January 2016 Surgeries

You are probably right, Kessa. I'm just so used to being busy all the time! One thing that helped ease my mind about the surgery day was thinking that all I had to do was show up and they would take care of everything else. I know that sounds silly, but realizing that I really didn't have to do anything that day other than get to the hospital was helpful for me mentally!

Kaybee- thank you for sharing! Sending good thoughts your way for a speedy recovery!

So it is preferable to have before or after surgery? Does it hurt? Where do they give it to you?

Sorry I am a baby and will be having my SNB the morning of surgery so kind of nervous about everything.

My BS mentioned it to me as an option and told me I should talk to anestiologist about it.

She said she has seen it help with about 50% of her patients.

Does it alter any other meds or anesthetia they give you?

Any risks or downside to having it?

Thanks.

I don't even know what the paravertebral block is...I guess I didn't have it!

Thought I would share the following that I received today from the Nurse Navigator at my BS office as I asked to get in advance. I am sure every doctor does things differently but hopefully there is some overall consistency in info we are getting. If anyone has anything to help that would be helping, please advise.

A friend who is a retired physician emailed me this earlier today:

Being apprehensive is a normal human response. Only a robot would have no feelings pre-op. Every patient before treatment also feels "ill-prepared physically and emotionally," but you just focus on one step at a time and gradually gain confidence that you can do this. Just look at the next step, and do that one step. I

By all means, be your own advocate. All the medical personnel are working for you - they are hired by you, and you are their boss in this relationship. Tell them politely how they can serve you better.

Hope everyone is having a good day.

DISCHARGE INSTRUCTIONS:

PLEASE NOTE that any written information/ teaching you receive in the hospital will SUPERCEDE any of this information provided below. Thank you!
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Drain Care:

You will go home with drains in place. The nurses will teach you how to care for your drains. Please record the drain output daily, and bring a log of the output to your clinic visit.

How do I empty the Jackson-Pratt drain?
Empty the bulb when it is half full or every 8 to 12 hours.
Wash your hands with soap and water.
Remove the plug from the bulb.
Pour the fluid into a measuring cup.

Clean the plug with an alcohol swab or a cotton ball dipped in rubbing alcohol.
Squeeze the bulb flat and put the plug back in. The bulb should stay flat until it starts to fill with fluid again.

Measure the amount of fluid you pour out. Write down how much fluid you empty from the JP drain and the date and time you collected it.
Flush the fluid down the toilet. Wash your hands.

When will my Jackson-Pratt drain be removed?
The amount of fluid that you drain will decrease as your wound heals. The JP drain usually is removed when less than 30 milliliters (2 tablespoons) is collected in 24 hours. Ask your caregiver when and how your JP drain will be removed.

When should I seek immediate help?
Seek immediate help if your JP drain breaks or comes out or if you have cloudy yellow or brown drainage from your JP drain site, or the drainage smells bad.
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Breast Surgery Discharge Instructions

You have been treated for right and left breast cancer. You will have had removal of both breasts and removal of sentinel lymph nodes in each armpit.

Warning signs to look for:
Fever >101.5, chills, persistent nausea, vomiting, uncontrollable pain, shortness of breath, swelling, fainting, redness or drainage from your surgical incision or drain site.

Activity after Surgery:
You will feel fatigued for several weeks after surgery. This is normal but your strength and stamina will improve over time.

You May-
Participate 3-4 weeks after surgery aerobic activity such as walking inside on a treadmill or outside. We also encourage you to walk around daily. Take showers.

You May Not-
Do not lift more than 10 pounds for the first 6 weeks. This will allow your incisions to heal. No bathing or swimming until after your post-operative clinic appointment (approximately 4 weeks), but it is ok to take daily SHOWERS.

Pain:
It is not uncommon to experience some pain for several weeks after surgery. It is from the natural inflammation of the tissue, muscles and ribs. The pain can be a dull aching pain or a sharp shooting pain. You may also have some numbness, tingling or irritability to clothing. This should all resolve within several weeks after surgery.
You will be given a prescription for pain. You should take every 4-6 hours as needed for pain. Try to wean off of the pain medication within a few weeks. Some patients do not require any pain medication after surgery.

Medications:
At the time of discharge, you can resume your normal medications.
Constipation is a common problem after surgery especially if you are on pain medication. You are encouraged to take a stool softener, such as Colace daily while you are taking pain medication. You may want to add a laxative as needed such as Milk of Magnesia, Miralax, Magnesium Citrate, or Dulcolax tablets. If you still cannot have a bowel movement after a few days, please call the clinic for further advice. Please complete your course of antibiotics as directed (if ordered).

Diet:
After surgery, you may resume the diet you were on prior to surgery. Your appetite will slowly come back over the next several weeks. If you notice you are having multiple loose bowel movements, you may eat foods that add bulk to your stool such as white rice, pasta, bananas, cheese, tapioca or rice pudding, potatoes, bread, applesauce or yogurt. If you feel bloated or nauseated, chew your food well and eat small frequent meals. If these symptoms continue, call the clinic. If the smell of food bothers you, try eating it at room temperature. Getting enough fluids is very important, but the majority of liquids should be taken in between meals, not with meals. Examples of high caloric drinks are Ensure, Boost, some nutritious juices, Gatorade, and milk.

Incision Care:
There should be little to do with your incision as it heals. You should shower every day. You may have someone help you the first few days in case you get unsteady on your feet. Gently wash the incision area with soap and water but do not scrub or rub the area. There is surgical glue on top of the incision called dermabond, which will wear away over several weeks. If the incision starts to become red, swollen or open, or drain a significant amount of fluid, please call our clinic. You do not have to cover the incision unless it is draining fluid. Do not apply any lotions or creams to the incision, or the area around the incision, until after your follow-up clinic visit.

Wound Care:Your wound is covered in Dermabond- this is a dissolvable skin glue that is holding your incisions together. It will dissolve on its own within a few days to one week. Do not try to peel it off - let it dissolve on its own.

Your drain sites are covered with Tegaderm.You can shower and do normal activities with this on. It will likely fall off on its own in 2-3 days. Do not try to peel it off. If your wound is covered with steristrips underneath the tegaderm (as described above), leave those in place. If not, you can cover the wound with a bandaid as needed--you do not always have to have it covered.

Drain Care: (Applies only if you have drains in place)

Empty the drain at least twice daily into a measuring cup. Record the output and quality of drain output in a journal and bring this with you at your next follow-up appointment.

Follow-up Appointment:
Your appointments have been scheduled and are printed (see below) in your Discharge Report.

By the time you come for your post-operative visit, you should be feeling better, having a better appetite and gaining strength and likely off of pain medication. It is expected that you will not be back to your normal routine yet but this will improve over time.

We hope that your stay with us has been pleasant. It has been a pleasure for me and my team to participate in your care.

Hello everyone. My surgery is confirmed for January 19th. Sentinal Node Biopsy - left breast. Had good news today because they did a biopsy of a second suspicious area in the same breast on Monday and found out today that it was benign.

So for now just the 1 small area of IDC for which I had a lumpectomy in November and hence now the SNB on the 19th.

Wishing everyone all the best as you have your surgeries this month!

Thank you Grandma3x for that information.

There are so many things to have to look into from treatment, surgery, recovery etc. it is great to have this forum as a way to prompt different discussions with all the different doctors.

This week has been a long one. Gearing up for surgery next week. Last day of work is Monday .... I hadn't told many clients of what I am dealing with sooooo having to tell some of them has been tough bc it seems they do not know what to say.

Heading to preop appt now...Hope everyone has a nice Friday

I would write back and say:

"Thanks for your response but that's not going to work for me. I'd like to speak with the anesthesiologist much sooner than that to get some questions answered and address some concerns. Please direct me to how I can reach him/her for a conversation ASAP. If you're not able to help me get this taken care of I need the name of someone who can help connect me."

Are you also working with a PS? If so, then I'd ask them to connect you to the anesthesiologist too. If not, I'd pick up the phone after I sent the email above and say the things in your email verbally to the nurse or someone else in the BS office (not in writing). I would also tell them that if they can't help you resolve this then you will postpone the surgery.

Balthus - I have not spoken with the anesthesiologist yet either. I was told by the BS that they don't assign anyone until the day before surgery. But the BS did say that she would order the block, so I think that's covered. As for anesthesia during surgery, she said she has no control over that, it's in the hands of the anesthesiologist. I sent an email to the head of the anesthesiology dept. today and asked to speak with someone there. So far, no response.

Best wishes to MTKCA - I hope your procedure goes well today!

Kaybee - how are you making out today? I hope you are continuing to recover from your BMX without too much pain! You put hope in my heart that I will be able to get through this next week.

I think my issue is that if they clearly have a patient who has anesthesia questions or concerns they should get them addressed right away to reduce any stress or anxiety that might be at play. It makes no sense to blow someone off until the day before their surgery if they are actively asking for help to answer questions.

I'd be very frank about making this particular point - from a patient care perspective.

If you still get no where, it's time to go over their heads.

that is excellent news, Gemma12!

Great news Gemma! It's also nice that you did not have to wait too long! Best wishes for your recovery!

Gemma12 - great news!

I did get a call from the anesthesiologist this morning. Perhaps the email helped so thanks.

He is open to the block and said if it were him he would do it but said he does not do them - that someone on his team would do and he could have someone call me Monday (surgery is Tuesday).

He basically did my pre-surgery call today in terms of asking health questions/issues/instructions/etc and gave me his cell # if I have any more questions. He was familiar with the PNB but not so much the pectoral block. I have spinal stenosis in my neck and was worried about where you get the needle injected.

He is 62 and has been doing this for years so I feel confident about him.

I guess I will decide on the block after I talk to who would be doing it on Monday. I'd rather have it after I am out not before.

Also was called by Nuclear Medicine who does the SNB and they do not want me to use the EMLA cream. It is not their protocol just like mixing lidocaine in is not.

She says their studies (teaching hospital) have shown they they see less lymph nodes but she said since my BS prescribed it that I could use if I felt I absolutely had to.

She said I will get 3 injections on each breast close to nipple. Then I am let back out to general area and to try to walk around & massage my breasts and "marinate".

She said sometimes they do get any image son the scan - depends on metabolism & body function but that BS will use probe & dye in surgery anyway.

Has anyone else been told not to use the cream?

I feel like my head is going to explode.