although they won't let me drive myself home afterwards. One thing I've noticed is that it makes a difference in healing the way the probe is inserted. If the doc goes directly in, there is some roughness around the edge of the puncture site and it hurts more over the next few weeks as well as forming a small scab at the site. If he makes a small incision first, the site heals quicker and better.

[Chris Guerra]

I just wanted to update my post. We traveled down to Southern Calif. May 16th to City of Hope. Tony had a consult with Dr. Stein, and a BMB with sedation on the 18th. Tony said it was great and worth the trip. We are returning on May 31 to get the results from the biopsy.
We had a great experience at City of Hope. Dr. Stein, is a senior hemotologist and is well versed in MDS. Dr. Stein is also a kind and compassionate doctor and the staff is equally so.
Tony is going to continue his treatment at Stanford as we both feel (I have breast cancer) that we have received excellent care from our doctors. Dr. Stein was in agreement with Dr. Coutre's (Stanford) current treatment plan for Tony's MDS RARS. Tony will receive a new treatment plan based on the biopsy and we will consult with both doctors, it will be interesting to see if both doctors agree on a new treatment plan.
Chris

[Ruth Cuadra]

Chris,

I'm so glad you and Tony got hooked up with Dr. Stein at City of Hope and that the biopsy went well. Dr. Stein was the primary doctor for a friend of mine during her transplant and was one of the doctors I saw on rotation during my transplant. He's low-key, but very compassionate--as is everyone at City of Hope. The doctors there know a lot about MDS. Keep us posted on what the plans are for Tony's treatment.

Regards,
Ruth

[Tom M]

I have had a couple of BMB's since my diagnosis. My last one was with a CAT scan to find the thinnest part of the hip bone, then some local anesthetic, and not too much discomfort. Apparently, my bone is unusually dense, so finding the thinnest part saves us both some some wear and tear. So far, I have been able to tolerate the discomfort, but I will keep the conscious sedation in mind.

[Jan49]

My doctor did my two BMBs in his office. I had a fentanyl lollipop and he used a Lidocaine local. I felt pressuare but no pain, except for a momentary "shock' like shooting pain down my leg. I am newly diagnosed with MDS and am on my fitst course of Vidaza. I hope it works.

Jan