Hi,
I'm a 56 year old healthcare professional, diagnosed with a lambda light chain MGUS in 2013 and chose to ignore it till now. Have developed significant tingling in feet and hands (feet been progressing for 2 years, hands are new) and worsening headaches, despite all my bloodwork and skeletal surveys being normal except for SPEP and light chain abnormalities.
I am definitely not multiple myeloma based on serology etc, but could be smoldering multiple myeloma. My hematologist appropriately wants to do a bone marrow biopsy and I refuse to have it without sedation. I was traumatized during laparoscopic surgery 2 years ago and I'd rather not have it than be awake.
Does anyone know whether biopsies are done under conscious sedation?
I am speaking with my hem/onc doc this week as I'll go anywhere to find a center that provides sedation. When I was younger, pain didn't matter, now, I don't want to undergo anything painful that is not necessary.
Your input will be greatly appreciated.
Forums
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Tingling_fatigue - Who do you know with myeloma?: I have MGUS or Smoldering Myeloma
- When were you/they diagnosed?: 2.5 years ago
- Age at diagnosis: 53
Re: Bone marrow biopsy with conscious sedation?
Hi there,
My husband just had a bone marrow biopsy done in September. We did it in interventional radiology in hospital under conscious sedation. I am a conscious sedation nurse and insisted he be sedated. (His 1st bone marrow was done in office under local and very painful.)
He received 100 mcg of fentanyl and 2 mg of Versed (midazolam) and had no pain.
With the drugs available today, there is no reasons to have pain during these invasive procedures. Heck we just started using Diprivan (propofol) routinely for colonoscopies.
I decided to have it done by a radiologist due to more experience with procedure along with comfort giving sedation. From start to finish it was about 3 hours.
Hope this helps.
My husband just had a bone marrow biopsy done in September. We did it in interventional radiology in hospital under conscious sedation. I am a conscious sedation nurse and insisted he be sedated. (His 1st bone marrow was done in office under local and very painful.)
He received 100 mcg of fentanyl and 2 mg of Versed (midazolam) and had no pain.
With the drugs available today, there is no reasons to have pain during these invasive procedures. Heck we just started using Diprivan (propofol) routinely for colonoscopies.
I decided to have it done by a radiologist due to more experience with procedure along with comfort giving sedation. From start to finish it was about 3 hours.
Hope this helps.
Re: Bone marrow biopsy with conscious sedation?
Kerri,
You are a blessing from God. It helps so much to read your response because my problem is that I tend to try not to be an "RN" when it come to myself and by doing that, I shoot myself in the foot. Ironically, I do most of my consulting work in the surgery arena and am well aware of the benefits to conscious sedation. I'm done with going through pain when pain is not necessary. My hem/onc doc offered me the option of having IR do it through guided imaging but I'm thin and not a "high risk" for a failed biopsy, however, I would never go through conscious sedation without being in a monitored environment so it may be better to do it through IR with anesthesiology present.
I am so thankful for your response and just spoke to an anesthesiologist friend of mine who absolutely agrees. There is no reason to go through this without a little "cocktail" or even straight Diprivan. Fentanyl and Versed have been used for years to "knock people out" and as you state, during endoscopic procedures, we don't blink an eyelid. You can't have a scope-related procedure without sedation.
Thank you so much and prayers for your husband.
You are a blessing from God. It helps so much to read your response because my problem is that I tend to try not to be an "RN" when it come to myself and by doing that, I shoot myself in the foot. Ironically, I do most of my consulting work in the surgery arena and am well aware of the benefits to conscious sedation. I'm done with going through pain when pain is not necessary. My hem/onc doc offered me the option of having IR do it through guided imaging but I'm thin and not a "high risk" for a failed biopsy, however, I would never go through conscious sedation without being in a monitored environment so it may be better to do it through IR with anesthesiology present.
I am so thankful for your response and just spoke to an anesthesiologist friend of mine who absolutely agrees. There is no reason to go through this without a little "cocktail" or even straight Diprivan. Fentanyl and Versed have been used for years to "knock people out" and as you state, during endoscopic procedures, we don't blink an eyelid. You can't have a scope-related procedure without sedation.
Thank you so much and prayers for your husband.
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Tingling_fatigue - Who do you know with myeloma?: I have MGUS or Smoldering Myeloma
- When were you/they diagnosed?: 2.5 years ago
- Age at diagnosis: 53
Re: Bone marrow biopsy with conscious sedation?
Kerri,
I just heard from my wonderful doctor who said that IR can do it at our hospital but he said that if I want propofol (Diprivan) it'll require an anesthesia consult versus fentanyl / Versed, which won't need a consult as the interventional team give this for inserting ports etc.
My last question to you is whether the fentanyl / Versed act in the same fashion as propofol in terms of me not being conscious because I'd hate to have it done with that "cocktail" and still feel it? I'm such a wimp! I know that some GI docs use this combo for endoscopy. Obviously they dose according to weight, but seeing as you are a CRNA or anesthesia-related nurse, I'm sure that your husband was fully "out of it" with this combo versus propofol.
Thanks again!
I just heard from my wonderful doctor who said that IR can do it at our hospital but he said that if I want propofol (Diprivan) it'll require an anesthesia consult versus fentanyl / Versed, which won't need a consult as the interventional team give this for inserting ports etc.
My last question to you is whether the fentanyl / Versed act in the same fashion as propofol in terms of me not being conscious because I'd hate to have it done with that "cocktail" and still feel it? I'm such a wimp! I know that some GI docs use this combo for endoscopy. Obviously they dose according to weight, but seeing as you are a CRNA or anesthesia-related nurse, I'm sure that your husband was fully "out of it" with this combo versus propofol.
Thanks again!
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Tingling_fatigue - Who do you know with myeloma?: I have MGUS or Smoldering Myeloma
- When were you/they diagnosed?: 2.5 years ago
- Age at diagnosis: 53
Re: Bone marrow biopsy with conscious sedation?
Hi,
Yes your doc is correct in that anesthesia or CRNA will need to give Diprivan. Diprivan is a sedative / hypnotic agent, not a pain med. We give a bolus of fentanyl with the Diprivan. There are also docs that use fentanyl or Demerol (meperidine) with Versed for endoscopies. Versed is a benzodiazepine that also has an amnesia effect so people often do not remember.
So my husband has had both sedations, his experience is this: They both provided adequate pain control. He doesn't remember much from either. The Diprivan recovery left him less lethargic throughout the day.
I believe Diprivan will give you a "deeper conscious sedation experience." In conscious sedation, patients maintain their respirations and are able to respond to verbal/tactile stimulation and maintain vital signs.
Monitored anesthesia care (MAC) means that a CRNA or anesthesiologist is responsible for sedating and monitoring the patient. It is a deeper sedation and can, with or without intention, transition to a general anesthetic.
Due to your anxiety, bad experience and probable need to repeat potential painful procedures, I would recommend you go for the MAC or even general anesthesia.
There is no shame. I've taken care of vasectomy patients that just had local all the way to general anesthetic. The important thing is that you have a good experience so that in the future you will not be afraid and possibly allow that fear to prevent you from getting treatment.
There is no reason you should feel anything but slight soreness after procedure...
Yes your doc is correct in that anesthesia or CRNA will need to give Diprivan. Diprivan is a sedative / hypnotic agent, not a pain med. We give a bolus of fentanyl with the Diprivan. There are also docs that use fentanyl or Demerol (meperidine) with Versed for endoscopies. Versed is a benzodiazepine that also has an amnesia effect so people often do not remember.
So my husband has had both sedations, his experience is this: They both provided adequate pain control. He doesn't remember much from either. The Diprivan recovery left him less lethargic throughout the day.
I believe Diprivan will give you a "deeper conscious sedation experience." In conscious sedation, patients maintain their respirations and are able to respond to verbal/tactile stimulation and maintain vital signs.
Monitored anesthesia care (MAC) means that a CRNA or anesthesiologist is responsible for sedating and monitoring the patient. It is a deeper sedation and can, with or without intention, transition to a general anesthetic.
Due to your anxiety, bad experience and probable need to repeat potential painful procedures, I would recommend you go for the MAC or even general anesthesia.
There is no shame. I've taken care of vasectomy patients that just had local all the way to general anesthetic. The important thing is that you have a good experience so that in the future you will not be afraid and possibly allow that fear to prevent you from getting treatment.
There is no reason you should feel anything but slight soreness after procedure...
Re: Bone marrow biopsy with conscious sedation?
Thanks so much for your amazing advice. Are you a CRNA? I think I'll hold off on MAC as I am already going from doing it as an office procedure to sedation.
I told the hem/onc to let them know I'll do the Versed / fentanyl, but when they call to schedule (radiology that is), I'll ask them to get me a consult with anesthesia for propofol. I don't like benzodiazepines, the after affect is not good versus propofol which has no lingering effects after we "sleep it off".
I should only need one initial biopsy as I don't have any signs or symptoms of multiple myeloma; I'm being worked up for MGUS versus smoldering myeloma.
You're the best!
I told the hem/onc to let them know I'll do the Versed / fentanyl, but when they call to schedule (radiology that is), I'll ask them to get me a consult with anesthesia for propofol. I don't like benzodiazepines, the after affect is not good versus propofol which has no lingering effects after we "sleep it off".
I should only need one initial biopsy as I don't have any signs or symptoms of multiple myeloma; I'm being worked up for MGUS versus smoldering myeloma.
You're the best!
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Tingling_fatigue - Who do you know with myeloma?: I have MGUS or Smoldering Myeloma
- When were you/they diagnosed?: 2.5 years ago
- Age at diagnosis: 53
Re: Bone marrow biopsy with conscious sedation?
That is a good plan, I am sure that you will have a pleasant experience.
I am not a CRNA, I work in endoscopy as a conscious sedation nurse. We are actually piloting a Diprivan delivery system called Sedasys that does not require any anesthesia personnel at bedside; one of only 3 places in the U.S. (Toledo, OH). I am sure this will be the "normal" in the near future.
I wish you the best and pray for a clear bone marrow.
I am not a CRNA, I work in endoscopy as a conscious sedation nurse. We are actually piloting a Diprivan delivery system called Sedasys that does not require any anesthesia personnel at bedside; one of only 3 places in the U.S. (Toledo, OH). I am sure this will be the "normal" in the near future.
I wish you the best and pray for a clear bone marrow.
Re: Bone marrow biopsy with conscious sedation?
I've had four of them, all in office with tongue depressor between my teeth. Every time they tell me it's time for another biopsy I hide under the desk. Why do it? Simple, money. Insurance won't cover sedation expense for marrow biopsy. Might want to check that out if you are concerned about $$$. Jerry.
Oh, I'd recommend two depressors, keeps you from cracking tooth during the extraction of the marrow
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Oh, I'd recommend two depressors, keeps you from cracking tooth during the extraction of the marrow
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JBarnes - Name: Jerry Barnes
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: Aug 17, 2012
- Age at diagnosis: 54
Re: Bone marrow biopsy with conscious sedation?
Had 3 bone marrow biopsies, one done by a physician (the first), and two done by a team of medical students. This team is working doing only bone marrow biopsies at the hematological / myeloma department of my hospital.
Here they only use use injections to take the the pain in skin, muscle and the outer bone tissue where they say that there are a lot of nerves. They are doing a lot to ensure that they injected enough of the painkiller.
The doctor was a bit inexperienced, it was at another department while being examined to diagnose myeloma. The students are great.
Not that I like having my bones punctured, but it is not scary after the first time and I do not understand the #%€$#% around bone marrow biopsies.
I would not let the inexperienced doctor do it again, but in February the students will get a third go at my hip to check 14 months after my autologous stem cell transplant (ASCT). Not worried.
Just insist that the team is experienced!
Here they only use use injections to take the the pain in skin, muscle and the outer bone tissue where they say that there are a lot of nerves. They are doing a lot to ensure that they injected enough of the painkiller.
The doctor was a bit inexperienced, it was at another department while being examined to diagnose myeloma. The students are great.
Not that I like having my bones punctured, but it is not scary after the first time and I do not understand the #%€$#% around bone marrow biopsies.
I would not let the inexperienced doctor do it again, but in February the students will get a third go at my hip to check 14 months after my autologous stem cell transplant (ASCT). Not worried.
Just insist that the team is experienced!
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Lev - Name: Lev
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: June 2014
- Age at diagnosis: 57
Re: Bone marrow biopsy with conscious sedation?
From the posts on this forum it seems to me that the attitude towards BMB's is almost a binary set; some of us loathe, hate, fear them, and simply do not understand why the medical profession/insurance companies would insist upon inflicting torture upon patients in order to save some money.
Others seem to think that it is 'no big deal.' and don't understand the @%# about the procedure.
OK, I'm in the first group, and I don't particularly care what others think of my opinion regarding this issue. I've had five babies without anesthesia, for crying out loud; I have absolutely nothing to prove to anybody as to my courage or ability to handle pain.
In fact, my position on pain is this: if is necessary, ok. However, if it isn't necessary, I don't see the point. Having had two BMB's now, I have informed my docs that when I have to do another one, it WILL be under sedation and with me at the very least not remembering it, or I'm changing docs until I find one who will do it that way.
It is funny, however, to see the dichotomy here; there doesn't seem to be a middle ground; we either dread and hate them, or figure that they are no big deal.
I'd rather have a root canal on an infected tooth, and since I HAVE had root canals on infected teeth, I know whereof I speak.
Others seem to think that it is 'no big deal.' and don't understand the @%# about the procedure.
OK, I'm in the first group, and I don't particularly care what others think of my opinion regarding this issue. I've had five babies without anesthesia, for crying out loud; I have absolutely nothing to prove to anybody as to my courage or ability to handle pain.
In fact, my position on pain is this: if is necessary, ok. However, if it isn't necessary, I don't see the point. Having had two BMB's now, I have informed my docs that when I have to do another one, it WILL be under sedation and with me at the very least not remembering it, or I'm changing docs until I find one who will do it that way.
It is funny, however, to see the dichotomy here; there doesn't seem to be a middle ground; we either dread and hate them, or figure that they are no big deal.
I'd rather have a root canal on an infected tooth, and since I HAVE had root canals on infected teeth, I know whereof I speak.
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dianaiad - Who do you know with myeloma?: Me
- When were you/they diagnosed?: Officially...March 2013
- Age at diagnosis: 63
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