Painlessly Saving Lives

00;00;00;22 - 00;00;24;08

Nicole McCoy

ient the beginning of January: 2020

00;00;28;26 - 00;00;46;01

Kevin Smith

This is the innovatively speaking podcast brought to you by the Medical University of South Carolina, the place where we dive into the origins of the next big things the who, the why and the how. We explore ideas that are changing what's possible here at the Medical University of South Carolina and in some cases all across the world.

00;00;46;05 - 00;00;54;08

Kevin Smith

I'm Kevin Smith here in the MUSC podcast studio with my co-host, Dr Jesse Goodwin, who is the chief innovation officer here at MUSC. Good morning, Dr. Goodman.

00;00;54;12 - 00;00;55;03

Jesse Goodwin

Good morning, Kevin.

00;00;55;15 - 00;01;10;18

Kevin Smith

Today we're gonna be talking to Dr. Nicole McCoy. Dr. McCoy is a physician who specializes in anesthesia and perioperative medicine and pediatric anesthesia, and she's been working on some innovation pertaining to the field of bone marrow transplants. I think it's gonna be an interesting episode today.

00;01;11;15 - 00;01;35;12

Jesse Goodwin

I agree. So I first became aware of Dr. McCoy and her work in the field through an article that was recently published. And I caught my attention because it combined two topics that I'm interested in. One, because I have a personal interest in bone marrow transplant. I've always thought about being a bone marrow donor. I really have never signed up and then to opioids because it's just such a timely topic.

00;01;35;12 - 00;01;43;27

Jesse Goodwin

And so I'm really interested to hear about her work and to learn a little bit more about myself. And maybe it'll finally push me across that line to actually sign up myself.

00;01;44;14 - 00;01;50;13

Kevin Smith

All right. Well, let's dove right in Well, Dr. McCoy, welcome to the MUSC podcast studio.

00;01;50;21 - 00;01;51;15

Nicole McCoy

Thank you for having me.

00;01;51;26 - 00;02;09;19

Kevin Smith

Yeah, we're glad you're here. The subject matter on the table today is the whole idea of bone marrow transplants and the fact that they're just it's a lifesaver, particularly for certain diseases and cancers. Can you maybe discuss a little bit about, in lay terms, what a bone marrow transplant is and what what it does?

00;02;09;25 - 00;02;31;23

Nicole McCoy

Sure. And just as a little caveat, my role with these patients is more on the harvesting side. So in terms of the anesthesia and the care that I provide, it's for the patients who are actually donating bone marrow to recipients who will then undergo bone marrow transplant. So I would say I am not the expert in bone marrow transplantation necessarily.

00;02;31;23 - 00;02;58;17

Nicole McCoy

That's why this was a fantastic multi collaborative project with the bone marrow transplant physicians. Dr. Hudspeth specifically, she is the expert. I was able to take on the role of caring for the the donor and and basically the procedure itself is a is a procedure where either someone related or unrelated. So, for example, if you sign up through be the match, you would be an unrelated donor.

00;02;58;17 - 00;03;27;04

Nicole McCoy

You'd be selected out of a large pool of people to donate bone marrow or peripheral blood stem cells to another person in the world. You would be recruited to an institution that undergoes or provides the harvesting procedure and then your bone marrow would be shipped off to a recipient. Again, it could be anywhere in the world. So that's the really unique thing is we've done a lot of harvest here and our bone marrow will go all over the world to patients in need.

00;03;27;26 - 00;03;48;10

Nicole McCoy

You can also have related donors, so family members donating on behalf of either their child, their parent or their sibling. So those are those are the two types of patients that I specifically take care of, related and unrelated donors. And that's kind of how my role has been in the transplantation process.

00;03;48;25 - 00;03;58;17

Kevin Smith

OK, and that's that brings us back to Dr. Goodwin here. Tell us a little bit about your interest in becoming a donor and maybe what are some of the things that were holding you back.

00;03;59;06 - 00;04;19;18

Jesse Goodwin

Yeah, so I had a sister who passed away from cancer several years ago, and when she was undergoing treatment, my parents had started Ronald McDonald House in Texas because she was out of state getting care and there were as a family there who was, you know, had a child who had cancer, and they were looking for a bone marrow donor.

00;04;19;18 - 00;04;40;16

Jesse Goodwin

And I think ever since then, I've always been a bit intrigued by this idea of, you know, just being able to sign up and voluntarily help someone, you know, save a life. I can how impactful that could be. But I think that my hesitation for doing it has really just been sort of a lack of full awareness of what's involved in it as a donor.

00;04;40;20 - 00;05;07;15

Jesse Goodwin

Right. And so what does it mean to sign up? What's the likelihood that I would end up being a match, although I know it's pretty low. And then what's that actual procedure and recovery time look like? And, you know, I think sometimes it's sort of that a little bit of inertia not knowing someone who had done it. And to ask a lot of questions, too, has probably been sort of just not not a real impediment, but I haven't had that, you know, sort of momentum to actually get on a registry.

00;05;07;15 - 00;05;14;23

Jesse Goodwin

Although for 20 years now, I've been every year periodically on my like I should probably sign up and then somehow I don't end up doing it. But but maybe.

00;05;15;02 - 00;05;32;12

Nicole McCoy

We'll solve that. We'll solve that by the end of this conversation. Right. So. Well, OK, let me step back and kind of tell you exactly how I got involved. Not only is it just a it's a fantastic population because obviously you're caring for someone who is doing this super altruistic, amazing thing for maybe someone they don't even know.

00;05;33;08 - 00;06;04;11

Nicole McCoy

But as before, the children's hospital broke away from the main hospital, ah, we were our owners were all integrated. And as a pediatric anesthesiologist, it's just a unique situation. The bone marrow transplant harvest physicians are actually both pediatric hematologists oncologists. So by way of that, the bone marrow harvests were all happening in our pediatric hours. By way of that, it ended up being one of us pediatric anesthesia, anesthesiologist staffing usually adult patients.

00;06;04;11 - 00;06;28;06

Nicole McCoy

So I had a period of time, this was in January of 20, 20, where I was able to take care of a couple patients back to back who underwent bone marrow harvest. I didn't really know much about the procedure. I wasn't signed up through the National Marrow Donor Program yet, and I was intrigued by, number one, like how how amazing this is how it works specifically.

00;06;28;06 - 00;06;51;02

Nicole McCoy

And when you learn a little bit about the procedure it is it looks painful. We we don't want to obviously scare people away from being donors. That's the primary purpose of this, is to encourage people to become donors and not be scared of things like pain and an opioid use afterwards. But it looked uncomfortable and patients were honestly very uncomfortable in the recovery room.

00;06;51;14 - 00;07;19;14

Nicole McCoy

I spoke with Dr. Hudspeth, and she also has a unique perspective because she was actually a bone marrow donor. So she's been through it herself before, through the National Marrow Donor Program, "Be the match." And so she had some perspective to share and to what it's like and, you know, what recovery was like. And she's like, if we can do anything to make recovery or hesitancy for donor for donors better, then by all means, let's do it.

00;07;19;14 - 00;07;48;00

Nicole McCoy

So what we changed was the way we numbed up basically a patient's back for good pain relief afterwards. So by way of incorporating some other actually multiple groups of physicians, nursing staff, the nurse coordinator through the oncology or the bone marrow transplant department, we were able to now incorporate this new procedure, which is a regional anesthesia technique, meaning with a teeny tiny needle.

00;07;48;00 - 00;08;15;28

Nicole McCoy

t at the beginning of January: 2020

00;08;15;28 - 00;08;28;02

Nicole McCoy

We didn't... we were confident that it was going to help but we, we were blown away by how successful it was. No where had we seen this being done in any sort of research or literature.

00;08;28;08 - 00;08;31;24

Kevin Smith

Contrast that to what it would be like without this new procedure.

00;08;31;25 - 00;08;57;05

Nicole McCoy

Sure. So the process before was that the procedurals would put in some numbing medicine, but right where the small incision was and and that's more of a called a field block and in some cases it works great, but it's not as reliable. So we offered to for that, you know, we had a great plan like let's switch this out instead of you doing this, let let our anesthesia team do it and see what we got, like see what happens.

00;08;57;05 - 00;09;05;13

Nicole McCoy

And we had a really fantastic first patient who was very amenable to participating in something new and different, and she was very pleased at the result.

00;09;05;19 - 00;09;14;01

Jesse Goodwin

So the spinal block that you're doing now from a procedural standpoint, how similar is it to like an epidural, which is pretty common?

00;09;14;08 - 00;09;44;16

Nicole McCoy

Good question. And that's actually a little bit of a confusing part. So there's actually two parts. So you can get you can have a spinal, which is a one time injection in the lower back. We often use this for women having C-sections to numb you up enough to have surgery so that you're comfortable. And actually, one, a group of patients that we had in the in our basically our cohort did undergo spinal instead of having a breathing tube placed.

00;09;44;25 - 00;10;06;18

Nicole McCoy

So so there's kind of two different things like how to have anesthesia in the O.R. to have your procedure successfully. And then another type like regionally anesthesia, where that's focusing mainly on post-operative, some intra op, but mostly post-operative of pain control. So some patients, yes, they did get a spinal. The difference with an epidural is that the catheter that stays in spinal is just a one time numbing shot.

00;10;07;15 - 00;10;28;25

Nicole McCoy

This regional anesthesia block actually goes on both sides with a small needle in between some muscle layers and it goes nowhere near any major structures like the spinal cord or the spinal nerves. And it numbs up nerves in an in a basically a layer in between two muscle layers. And that's what gives you the prolonged pain control that's fascinating.

00;10;29;04 - 00;10;37;08

Jesse Goodwin

And so you said the first patient you did this on required no opioid pain meds afterwards, which I think is a really fantastic outcome.

00;10;37;16 - 00;11;19;14

Nicole McCoy

Yeah, we were we were absolutely floored by how successful we were in decreasing the immediate post post-operative opioid requirement. What was a little bit harder to tease out was what patients were taking when they went home. And so previously, in talking with the nurse coordinator Stacie Warnecke we would see that patients would take narcotics or opioids, most, most likely oxycodone afterwards fairly regularly, sometimes requiring an extra prescription refill and sometimes requiring, you know, delayed return to work notes, which is really important when you're thinking about the population that's going to be donating.

00;11;20;08 - 00;11;45;01

Nicole McCoy

Usually these patients are like productive citizens. They need to get back to work. They need to get back to their lives. And that becomes not only with pain. A huge reason to avoid donating is like, how, how am I going to fit this into my busy lifestyle? And so once we started doing this numbing shot to help with pain control, we were we were able to prescribe less oxycodone afterwards.

00;11;45;08 - 00;11;52;22

Nicole McCoy

We've given no refills and we've not written any delayed return to work notes. So none non zero family.

00;11;52;22 - 00;11;53;09

Jesse Goodwin

Fantastic.

00;11;53;18 - 00;11;54;13

Nicole McCoy

It's amazing.

00;11;55;18 - 00;12;02;15

Kevin Smith

Well, let's let's talk about that block. I wrote a couple of notes here. This the Q-L block. Yes. Can you maybe describe that a little bit to us?

00;12;02;24 - 00;12;24;00

Nicole McCoy

Yeah. So this is a Quadratics Lamora block. The QL muscle lies on both sides of your lower back. It's a deep muscle. And there was a lot of research going on about like, what if you injected numbing medicine behind or near this muscle? What would it, what would it numb up? So it is mostly used for lower interior abdominal surgery.

00;12;24;18 - 00;13;03;01

Nicole McCoy

It does a good job in the front part of the abdomen, especially the lower part. And again, it works. It helps with pain control during the procedure. It doesn't negate the need to be usually asleep under what we call generally anesthesia, but it helps a lot with pain control afterwards. So there were some reports that surgeons and anesthesiologists have used this for lumbar limb and activities, which is a surgery on the lateral portion of the vertebrae in the lower back and so I thought, well, if it's if it's helpful in that case, it may be helpful on where they're doing the harvesting from which the technical term is the posterior iliac crest.

00;13;03;01 - 00;13;25;04

Nicole McCoy

So you're basically the top most back portion of your hip bone. And so we were able to see that it pretty consistently numbed patients up in that area. And you get get some numbness in the front part. But it's you know, the patients can't really tell because that's not where they're having surgery. So but we use the ultrasound machine to do it.

00;13;25;08 - 00;13;47;14

Nicole McCoy

Adult patients that we do this for will have it done in the pre-op area with a little bit of sedation before they go back to the O.R., which is good because it also allows them to have less anesthesia time so we can knock that procedure out before they go back to the operating room in our pediatric patients because we've started doing the same thing.

00;13;47;14 - 00;14;07;14

Nicole McCoy

We to be equitable and we think that the kids deserve the same adequate pain control so we actually do this procedure after they're asleep under general anesthesia, and that is mostly due to compliance. We need the patient to be still for the most part still. But it's much easier in the pediatric patients to do it when they're asleep.

00;14;07;14 - 00;14;14;23

Nicole McCoy

And there's good pediatric anesthesia data that the safety profile of doing it to sleep is just as good as in the adults.

00;14;15;01 - 00;14;19;05

Kevin Smith

All right. Dr. Jesse, are you convinced yet to sign up I am.

00;14;19;06 - 00;14;39;00

Jesse Goodwin

You know, I you know, even as someone who's had surgery in the past and refused to take oxycodone afterwards, I just don't like the idea of taking opioids. And so the idea that there is a way to mitigate the pain, to minimize the likelihood that I would need to actually is really appealing as well. So I'm almost there.

00;14;41;08 - 00;15;01;12

Kevin Smith

Well, talk a little bit about what the discussion here is about innovation. And it sounds like you are right in that sweet spot. Talk to me a little bit about your your pediatric experience feeding into this, because I would imagine, you know, physicians since that sensitivity to the pain of their patient, I would imagine would be even higher if that patient is a child.

00;15;01;20 - 00;15;07;17

Kevin Smith

Tell me a little about how that how that perspective played into how you approach doing this treatment now.

00;15;07;20 - 00;15;26;02

Nicole McCoy

Like I personally, I have a little bit of a different background Just maybe this will shed some light, too. I actually was a general pediatrician for five years before I went back to do anesthesia. And I was looking for a career I mean, I found it in anesthesia. It's exactly, exactly what I dreamed my career and life goals would be.

00;15;26;10 - 00;15;43;28

Nicole McCoy

But because of that, I think I look at all patients, even adults, a little bit differently. You know, I'm not just here to make sure all of the general anesthesia, things like the boxes are checked, like you have your procedure, you're safe, you're comfortable, you get home in an appropriate amount of time. Like, I want to I want to take care of you.

00;15;43;28 - 00;16;04;05

Nicole McCoy

I want to take care of your family. And I think that's just a product of the way of all my general PEDs training and how it was more of a family centered and patient centered home, which is carried over a lot into how I practice now. So I, I was very I didn't just show up to work and, and say, OK, let me staff this case and see you later.

00;16;04;05 - 00;16;23;18

Nicole McCoy

I was, I was honestly intrigued by how does this patient, like, go about their daily functioning tomorrow. And I actually well, I think what really solidified it for me was that one of the first patients that I took care of that not that we did not do this procedure for was a family member donating to another family member.

00;16;23;28 - 00;16;46;06

Nicole McCoy

And I saw them outside the hospital the next day after their procedure. And they just didn't look fabulous. I felt like we could have done a better job of making them. And another caveat is when you have a family member joining in with a family member, they have to be there for that other person. They have to care for their child.

00;16;46;06 - 00;17;06;18

Nicole McCoy

They have to care for their parent. They've to care for their sibling or and they want to be seen. So let's give them the best experience we can. If we can really make them comfortable, then they can actually participate in a useful, healthy, happy way, supportive way for their family member. And so I think that's how I approached each of my patients.

00;17;06;18 - 00;17;14;16

Nicole McCoy

I mean, I think that's how I approach my patients every day. But this project in particular was really had it was really has been really special to me.

00;17;15;05 - 00;17;27;20

Jesse Goodwin

Have you seen an increase in people signing after being willing, I guess, maybe going that I should have been actually donating because you're able to explain sort of these pain mitigation factors that we have?

00;17;28;07 - 00;17;51;07

Nicole McCoy

I would like to say I hope that's the outcome. And honestly, I think that is our our ultimate goal is to really show programs like the National Marrow Donor Program that we can actually if you go to their website, you know, it says like you shouldn't be worried about pain, which you shouldn't like you really should not be a donor and you should not be worried about pain.

00;17;51;07 - 00;18;21;27

Nicole McCoy

That is a totally true statement. But we need to be more proactive about, you know, publicizing why they shouldn't be worried about pain. And I think if you look at some studies like health care related quality of life has like a little bit of a dip after these procedures. If pain isn't well, treated. And again, for families who are donating to their own family members and then those who are just doing it to be altruistic because they got called up and they're imagine this is important to them we have to get them back to their daily functioning.

00;18;21;27 - 00;18;32;12

Nicole McCoy

And we do not want to have any risk or untoward side effects that prevent them from continuing to contribute to their to society and their families.

00;18;32;28 - 00;18;42;29

Jesse Goodwin

Well, hopefully this podcast can be part of that amplification of the message to get it out there that there is a reason why you don't have to be so worried about the pain associated with bone marrow.

00;18;43;00 - 00;18;43;26

Nicole McCoy

Agreed, agreed.

00;18;43;29 - 00;18;44;16

Jesse Goodwin

Harvesting.

00;18;44;25 - 00;18;53;23

Kevin Smith

All right. Let's talk a little bit about the specifics of the procedure and maybe some of the things that happen during the procedure, such as heart rate and blood pressure.

00;18;53;28 - 00;19;18;05

Nicole McCoy

I get asked this question a lot, like how do you know someone is in pain when they're asleep under anesthesia? So good question. And I think it's very confusing to people in the community or people who are non medical or actually, to be honest, people who aren't anesthesiologists. So things that we look for, they're indicators of pain while patients are under anesthesia are an increase in the heart rate, an increase in the blood pressure.

00;19;18;17 - 00;19;59;17

Nicole McCoy

Those two things typically signify some sort of change that most often can be associated with a painful stimulus. So for example, at the beginning of surgery, when the surgeon starts, if there is not adequate pain control at that time, you'll see an increase in the heart and blood pressure. And so those are those were the indicators we were seeing prior to incorporating this numbing injection we would see a lot of changes in heart rate and blood pressure throughout the case, which also led to additional administration of pain medications in the operating room.

00;20;00;05 - 00;20;23;27

Nicole McCoy

So not only did we... an interesting caveat is not only did we decrease the amount of pain medicine given in the recovery room because patients were just not having pain, we also saw less swings, increases in heart rate and blood pressure or indicators of pain during the surgery. So we could cut down on opioid administration while they were under anesthesia.

00;20;23;27 - 00;20;56;15

Nicole McCoy

And that's really critical in thinking about opioid induced side effects. So constipation, nausea, itching, a lot of things that a lot of side effects patients have after surgery or in general when they're taking an opioid or a narcotic. And so we were able to decrease both the administration or providing pain medication during the procedure and after and and also feeling comfortable that we weren't just not giving it because we didn't want to we were giving it.

00;20;56;15 - 00;21;03;10

Nicole McCoy

We were avoiding giving it because we weren't seeing those big swings in her blood pressure like we had been seeing before. Does that make sense?

00;21;03;10 - 00;21;05;10

Kevin Smith

Yeah. The need for the pain medicine was less.

00;21;05;11 - 00;21;05;25

Nicole McCoy

Exactly.

00;21;06;06 - 00;21;23;09

Jesse Goodwin

Nicole, now that I think everyone listening to this is going to be convinced that you figure it out with your fantastic collaborators, how to minimize some of the side effects of doing this. In terms of pain, how does one go about signing up for the registry and what type of information is required when they go to do that?

00;21;23;28 - 00;21;45;11

Nicole McCoy

It's actually very, very easy and it only takes a few minutes. You just do it through the NCPDP website and they'll send you an at home kit where you do a cheek swab, you send it back and that's it. For the most part, it's a simple, easy process. And I, I noticed that over in the wellness center, there's often some college like health professions, tables set up trying to recruit people.

00;21;46;07 - 00;22;17;23

Nicole McCoy

The hard part is I don't think people understand what they're signing up for by just walking up to a table. It's one of those things that you you probably know somebody or you read a little bit about, but having more donors in the donor pool is just going to continue to have available people to save lives. And I think that's what this ultimately boils down to, having, you know, some amazing altruistic people that are signed up and then taking the best care possible and making sure that they have a good experience.

00;22;17;23 - 00;22;20;02

Nicole McCoy

That's ultimately it. Having having a good experience.

00;22;20;21 - 00;22;47;23

Jesse Goodwin

I think that's fantastic. And I can say anecdotally I was listening to another podcast called The Happiness Lab, and it's all on the science of why people are happy. And one of the episodes is focused on giving altruistically so people who give altruistically tend to be much happier than individuals who don't. And they actually specifically look at people who donate kidneys to a non-family member and how these individuals tend to be like the happiest people that they can find scientifically.

00;22;47;29 - 00;23;01;05

Jesse Goodwin

And it's just because of the act of just doing something entirely selfless. So that is one of my catalyst reasons for contemplating doing this. But I think I am going to sign up. I'm going to I'm going to go online and do the tubes.

00;23;01;14 - 00;23;20;16

Nicole McCoy

Yes. Yes. And again, it takes 5 minutes. And and the you know, the nice part about the being a bone marrow donor is it's not it's not it's not as involved as being a kidney a kidney donor. Like you're not without that organ for the rest of your life. You will your bone marrow will regenerate. It's a fabulously interesting process.

00;23;20;25 - 00;23;35;22

Nicole McCoy

I've learned so much about it from my hematology colleagues. And really, you might be fatigued for a couple of weeks, but that's you know, that's pretty much it. So I think I think you should.

00;23;36;02 - 00;23;39;29

Jesse Goodwin

Yeah, I think I can survive being a little bit fatigued to be a lot more happy there.

00;23;40;00 - 00;23;40;06

Nicole McCoy

Yeah.

00;23;41;17 - 00;23;42;10

Jesse Goodwin

It's like a trade off.

00;23;43;17 - 00;24;04;28

Kevin Smith

Let's kind of land the plane with maybe a an ask from you as as a physician to potential donors out there like to go and talk to them, maybe give them an overview, the elevator pitch for why it's important to be a donor and why it's safe and more comfortable than ever.

00;24;05;03 - 00;24;24;27

Nicole McCoy

Yeah. Your simple act of swabbing your cheek puts you in this amazing registry that can actually save someone's life. And it's could be a baby on the other side of the world. It could be someone in your own community. And there are very few things in life where, you know, just just saying, I'm willing to sign up to try and save someone's life.

00;24;24;27 - 00;24;41;18

Nicole McCoy

I don't think there are very many things like that that exist. So, you know, signing up is the first step. And and I think getting the message out there that we can do better to help you with pain control, not everywhere in the country is going to be set up to facilitate the kind of workflow that we had here.

00;24;41;28 - 00;25;24;29

Nicole McCoy

But by way of sharing our process and our, you know, our hiccups and our success is with other institutions across the nation, we can provide a framework that other people can follow to provide similar care to patients undergoing bone marrow harvesting. So knowing that there are options out there for pain control other than opioids and narcotics, which is very, very important to a lot of people and knowing that there are resources like our own institution willing to provide education to other anesthesia departments or hematology, oncology, bone marrow transplant departments, that we can we can show your team how to take better care of patients.

00;25;25;07 - 00;25;29;22

Kevin Smith

So on that note, have you had other institutions reaching out for help with this process?

00;25;30;04 - 00;26;00;07

Nicole McCoy

Yes, by way of some networking ideas through the society of PEDs, anesthesia, as well as some requests through the Eureka Alert, it actually was news blasted to our anesthesia governing bodies, news, email, weekly email letter. And so I've actually gotten a few requests to share the protocol with other institutions. And these are academic institutions which are set up with a service that can do that could, you know, could easily set this up.

00;26;00;17 - 00;26;22;20

Nicole McCoy

But I have a generic protocol I'm able to email. And actually, I think the article itself has supplementary material with the protocol in it. So really anyone it's open access articles, anyone can see it, anyone can look at the protocol, but it's been really fun to actually share my, my projects, our projects, in fact, with some other really big name institutions around the country.

00;26;23;03 - 00;26;31;20

Jesse Goodwin

I think it's fantastic and how gratifying it must feel to be able to contribute to driving best practices forward and advancing your own field. So it.

00;26;31;20 - 00;26;32;05

Nicole McCoy

Is it's.

00;26;32;05 - 00;26;33;03

Jesse Goodwin

Great to meet you.

00;26;33;05 - 00;26;34;04

Nicole McCoy

Thank you so much.

00;26;34;10 - 00;26;35;16

Kevin Smith

Changing what's possible, right?

00;26;35;16 - 00;26;36;10

Nicole McCoy

Yes, exactly.

00;26;36;13 - 00;26;49;23

Jesse Goodwin

So, Nicole, we've talked a lot about the benefits of doing the nerve block in terms of pain mitigation and decreasing opioid use over time. Are there any downsides to the two, the nerve block in and of itself, either during a procedure or after?

00;26;50;08 - 00;27;13;29

Nicole McCoy

That's a that's a great question and so important when discussing with patients the risks and benefits of adding an additional procedure. So for this procedure itself, the risk is very, very low of any complications. And any time we put a needle in the body, whether it's an I.V. or for a nerve block, such as this, there's a risk of bleeding and infection, albeit extremely low.

00;27;14;11 - 00;27;40;08

Nicole McCoy

We do the procedure using a sterile needle and we clean the skin very well beforehand. Additionally, there's no major blood vessels where we're injecting this medication. So the likelihood of causing any major bleeding is extremely low. And the risk of causing any negative effects from injecting the numbing medicine into a blood vessels are also very low. Those are the main things we talk to patients about.

00;27;40;17 - 00;27;59;16

Nicole McCoy

An interesting caveat with regional anesthesia is one of the main risks is actually a failed block. So I always tell my patients that there is a risk that for some reason, based on your anatomy or just the technique that we use on every other patient just didn't work and you could wake up in pain. It's called a failed block.

00;28;00;08 - 00;28;24;24

Nicole McCoy

It's not out of the realm of possibilities. And in that case, you would need to take some opioids or narcotics, and that's OK. There's nothing wrong with that. And again, I tell patients, if you're having breakthrough pain, it is OK to take an opioid if you need it. But one of the risks is a failed block. And so it's important that we discuss with patients that there's a small potential for this not to work, but it's going to be OK.

00;28;24;24 - 00;28;28;21

Nicole McCoy

You're not going to be in extremis after the procedure in the event that the block fails.

00;28;29;17 - 00;28;38;26

Kevin Smith

If it didn't work, you would just do the the the normal pain medication on the back and with opioids, right. I mean, that's what would normally be before this procedure.

00;28;38;27 - 00;28;59;02

Nicole McCoy

Exactly. Exactly. So in any case, where we do regional anesthesia or a numbing injection to numb up an arm, a leg you know, the back or the belly, if patients wake up in the recovery room and they're hurting, then obviously we're going to administer some pain medication and that can be an indicator of the block not working in some instances.

00;28;59;02 - 00;29;07;21

Nicole McCoy

We can repeat it in the recovery room, but many times we are able to treat it, treat the pain adequately with some opioid medications.

00;29;08;02 - 00;29;09;24

Kevin Smith

Have you had the block not work?

00;29;10;18 - 00;29;42;03

Nicole McCoy

I have had two patients who have required two. Let me rephrase that, two adult patients who have required opioids in the recovery room. They were unique individuals in that their procedures were very long and very involved, meaning there was a large amount of bone marrow harvested from each of these patients. And there is some information in the scientific literature that longer, more higher volume boomer harvest can be more painful.

00;29;42;03 - 00;30;03;26

Nicole McCoy

It makes sense. And so those patients each required a couple of doses of I.V. narcotics in the recovery room on their phone, follow up calls. They actually did not take any pain medication after they got home and had long car ride home and didn't take anything in the car ride. So there was some aspect of their nerve block that was working for a prolonged, you know, pain, pain relief.

00;30;04;06 - 00;30;21;09

Nicole McCoy

I want to be very transparent with all of my patients that this is not, you know, 100% guarantee to work. It is very, very close to 100%, but not 100%. And so in the off chance that you are that very small percentage, it's not going to work. Don't worry. We're still going to treat your pain. We're not going to let you sit in suffer.

00;30;21;28 - 00;30;24;07

Nicole McCoy

We just you know, that's just me being transparent.

00;30;24;19 - 00;30;34;13

Jesse Goodwin

We've talked about the the nerve block that you've been doing. Have you made any other modifications to the way that you've approached this procedure in either your pediatric or your adult population?

00;30;34;14 - 00;31;06;02

Nicole McCoy

Um actually we've made a big change since we've opened the children's hospital. We noticed that related donors were being done. Sorry, we're having their bone marrow harvest done at the adult hospital, then having to come across campus many hours later to be with their family members. And often they were missing the transplants. And that's one of the one driving factor for related donors is, again, we want them to be with their family for their transplant which usually happens a couple of hours after the harvest.

00;31;06;13 - 00;31;31;28

Nicole McCoy

So what we we talked with hospital leadership about moving these adults to have their bone marrow harvest procedures done in the pediatric hours so that they are there when adults and all obviously all of the children are going to be done at the children's hospital. But when we say adults, this is parents donating to their children or an adult donating to their sibling or their own parent, again, typically those will be done at the adult hospital.

00;31;31;28 - 00;31;58;26

Nicole McCoy

But we felt that since the family members are either housed at the Ashley River Tower or at Sean Jenkins, that it just made sense for them to have their procedure and recover it at the children's hospital. And it has really helped with getting patients to their families more quickly and availability of family members to stay with. The patient who's just undergone the procedure is often they were by themselves in the recovery room.

00;31;58;26 - 00;32;05;23

Nicole McCoy

And now we have a much more family centered care model which is, I think, also increased patient satisfaction.

00;32;06;10 - 00;32;16;04

Kevin Smith

So from the research I've been doing, this is obviously very close to your heart. This is your baby. Talk a little bit about why that is. Why why is this so something you feel passionate about?

00;32;17;18 - 00;32;58;11

Nicole McCoy

Well, this was something I kind of had to learn a lot about myself and and how proposing an idea that is really outside the box takes a lot of work. But the most amazing thing was it was so satisfying working with all of the different groups of people. I was able to work with and continue to work with was just so satisfactory for my career and wellbeing and my job I'm working on a project that I could see was making a difference and providing joy and hope and pain relief.

00;32;59;00 - 00;33;26;13

Nicole McCoy

I don't know, it just really makes you love your job, and nothing about this was ever work. So any time I was working on this, working on the protocol, working on meeting with statistician, trying to work on getting this research published, it never was work because I enjoyed every moment of the patient population the procedural. As I got to do my my job, I got to take care of everyone, almost every one of these patients by myself.

00;33;27;06 - 00;33;35;14

Nicole McCoy

And it just provided a really good I don't know. I think career satisfaction is really where it was really underlying it.

00;33;35;20 - 00;33;58;26

Jesse Goodwin

Thomas Edison, I think, is famously quoted as saying that an innovation is 1% inspiration and 99% perspiration. So it's just a lot of effort to carry something over the finish line. But I think it's great when something can become a labor of love such that that 99% perspiration that it takes to get it there can just bring immense gratification to you personally.

00;33;58;28 - 00;34;04;23

Jesse Goodwin

Yes. You're working on it and just, you know, it's a way to keep it going and to really feel like the work is meaningful.

00;34;04;25 - 00;34;18;01

Nicole McCoy

Oh, it's incredibly meaningful. And to have other institutions reach out and want to learn more about it and potentially implement it in their hospital systems makes me really proud.

00;34;18;14 - 00;34;18;29

Jesse Goodwin

And it should.

00;34;19;15 - 00;34;20;20

Kevin Smith

Well, thank you so much for joining us today.

00;34;20;21 - 00;34;21;22

Nicole McCoy

Thank you so much for having me.

00;34;21;27 - 00;34;22;09

Jesse Goodwin

Thank you.

00;34;25;13 - 00;34;46;09

Kevin Smith

You've been listening to the Innovatively Speaking Podcast with the Medical University of South Carolina. If you enjoyed this episode and would like to support the show, leave a rating and review to hear more innovative ideas and to share your own. Subscribe to the show or visit us on our web page. Web Dot MUSC Dot Edu Slash Innovation.

00;34;46;15 - 00;34;49;11

Kevin Smith

And remember, don't hesitate to innovate.