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.

[l-horn]

My GI doc scheduled me at a hospital and told me to call them. I did, they set up an appointment time.  I believe a radiologist does the biopsy then, at least for me, two pathologists look at the sample.

Sounds like he wants you to just take the Rx to the hospital but I'd call first to schedule, unless it's really close. If I recall they didn't let me drive afterward either.

[FlGuy]

You can't just walk in and give them an rx like you were getting a prescription filled.  It needs to be scheduled and you'll probably be required to get a couple of blood tests done in advance.  The doc doing the procedure needs to make sure that you are healthy enough for the procedure and take pre-surgical precautions.

[pigeonca]

I'm genotype 2, go to Kaiser Sunset, and my hepatologist insisted that I have a biopsy.  She believes, as do most of us in this group, that you need this inforrmation for reference.  What if treatment doesn't work?  If you're only a stage 1 or 2, you can wait for new drugs, but if you're in worse shape, then you need to act more aggressively.  I don't think you have to have your treating doc perforrm the biopsy, however, just as long as you have one done.

[FlGuy]

Mine was done by a steady-handed Radiologist who who did 'an ultrassound guided' biopsy.  That is, he located the target area where he plunged the harpoon.  It was done in the same day sugery section of local hospital.  Wasn't so bad.  The worst part was the anxiety before th procedure and the laying around for a few hours after.  I'd suggest getting the first, or earliest, appointment available to avoid the inevitable delays that go on in such places.

[frijole]

My GI asked who I wanted to do the  biopsy - a Tech or a Surgeon.   It sounded like a no-brainer to me -- I said a surgeon.  However, being active on this board I found out that hardly anyone uses a surgeon.  Mine was a laproscopic biopsy.  Most have a needle ultrasound guided biopsy done by a technician.  YOu should ask your hepatologist for some references.

The Janis site ha a lot of good information on understanding biopsies.

When I get another biopsy next May I am going to have the same surgeon do it.

Janis site:              http://janis7hepc.com/biopsy.htm

frijole

[Verdugo]

Pigeonica,
It's weird that my doctor wouldn't insist that I get a Bx, right?  Especially knowing I want to wait on Tx.  He's pretty green.  I like him personally, but if I do Tx, I would need to find a doctor with more experience.

FIGuy,
Just called to schedule, and I was told a radiologist will do it.  Now I'm thinking it dosen't matter who does it, as long as they have MUCHO experience!

Thanks,
Verdugo.

[FlGuy]

It's not all that odd for a doc to not  suggest a bx for a Geno 2.  I've read similar situations here on several occassions.  The thought (I guess) is that G2 have a high rate of svr (about 85%, or so) and that treatment is usually shorter (24 weeks) that doc's believe go with the numbers and get on the tx wagon.  If your intent was TO Treat no matter what, then what impact would the bx result have for you?  On the other hand, if you have not decided to treat, as you indicate above, then the results of the bx have more significance for you.  Keep in mind that although 'simple' a liver bx is not without some amount of risk.  They stick a pretty large needle around some important parts and into an important part.  It's not like having a boil lanced.    

[Verdugo]

I definetly don't take the Bx lightly.  I'm pretty nervous!   This makes it even more difficult to push a reticent doctor.  I just feel like it's what I should do to know where I stand.  I've had the disease for more than 35 years - so it's probably about time.

[Tippyclubb]

I had a biopsy Monday which was done by my hepatologist.

Try not to be nervous as its pretty much a painless procedure.  The shot they gave to numb the area hurt ( just a little),  more than the biopsy.  Barely felt the needle going in and it was over in a matter of seconds.  After the biopsy you will feel slight discomfort in the liver area.  Go home and rest and you'll be fine the next day.

The biopsy was easy--its the waiting game for the results that I find to be nerve wracking.

Good luck
Tippy

[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!

[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.

[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.

[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...

[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!

[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.

[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

[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.

[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!!!!

[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.

[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.

[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.

[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.

[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

[frijole]

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