question about sentinel node injection

PKathleen

can local anaesthetic be used?

LuvRVing

Kathleen - when I had this done last year, I requested the EMLA numbing cream be applied about 45 minutes before I was scheduled to go to Nuclear Medicine for the injections.  That made the procedure painless for me.  Also, at my hospital, the injections were tiny and included a bit of lidocaine.  Ask to speak to a Nuclear Med tech before you have the procedure.  And ask your breast surgeon to order the EMLA cream for you.  The nurses have it available.

Wishing you a pain-free experience,

Michelle

ruffy

Hi Kathleen, I was really worried about the injection, more scared about that then the sx. I brought my iPod, closed my eyes tight- then I had to ask if it was over, I didn't feel a thing! And I honestly lost alot of sleep over it prior to. The Emla cream is a great idea too. I think the idea and description of it sounds more painful then it actually is. Atleast for me anyways, good luck

22tapper

They did some tiny injections around the nipple which i thought would hurt but weren't bad at all and I am a weenie!  The contrast is put in and a bit of waiting.  Remember it may or may not work so stay positive but be prepared in case!  This was an easy one!  Don't worry!

suzanneinphoenix

I read so much on~line about the SNB, I was totally freaked out!  The bilateral mastectomy didn't scare me...but THAT DID!  I had the injection in the Mammography department of the hospital.  They ran the dye when I was in surgery.  I was in and out of the breast center in no time.  And after the injection...I almost said "THAT'S IT????" because I could not believe it was so easy and painless!  You'll be ok   ( I lost a lot of sleep over it too......sometimes the internet is NOT a good thing!)

RetiredLibby

Mine is coming up next week.  I got a script for Emla cream from my breast surgeon, and the nurse navigator told me that they put a lidocaine patch on you before they do the injection. I'm gonna do both -- I told my plastic surgeon that I was going to put the Emla cream on before I got to the hospital and not tell them, and let them use the lidocaine patch too and he laughed.  It's not like I'm going to overdose on lidocaine! 

L

belleeast

my experience with the SN injection was horrible,i don't think it could have hurt more if they had injected acid in my breast. my legs came off the table,the only thing that kept me from knocking the dr/tech away from me was the thought he might still have a needle in my breast. i did say a few choice words,then couldn't speak for fear of screaming. i told him,he needed to change his little speech about maybe feeling a little sting when the radioactive trace entered the breast. i said you need to say it might feel like FIRE is being injected. never again!

mommichelle

I also had a bad experience.  Pretty good pain tolerance, I think...2 c-sections and mastecomy and strongest pain med was Tylenol extra strength (without codine).  I was told the numbing agents can interfer with the way the dye travels.  Not sure if that is true or not.  It hurt a lot!  I almost wish I could have had a numbing agent.  Good luck - hope you are one of the lucky ones!

AmyIsStrong

My bs did it when I was already under anesthetic for the lumpectomy. I missed the whole thing which was fine with me!

Elizabeth1889

I also had the injections done when I was already under anesthetic.  My BS said he had gotten too many complaints from women who had had it done beforehand and he wanted to spare them that pain.  Thank goodness for surgeons who actually listen to their patients.

cycle-path

It's interesting that some women experience a lot of pain while others say it was basically just a bee sting. I wonder what the difference is? There have to be reasons why the difference is so dramatic. It could be the location of the injection, the type of breast tissue one has, or maybe even the properties of whatever the carrier of the tracer is. (I assume there are different carriers used.) It would be very interesting to know why it's painful to some but trivial for others.

For me it was completely trivial. I had no lidocaine or anything. It was just a needle stick like any other needle stick.

Now, when they started my IV later in surgery, I almost jumped off the table and strangled the nurse. But that's another story. 

catbill

I didn't have any pain med, but since my surgery had gotten delayed by 2 hours because of something with the person ahead of me, I had been given some anti-anxiety med in my IV which was already started.  It wasn't fun, but the injections weren't as bad as I imagined they would be.  Good stuff that anti-anxiety medication.

mawhinney

I had the dye injected in the bend of my arm the afternoon before my surgery. Only felt a needle prick. Wonder why some gals had the dye injected into their breast.

catbill

Mine was done the same day as surgery so they put it as close to the lymph node chain as possible.  I think that's one of the reasons, but I'm not sure.

Cat123

They told me that they could inject a pain med but it would be as painful as getting the needles for snd.  It passes by quickly even though there is pain for a minute.

cycle-path

mawhinney, the "dye" (it's not really a dye, it's an isotope) must be injected into your breast if you're having a sentinel node biopsy. If not, there's no breast injection.

survivor11

I guess I was one of the luck ones because it was no big deal at all. Was freaked like anyone else about it beforehand but was pleasantly surprised that I really felt nouthing. Did also have the EMLA cream applied in pre-op but no other meds. You could ask for them to give you a small dose of Versed before you go to NucMed, that should make it much easier.

Good luck to you, I know how frightening this part is. Just try to hang in there and take one test, one procedure, one day at a tiime.

Joan811

Hi all,
Like everything here, some experience more discomfort than others.
My dye and isotope will be administered the day before the lumpectomy.  I never even thought about it being very uncomfortable, just unpleasant.  My initial diagnostic biopsy was bearable except for the last sample which seemed to be on the edge of the numb zone.
So, I will look into your suggestions.  I have pre-op tomorrow and will ask about a med for relaxation and ask for the local anesthetic.  It seems to me that it shouldn't have to hurt much.
I will let you know.  But I am glad I read about this.

etherize

I'm glad I found this thread, although not too happy that some have had painful experiences.  

I'm one of those who isn't scared of radiation, or chemo (not yet, anyway), or anesthesia/surgery.

But I have to have a SNB AND a wire loc lumpectomy.  Just thinking about it is enough to make me hyperventilate or feel like I'm going to throw up! (a slight exaggeration, but not much).  I also faint pretty easily, so I'm afraid I'll faint during the wire insertion or the other stuff.

I will get the EMLA cream for the radiation dye injection; that much I know for sure.   And the BS said something about lidocaine for the wire insertion, but I sort of stopped hearing things after I heard "insert a wire into your breast" so I'm not sure about specifics.  (I'll call to find out, but I doubt it'll make me any less nervous!)

I have a VERY low pain threshold (I tell my DH I am the original "Princess and the Pea").  The only way I made it through the core biopsy was with 2 mg of Ativan and a Percocet (left over from an old back injury).  I didn't feel any injection, but some pressure and tolerable pain during the punching of the needle.

I've been told I can take the Ativan prior to the dye injection/wire insertion, but I'm sure they won't want me to take any painkillers, since I'll be having surgery and general anesthesia.  

Wendyspet

The wire insertion was painless for me.  They numbed my breast.  But the lymph node mapping I felt.  They gave me 4 shots around the nipple, and the last one hurt the worst (I thanked them for that).  I don't know why there was no lidocaine.  The nurse assisting said she had had it done, and it wasn't bad.  But, I am grateful that my nodes "lit up" off the chart, and I only had to have 2 taken out. 

If I had known more, I would have asked for some pain medicine.  It wasn't horrible, but I did sure feel it.

Joan811

Back home from yesterday's out patient lumpectomy...
I had the isotope injection into my site the day before. I had such anxiety, and felt overwhelmed by the impersonal air of the huge New York cancer hospital.  I asked about the Emla on my pre op visit and was assured they use it.  But no - I was told "it only takes 2 seconds, really" and I replied "they lied to me" but then I had to lie down and take it....and....it really only took 2 seconds.  Yes, it burned, but it was not worse for me than the lidocaine burn.  What was worse for me was the camera scan 2 hours later - I am claustrophobic and hate confinement.  I had to lie still with the camera inches over me for 5 minutes; then again.  The technician was wonderful and let me take a break in between. 
Surgery day - the wire!  What a hideous experience. I had a Xanax early AM.
Mammo ultra squeeze - I had to stand - followed by topical injection followed by needle placement - take pic -not quite right - remove, re-insert - take pic - not quite right - move again - take pic - back it out a little, reposition and take new mammo with needle in place (can I open my eyes yet??) then remove the needle and reposition mammo and take more pics. Done.
I knew it was the very last nasty thing to have done before the surgery.   
My pain tolerance is pretty good. My anxiety level is off the roof. Can't breathe, can't swallow, have to wiggle, etc.

Sassa

I have a very high pain threshhold. 

Spring Hill Hospital in Florida is where I had my SNB and first mastectomy done.  That hospital seems to feel that  any patient is a druggie looking for a fix and is stingy with pain meds.

As a result, no numbing agent was used prior to my four injections of dye and isotope.

The injections were extremely painful and I needed a half hour break between the 3 and 4 injection to let the pain level decrease a bit.

Make sure you have some type of numbing medication.

Jellydonut

Mine was in 2002, no numbing cream or anything else to numb (and I didn't know to ask for it).    The female surgeon apologized and said I really, really don't want to do this to you, but I have to....four needle injections into my breast.  It  was horribly painful - but I'm still here to talk about it.

Happy that things are way different in 2011.

Starak

I asked for pain meds or even to ice it but they said they couldn't because it might affect how it travelled to the sentinel nodes.  It was extremely painful.  I had tears streaming down my face for a good half hour and was nearly unable to speak. Nothing else to do with the mastectomy, recovery or even rebreaking my wrist afterwards was as painful as that.  I rarely take pain meds at all and only 1/2 doses when I do.  I am ultra sensitive to many chemicals and drugs so it may have been because of that.  Previously when I had the biopsy, they iced it and that went really well. Hopefully you will be one of the lucky ones with barely any reaction. Barb

etherize

Yikes, the last few posts are really scary!  I had a pre-op meeting today and told the doctor I had a very low pain threshold and she just said, "they'll manage your pain" ... but when I asked where do I get the EMLA cream, she had no idea what it was -- and neither did the medical assistant, whose mother had just had the same procedure at the same hospital!

Fortunately, they were able to coordinate and somebody ordered the cream, so at least I'll have that.  But I'm definitely going to need the Ativan, too.  Oh, and I've asked a couple of times and been assured twice that I'll only get one injection for the dye.  Fingers crossed!  And toes, too! 

Leah_S

Etherize, the cream needs time to work, so if you have it at home, put it on and cover it completely with saran wrap. If they're giving it to you at the hospital then get there early and ask for it. Tell them it needs to be covered with Tegederm (plastic dressing that looks like, um, saran wrap) and it needs to be put on an hour before the shots.

Best of luck.

Leah

etherize

Thank you, Leah!  The nurse did tell me to put it on 45 minutes before we left for the hospital and cover it with saran wrap.  I'm glad you mentioned it, though, for others who may read this thread and not know!

Joan811

I had my isotope injection the day before surgery.  It was a single injection.
I did not have the dye until after I was sedated for surgery the next day so I do not know if the blue dye is painful as well.
Wow, there are lots of ways to do this....and it is so hard to adjust when we expect one thing and something else occurs.  I definitely recommend some kind of relaxation meds.
Does the cream that is applied ahead help with the burning or just the site of injection?

Emaline

There is a difference between "dye" and the nuclear injection.  If you have the dye, you pee blue for a few days...if you have the nuclear injection, you don't.  I've heard the dye hurts like a censor censor censor...and the nuclear not so much.Then again, I've heard the opposite. Go figure.

My doctor does the nuclear injection a few hours prior to surgery, and if when they do the reading, nothing shows up, then they will do the dye.  Luckily for his patients, when he does his readings, is when they under, so they never feel the dye.  I read walking was good to get the injection moving around the system. After it was done and I had some time, I asked if I could walk with my husband and they said sure, so we did.  My doctor did not have to use the dye.

I've heard varying, and I admit it amazes me, degrees of reaction from lidocaine.  For me, yeah it is like a bee sting, hurts like a censor censor censor for about 10 seconds then it is gone.  I had lidocaine previously, in a very sensitive area (right where your thigh and groin meet) to have a mole remove.  Not my favorite ever experience but hardly the worse.  IVs rate a thousand times worse in my book.  I admittely do not have a good pain tolerance, but this did not bother me so much. Yet other girls who I knew had lidocaine (not just for BC) felt it was like demon fire under their skin, worse then anything. Girl at work, she had it for stitches in  her hand...said getting the lidocain injection was a 100 times worse then giving birth natural, and she had 3 children naturally.  

Maybe they need to study lidocain and how people react to it?  It is so odd to me that people react so differently to it.

etherize

When I had the core needle biopsy, the radiologist injected lidocaine but I don't know if it was before or at the same time as the needle for the biopsy.  I don't think I even felt it, but then I'd taken a Percocet and an Ativan prior.  I did feel the "punching" of the biopsy, though ... that was really weird and did kind of hurt, although not really bad, and not like an injection.

I think the EMLA ointment is just so you don't feel the needle injection.  But now I'm confused about the dye and the nuclear injection.  I know the nurse told me I'd have an injection and I'm pretty sure she said I'd pee blue, too.  I'm definitely getting an injection in the nuclear medicine department, an hour and 45 minutes before surgery.

Emaline, I think I will email my breast surgeon or call the nurse to see if I can figure out exactly what's going on. 

Joan, you're right, it's very hard to feel "settled" about this when we're not sure what's even going to happen! 

etherize

OK, I just found this on the Mayo Clinic site:

"The first step in a sentinel node biopsy is to locate the sentinel node. There are two options for locating the sentinel node:

Radioactive solution. Your doctor may inject a weak radioactive solution near the tumor. This solution is taken up by your lymphatic system and travels to the sentinel node. This injection is usually done several hours before the surgical procedure to remove the sentinel node.

Blue dye. Your doctor may inject a harmless blue dye into the area near the tumor. The dye is taken up by your lymphatic system and delivered to the sentinel node, staining it bright blue. The blue dye is typically injected just before the surgical procedure to remove the sentinel node.

Whether you receive the radioactive solution or the blue dye to locate the sentinel node is usually determined by your surgeon's preference. Some surgeons use both techniques in the same procedure to double-check the sentinel node identification."