Nuclear dye injection

GramE

Add me to those who cried.  The surgeon ordered ativan and by the time I had the wire localization, I was pretty loopy.  But it DID hurt, and my pain tolerance is high.   I was on my side, looking right at the crotch of the male tech doing it.  After the first one, he said, sorry, but I have to do this 2 more times.   I was ready to take a "bite"... if you know what I mean...!!!   

I had been warned by other patients, but nothing could compare with the pain, and it still hurt as I was wheeled into surgery.   

JulieC

Nancy,

At least you had ativan.  I didn't find out about that wonderful drug until I got to chemo.  I'm sure that would have helped with both of my surgeries.  It's amazing what we find out after the fact.

Julie

rdrake0

I have decided to complain to my hospital executives about this procedure.  I talked to my surgeon who said nothing would numb me sufficiently, so why bother?  I even e-mailed and eventually talked via phone to Dr. LaSalle LeFall, past-president of CNI, who had no answers.  It is interesting that Stanford (http://www.stanfordhospital.com/default) and Central Florida Breast Center (http://www.mybreastdoc.com/meet_our_providers.htm) will put the woman under anesthesia, but the rest of the world won't!  I want to know why others haven't changed!  Being quiet about it hasn't helped for sure.  And pretending it didn't hurt, putting it all behind you, etc, won't make it any easier for other women who come after us.  I have a daughter and two younger sisters, not to mention another breast and centinel node of my own.  That is why I am taking action.  I feel like I have to do something.

I must say here, though, that those of you who said it didn't hurt or didn't hurt much, I wanna be you!  But I can't. 

Sukiann

Thanks so much ladies.  Even though I am still scared about the procedures (both of them!) I do want to know what is going to happen.  I was getting an ultrasound today (btw - everything looks good - well except for that darn tumor but nothing else new showed) and a woman was there who was looking for a nurse to hold her hand through a procedure.  I asked her which procedure and she told me the core biopsy.  She said that she was told it wouldn't hurt (lie, lie, lie) but she still wanted someone to hold her hand.  I wish I could have gone with her but they called me for my ultrasound so I couldn't.  I told her, yes, it would hurt but she would be ok.  I don't know why they say it won't when it will!  I didn't scare her but I told her the truth (well, at least what I felt).  So, I appreciate your honesty here.  Thanks so much.  I'm soooooo glad I found you all! 

Lories

Sukiann - there is another thread where a lot of folks are reporting on their sonogram guided core biopsies.  That is a whole other test, and is not nearly as painful to many as the dye injection (which this thread is about).

You may want to check the other threads out. 

Traci-----TripNeg

I remember this pain like it was 5 minutes ago. (It happened two years,  (in 2 months and 4 days) ago. March 22nd, 2007. The nurse said it was going to "sting". It was after this injection that the reality of my breast cancer finally hit me hard. Until then, there was no pain. (Mammograms hurt my ass!!!!!) I remember her saying "only 5 more times". I think that is still....the hardest I have cried in my life. It hurt so bad. My double mastectomy was a breeze compared to that pain. And, I mean that seriously.

Hugs girl,

Traci

deborye

Yes that dye injection was the pits, even the poor radiologist kept apologizing to me as I was wincing in pain jabbing that needle in 5 friggen times and then the wire, omg, then the mammo with the wire inside, wtf. and the stupid cup they put over the wire while you are in another waiting room waiting for surgery.  That will be 2 yrs ago April 17 then 2 wks later had to go back for a re-excision to get clearer margins.

  

Now I feel better♥   

Imasurvivor

I had the cream and it still felt like four yellow jackets stung me.  Bearable but very uncomfortable.

vlwuertz

I can't say enough good about the Emla cream.  I put it on 2 hours before my injections and hardly felt anything.  I had 4 nuclear injections, then went to have to have 2 needles inserted for localization.  It felt like no more than a touch with the point of a pin.  I will use it on my chemo site!

Great stuff!

 Vivian

vegas

I am with those who screamed and cried from the SNB injections. It felt like my entire nipple was on fire. No numbing cream or anything else for me. I had heard the woman scream who went in and had her SNB done just ahead of me and I had thought she just had a low tolerance for pain. My tolerance is high - I relatively breezed through recovery from the mastectomy and hardly needed any pain killers. But this was awful. They told me that I could not have anything because they needed me to be mobile to get on and off the table. It was for THEIR convenience, not the comfort of the patient. That definitely needs to change!!!

Marthapw

I am scheduled for a sentinel lymph node biopsy next week and am guessing that you are all talking about this procedure.   I am horrified and scared and cannot beleive that they would do this without an anesthetic or something.  I have called the hospital two times and talked to the techs (or whatever) and both times have been told something different.  But the last one told me that they couldnt do numbing because of the lymph glands.  I dont believe it.  I think it has to do with money and time.  How can we women put up with this. I am thinking of going to another Dr. and (yet another which I hate to do) but having unecessary pain is just not OK and worrying about it is worse.  Anyone have an idea????? Martha

Marthapw

I will do anything I can do to help. Why hasnt this changed.  I am looking for a dr or hospital in No California that will do something and if you know of any besides Stanford please let me know.  I am horrified at the prospect of this and that no one has done anything.  Again if this were a man it would probably be different. 

BFidelis

I also had no numbing cream, injection or ANYTHING.  Techs were as nice as could be which means they kept apologizing while tears just streamed down.  Then went to the surgeon's office for the wire insert.  He told me I didn't get any anasthesia because my insurance wouldn't have paid for it.  (Guess the insurance company CEO bonus is more important than my pain.  Maybe we should kidnap the CEO and inject his pons.)  Once again, our "standard of care" is set not by what is medically best for us, but what is most lucrative for insurance.  I don't believe for-profit companies should be licensed to provide healthcare insurance--only non-profits whose primary goal is MY HEALTH, not their bottom line.

Now, the "Insult upon injury" award:  Because I was getting the SNB injection at 7:30 am, then getting the wire in @ 8:30 am with a 10:00 at surgery registration, I told DH to meet me there.  Didn't want him just hanging around feeling useless.  I got up to register in surgery early and they asked me where "my ride" was.  I told him he was meeting me.  They proceeded to tell me that they would not take me into surgery until they had "confirmed" my ride.  The intake clerk started to try calling him, and I told her it was no use--he was already on his way and was taking the subway and would not get a cellular signal.  She said she'd keep trying and sent me to sit in the waiting area.  After all the pain I had gone through, I lost it.  It started with a soft sniffle and escalaated to tears.  Someone came over and gave me a tissue.  The more I tried to stifle it, the worse the crying got.  Pretty soon 2 nurses marched me off (sobbing uncontrolably by this time) to a 'side room' and wrapped me in blankets and told me to stop crying or my lungs would fill up & I wouldn't be able to have surgery.  (Can somebody please find some MORE gasoline for this fire?)  Finally, someone came in an informed the nurses that my ride was there.

This whole episode is the most common flashback that I have.  I still have dreams that when they said no ride/no surgery that I get up and walk out of the hospital with a wire in my boob and a big blue dye stain on my chest.  (Don't know where I go like that or what I do; at that point I always wake up.)  When a medical person says you will have "some discomfort" that means extreme pain.  When the say it will be "a little painful" you should ask for a knockout.  Hell, they didn't even give me a leather strap to bite down on!

And they act like we're a bunch of babies.  A couple of years ago, I had a gyn who insisted on confirming my onset of menopause by biopsying my uterine lining.  It was 'an office procedure.'  He told me to take 2 advil an hour before hand.  By the time he got his equipment lodged my legs were shaking uncontrolably and the nurse was wiping the steady stream of tears.  Gyn ask if I wanted him to take a break!  I cried JUST FINISH IT.  I later learned that a simple blood test could have confirmed it.  Not as much profit in that for the Gyn, I guess.  I have not been to see a Gyn since.

Dona Nobis Pacem,

Beth

joanmac52

Having just had this done on Wednesday, I did get numbing injections although they said it would feel like bee stings they forgot to tell me they were giant bees!!!! After I had that done they sent me to have the wire put in my breast the radiologist there said that the numbing shot hurt as much as the actual insertion of the needle with wire, I went along with that and I balled my eyes out not uttering a sound. That was the beginning of my day next came the lumpectomy which no one really explained how much that would hurt and how large an area would be involved. The dye did not show up in my lymph nodes so she removed alot of them to be on the safe side.... Did this ever happen to anyone else. I am better today though and now I have to wait till next Wednesday for the results. Yikes.... Thanks to all th einfo you gals have given me you are my true heroins. Joan

Ellen08

I too had the Emla cream.  I was told that it was EXTREMELY important to slather it on ONE HOUR before.  I did not feel any of the needles except for one, and that one really wasn't bad.  They asked me if I could rate the pain between zero and five, zero being the lowest, what would it be, and I told them a two.  I highly encourage anyone going through this that they do this!!!  So sorry to hear about the horror stories.  I cannot imagine.

Raeanne

I feel so fortunate to not have experienced no more than a slight  bee sting and that was only on a couple of the sticks, I did not have to have a wire inserted and I guess I don't understand what that is for. I am still getting my crash education in Breast Cancer,

mela4409

This was by far the worst thing about my surgical experience.  The people were very nice, but the nurse told me it would feel like a TB test...which is nothing.  Then the radiologist told me it would feel like a bee sting, but it felt so much worse.  I had two on each side, and squeezed the nurses hand the entire time.  My cousin had 4 on each side and she said her's weren't too bad.  I thought about that for the longest time, and the pain is finally out of my head!

cindy1cpa

I had my SNB on Feb 3rd. I knew what to expect because of this website. I didn't get the cream which was a bad thing. I could have used anything to help the pain. I had a hand to hold which was helpful. I think I bruised her hand!

I was told that they cannot numb the area because the medicine will interfere with the dye that is injected. I'm not so sure of this, but that is what I was told.  After my procedure the doctor said maybe they should try to ice the area before the injection. Too little too late for me, but maybe those that have yet to have the procedure can ask for this to see if helps.

lvtwoqlt

RAyeanne, the wire is used to in the or so the doctor can find the area if there is no mass visable (microcalcificaitons) and a lumpectomy is performed. If you had mastectomy they don't need the wire to locate the area.

cindy, I too was told that the lidocane would interfere (dilute) the dye that is injected because it would all go to the same nodes. the assistant just kept rubbing my shoulders and said you are doing fine, and wiped a few tears from getting in my ears. The tech that did my injections used warm packs before and after that helped move the dye and also lessened the pain on each boob (I had it bilaterally 6 shots each side).

Sheila

Marthapw

I dont believe that they cannot use a local anesthetic.  I have been told that they can but it is easier for them not too and a lot of insurance will not pay for it.  This is beyond barbaric and I have canceled my surgery until I find a surgeon who will do the numbing.  I am not afraid of the pain just dont want to be treated this way and dont beleive any of us should stand for it.  So much for the lumpectomy and how great it is if this is what one has to indure.  Why cant they work on a way to make us who  have breast cancer as comfortable  as possible.  I will do something after I finally get my surgery and I hope the rest of you do too.  Martha 

Lainey64

I used half a tuble of the EMLA cream and didn't feel a thing.  The only pain I felt was the burning sensation of the dye when it entered.  The technician was getting a good laugh when she removed the plastic wrap and saw the cream all over my boobie. When I went back for my PET scan I had the same technician and she said "You're the girl with all the cream!".  It's not a pleasant experience at all but the cream made it tolerable for me.

rdrake0

Sleep is bliss!  If they can put you under for a colonoscopy and upper GI, then they can certainly put you under for this aweful injection, period.

idaho

I think is has to  do with which kind of injection you get.  I did not have to have a needle injected into my nipple,  they just injected a few times right into my breast,  it stung but did not hurt.  I think if I had to have it in my nipple it would have hurt much worse.  I did not have any numbing.  The thing that hurt me the worst was the biopsy (vacuum type),  they said bee sting,  it felt more like a hot huge nail.  ouch ouch ouch.  THey definately should find a better way.  I agree that using whatever they use for colonoscopies would be the answer.  It will not change unless enough women say it needs to, so lets all raise an uproar and see what happens!   Tami

Sukiann

I had my lumpectomy on 3/13 and an SNB as well with a local surgeon.  The surgeon did ALL of it under anesthesia.  I had a second opinion in Boston before I went with the local surgeon.  The Boston surgeon would have done it the way you are all describing.  She even gave me the emla cream and xanax prescriptions before I left the office (I asked her for those prescriptions in case I went with her).  I  chose the local surgeon who puts you out (that was not the reason why I chose this surgeon but it was a bonus!).  I think it depends on how your surgeon was trained.  The local surgeon trained at the Faulkner and she said that this is the way she learned how to do a SNB.  You CAN find a surgeon who does this procedure under anesthesia.  If my surgeon can do it then so can others.

Cherine

Hi there,

I totally agree, in Ontario we can buy it over the counter.  I used it on my port before treatments and didn't feel the needle go in once.  It was amazing.  I would have loved it for my biopsy - I almost fainted.  Best Wishes...

Sukiann

Thanks rdrake0 for your pm!  I am going to share with you all something I learned from Dr. Susan Love's Breast Book.  The reason why some surgeons can put you under and some can't is because of what they use to find the nodes.  My surgeon only used blue dye.  Blue dye can be injected at the time of surgery while the patient is under.  This is because the blue dye gets to the nodes very quickly.  Other surgeons chose to use radioactive tracer that has to be injected 2 hours before the surgery.  This is why only a local anethestic is used.  Once the radioactive tracer gets to the nodes a tool called a stereo geiger is used to find the node.  Some surgeons even use both.  There are reasons why a surgeon would choose to use one over another.  Some people are allergic to the blue dye (sulfa allergy) .  Sometimes the sentinel node is not located in the armpit but in the sternum. The radioactive tracer would tell the surgeon where to make the incision to find the node. My surgeon was trained at the Faulkner Hospital in Boston where she learned to use only the blue dye.  She doesn't feel she needs to use the radioactive tracer (I hope she knows what she's doing!!!).  I hope this helps to clear up why some people can be under and some can't.  I think it depends on the training of the surgeon and also how comfortable they are in finding the sentinel node.

LRM216

I just do not understand, as we are all going through the same exact tests, no matter what our cancer turns out to be, why there is no uniformity in what we go through during these tests.  It seems as though half of us have to suffer unmercifully and the other half feels no pain or very little.  I have been recently diagnosed, been through the Core Needle (no pain whatsoever), the wire guided US right before lumpectomy (no pain whatsoever) and the nuclear dye in the nipple (again no pain) all due to lidocaine shots before everything.  What's with these hospitals and doctors that our procedures are not all done the same to assure the minimum amount of discomfort for all that must go through them.  It just doesn't seem fair or correct that this should be happening.  I am in the Atlanta, GA area and have had everything done through Northside Hospital's Womens Center and each time, they could not have been more wonderful.  On a side note; however, every single person, doctor, nurse, radiologist, breast surgeon, etc. that has even touched me has been a female!  Wonder if that has anything to do with it???  I am so sorry to all my sisters that have had to endure more pain than they should ever have had to.

Hugs,

Linda

ICanDoThis

I posted this last May - it's the result of a study done to determine if lidocaine actually affects this test:

This was published today in the Dr's Guide Media Review

 Preoperative topical 4% liposomal lidocaine (LLC) significantly decreases the perception of pain during sentinel lymph node (SLN) biopsy injections, without any compromise in lymph node identification, investigators reported here at the 9th Annual Meeting of the American Society of Breast Surgeons (ASBS 2008).

SLN biopsy is an essential component of breast cancer staging and requires that radioactive tracer technetium 99 sulfur colloid be injected into the periareolar area. This process is known to cause pain and anxiety among patients, according to researcher Daniela J. Schupp, MD, Surgery Fellow, Inova Fairfax Hospital, Falls Church, Virginia.

To determine the effect of LLC cream on pain and adverse effects, Dr. Schupp and colleagues performed a prospective, randomised, double-blinded study. They enrolled 42 patients aged 18 years or more who presented to the outpatient surgery centre and were not breastfeeding, had no lidocaine allergies, and had no prior periareolar surgeries.

Patients received either placebo or 4% LLC cream to their areola with a 1-cm margin prior to SLN injection.

The study's endpoint was perceived differences in anxiety and pain due to SLN injections as evaluated before the creams were applied and then within minutes after the injections as measured with a 2- to 10-point visual analogue scale. The researchers analysed the data using Wilcoxon rank tests.

Caucasian women comprised the majority of patients (88%), the average age was 55 years, and the average weight was 75.7 kg. None of the patients had signs of an allergic reaction to the creams. Participants received injections within a mean time of 32.2 minutes (SD, 12.2).

The difference in pain perception among the 20 patients in the LLC group and the 22 patients in the placebo group was statistically significant (P = .052). The lidocaine group reported a 1-point increase in median pain score from baseline (P = .002), and the placebo group had a 4-point median increase from baseline (P < .001).

"Anxiety is not affected by placebo or lidocaine cream application," Dr. Schupp noted in a presentation on May 3. Levels of anxiety before and after the injections were the same in the 2 groups, and there was 100% lymph node identification in both groups (P = .5).-

MillieD

I'm learning about the pain of this test through this site right now.  I'm so glad i'm here.  I'm having mine done at 8:30 a.m. on 5/13.  The doctor's office didn't mention anything about any discomfort, pain, etc.  I was just told that i needed to get this done so they can read my lumph nodes better (you know what i mean)...

I will call them Monday morning to ask about the EMLA cream or local anesthesia.  I'm learning so much with you guys.  Thank you.

barbe1958

I had to have mine done the day before surgery so it would work it's way through my system. I asked about freezing, but the nurse said "You really want a 5th needle?" Good point. It was quick and the discomfort lasted only as long as the needle was in. I have a LOW threshold of pain due to Fibromyalgia. I expected worse, so to me it wasn't too bad. Then I had to remember to massage the area through the rest of the day. I walked into this apointment and walked out. I was alone. They inject a dye during surgery to "link" up with the stuff injected the day before. Where it lights up is where the SN is. I was fortunate that just one month earlier my hospital had stopped injecting right into the nipple. (The thought of that just turned my stomach!)

As for the wire placement. I got that the morning of surgery. I arrived at 6 am as requested by the hospital. Got an ultrasound guided wire at about 10 am (long wait!). They did freeze the area as you can't move while they put it in. You don't want them to miss the tumour cause you don't want them to do this twice. I walked around until 1 pm or so. Finally asked for a pain killer as the area was starting to ache. They gave me Tylenol 3. Finally went in for surgery around 1:30 I  think.