Bone biopsy - drill method vs manual method

[mrfreeman]

Hi, I'm new to this forum but just wanted to ask if any of you have had a marrow biopsy with the drill method (OnControl) via the NHS (UK)? I read that it is a bit better than the manual approach? My doc wants to do a standard manual biopsy for persistent low WBC (ANC 1.0-1.5) and I wondered if anywhere in UK uses the drill, and is it less painful? Either way I think I would prefer conscious sedation! I am not looking forward to it. I am amazed in this day and age they haven't come up with a better way to do this, considering other technology improvements everywhere else. It feels like something from medieval times lol!

I wonder if I just need more vit b12/folate. The neutrophils did go up briefly at one point when I had more in my diet, but they came back down again when I had less. I will try increasing them again, plus other vits. I have a bad feeling though it's more serious than vitamin deficiency. Also, I wonder if wifi in home has anything to do with this? I started using that this year, and wonder if it's true that wifi suppresses immune system? I've stopped using it now, but the signals are all around us from neighbors etc. so can't really escape it. Anyway, thx for any experience re BMBs.

[DanL]

Mr. Freeman,

The drill is far superior to the manual method as far as I am concerned. I have had 8 biopsies, the last half with the drill. You are in and out within about 45 minutes with the drill, no sedation. Sedation takes you about 2-3 hours, then you feel off most of the day.

The doctors have also had a much easier time with me because i have hard hip bones, so they had given up on core samples manually. Residual pain also tends to be much lower for me - an average of 1-2 days instead of 5-7.

cheers.
dan

[DebS]

My husband has had "conscious sedation" during his biopsies and has sailed through every one. He didn't feel a thing and was groggy only a very short period of time.

Tenderness for the next few days is expected. But for him, it was really not that bad.

Good luck!

Deb

[mrfreeman]

Wow, thank you Dan for the response, that is so good to hear! What about the pain during the procedure though (seeing as no sedation), any less or about the same? My main concern is that and also long-term bruising/aching when sitting/driving/sleeping, how do you find those activities? Sounds like the drill method could improve the outcome there.

Can I just ask also, does that mean you have 8 HOLES in your bone?? They can't re-use the same holes can they lol? And do those holes ever close up? I didn't think bone grew back. It seems like that would seriously weaken the bone? Sorry just a bit clueless about all this.

Hope you're treatments do some good. I am in UK so not sure if my hospital uses the drill, I will ask the nurse/doc. Thx and good luck with your healing!

And thx Deb (simul post lol!), that's good to hear aswell (I will also ask about the conscious sedation, but they said before they don't need it, hmmm yeah right but I DO lol!). I wonder if the drill method will become standard in future?

[DebS]

Mr. Freeman,

Doug will ALWAYS ask for "conscious sedation." I am not sure who decides that you don't need it!!!!

Deb

[triumphe64]

Originally Posted by DebS

Mr. Freeman,

Doug will ALWAYS ask for "conscious sedation." I am not sure who decides that you don't need it!!!!

Deb

I have never had a choice. I've had five. At UCLA it was local because all adults got local. At Cleveland Clinic it was local because I had no one to drive me, and I was even using the hospital shuttle back to the motel.

[DanL]

Mr. Freeman,

all of the holes are very close to each other, 4 on each side. The doctor says that the risk of weakening the bone is fairly low.

As for recovery, i am usually in good enough shape to drive within the same day, walking around is a little slow, but not bad. Swelling is much reduced as far as my experience has shown - i only have about 30k platelets, and with the manual method, my whole back would swell. With the drill it is very localized for some reason.

The paid during the procedure is moderate to high but only for about 30 seconds to a minute, which is ok by me.

After the first four times under sedation and swelling with big bruises across the back, being able to compare the relatively small bruising and faster healing with the drill, my choice is easy, even without the sedation.

[Chirley]

I like sedation. My haematologist used to joke about how much I liked it. They used to give 5mgs Midazolam IV and I used to tell them I would like more

My haematologist refused to do BMBs without sedation. I had it done without sedation when a pathology company sent a doctor to do it.....it was okay, only really hurt a bit near the end.

I've never had the drill so can't compare. I've had at least 12 biopsies probably more.

[mrfreeman]

You guys have really been through it, you are quite inspirational and I wish you all the best in your treatments. I haven't been through anything like that (yet) but I suppose it can soon escalate. I do think the drill method sounds best, but maybe a lot of places don't use it because the battery isn't replaceable and so the company keeps making money for new ones. I hope this or something becomes standard to reduce suffering for people in future, the conditions/diseases are bad enough without this adding to the stress and anxiety. Thx for all your feedback!

[triumphe64]

Originally Posted by mrfreeman

You guys have really been through it, you are quite inspirational and I wish you all the best in your treatments. I haven't been through anything like that (yet) but I suppose it can soon escalate. I do think the drill method sounds best, but maybe a lot of places don't use it because the battery isn't replaceable and so the company keeps making money for new ones. I hope this or something becomes standard to reduce suffering for people in future, the conditions/diseases are bad enough without this adding to the stress and anxiety. Thx for all your feedback!

I remember from prior discussions that the battery is VERY expensive. Not very good marketing in my opinion. They aren't selling razor blades.

[mrfreeman]

Really, I wonder how much? Doesn't surprise me, they are probably cashing in as there is no competition. But it's only a fairly standard drill (similar to a household DIY drill), you would think somebody else could come up with something similar. Do they have a patent on it which stops anybody else from using that idea? If so, it's a shame if that prevents it from becoming more widely used.

Wouldn't it be amazing if they could just use a tiny camera to analyse people's marrow without extracting it?! And you would think removing the marrow would damage it so it wouldn't behave in the same way. I suppose it needs to be magnified under microscope though, but technology is so advanced these days anything's possible.

[triumphe64]

http://www.vidacare.com/OnControl/Bone-Marrow.aspx

[jayc]

Mrfreeman, I had my bone marrow biopsy in my oncologists office and I'm being honest in stating that it was a somewhat comfortable experience. probably because I chose ,conscious sedation. I was given the lowest dose of Ativan , IV, and all I felt was a little pressure for a second or two. My doctor nurse and myself talked and joked during the procedure. I needed a ride home because I didn't know what my condition would be but was able to drive later on that day. I never had any pain or discomfort at the biopsy site. This may be unusual but I'm not fearful if I need another. if it needs to be done there's no way out but to do it!!! good luck and I hope you have the same experience I did.

[Glenda H]

I had my third BMB recently. The other 2 were done using local anaesthetic. This time the haematologist said he would do it under sedation. I was given an injection (I didn't watch had my eyes closed) and next thing I woke up all done and didn't feel one bit sick. That was 3 1/2 weeks ago. It was tender for a while and still a bruise there.

[mrfreeman]

Thx Jay, glad you had a good experience (again with conscious sedation!). Glenda, does the bruise still hurt? You probably had the manual method. That's what I'm concerned about, longer term pain/discomfort. Good that you had no pain during the procedure though, and sounds like it was ok for you, but how were the first 2, were they worse?. I think sedation is definitely a good option. But you can imagine how manually trying to dig a needle through bone must be rather difficult and cumbersome, it's bound to involve a lot of twisting and pressure which causes more damage around the area, even if we don't feel it during the op. That's what I hope the drill method can reduce.

The Oncontrol system is being trialled in the UK at the moment (we are always so far behind the USA in things like this!). I think they are trying to get some NHS hospitals onboard, but it is in the very early stages. I think it could catch on, because I read that a lot of doctors are getting RSI/carpal tunnel syndrome from this procedure! All that pressure and twisting the needle by hand takes it's toll. We will see how things progress.

[Chirley]

The first BMB I ever had the female Registrar was grunting and groaning and I asked her if she was okay back there, she said my bone was tough and she hurt her hand. I replied that I felt sorry for her. All this while I was supposed to be sedated. I remember it vividly.

[dougr]

My first BMB is scheduled in about three weeks. Thanks to all for sharing your experience and advice.

[mausmish]

Doug,

I was terrified before my first BMB but discovered it wasn't as bad as I anticipated. I've had 10 altogether, all manual with just local lidocaine. Some were better than others but even the worst one wasn't as bad as my initial expectation. The worst part for me is the draw, varying from a pulling sensation to some pain running down my hip and leg, but that part was done in a couple of minutes or less. Afterwards, I was slightly sore but required no pain medication. It's a different experience for everyone. Hoping yours goes well! Waiting is often the hardest part.

Karen

[dougr]

Karen, thanks for sharing your experience and encouragement. The dx scares me more than anything. This forum is helping me to sort through what is going on and ask the right questions. Earlier this week, Monday, I did not even know how to spell Myelodysplastia

[bailie]

I agree with most everyone else. The anticipation is the worst part. I was pleasantly surprised that it wasn't bad at all. I golfed/walked 18 holes the next day and never felt anything bad. I will be getting my third biopsy in three weeks which will determine if I am going straight to transplant.

[mausmish]

Doug,

You've found the right place. This forum has a wealth of information, experiences, and support from people around the world. Best wishes to you!

Karen

[dougr]

Originally Posted by mausmish

Doug,

You've found the right place. This forum has a wealth of information, experiences, and support from people around the world. Best wishes to you!

Karen

Thank you so much Karen. My daughter and her family live in the Potomac area and I may have to have some help from them from what is being posted.

[JohnnyM2]

For anyone who reads this thread you need to realize that every patient and biopsy is different. I have had one biopsy of the right hip. They really wanted to do it under conscious sedation, probably because it makes it easier to control the patient. I don't like wasting my day so I refused. They thought I was nuts and put in a line just in case I couldn't tolerate it. I was prepared for it to be very painful but, except for the lidocaine injection (local anesthetic), which feels like a bee sting for about 5-10 secs, it really didn't hurt at all and I wad only a little sore for about 24 hours. I suspect it's generally better for most people to have conscious sedation, especially if you are apprehensive. If, however, you need to forego conscious sedation, I wouldn't get too upset about it. After working for a long time to get into my bone and after bending 4 manual punches, they gave up. I am returning in a week for a second attempt with a drill. I don't plan to have conscious sedation.

[Chirley]

I have bad news for you Johnny. Getting into the bone isn't the worst part. Taking the aspiration (near the end of the procedure) is the most painful part. As they didn't get into your bone you won't have experienced this.

Having said this...I have had BMB both with and without sedation and it's not awfully painful when you are awake but my thinking is that if you have to have them every few months for possibly years to come, why put up with ANY pain when you don't have to? You don't get medals for being stoic. Conscious sedation wears off in a very short period of time and I've been able to go back to work in the afternoon after having a BMB under sedation in the late morning.

As you said, we are all different but I just don't see the point of having pain if you don't need to have it.

[bailie]

I completely agree with Chirley, the "conscious sedation" is a "no brainer". I have had 13 BMBs and the "conscious sedation" is absolutely no problem in any way. If I weren't retired, I could have gone back to work 30 minutes after the BMB. I felt nothing from the sedation during or after the procedure. They have me stay on the table lying on my back for 20 minutes just to put pressure on the hip to stop any bleeding (which there is very little) and then I hop off and am on my way.

I have had both the drill and the needle, can't say which I prefer ... they are both fun.