question about sentinel node injection

Dear PKathleen

On the breastcancer.org site there is a lot of information about sentinel lymph node dissection.

You should be able to find a lot of answers to your questions.

We hope this helps.

The moderators 

Ladies!

Here is my story & I'm sticking to it. I am the "evil" nuclear medicine technologist (so evil that I received nominations for employee of the quarter at least 3out of 4 last year, 4th quarter I missed too much work due to my diagnosis).

I try to call my lymphoscintigraphy patients a day or 2 before their procedure. I will explain that our radiologist cannot give them anything for pain prior to the injections, but that her surgeon might be willing to prescribe the Emla cream. (I have not been pleased with the used of Emla, it has not seemed to help the ones who have a low pain threshhold, IMO) My radiologist will usually inject around the nipple with 4 sub-dermal injections of the radioactive tracer, the radiologist does not inject the blue dye. I will then document that part of the procedure and take my patient to the pre-op surgery area, the nurses will get her vitals, get consents signed for the procedure, and start her IV's. About 1 1/2 to 2 hrs after the injection I will bring her back to radiology and image to see if I can locate a sentinal node, if I am able to image an area of interest I will mark it with a surgigal marker and print images for the surgeon. This is only a map for the surgeon to be able to uge a gamma probe to pin point the node. If they cannot locate a node this way they will then use the blue dye. It is injected while in surgery, so you would not know about that at my hospital, until recovery and they should tell you about possibly urinating blue for a while.

I have been very honest with my patients about what I have been through the past year, and I do let them know that I have not had this procedure since we knew that there was lymph node involvement already known from my initial biopsy.

I wish you all of the best in the world and hope that you will always have caring technologists in radiology, whether it be X-ray, mammo, MRI, or nuclear medicine.



Becca

I had it done the morning of my bmx.  Did the radioactive thing with the 4 needles in each breast.. ouchie...not gonna lie it hurt but was over quite quickly.  No numbing anything.  Guess I got the blue die at surgery cuz I peed blue for a couple of days.  The gal who did the injection said that the radioactive material actually is attracted to the cancer cells and can aid in possibly killing some of them...not sure if that is true but it made me feel a little better about having to have it done.  Everything we do is to help us in this fight so know when you go in regardless of whether or not it hurts you are on the front line of the battle field.

Maggie

Cycle-path, my feelinf (thoughts) on the pain or no pain is how the technologist, nurse, or other medical staff have treated you before you get that injection.  I know if I can get my patient comfortable, or talking about something comforting or familiar to them I can inject them without them realizing or just barely feeling the needle going in, BUT if they are convinced that it is going to hurt and nothing will help they will be right,  I have also found that if I do not get an IV injection in the 1st or 2nd try I staart getting stressed and then I cannot get it.  That's when I get another technologist or a nurse, because I do not want to change your middle name to "Pin cushion".

Hmmm, I guess I better add this to my favorites, at least for a while.

Take care ladies.

Becca 

Mags, I don't know about the radioactivity from the Lymphoscintigraphy injection helping to kill cancer cells, we use the same isotope for almost all of our scans, it is just tagged to go to different organs, depending on the scan.  

Beccad, In nuclear medicine, I got a single injection towards my site (my tumor was deep, not palpable, and nearer the back of the breast). Why do some get 3 or 4 injections?  That does sound a lot more uncomfortable than what I had. 
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You are right about the approach of the technologist making a difference.  If I don't get empathy when I'm anxious, I try to summon up the mental strength to endure and somehow, it works for me.  My rant is 'I can do anything for a short time' although sometimes I don't believe myself.

as per my previous post my experience was horrible, i just want to state i have a very high  threshold of pain, the radiologist/tech explained it would be similar to a tb test,have 4 injection sites, he said the dr ordered it to be done at the 1 o'clock position by the nipple. said i would feel a sting and feel more of a sting when the nuclear trace actually entered. the tech was very nice ,explained everything, i was cool ,calm,collected. just did not expect it to feel like acid going thru my breast , so kinda resent the remarks that it was so painful because of the tech not making me comfortable or my emotional status at the time. my theory is maybe it is the location of the injection site that causes such a difference in the pain level. by the way my tumor was located in upper inner quadrant at the 1 o'clock position 9 cm from nipple.

Becca I'm going to copy what I wrote in a PM to you, in hopes that you will come back to the conversation.

 My doctor used lidocain, why don't all doctors use it?  I  know  that the nuclear injection is hit or miss, and it seems the blue dye works...and the blue dye can be injected when the woman is already under, so why not just use the blue dye all the time?

I don't know if you have the answer to these questions but I appreciate your input

 

Well, even if we don't have a one-size-fits-all definitive answer, getting info from the personal experiences of everybody here sure has helped me.  I'm so glad I found this site! 

Boy, I'm glad I didn't see this thread before I had my SNB!  I put a thick layer of the Lidocaine and Prilocaine cream on the nipples & areolas about 90 minutes before my scheduled biopsy. Wrapped saran wrap around my body, then put my bra on to keep the saran wrap in place.

While it wasn't fun it wasn't awful either. I've had a cortisone shot put into my foot and that was 10 times worse.

Please let us know how you are doing.  I didn't get nervous until I was put in the hospital bed & wheeled down the hallway.  By then the anti anxiety drugs were doing their thing.  Best wishes.

Good luck, Caryn!  Hope everything goes easily and painfree for you!

I just got my EMLA cream yesterday so I'm prepared! :-)

I was told how much the injections would hurt for the SNB.  I was TERRIFIED.  I cried the entire time they carted me off to the room where they did it.  I didn't have EMLA cream or anything.  Turns out, they front-loaded the syringes with lidocaine and I felt nothing.  Piece of cake.  Then they put me out for the lumpectomy/lymph node removal.

I felt very little (if any) pain when I had the radioactive tracer injected before my mastectomy. However, the wire insertion I had before my lumpectomy was traumatic. I don't think it was particularly painful but I just remember bursting into tears when it was over. Having long wires driven into my breast seemed so barbaric.

I hope it goes well for you etherize. As I said, neither procedure hurt very much so I hope it's the same for you. Good idea to keep your eyes closed. I always do that when I have needles. And don't forget to breathe - slowly and deeply.

Hugs, 

Jane

I had 4 wires placed before my biopsy.  Unlike the barbaric Spring Hill Hospital for the SNB, the hospital where I had it done numbed the breast with lidocaine.  No pain at all.