Anesthesia and Bone Marrow Biopsy
August 22, 2019 at 2:59 pm #48723
We went to a recent MDS forum meeting, and one of the speakers said that all MDS patients should get at least one bone marrow biopsy from an MDS Center of Excellence to fully understand what type of MDS they have. My wife is pretty much drug naive(meaning she is very reticent about taking any drugs, particularly pain meds) because her whole family have allergies to opiates. She is too nervous to get a biopsy without light anesthesia, but so far, two different Centers of Excellence only use fentanyl, which is an opioid. Does anyone know of a Center of Excellence in the western US that will do a bone marrow biopsy using propofol? Her first biopsy was done at hospital that had no MDS expertise, and the biopsy provided an inadequate sample for detailed testing. Anybody have similar problems? Do we just have to live with an inadequate specimen until blood counts get to the point of needing treatment?August 23, 2019 at 6:24 am #48731
Don, it’s unbelievable to me that an institution would not listen and respect a patients wishes especially with a history of adverse effects of opioids. I have had 3 biopsies done in the clinic with just some versed as a minor relaxant. The key is to get the practitioner who does the most biopsies who can be quick and thorough. I have requested this same person every time. It would seem to me a frank discussion with the anesthesia provider or whom ever is providing sedation should be able to accommodate your wife’s needs. I am followed at the University of Minnesota and they are more than willing to work with you based on the patient. As a 35+yr health care provider, it’s very disconcerting that providers don’t listen and respect that patients may know more than them as it relates to their bodies and what is safe and in their best interest. Continue to be your best advocate in this issue and best of luck. I’m sure you’ll find an institution that puts the patient first.August 29, 2019 at 2:33 am #48762
Don, I know there is a preference to just use a local anesthetic for bone marrow biopsies (BMB) due to logistics–with propofol, patient must be driven to and from, no food or drink from midnight before–and cost. I agree with Kathy that patient’s request should be honored. I had a BMB at Torrance Memorial Medical Center in the Los Angeles area, and, at registration, was given the choice of propofol, which I gladly chose. No pain during or after BMB. Both my treating oncologist who wrote the order, and my consultant at City of Hope, were surprised I got propofol and indicated that they just use a local. Now, 6 mos later (after 5 cycles of Vidaza) I am going to get another BMB and will request the propofol again.
Kathy, in your post you referred to a minor relaxant: “versed”????August 29, 2019 at 4:08 pm #48767
I had my first bone biopsy recently, performed by my oncologist. I was so scared prior to the procedure, but it was not a big deal. The worst part was the local anesthetic, and that sting doesn’t last long. My doc is adept at this procedure and made it easy. If the biopsy is done by someone experienced and skilled, the local anesthesia should be adequate. I didn’t even have a sore spot afterward. Best of luck to you!August 30, 2019 at 1:15 pm #48780
Yes Dale it was versed what in the medical world is known as the “I don’t care” drug. Everyone has a different pain perception and should be comfortable whatever they choose/need to get the biopsy done. Had propofol for my first one and as I was asleep don’t know how much digging was done but I was really sore. Found a good PA who has done my next 3 in clinic with versed and lots of local and all good.
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