Poll on Sentinel Node Biopsy Pain

The snb injection was the worst for me as well. I didnt know there was a cream that could be put on to help. Luckily I had a bmx so I wont have to go through that again. I was lucky that my surgeon only did 2 injections and she did them very quick but I definitely saw stars. The core bx I had a week prior wasnt that bad and it took a lot longer. I also had a xanax that morning which helped to keep me calm. I cant imagine anybody saying that it didnt hurt. But Im glad that it didnt cause pain to some.

I felt compelled to write on this topic. I've had many different procedures for colon cancer about 10 years ago and then for BC this year. I am not easily affected by pain. I've done a number of procedures and walked away not even remembering the what we did.....but the SNB procedure was the absolute worst pain I've ever experienced. It was done the morning of my BMX. My doctor was very honest and said it was "not pleasant". I asked why they couldn't give me something, or wait until I was under for the surgery and was told that the test results were not reliable unless it was done awake. I had an incredible nurse who held my hand the entire time. Her name was Cathy, the only name I remember from that day. I had 4 shots around the nipple. I cried, bawled really. The pain was excruciating. Once it was done, it was done, but after I got wheeled back into pre-op, EVERYONE came to check on me to ask how bad it was. Ok, so everyone knows how bad it is, but they CONTINUE to do it? I'm sorry for all the women reading this, who have to endure it. It is the worst memory from my BC diagnosis, and I truly beleive how they do it HAS to change. I'm the proud mother of two dogs, and I would NEVER allow a vet to hurt my dogs the way I was hurt that day.

I have heard that my hospital COULD do it under general anesthesia.  But they do not want you to be under for that long.  I was under for over 13 hours with my DIEP.  Another 30 minutes to spare me that pain I so would have done.  Just FYI,  hospitals are competitive for a profit.  As much as I love my PS I would never ever go to the hospital I used again only because they are horrible at pain management.  I will tell anyone in DFW area to find another hospital that cares about women and the pain they must endure.  Medical City Dallas truly does not care about it either before surgery or after while in the hospital recovery.  I seriously doubt any man in the hospital would ever suffer as much.

Hi everyone.  Two of us here in central FL are trying to get hospitals and physicians to acknowledge the extreme pain  that many of us experienced when our nipples were injected prior to the slnb mapping.  We did contact Dr. Rick Bosshardt, a local plastic surgeon. Dr. Bosshardt writes weekly articles on medical problems of all kinds for the Orlando Sentinel and he has written an article based on your discussion blogs, which he took the time to read.  It will appear in the Sentinel this coming Sunday, Sept. 2, 2012.  If you are in agreement that physicians need to hear our pleas, then please respond to his article with your own thoughts.  His email will appear underneath the article. On this site, we've been "preaching to the choir"; this is a chance to push for a protocol change so that more women will get pain medication before this procedure.

Looking forward to that article. Definitely saving it. Talked to BS yesterday and got some bs about it being uncomfortable and they don't use any anesthetic. She said it would mean 2 shots which obviously it doesn't and I don't care if I have 2 shots. Want to just say no but I know the results are more important than my temporary well being. Although I may end up hitting whoever gets to do the injection. :-/ Wasnt worried about UMX but horrified over this.

Hello ladies

I had the blue dye with the radio tracer injected in February 2012 for the SNB.

Can't remember feeling any pain at all except for a tiny sting. Just closed my eyes, almost fell asleep and then it was over.

Good luck to you!

Best wishes

Alice

I had this procedure done in 2004 and it was one shot and not in the nipple...no worse than any other shot.    Had not read these posts and have had a recurrence in the other breast.    So I went for the snb August 30th...probably glad I did not read ahead...as I do agree very, very, painful.    They had me take an ativan before I left the house, rubbed some cream on the area to numb it, but honestly do not think either helped.

 But I do have a question now...it has been 8 days and my nipple area is very, very sensitive and has a burning feeling....anyone else experience this???   And how long did it last??

I am one of those that felt the bee sting. Remember that before they did the SNB they removed all the lymph nodes. Since I honestly cannot put myself in your place, what would you prefer? That is an honest question. For me I am grateful that they only removed 4 to biopsy and not all.

The radio isotope injections were like bee stings. The blue dye was done under anaesthetic at surgery time. After, the pain was mainly burning from the dye. My breast was still swollen and patchy 3 weeks later when I had BMX.

I so appreciate all of your input!  On Wednesday I will go for the radio isotope injection.  I called the BS's office today and requested some numbing cream.  I was told that women react so differently to the injection that they don't prescribe a numbing agent as protocol.  Well, they never offered it or told me anything about the proceedure - thank goodness for these boards so I knew at least to ask for something! The office told me to please report back regarding the creme so they have more input for future proceedures.  This is scary!

I'm so very sorry Seabear (tears).  From the research I've done, the medical folks just don't know or don't seem to care much about the pain from this proceedure.  Mine is today and likely another portion tomorrow just before my mastectomy.  Thanks for reporting - it does help others to be advocates.

Wendy

Just writing to report that the radioactive isotope injection proceedure I had today was fine...much easier than my biopsies.  The technician held my hand and talked to me while the radiologist did 1 injection.  I did have lidocaine cream and I think that helped a great deal.  My conclusion is that for me, it was just like a bee sting.  Painful, but tolerable and forgettable.  Tomorrow (bilateral MX) may include a second blue dye injection but I was told that I likely will be under anesthesia at that time. 

Wendy

Hi friends. I had my injection today at UAB in Birmingham , Al. I had one injection on the left side of my breast. Sting lasted about 45 seconds and then it was over. It was less painful than my core biopsy. The nurse and I chatted and she says diff hospitals do things differently. She said they have never done multiple injections or any in or around the nipple. I was prepared for terrible pain and was very surprised. Surgery tomorrow!!!

ShaneOak - First, I'm sorry that you have to be here.  Looks like things are moving along quickly for you so I'm sure you're still feeling a bit dazed by all of this.  It usually gets somewhat easier once your surgery and treatment plan are firmly in place.

You asked for honest feedback so here goes...

I know this is all overwhelming and scary and unfair and surreal and sometimes painful.  It sucks, plain and simple.  However, I encourage you to go forward with the sentinel node localization.  As you wrote, an MRI can only diagnose nodes if things have advanced to the point where the node is enlarged.  Only the pathologist can really examine the nodes for signs of early spread of cancer.  This is essential to determine your treatment plan.

There are two ways to localize sentinel nodes:  blue dye and nuclear tracer.  As with most things in life neither method is perfect and without problems.  Many (most?) surgeons use both methods to assure that the right nodes are analyzed. 

The blue dye is performed in surgery once the patient is asleep so this method doesn't get much attention on breast cancer threads.  It is the method that has been around longer, but requires the surgeon to be able to actually see the nodes to know which is the first/brightest.  I would venture a guess that your surgeon plans to use blue dye in addition to the nuclear tracer.

The nuclear medicine method involves injection of a nuclear tracer hours before or the day before surgery to allow time for it to migrate to the lymph system.  Sometimes imaging is done to mark the skin over the first/hottest node.  Sometimes the injections are done around the areola regardless of the cancer site.  Sometimes the injections are done around (not usually into) the biopsy site.  Sometimes lidocaine injections or numbing cream are used in an effort to make it less painful.  Sometimes nothing is used prior to the nuclear injections.  I haven't read of anyone receiving IV sedation, but it might be possible.  The surgeon will use a tiny Geiger counter in surgery to locate the "hot" node by a reading on the meter as well as by sound.

The fewer nodes removed the less chance for developing lympedema.  Before sentinel node mapping women had full lymph node dissections and lymphedema was quite common.  It is an awful thing to live with for the rest of your life.  The goal now is to remove one (or two or three if there's any doubt) lymph node to diagnose spread of cancer.  I encourage you to do whatever you need to do to allow your surgeon to remove the correct node.  If he/she wants the assurance of the nuclear localization I personally wouldn't (and didn't) hesitate to do everything possible to get the most accurate diagnosis possible.  Obviously, it's your right as a patient to refuse any test or treatment with which you are not comfortable.  You might talk to your surgeon to see if he/she is comfortable with the blue dye only if you really feel strongly about this.

I have experience as both a patient and as a Nuclear Medicine tech who has assisted with the procedure on many women.  As the patient, I had the sentinel node study at a facility that uses no numbing cream or lidocaine.  For me, it truly was like a bee sting.  It hurt, but it was quite tolerable and didn't last long.  I was pleased to learn that both the blue dye and nuclear tracer led to the same node so I only had that one removed for pathology. 

As far as being on the other end of the procedure, I witnessed some tears but most women tolerate the injections quite well.  I'm not suggesting that it's a breeze, just that most are prepared for some discomfort, grit their teeth, and get through it.  The pain typically is temporary.  That said, everyone is different.  Pain tolerance varies.  There are doctors who are more skilled at giving injections than others.  There is a high stress level going on just before a mastectomy.  Lots of variables come into play.

I waffled about commenting here, but I just think refusing a test that can offer such important information based on fear of temorary pain is not a good decision.  The pain was not significant for me, but apparently it is for some.  I never witnessed tremendous pain assisting in many of these procedures, but obviously it can occur.  You asked for honest opinions and that is mine. 

Best wishes on Monday.  I hope all goes smoothly no matter what you decide!

Tinat, thank you for your honest feedback and for sharing your experience.  I really don't mean to sound like a baby.  I really am a pretty tough cookie and take nearly all kinds of pain in stride.  I think I'm just still reeling from my biopsy.  The first stick of lidocaine in my breast was a piece of cake, then he went much deeper and it was pain like I've never felt before. 

I feel like I've already been through enough and have much more to go through that it honestly just seems unfair to slip in one more horrible procedure. 

I will ask a lot of questions about it first, then make a smart decision.

I think I'm just so tired of all of this. 

Thanks again for your honesty.