Yesterday I set the stage for an unexpected storyline I uncovered while doing research for my story comparing and contrasting bone marrow biopsy technology at the American Society of Hematology meetings in Orlando, Florida last December.
My original plan was to write the story from a patient’s perspective. I would compare, contrast and evaluate different bone marrow biopsy systems with a patient’s comfort in mind.
I hinted I had stumbled upon a number of interesting and disturbing story lines, promising to share them with you today.
Once again I have gotten ahead of myself.
Let me pause here and add some additional–and often painful–background information about bone marrow biopsies from a patient’s perspective.
Many patients who undergo bone marrow biopsies only experience a bit of discomfort–it’s no big deal. But others are not so lucky. Like me, some have extra hard bones, making the procedure difficult and painful, regardless of which type of hand held, non-automated tool is used. Others are forced to endure the excruciating twisting and turning of an inexperienced or incompetent med tech.
In my first book, Living with Multiple Myeloma, I describe the biopsy process and what I went through back in April of 2007:
How do I best describe a bone marrow biopsy? Easy! Imagine someone bearing down on your lower back with all their weight using a corkscrew!
There are two types of bone marrow biopsies, sedated and non-sedated. I know several patients that don’t seem to mind undergoing a non sedated biopsy. But if anything goes wrong, you will never get a non-sedated bone marrow biopsy again!
Of course, you usually need to undergo a procedure before you know any better! The area of choice for a bone marrow biopsy is most often in the lower back. I think physicians choose that particular spot because, since you are lying face down, you can’t watch what is about to go down or hit the surgical tech as he starts to twist the surgical coring tool slowly into the bone! Trust me, Novocain doesn’t help! But by the time that is made clear, it is too late. The twisting and pushing has begun and all you can do is try to lie still while the nurses get a good look at your naked backside.
I will admit that I have never been a fan of needles. Who is? But when you’re stunned and facing your own mortality, you suck it up and tell yourself you have to do whatever it takes to get a handle on this thing! I actually thought I was enduring things quite well. But what should have been a two or three minute procedure was taking much longer. With tears in my eyes from the pressure and pain, I squeezed my nurse’s hand harder and harder as the doctor stood on his toes to get more leverage. “Man, you have hard bones!” the doctor exclaimed, sounding frustrated. I finally gasped “Maybe you need a sharper tool!” “Great idea!” said the doctor as he asked the second nurse to bring a replacement. Ouch! I was kidding! Like he couldn’t have figured out that his instrument wasn’t sharp enough before then?
There were two nurses in the room. As they both tried to reassure me about how experienced my doctor was, he started the procedure again. Less than ten minutes later, I was back in the waiting room and headed home. I guess he had needed a sharper tool!
Although my first biopsy was probably worse than normal, my experience was not unusual. Many other multiple myeloma patients I talked with during the months following have shared similar experiences. It hurts!
Later second and third sedated bone marrow biopsy at the Mayo Clinic in June and September were not unpleasant experiences. Except for the nurse in training who couldn’t get my IV started the first time, both procedures went off without a hitch, with very little discomfort. When given a choice, you may decide to try an non-sedated biopsy. However, I recommend that you learn from my mistake and ask for a sedated biopsy instead.
Fond memories, indeed! But I’m not sharing my experiences with you so I can take another walk down memory lane. My painfully memorable experience might have been caused by an incompetent med tech–or the fact he was using poorly designed technology. It could be as simple as my bones are unusually hard. None of this matters.
The important thing to note is I now request and get sedated biopsies. I’m more comfortable with that. But consider the cost. An anesthesiologist needs to be involved. A nurse is needed to start an IV. Then there is the cost of the anesthesia and monitoring equipment.
I’m only guessing the additional cost must be thousands of dollars. Keep that in mind as I continue our story.
My first stop after leaving the OnControl exhibit was to visit the HS TrapSystem booth at the end of the isle. There I spoke with a pair of very knowledgeable sales reps, Ken and Elena. At first we talked about features. The company’s TrapSystem set utilizes a basic, coring tool designed to trap the bone marrow sample into a specially designed Jamshidi needle, thus avoiding something they called “the deflection technique.”
What? To illustrate her point, Elena let me try the tool on a block of fiberglass, designed to mimic the look and feel of bone and marrow.
Applying steady pressure, I slowly twisted the tool until it broke through the outer bone-like material and pushed into the core. It seemed simple enough to use. Lightweight and simple. The coring needle seemed sharp and efficient–easy for me to say–I wasn’t working on a live patient screaming on an examination table!
Still, I walked away impressed. The HS TrapSystem was certainly priced to sell at between $25-30 a kit or tray.
Let me pause here. I would soon learn all three companies I visited used the same type of synthetic bone prop–and they all sold something called a “tray.”
These disposable trays included pre-packaged, sterilized aspiration needles and other necessary disposable parts.
Mike with the Ranfac Snarecoil Biopsy products also allowed me to try their product. I won’t go into the details, but I felt both the HS TrapSystem and Ranfac’s Snarecoil tool and systems had subtle feature differences and advantages.
Like the TrapSystem, Ranfac’s basic Snarecoil tray was priced less than $30. Both companies provided complimentary tools to institutions who purchased their product.
Up to that point, I hadn’t given the cost of the two non-automated systems a second thought. Yet all of the reps kept mentioning the affordability of their product.
Now I started to understand why. I’m not sure which company mentioned Cardinal first. Another biopsy system company, I was told Cardinal owns a majority of biopsy market share–approximately 60% of the worldwide market.
Why? Cost. Apparently Cardinal’s trays only cost $16. “So what?” I asked. To me–a patient–it seemed totally insignificant to be saving $9 or $10 dollars a biopsy equipment tray in a world where a single 10 mg capsule of Revlimid costs me and my insurance company over $500!
I originally approached this story with cost savings in mind. But I was focused on the industry saving thousands of dollars a patient by using the mechanized OnControl drill instead of sedated biopsies.
But no one was talking about that. It hadn’t even come up. Why?
We are getting closer to the “rest of the story,” as legendary radio news icon, Paul Harvey, used to say.
More tomorrow. Feel good and keep smiling! Pat