Bone Marrow Biopsy - Page 2

"Mike Radcliffe" <mikeradcliffenospam@optusnet.com.au> wrote in message
news:40d8f7fa$0$25463$afc38c87@news.optusnet.com.au...
> .
>
> > I hear some people don't feel that much pain while
> > others experience the most grueling pain imaginable, me
> > being in the later group. Most people
> are
> > in that later group as a matter of fact.
> >
> > Pmb
> >
> There are lots of differences in the way people
> feel/express pain. Doctors will give analgesia or sedation
> according to the accepted norm but there will always be
> people who feel the pain anyway whether because of their
> physiology or fear (the pain is still real to them). The
> answer is for them to discuss the problem with the doctor
> who may use more local anaesthetic or sedation or maybe
> suggest an adjuvant therapy
like
> hypnotherapy to lessen the pain/stress of the
> procedure. MIKE
>
>

And like any other test............... Is the potential
benefit from the result larger than the distress from the
procedure? If not, don't do it!

"madiba" <down@thekraal.com> wrote in message
news:1gfsse3.yuffwx1awot3eN%down@thekraal.com...
> Larry <Larry@nospam.net> wrote:
>
> > I would respecfully disagree. I think the pain (for the
> > people who have a low pain threshhold is with the
> > aspiration and not the biopsy).
> >
> > Larry E.
>
> Could explain why none of my patients reported pain during
> BM biopsy. I only had to cut through bone, never aspirate.
> Sedation with midazolam (Versed/Dormicum) was standard.

That doesn't explain anything. If the patient is sedated
then you're comparing apples and oranges. Some oncologists
don't use anything more than a shot of lidocaine. Some use
stronger drugs.

Next time give them only a shot of lidocaine and see how
they respond.

Pmb

> > There are lots of differences in the way people
> > feel/express pain.
Doctors
> > will give analgesia or sedation according to the
> > accepted norm but there will always be people who feel
> > the pain anyway whether because of their physiology or
> > fear (the pain is still real to them). The answer is for
> > them to discuss the problem with the doctor who may
use
> > more local anaesthetic or sedation or maybe suggest an
> > adjuvant therapy
> like
> > hypnotherapy to lessen the pain/stress of the
> > procedure. MIKE
> >
> >
>
> And like any other test............... Is the potential
> benefit from the result larger than the distress from the
> procedure? If not, don't do it!

The most poignant point of all! Like I tell my patients,
there is no way on earth I would go through
chemotherapy........but , then, nobody has diagnosed me with
cancer...yet. MIKE

Larry <Larry@nospam.net> wrote in message news:<cbaieh$pne$1@news.btv.ibm.com>...
> I am not a doctor, but a patient that has had 5 (sorry I
> can't compete with your 8, but close enough :-)).
>
> I'm afraid that I really do have to disagree with you on
> this (respectfully, of course). I have had many
> discussions with other patients on this topic, and have
> also read many discussions on the topic at the Multiple
> Myeloma Listserver. Please understand that I didn't record
> the level of pain that each person experienced and I don't
> have a tally ... I am basing my conclusions on my memory
> of these discussions over the years ... and, of course,
> upon my own experience.

Did you have medication before this or did the doc simply
walk into the room and start drilling? What makes you
think that when you're comparing yourself to everyone else
that you're holding all other variables constant. E.g. a
dab of EMLA cream on the area before adding lidocaine and
demerol before the procedure starts can drop the pain from
a 10 to a 5.

> It really does have a lot to do with the practictioner's
> technique and upon the individual's threshold for pain
> tolerance.

The term "pain threshold" is pretty much meaningless until
it is actually define and a procedure is devised to actually
measure it. Perhaps there are a few people who have a low
density of nerves in the place where the drilling is done.
Perhaps anestesia helps some and not others. Anticipation
anxiety plays a large role in how much pain the patient
experiences too.

> You are welcome to your opinion, but it certainly isn't
> accurate (IMHO) to say "Bone marrow biopsies are famous
> for being extremly painful."

I;m not basing this on opinion. I'm basing this on numerical
fact. Go the the Leukemia and Lymphoma Societies discussion
board and look around. You'll notice that everyone there who
had a BMB has experienced large levels of pain.

> Take a look at
> http://www.cancernetwork.com/journal...ews/n0004p.htm
>
> This is a study of an analgesic where patients were
> surveyed on their experience during BMBs before and after
> using it. Note the average "pain" score of 3.97 (scale 1
> to 5) across 26 patients with no meds.

It says

" 3.97 for previous procedures. The previous procedures were
sometimes conducted with ------->analgesics,<----------
sometimes without."

By the way, 3.97 is nothing to sneeze at since that is a 7.1
on a scale from 1 to 10. Not to mention that people can't
accurately gauge pain with numbers in a non-subjective
fashion. And that's a 7 out of 10 with pain meds. Pain meds
don't work the same on everyone.

> Just curious ... have you had all 8 done by the same
> person?
>

The first was done by a an oncologist from my home town. He
just gave me a shot of lidocaine and started drilling. It
was a nightmare. I can tolerate pain pretty well but that
was overwhelming. It was the first time I ever screamed from
pain in the last 25 years. I had to have anotherone the next
day at Dana Farber. I begged them to give me as much drugs
as theyu could. They gave me demerol. That was a different
doc. The next six were done by the same person with
differing levels of pain, ranging from 7 to 9. I did some
research during this time to learn how to lesson the pain. I
learned that anxiety increases the pain. I also learned that
EMLA cream can kill a lot of the pain. The last one was a
piece of cake. The third one was kind of funny since the
doctor said "Uh oh!" It was his first one and he thought he
didn't hit the bone. He actually did but he didn't know it
right off, hence the "Uh oh!" And, of course, I remind him
of that occasionaly. :-)

Pmb

Pmb <someone@somewhere.com> wrote:

> "madiba" <down@thekraal.com> wrote in message
> news:1gfsse3.yuffwx1awot3eN%down@thekraal.com...
> > Larry <Larry@nospam.net> wrote:
> >
> > > I would respecfully disagree. I think the pain (for
> > > the people who have a low pain threshhold is with the
> > > aspiration and not the biopsy).
> > >
> > > Larry E.
> >
> > Could explain why none of my patients reported pain
> > during BM biopsy. I only had to cut through bone, never
> > aspirate. Sedation with midazolam (Versed/Dormicum) was
> > standard.
>
> That doesn't explain anything. If the patient is sedated
> then you're comparing apples and oranges. Some oncologists
> don't use anything more than a shot of lidocaine. Some use
> stronger drugs.
>
> Next time give them only a shot of lidocaine and see how
> they respond.

Afraid you're the one mixing up apples with oranges, a
midazolam sedation is just sedation and not analgesia. Of
course they got lidocaine locally from skin to periostium as
well. Anyway, nowdays I leave BM biopsies to the youngsters.

--
madiba

Gauge wrote:
> Larry <Larry@nospam.net> wrote in message
> news:<cbaieh$pne$1@news.btv.ibm.com>...
>
>>I am not a doctor, but a patient that has had 5 (sorry I
>>can't compete with your 8, but close enough :-)).
>>
>>I'm afraid that I really do have to disagree with you on
>>this (respectfully, of course). I have had many
>>discussions with other patients on this topic, and have
>>also read many discussions on the topic at the Multiple
>>Myeloma Listserver. Please understand that I didn't record
>>the level of pain that each person experienced and I don't
>>have a tally ... I am basing my conclusions on my memory
>>of these discussions over the years ... and, of course,
>>upon my own experience.
>
>
> Did you have medication before this or did the doc simply
> walk into the room and start drilling? What makes you
> think that when you're comparing yourself to everyone else
> that you're holding all other variables constant. E.g. a
> dab of EMLA cream on the area before adding lidocaine and
> demerol before the procedure starts can drop the pain from
> a 10 to a 5.
>
>
No meds at all. Just Lidocaine, and lot's of it.

>
>>It really does have a lot to do with the practictioner's
>>technique and upon the individual's threshold for pain
>>tolerance.
>
>
> The term "pain threshold" is pretty much meaningless until
> it is actually define and a procedure is devised to
> actually measure it. Perhaps there are a few people who
> have a low density of nerves in the place where the
> drilling is done. Perhaps anestesia helps some and not
> others. Anticipation anxiety plays a large role in how
> much pain the patient experiences too.
>
>
>>You are welcome to your opinion, but it certainly isn't
>>accurate (IMHO) to say "Bone marrow biopsies are famous
>>for being extremly painful."
>
>
> I;m not basing this on opinion. I'm basing this on
> numerical fact. Go the the Leukemia and Lymphoma Societies
> discussion board and look around. You'll notice that
> everyone there who had a BMB has experienced large levels
> of pain.
>
>
>>Take a look at
>>http://www.cancernetwork.com/journal...ews/n0004p.htm
>>

Well then I'm basing my statements on numerical fact also.
Take a look at
http://listserv.acor.org/archives/myeloma.html , search on
"BMB" "Bone Marrow Biopsy", and "Bone Marrow" and I think
you will find almost as many people who feel the pain is
tolerable as those that feel it isn't. And I don't think
you'll find very many who describe it as excruciating ...
some will say "very painful" or something like that.

>>This is a study of an analgesic where patients were
>>surveyed on their experience during BMBs before and after
>>using it. Note the average "pain" score of 3.97 (scale 1
>>to 5) across 26 patients with no meds.
>
>
> It says
>
> " 3.97 for previous procedures. The previous procedures
> were sometimes conducted with ------->analgesics,<----------
> sometimes without."
>
> By the way, 3.97 is nothing to sneeze at since that is a
> 7.1 on a scale from 1 to 10. Not to mention that people
> can't accurately gauge pain with numbers in a non-
> subjective fashion. And that's a 7 out of 10 with pain
> meds. Pain meds don't work the same on everyone.
>
Never said it was pain-free or that it was something to
sneeze at. But
3.97 is an average across 26 patients. Seems
reasonable to me.

>
>>Just curious ... have you had all 8 done by the same
>>person?
>>
>
>
> The first was done by a an oncologist from my home town.
> He just gave me a shot of lidocaine and started drilling.
> It was a nightmare. I can tolerate pain pretty well but
> that was overwhelming. It was the first time I ever
> screamed from pain in the last 25 years. I had to have
> anotherone the next day at Dana Farber. I begged them to
> give me as much drugs as theyu could. They gave me
> demerol. That was a different doc. The next six were done
> by the same person with differing levels of pain, ranging
> from 7 to 9. I did some research during this time to
> learn how to lesson the pain. I learned that anxiety
> increases the pain. I also learned that EMLA cream can
> kill a lot of the pain. The last one was a piece of cake.
> The third one was kind of funny since the doctor said "Uh
> oh!" It was his first one and he thought he didn't hit
> the bone. He actually did but he didn't know it right
> off, hence the "Uh oh!" And, of course, I remind him of
> that occasionaly. :-)
>
> Pmb
I have had nothing more than lidocaine every time I've had
one. Like I said, it's not something I'd volunteer to do or
go out of my way to do, but I find it tolerable. I've never
had to scream or yell ... the most I've done is wince. I
have more pain when the lidocaine wears off and I roll over
on it that night while sleeping. As I said, this has a lot
to do with the practitioner's technique and I think someone
else said it has a lot to do with the amount of lidocaine
used. It's a very interesting procedure as it results in a
wide variety of experiences.

Larry

Larry <Larry@nospam.net> wrote

> Well then I'm basing my statements on numerical fact also.

Question: What is your point? I said that BMBs were not
painful to some people but some people experience a lot of
pain where most fall into this later group. Is it the "most"
that you disagree with or do you claim that most people feel
no pain at all?

I based that on my personal experience speaking with fellow
leukemia patients over the last few years at the LLS forum.
However, using personal experiences is not an accurate
method of collecting accurate information. I don't recall
many people who said they didn't feel much discomfort and I
do recall many people stating that it was terribly painful.
They may have used different adverbs than I do to describe
the same thing but that is another story all together.
Because they didn't use the adverbs I use is of little
importance. I say "Terribly painful." Many of the women I
speak to say that childbirth was less painful. To me that
means terribly painful even if they didn't use that term.

Is this all about ratios (pain to no pain) and adverbs
(painful/horribly painful)?

If you hold that BMBs are not considered painful then that
seems quite incorrect to me. Bone Marrow Biopsies are well
know for being painful.
E.g.

From the "Southern Medical Associates" --
http://www.sma.org/smj1999/maysmj99/dunlop.pdf

"Bone marrow aspirate and biopsy is universally recognized
as being painful"

> I have had nothing more than lidocaine every time I've had
> one. Like I said, it's not something I'd volunteer to do
> or go out of my way to do, but I find it tolerable. I've
> never had to scream or yell ... the most I've done is
> wince. I have more pain when the lidocaine wears off and I
> roll over on it that night while sleeping.

That tells me is that you didn't experience the same pain I
did. It does not automatically hold that you have a higher
tolerance of pain. The phrase "higher tolerance" is quite
vauge. If by this phrase you mean "I experience the exact
same pain you do but I don't let it bother me" then that is
very difference than "I don't experience the exact pain that
you do under identical circumstances" - Tolerance means to
experience and to put up with. Anybody can have a high
tolerate pain if they don't feel it. But its quite
impossible for anyone on Earth to claim that they know what
the pain I experience is like. Just because they have the
same procedure it doesn't mean they have the same pain.

Pmb

Gauge wrote:
> Larry <Larry@nospam.net> wrote
>
>
>>Well then I'm basing my statements on numerical fact also.
>
>
> Question: What is your point? I said that BMBs were not
> painful to some people but some people experience a lot of
> pain where most fall into this later group. Is it the
> "most" that you disagree with or do you claim that most
> people feel no pain at all?
>
My point is that I agree that BMBs were "not painful to some
people". Your earlier statement was "I know of only one
person who said it wasn't bad". Big difference. Sounds like
we're in agreement now.
>
>
> I based that on my personal experience speaking with
> fellow leukemia patients over the last few years at the
> LLS forum. However, using personal experiences is not an
> accurate method of collecting accurate information. I
> don't recall many people who said they didn't feel much
> discomfort and I do recall many people stating that it
> was terribly painful. They may have used different
> adverbs than I do to describe the same thing but that is
> another story all together. Because they didn't use the
> adverbs I use is of little importance. I say "Terribly
> painful." Many of the women I speak to say that
> childbirth was less painful. To me that means terribly
> painful even if they didn't use that term.

I agree on the subjectivity of people. Can't imagine how
someone could think a BMB is worse than childbirth. Only
possible explanation is a botched up BMB or bad technique.
>
> Is this all about ratios (pain to no pain) and adverbs
> (painful/horribly painful)?
>
> If you hold that BMBs are not considered painful then that
> seems quite incorrect to me. Bone Marrow Biopsies are well
> know for being painful.
> E.g.

Never said that.

>
> From the "Southern Medical Associates" --
> http://www.sma.org/smj1999/maysmj99/dunlop.pdf
>
> "Bone marrow aspirate and biopsy is universally recognized
> as being painful"
>
I agree. Never said it wasn't.

>
>>I have had nothing more than lidocaine every time I've had
>>one. Like I said, it's not something I'd volunteer to do
>>or go out of my way to do, but I find it tolerable. I've
>>never had to scream or yell ... the most I've done is
>>wince. I have more pain when the lidocaine wears off and I
>>roll over on it that night while sleeping.
>
>
> That tells me is that you didn't experience the same pain
> I did. It does not automatically hold that you have a
> higher tolerance of pain. The phrase "higher tolerance" is
> quite vauge. If by this phrase you mean "I experience the
> exact same pain you do but I don't let it bother me" then
> that is very difference than "I don't experience the exact
> pain that you do under identical circumstances" -
> Tolerance means to experience and to put up with. Anybody
> can have a high tolerate pain if they don't feel it. But
> its quite impossible for anyone on Earth to claim that
> they know what the pain I experience is like. Just because
> they have the same procedure it doesn't mean they have the
> same pain.
>
> Pmb
Larry

"Gauge" <gauge5@hotmail.com> wrote in message
news:e7203033.0406231126.54fa8119@posting.google.com...
> Larry <Larry@nospam.net> wrote
>
> > Well then I'm basing my statements on numerical
> > fact also.
>
> Question: What is your point? I said that BMBs were not
> painful to some people but some people experience a lot of
> pain where most fall into this later group. Is it the
> "most" that you disagree with or do you claim that most
> people feel no pain at all?
>
>
>
> I based that on my personal experience speaking with
> fellow leukemia patients over the last few years at the
> LLS forum. However, using personal experiences is not an
> accurate method of collecting accurate information. I
> don't recall many people who said they didn't feel much
> discomfort and I do recall many people stating that it
> was terribly painful. They may have used different
> adverbs than I do to describe the same thing but that is
> another story all together. Because they didn't use the
> adverbs I use is of little importance. I say "Terribly
> painful." Many of the women I speak to say that
> childbirth was less painful. To me that means terribly
> painful even if they didn't use that term.
>
> Is this all about ratios (pain to no pain) and adverbs
> (painful/horribly painful)?
>
> If you hold that BMBs are not considered painful then that
> seems quite incorrect to me. Bone Marrow Biopsies are well
> know for being painful.
> E.g.
>
> From the "Southern Medical Associates" --
> http://www.sma.org/smj1999/maysmj99/dunlop.pdf
>
> "Bone marrow aspirate and biopsy is universally recognized
> as being painful"
>

But that's untrue. I'm part of the Universe, I have lots of
patients who have bone marrows, and I ask them
all.........some find it painful, most do not.

"Steph" <steph@vancouver.island> wrote:

>
>But that's untrue. I'm part of the Universe, I have lots of
>patients who have bone marrows, and I ask them
>all.........some find it painful, most do not.

But people must be very tough to survive in that snow
covered piece of nowhere you live on!

"_PT_" <ZfulanoZ@x-mail.net> wrote in message
news:e7ald0prrum9ai7qoa8p3nlanasf8qs3r5@4ax.com...
> "Steph" <steph@vancouver.island> wrote:
>
> >
> >But that's untrue. I'm part of the Universe, I have lots
> >of patients who have bone marrows, and I ask them
> >all.........some find it painful, most
do
> >not.
>
>
> But people must be very tough to survive in that snow
> covered piece of nowhere you live on!
>
>
>
>

If you knew anything about Vancouver Island, _PT_, you would
realise how stupid that comment is. But you don't, so you
don't. It doesn't surprise me. You seem to be an expert in
many areas in which you haven't bothered with the facts.

There, I've done the work for you
http://www.islands.bc.ca/general/climate.html

"Steph" <steph@vancouver.island> wrote:

>
>"_PT_" <ZfulanoZ@x-mail.net> wrote in message
>news:e7ald0prrum9ai7qoa8p3nlanasf8qs3r5@4ax.com...
>> "Steph" <steph@vancouver.island> wrote:
>>
>> >
>> >But that's untrue. I'm part of the Universe, I have lots
>> >of patients who have bone marrows, and I ask them
>> >all.........some find it painful, most
>do
>> >not.
>>
>>
>> But people must be very tough to survive in that snow
>> covered piece of nowhere you live on!
>>
>>
>>
>>
>
>If you knew anything about Vancouver Island, _PT_, you
>would realise how stupid that comment is. But you don't, so
>you don't. It doesn't surprise me. You seem to be an expert
>in many areas in which you haven't bothered with the facts.
>
>There, I've done the work for you
>http://www.islands.bc.ca/general/climate.html
>

Know the internet convention of the smile? That's what the
is doing just below my message! Your sense of humor and
your bad manners don't improve with time... Have considered
testosterone patches?

But there is a FACT beneath my humorous comment! Emigrants
are usualy tougher and boulder people compared with their
starving contryman that had no courage/drive to seek a
better life away from home. You should acknowledge that and
feel proud about it instead of being rude and insulting!

There was another intention when changing to humor in
replying you in this thread -- making you realize that you
don't have to persist in having the last word in a subject
you aren't an expert in. I've done thousands of aspirations
and biopsies and still do some almost everyday. You don't
(unless radiotherpy is very odd in your place).

And Vancouver Island IS a piece of nowhere, as any other
place away from Europe (25 and growing!)

"_PT_" <ZfulanoZ@x-mail.net> wrote in message
news:rv2md09o7no1bmn359lj87liae6a27shbq@4ax.com...
>
> But there is a FACT beneath my humorous comment! Emigrants
> are usualy tougher and boulder people compared with their
> starving contryman that had no courage/drive to seek a
> better life away from home. You should acknowledge that
> and feel proud about it instead of being rude and
> insulting!
>

Well, I admit you are an expert on rude and insulting, true.

> There was another intention when changing to humor in
> replying you in this thread -- making you realize that you
> don't have to persist in having the last word in a subject
> you aren't an expert in. I've done thousands of
> aspirations and biopsies and still do some almost
> everyday. You don't (unless radiotherpy is very odd in
> your place).
>

I've done hundreds, not thousands, but I don't do them now
because I have a very slick pathologist who does them
better. I guess the real issue is how many of your thousands
were indicated.... It's your place which seems to have odd
"radiotherapy". We have radiation oncology here.

> And Vancouver Island IS a piece of nowhere, as any other
> place away from Europe (25 and growing!)
>
>

As a European, I am ashamed of your parochialism