Biopsy: Who should perform it?

[Verdugo]

Hi All,

I finally got the prescription/order for a biopsy that my hepatologist was resistant on giving me.  I'm a Geno 2, and my doctor believes I should just treat, treat, treat and ask no questions.  Anyway, he focused on the risks of the procedure in an effort to discourage me, but as I want to wait to treat (if I can), then I felt I needed to get a bx.  Anyway, my quesiton is this:  my hepatologist will not be performing the biopsy.  Is this common?  Should I find a doctor who will do the procedure himself?

Thanks,
Verdugo.

[EarthMan]

You can check out the following link and read about the non-evasive FIBROSURE Test also. It is an alternative to the biopsy. Lab Corp obtainted approval from FDA I believe in 2004. I know many people who have used this Lab Test in lieu of Biopsy.

Click here: http://www.labcorp.com/pdf/08_HCV_Fibrosure_TR_1080.pdf

[HappyDeb]

Verdugo,

NO I did not ask to be knocked out it is normal procedure in a hospital, but if you want to make your own request to your Doctor, let him explain it to you. This procedure the radiologist does and or a surgeon that does biopsys all day. This is so standard in a hospital, they don't only do it for hep. c patients, so many other cases. To them it is like there job and they do it all day every day and are superb at it.If you are a control freak, remember something like this you can't control, unless you know better then them and want to tell them how to do it. So my suggestion and it's only a suggestion, Get knocked out enjoy the drugs and wake up like nothing ever happened. Enjoy the day off. No biggie BiG BOY, LOL !!! I can't wait to hear from you and hear you say OMG it was nothing.


                                                      CIAO FOR NOW

                                                         DEBBIE :)

[Verdugo]

HappyDeb,
Did you asked to be knocked out?  Or was it your doctor's choice?  I'm a control freak, think I'll need to be awake but like to know my options.

JmJm,
My biopsy will be guided by an ultra-sound but apparently that can't tell the stabber where the veins and arteries are, or so I'm told by the biospy scheduler.  But yeah, I want the guy/gal who's stuck hundreds and is wearing an unstained lab coat.

GoofyDad,
Do you know I had to read your post a few times before I got it and now that I have, I can't stop laughing at my own user name.

ForSeeGood,
Here's my new mail address:  hepperwood at gmail and you know the rest.

[HappyDeb]

Wow all of this feedback. great to read everyones stories. For me I had mine done 5 weeks ago and went to the hospital got nkocked out a radiologist proformed the procedure with the scope . I woke up in the recovery room nurses were so friggen nice, waited till I did'nt feel dizzy and went home. I walked out of the recovery and went home and relaxed on the couch and was absolutley fine. Just alittle discomfort, but if I would have hit my side on a table that pain would have felt worse. I am a 48 yr. young woman,119 lbs., pettite frame 5'3. I'm not such a warrior as you see, LOL. Go in there ,smile ,know it's for your benefit and it will be a piece of cake for you too. ADDITUDE is needed to fight the dragon THE GOOD KIND !!!!!!!!!!!!!!!!!!!!! Slays him right in the heart.




                                                                 :() DEBBIE

[jmjm530]

Just to offer another experience with "old school" unguided needle biopsy without systemic sedation.

Except for my first one -- performed by a resident I believe -- all the others were performed by experienced hepatologists who have done hundreds -- if not more -- each. In these experienced hands, the biopsy was done so quickly (less than a second) that in each instance I didn't know they had actually finished  the biopsy until I was told it was over.

My advice is that if you're going to have a biopsy performed by a heaptologist with a lot of experience in needle biopsy -- then follow his/her advice as to the amount of sedation you should take and do not get anxious if they don't give you the same systemic sedatives, etc, that some here have gotten. The key again is "experience" and not technology, IMO.

-- Jim

-- Jim

[jmjm530]

Just to offer another experience with "old school" unguided needle biopsy without systemic sedation.

Except for my first one -- performed by a resident I believe -- all the others were performed by experienced hepatologists who have done hundreds -- if not more -- each. In these experienced hands, the biopsy was done so quickly (less than a second) that in each instance I didn't know they had actually finished  the biopsy until I was told it was over.

My advice is that if you're going to have a biopsy performed by a heaptologist with a lot of experience in needle biopsy -- then follow his/her advice as to the amount of sedation you should take and do not get anxious if they don't give you the same systemic sedatives, etc, that some here have gotten. The key again is "experience" and not technology, IMO.

-- Jim

-- Jim

[EarthMan]

I had the Ultrasound Guided Biopsy as well. I requested 1 tablet of .05mg Xanax to take 2 hours before procedure and also requested an IV injection for Conscious Sedation just prior to having the procedure performed. This way you don't have all of the Anxiety and pain from the local numming shot. My biopsy was performed by a Radiologist and even had a couple of students in there telling them what to do, but he actually did the Punching of the guided needle. Layed in bed for 4 hours after that before being released and felt great the whole time. I didn't even feel the procedure. Was a little sore in that area after the meds wore off but no big deal. I've learned to ask for things they will give you to make you more comfortable, but won't "unless you ask"
Hope all goes well.

[FlGuy]

The thought is there , but not the requisite temptation - not in the least.  So, onward and no looking back.

[mremeet]

#1 - No, repeat NOOO student doctors or interns are to perform the procedure. Only a super experienced, super smooth operator should have his or her hands on that sampling needle (which looks a bit like a caulk gun, incidentally). It has this pistol grip thing and a big trigger that makes this big SNAP! sound. Oh it's a thing of beauty alright. So don't forget, if some baby faced doctor hovers over you biting his lower lip saying something like "does it go here?" GET THE F*CK OUT - MAKE A BREAK FOR IT BEFORE IT'S TOO LATE.

#2 - Take, repeat TAKE significant premeds which will numb the pain and/or reduce anxiety. Don't let any asshat doctor, nurse or tech tell you "Oh this won't hurt a bit, you won't need any meds - just sit veeeeeery still."  DEMAND good premeds and have someone there with you to drive you home at the conclusion of the procedure.

If you follow these guidelines, you should be aiggghtt. Don't let 'em swissinate your liver dude.

[frijole]

Get off that Drusano buzz, man.  It's just a pipe dream!!!!!!!

[dlr2007]

Hi- My bx was done 12 years ago by my gastro. I love him- he's been practicing for a long time and he's done tons of bx's. I would only trust him to do it. I'm getting another bx next month by him. I'm wondering if it will be ultrasound guided. I don't care really- I just want some kick-@ss pain meds- lol.
  Btw, it's good to see some of my favorite members on here today. There are people here that I've seen since Day 1 on this forum, and they always make me smile- and have some great advice! Good luck to all!
-Dee

[FlGuy]

This Friday I complete 38 weeks, of which 36 have been undetected.  I'm expereincing the phenomenon known as the 'Drusano Buzz', as I expected.  But since it's tolerable and there will be  only 8 to go, I can get through it. Work is a tougher go these days, seem to work longer and getting less done - story of my life.

[GoofyDad]

Underwear huh? Your stock just keeps going up around here, Dude. Great eye, that pic was last summer in Glasgow. Hey, I don't change pics that often - but a dude who's been working out wants to show it, ya' know?

How are you holding up coming down the the home stretch? Managing work OK without looking too out of it? That part was easy for me, I started low enough that I didn't have far to fall.

Take care and get ready for SVRville.

[GoofyDad]

Your name makes me dizzy. I forgot to mention that generally the guided bxs are done by radiologists. Not at all unusual to have your doc farm it out - and that would be my personal preference.

[Verdugo]

No, that's Half Dome at Yosemite.  BUT I live REAL close to the Hollywood sign though and occaisionally hike up there myself!  Anyway, I'll work on getting a junk email address and flag you when I do.  Definitely stay in touch.

Anna.

[Forseegood]

happy to! is that the Hollywood sign behind your head? An old staple for sure...I used to do hikes up there, now I can barely make it to Hollywood Blvd, he he.....do you have a junk email address? I had one, but mine doesn't work till I get it fixed, and I don't want to give out my real one...we can be treatment partners....I'll be the big whiner, you be the big stoic one! Have a feeling it'll shake out that way anyway, take care!!!!

If you call Cedars, just ask who is the head of the liver dept there, that's him!...Hey..... maybe he'll give us a toofer deal!!!!

[FlGuy]

Not to imply that I'm keeping my eye on you, but you seem to change photos more frequently than I change underwear.  In the photo that you had a few days ago I noticed that the receptacle you posed with had the polite word 'Litter'.  I'm more used to seeing 'garbage',  'trash' 'waste' or a broken swing door.  Where was that picture taken?  By the way, I'm keeping my eye on you.

[jmjm530]

Perhaps the most important criteria is how many biopsies has the doctor performed. What you want to hear is "hundreds" or more. Five out of my six biopsies were performed by a hepatologist, never by a surgeon and never "guided". They were virtually painless, except the first one. If I remember correctly -- it was around 40 years ago -- that biopsy was performed by a resident who probably hadn't done more than a dozen. It showed. My last biopsy was over five years ago so maybe things have changed some. ]

-- Jim

[Verdugo]

Thanks for the thoughts. It's funny but I'm not worried about the pain, only the idea of needed surgery to stop the bleeding (as my doctor has so kindly warned me of this risk, OVER & OVER)!  Hey, Forsee, maybe we should schedule our Bxs together, as I'm going to Cedars too!  Let's stay in touch, so that if I do Tx, I could get your doctor's name.

Elaine, whatever do you mean!  LOL.

Cheers everyone.

[GoofyDad]

Verdugo: No bx for G2's is preetty standard in some practices. I disagree with it though. If your bx says you can - you might still wait - I bet VX will be doing G2 trials at some point. Also, as noted, once you start, you might question how important it is for you to reach the finish line - that is of course proportionate to your damage level. High damage = highly important. Good luck to you!  

Flguy: "They stick a pretty large needle around some important parts and into an important part." Dude - this isn't your peircing forum - look at the top of the page.... Liver's on the menu here.

Forsee: "....lawn maintenance?" You should be hung!

[Forseegood]

youre one of the people here who always has something constructive, or just plain funny to say, you prob don't even know how many you've helped...those things you say about your wife and family crack me up! You sound really tight with them....

It's good to hear good news about relationships too! I love men! Who else are you gonna ask if you need a couch moved? lawn maintenance? or to fix the garbage disposal? they are great!!!!! he he....Just wait till youre done, and you'll be shootin off the back nine! I wish this for you!

Did I tell you I did this guy's hypnosis course (which was nothing, just listening to a few tapes, reading a pamplet and watching one video once, and low and behold, my years old needles phobia was gone! I thought he was just another BSer trying to take my money, cause he said it would be that easy...one of the best 100 bucks I've ever spent...he's  has  really good methods that are really fast...anybody got a phobia you wanna get rid off, elevators, needles, flying, snakes, snakes ON a plane:) I'll tell you his name, from that you can get his website...

[JodyLynn]

My doctor sent me to this hospital to have it done some doctor there did it. Everyone i talked to said you feel no pain at all.....  for me that was BULL S*** i have never felt so much pain as i did that day. And they even gave me a shot of Dilaudid before they took me back. After the biopsy had to lay on my right side for 3 hours. Good Luck to you.

[FlGuy]

I see from your recent posts that your toes are edging a little closer to the water's edge.  I remember you mentioning you feeling around needles and such things.  Whether it's the bx or tx, you'll do fine.  Just expect to get as much support as you provide, which is always a bunch.  Hang in there.

[Forseegood]

Hi, welcome to the club, I'm going to get a biopsy soon myself, maybe within a few weeks, my doc at Cedars Sanai off of Beverly and 3rd...told me he'd do it himself, he's the head of the liver dept...but you know, I was even thinking, maybe the biopsy doc would do better cause he's doing them all day with a lot of experience in them! ha ha...but my doc told me in the 15 years he's been performing them, he's never had anything untoward happen, so that's positive! we can be nervous nellies together, the anticipation is always the worst of course...Pigeon really likes it over there at Kaiser on Sunset Blvd. as you saw....btw...I really like Cedars and they have some very good hepatologists there, I think....I've never been seen at Pigeon's hospital though...nice lobby though, ha ha!