Nurses with Breast Cancer
Comments
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I just saw this thread, thank you for starting it, the issues of being an RN with breast cancer are timeless so I thank you all for sharing your thoughts and feelings...being a nurse is a lonely place when you have a serious illness...I am an RN, and being on the "other side" of the table has been so difficult, but I'm sure you all know that feeling...
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Being a nurse with a serious condition presents some real challenges. I kept running into the "she's a nurse, she knows everything she needs to know" attitude, and got just about NO teaching and definately no support from medical staff. I strongly recommend not telling caregiver you are a nurse. Pre-op versed is a definate "yes" in my book, but here in Maine there are very few places that give any pre-op sedation anymore. Makes it take longer for people to wake up after, so beds don't turn over fast enough. It's even harder to deal with anxiety and fear when you know there IS help, you just can't get it!
When I was teaching all my students had to demonstrate competency with thigh blood pressures. I also taught them to always ask patients if there was any reason one or the other arm can't be used for b/p's, IV's etc. don't know if the teaching held, but I tried.
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same here nm ,manuel bps is getting to be a lost skill, but at least we have limb alert bracelets and if the limb has the bracelet you cannot use it, the in the foot iv tend to come in batches where i work, must admit the foot lab draws always make me cringe.
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I tend to become pretty passive as a patient which is weird because as an L&D nurse and now as nurse faculty, I am pretty big on advocating. I watched the preop nurse for my original BMX attempt an IV in my foot that I knew she wasn't going to get and yet I just watched. I have since done a lot of research on the LE front and have decided what I am comfortable with in my situation. All the rest of my IVs have been for OP surgery. They were in for maybe 4-5 hours and were placed quickly and expertly by nurses who did it several times a day. I have a garden hose vein in my wrist and I was not overly concerned with infiltration or infection for myself in those situations.
I notice there is a big difference in care when I have a nurse that can critically think as opposed to a nurse that is too black and white. I tell these stories to my students and hope it is sinking in. My program is competency-based and they have to demonstrate an accurate manual BP on an actual patient in the hospital in 3 attempts in order to get out of Fundamentals. It can create a crazy amount of stress for some, but I think it is a good practice.
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on the good news front, i have had several procedures-egd/colonoscopy,mri ,wound debridement in 3 different hospitals and they all asked did i have any restrictions on what arm they can use
plus for my labs i tell them they are "stuck "with my left arm and have no body argue with me , he only took the one node with the snb but why take the chance. nm and i have had this discussion before but the difference in local polices re local anesthesia is amazing, i have never had to take ativan or xanax before a procedure because i usually have a px for emla cream for the wire insertions and know lidocaine comes before they do anything! -
Greetings! I am newly diagnosed. Bx done 1/11. Probable IDC per my surgeon, but still awaiting pathology. My scans are all being done this week. Def getting a mastectomy. I have been a peds nurse for 12 years, 12 hour night shifts. I have no idea what I will do about work.it's a bit worrisome due to bills and the amount of paid leave I have + our insurance is through my work! So happy to find a thread full of nurses!
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zennurse......I too was worried about work. I work mostly 12 hour days. I used FMLA and short term disability and my wonderful co-workers donated PTO time to supplement my STD. I could have never worked during chemo. Between the STD and PTO, my checks were about the same if I had been working. My insurance is also through my work and they took my premiums from the PTO. It will work out!
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TB tests & flu shots. How is this handled where you work?
Here's my story. BMX with nodes removed on both sides(4 left non-dominate, 5 right). I have residual pain issues on the left side but no visible LE. I've spoken with 3 LE trained therapists & have been told to have all needle sticks & BPs done in my lower extremities.
Last year I explained my situation to an employee health nurse. She contacted the medical director & got approval to place the TB test on my thigh. So, I thought it would be clear sailing.......
We are required to wear a mask if we decline the flu vax. I contacted the nurse who was helpful with my TB test. She checked with the medical director. I was told I couldn't get the flu vax in my thigh because the vaccine they use has only been tested in the deltoid site. The empl health nurse also told me she checked with the nurse manager of the oncology unit regarding how they handle patients in my situation. She was told that if I were a patient on her unit, the doctor would become involved & it would be decided which arm would be used. That patients like me do in fact get needle pokes & BPs in their arms. I was furious!
So, how is this handled at other hospitals????
The CDC guidelines do say that the thigh is an alternative site to the deltoid. I'm thin & workout, run, etc...... so it's not an issue of not being able to reach muscle in my thigh, even with the short needle that comes on those prefilled syringes.
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The vaccine is only tested in the deltoid site?????? Isn't the deltoid a muscle? Is there that much difference between deltoid muscle and other muscles? If that's true it's news to me! How are they giving flu vaccine to babies and toddlers whose deltoids aren't large enough? That argument just does not make sense.
The local cancer center docs hold the opinion that LE is not a risk for women after SNB. Funny, I got truncal LE after SNB with only 1 node taken.
Where I was teaching students had to demonstrate manual bp's to get out of Fundamentals, but most never take another manual after that. All the clinical sites depend on mechanized vitals measurement. It's becomeing what used to be called cookbook medicine--treat the numbers, don't look at the entire patient. I've seen nurses putting oxygen on pts whose O2 sats where "low" when in reality the measurement wasn't taken correctly by the aide. Some working nurses don't know what cyanosis looks like. Nursing is turning into slaves to the technology rather than using the tech as the tool it is.
There is a big difference between a nurse that can think critically and one who follows procedure.
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One of the toughest things for me (now that I am a "patient") is watching other nurses who are providing me with nursing care and cutting corners or demonstrating sloppy practice...Most have looked at my facesheet and already know I am a nurse and I know what they "should" be doing! For LE prevention I found a nice beaded bracelet with a medical alert tag on it in hopes that that would deter them from trying to use my left arm since that's where the lymph nodes were removed but they still grab that arm and try to use it for blood draws, IV's and BP's - I have to explain to them that I am "at risk" for LE but they look at me like they don't know what I'm talking about? Before they knock me out for surgery I make sure they put a big "limb alert" bracelet on that arm!
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thats funny maureen, because acls here still stress' treat the pt not the machine, mind it an instructor of many years teaching the class! but you go through the same with all the aides and new nurse that under certain circumstances the machines can be unreliable especailly if the heart rhythm is irregular or slow.. forgive my ignorance as i have not done peds for many years but don't they get their shots in the thigh? here if you don't get the flu shot you are required to wear a mask for for all pt care but as some systems are saying get it or lose your job! shouldn't they have got a firm policy in place for those who are allergic or have limited options for injection sites but it does open a lot of discussion about what you can be told you have to do just because you work in healthcare. does anybody else find it ironic that somebody can start a thread and name and shame healthcare workers but we don't have the right of reply because of hippaa. sorry very sensitive to that right now as a colleague got stabbed in work a few months ago. ps the first 2 surgeries they didn't know i was an rn but now due to emr they know i'm an employee so always ask where i work. . the procedure don't bother me as i've had 6 differnet radiologists and none have hurt me but how do you cope with waiting for results? i'm a light weight when it comes to drugs so am reluctant to take anything .? ps nm you can have any of future doses of verdsed ordered for me, it gives me intemittent amnesia which i find more disconcerting than the procedure but i always remeber the induction drugs going in
it always feels like my arm is on fire for those few seconds i'm still conscious -
Namaste!
It is usually the propoful that stings/hurts so much. Usually anesthesia just give about 2 mg of versed as they get ready to take you to the OR but for some reason it takes about 6 to work on me. Anything less and I remember the arm on fire from the propoful that they use for induction. It is just a few seconds but D___ it hurts.
I had nipple reconstruction in Dec and I found it strange that I was prescribed Norco 10/325 for pain (which I never experienced any pain and thus didn't need anything for pain), while all my other surgeries they only prescribed Norco 5/325 when I did have some pain and with one revision I had serious pain. All from the same PS. Strange. Wish I would have had the 10/325s when I developed shingles in Oct (which has been the WORST pain of my entire life, worse than broken bones and worse than an abdominal hysterectomy). It was dermtomes C 6-7-8 and it was 10 days of severe prodrome pain before the vesicles appeared and I got DX and started on valtrex. The docs all thought I was nuts because CT, x-rays and MRI were all normal. So they were not treating my complaints of pain very seriously. Anyway, glad that part of the shingles is over.
Karla
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Yes, IMs are given in the thigh of babies and toddlers. The nurse who stated the vaccine was only tested in the deltoid, using that same logic, could not give the vaccine to a baby or a child, becuase the only acceptable site is not available.
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I don't have enough knowledge of flu vaccines given in children. Are they the same or do they get a smaller dose? Perhaps some vaccines(different manufacturers) aren't tested in children & aren't approved for kids. I doubt any vaccine is tested in more than one site(most certainly the deltoid). The hospital I work at doesn't deserve to get the 90% compliance they are looking for. Employee heath is known for their rudeness. And now their idiotic decisions. IMHO
I was able to get the vaccine. I'm not sure if my internist's office even offers vaccines anymore. I think we're suppose to go to Costco or CVS or Walgreens(CVS also told me "no"). Got the flu vax at a county clinic. I think it was meant for low income people. They had no problem giving it to me in my thigh. I wore yoga pants that I could easily pull up a pant leg. I just think that if the hospital really want me to get it, they should have payed for it & accomodated me. Instead, I took a vaccine away from someone who wanted one & probably could afford it. Now that there is a shortage of vaccine. Still pisses me off, though......
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Coraleliz,
The flu vaccine is given to children under 4 in 2 shots, a few weeks apart. It is a different formulation. There is also a "double strength" formula for the "elderly" but there doesn't seem to be much difference in the effectiveness and Medicare won't pay for it.
Call me crazy, but in 36 years of being a nurse, I have never heard of needing to use the deltoid only. If I did that on some of my 85 pound/98 year old residents, I would have hit bone. There are just a few drugs that require deep IM (gluteus) sites but that's the only site restriction I know about.
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My TB test is due next month. I hope they'll apply it to my thigh like last year. I'm sure it wasn't tested on any other site but the forearm. I may have to shop around & try to find somewhere that will administer it appropriately(given my situation). That's assuming the hospital will accept it from another source. I usually get it at the hospital & use it for my other job(s) as well as volunteer work I do. Sounds like I'm the only one having problems in this area.
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When I went thru the health department training to give and read TB tests they told me it just had to be intradermal - using the forearm was preferred because it's where we are all used to looking for it when we had to read it later and it did't have body hair that would make it harder to give or read - but they never told us we couldn't use another site ? I hope it works out for you and you don't have to go somewhere else for the test...
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Namaste!
Today I am sick of nursing. The system holds nurses accountable to chase down MDs when the docs forget to do what only they can do! The nurse gets dinged if the doc hasn't completed the right things. The doc only gets a reminder.
And another point the system is teaching the new generation of nurses to focus on non pt priorities. It has not been a good day.
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Don't you love the way nurses can be used to cover just about anything? I've always hated chasing doctors down to do their stuff. I've asked a few times why/how I can be held accountable for something I cannot control or do, got told once that nurses are held responsible because they cost money, doc's get a pass 'cause they bring in money. This makes sense how? Another think I hate is that nurses can give nebulizer treatments on nights or weekends, but not during weekdays when resp therapy is working. Nurses can't supervise a pt in an exercise program during the week but are expected to on the weekends when PT isn't working. Smacks way to much of convenience decision making, to my mind.
Sorry you had a bad day, Hanta. I sympathize.
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Namaste!
Thanks Native Mainer.
Karla
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Hope it is okay to ask you all this question. I had my bmx and reconstruction almost a year ago. The highly recommended bs and ps ( they were called the dream team) had huge egos. I was constantly told how "lucky" I was to have them. I had a not so good hospital experience due to their lack of pain mangement. My absolute rage though comes from my bs not telling me she had taken 16 perfectly healthy nodes after suffering through the sentinel node injections. I thankfully have gone to another facility that has restored some of my faith in the medical profession ( btw my mom is an RN ). I want to write my bs and ps a letter telling them my disappointment. I do not seek any revenge but want to treat their other patients better than they did me. Is this unrealistic that they would even care? Would I be written off as crazy? I stopped going to the support group at the hospital because I got so sick of the nurses telling other women how wonderful this team was. Many thanks for any replies.
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Namaste!
grt: Sorry for your bad experience with pain control. Also sorry that so many of your healthy nodes were removed. I had a similar experience with my nodes. I had a sentinel node injection and 3 nodes were identified as being sentinel and were specifically removed by my BS. However as my BMX were completed 14 additional nodes from my cancer side and 4 from my non cancer side were also removed. They were embeded in the breast tissue and were identified on pathology and not in the OR room. It has been explained to me that although this is not common it also is not rare. To have left the nodes would have meant leaving behind breast tissue. I can't say your situation is or is not the same as mine but it could be a possibility. Unfortunately I developed moderate lymphedema on my cancer side and mild lymphedema on my non cancer side. When I was participating on the lymphedema thread there were several there that had encountered this same thing themselves or knew of others for which this has happened. Have you developed lymphedema? If you have, I am so sorry. It stinks. This whole business stinks. If you have not you certainly should consider yourself at risk and take precautions.
In regards to giving the surgeon's feedback on your experience I would encourage you to do so. However, you might want to have an objective third party help you edit it so that it says exactly what you want it to say in a way that will be meaningful to them and their practice.
Hope you are experiencing warmer weather than the deep freeze we are currently in!
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Grt42btexan: Go ahead and write the letter. It may or may not make the PS and BS change their practices, but it may. Or it may at least get you an explanation that makes sense to you. If other women have a similar experience and also write in that may make a difference.
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I was at sloan kettering. Woke up in OR asthey were wheeling me out. I said Ineed mg of ativan ,I just lost my breast. Got to recovery wide awake btw. I asked where my pca was they said they wjpherereserved for biaterals. Proceded to treat me with 0.2 and 0.4 mg of dilauded. Etc etc story gets worse. I complained to there pt advocate or someone . I wrote letter. But it still makes me very distrustful of medical providers now. Was at methodist hosp in san Antonio last oct where i was treated perfectly
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The nurses covered so much for the doctors and I tried to be a noncomplaining patient. I wanted to be liked by my dream team. I totally get that my nodes may have been in the breast tissue but the first question I asked out of surgery was "how many nodes?". My husband asked. It was a huge question because it was almost guaranteed to me that the cancer had spread. She assured us many times during my week stay in the hospital that it was 3 nodes only. During the next month when I went every week for post op ( I still do not understand why so many post ops with her) she never ever mentioned the additional nodes. I finally asked for my pathology report and confronted her PA with it. She stammered and acted like she had never seen my path report. I just do not want another woman getting treated the way I was treated.
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Namaste!
grt: In my situation the surgeon did not elect to take any more than the sentinel nodes and was not aware of the extra nodes being removed until the final pathology report. The nodes were embedded in the breast tissue and were not discovered until the pathologist disected and did all those minute little slices in the tissue on their exam. This information was not on the preliminary report. The preliminary report focused on the immediate area of the identified cancer and the exam of the intentional nodes removed. The surgeon, the OR staff, the post op staff all were only aware of the 3 sentinel nodes removed. So I am certain your nurses did not lie to you and your husband. That was the most complete information that they had available to them at the time. The final pathology report comes weeks or more than a month later because the pathology work is so extensive as they make minute slices throughout the tissue to see everything that is there. That allowed them to "find" the nodes embedded in the breast tissue. I talked to a pathologist and they said the removal of the nodes could not have been avoided by any surgeon who was meticulous enough to remove as much breast tissue as possible. Only a lumpectomy would have left some of those nodes (I was not elegible for a lumpectomy).
Karla
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Namaste!
Every surgeon and hospital have a different practice in regards to length of hospital stay and what meds are used for pain control. In addition, every individual has a different experience with pain.
I had a BMX with attemped/aborted first stage implant reconstruction (all the internal pocket work etc was done but the skin died and there was not enough skin to cover the expanders so no expanders were put in).
I had my surgery mid day and was dismissed the next morning. The surgeons at our facility do not order PCAs for mastectomies or implant reconstruction unless a flap has been done. You get some doses of fentanyl in PACU. Once on the floor they start you on Oral pain meds immediately if you tolerate oral fluids. For breakthrough pain you can have up to two doses of Morphine 1-2mg but most patient's with BMX or BMX first stage implant reconstruction don't need it. Next morning you go home.
If some one comes in for first stage implant reconstruction or for exchange surgery it is outpatient and you go home about 1-2 hours after you roll out of surgery.
Flap surgery is a whole different matter with PCAs and usually 2 -3 overnights depending on which flap procedure is done. Our PSs prefer to manage their pts out of the hospital and in their own homes ASAP. They strongly feel that the incidence of infection will remain lower if they are in their own germ envirnonment. They would rather see them every day in the office rather than have them stay in the hospital. Patient's seem to do well on oral pain meds. Please know our hospital does not do the 12 hour extensive procedures done in some places. Flaps are mostly laps and trams.
Karla
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The plastic sx, dr desa talked to my hubby when it was over. He told him she will be in lott of pain, since he had filled my TE with 300 ml fluid, and that I would need to be in hosp two nights for pain control. He was right. I was in a lot of pain
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Just diagnosed on 1/22/13. Saw plastic surgeon on Friday, 1/25/13. BMX will be scheduled in 2 weeks after I have not smoked for those 2 weeks. I know I sound crazy bout now, but I smoked 35 years and on 1/25/13 was told that was my last day, I had too quit for "healing purposes". Quit multiple times in the past, unsuccessful. Can't even use nicotine patches, gum, etc. No longer consumed with thoughts of Cancer or surgery, now only not smoking! Anyone have any ideas? Been without a cigarette since 1/25 at 1830!?!?!
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Hi all,
I have been on the forum for over a month but just found this site. I am a RN for 30 years, 20 ICU and Open Heart Recovery, Med/Surg Progressive Care, then nuse manager. At this time I have been at an outpatient dialysis clinic for about 1 1/2 years and am currently on STD. Don't know when I am gonna go back as I worry about infection as many of our patients come from nursing homes, and we even have homeless folks and in addition to HIV, Hep B and C, we have the normal run of every other type of viruses. I can handle being out but when the 12 weeks are up not sure I want to potentially lose my job. While I feel I could get on at another clinic not sure I want to. Oh well I have a month to make the decision.
I so agree with some of what I have read here that because we are nurses we don't get the explanations we should for so much of the care/treatment etc. I have another problem as I have a history of substance abuse (opiates) of which I have to disclose as I am still in a recovering nurse program and tightly monitored. Because of this no one wants to give me pain meds. I even was referred to pain management who was more concerned about my "weak" recovery program (in his opinion) and not at all concerned about my pain. Two MRIs indicate future surgery for my back plus a bunch of other health issues. He wants to inject the degenerative changes in my back. I am not concerned about the chronic stuff I deal with that, my concerns are the acute pains I felt after chemo, especially a couple of days after I rec'vd the Neulasta shot, it was horrific. I did get pain meds for that and was able to get through it ok, but that was before I saw the pain management doc. Anyway let me stop for now, just nice to find another forum that I can relate to.
Thanks, Sheryl
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