No pain, no nausea
I posted this in the Pain thread but thought it might be of interest here as well.
I had a unilateral mastectomy with tissue expander placement in January, 2016, and wanted to share my experience. Please note that I AM NOT A HEALTH CARE PROFESSIONAL - be sure to discuss all of this with your surgeon! This regimen should only be followed under the direction of your surgeon and anesthesiologist!
First off, for those of you coming up on surgery, go to the Clinical Trials thread and read through the thread on propofol and paravertebral block:
https://community.breastcancer.org/forum/73/topics/834546?page=2#idx_44
The gist of these threads is that the anesthesiology regimen used during surgery can have an impact not only on the amount of pain and nausea that you will experience but may also increase the risk of recurrence of cancer.
A week before my surgery, I contacted my breast surgeon and asked about getting a paravertebral block for regional anesthesia and propofol for general anesthesia. She agreed with both of these requests. (Be sure to specify that you want the paravertebral block before surgery, because they can also be placed after surgery). I also asked to speak with the anesthesiologist but was told that they would not assign one until the day before surgery. I then emailed someone in anesthesiology who immediately put me in contact with one of the anesthesiologists who was scheduled to work that day. I discussed my concerns with him and he was actually pleased that I was requesting an opioid-sparing regimen.
I don't have the details of what was done during surgery, but here is what I do know: I was instructed to drink a 20 oz. bottle of Gatorade at least 2 hours before surgery. This is supposed to help prevent nausea and insulin resistance post surgery. Just prior to surgery, I was given the paravertebral block. This involved injections along the side of my spine to numb the nerves going to my chest. They gave me a light sedative so that it did not bother me too much to have this done. I was then given acetaminophen, Celebrex, and gabapentin before surgery to help with pain. They put a scopolamine patch behind my ear to help with nausea and also used anti-emetics. After transferring to the operating table, I was given a dose of propofol and immediately fell asleep.
I awoke after surgery feeling refreshed- no nausea, no pain, no fuzzy feeling from anesthesia. When I was released the next day, they wanted to give me a prescription for oxycodone but I asked for Tramadol instead. This is a non-opioid narcotic that has been shown to stimulate natural killer (NK) cell activity. My pain level for the first week after surgery was barely a 1 on a scale of 1-10. I was able to control any pain with Tylenol and after the first day, took the Tramadol only at night because it put me out for 8 hours of sleep and I think that sleep is essential to good recovery.
I felt a bit more pain the second week at the incision site for the sentinel node biopsy. This pain slowly decreased. I went back to work at 3 and a half weeks after surgery. I think I could have gone back earlier but we had a huge snow storm and I did not feel comfortable driving the 30 miles to work.
I'm now at 7 weeks post surgery and feel great. I've completed 10 sessions of PT, which helped immensely with range of motion. I'm back up to walking 5-6 miles each day and working full time.I scheduled a prophylactic mastectomy of my right side in May, and have no anxiety as I did before my first surgery.
Feel free to PM me if you would like more details. Overall, I think that having an anesthesiologist who was willing to use an opioid-sparing regimen made a big difference in how I felt after my MX.
(Edited to provide more links):
There are also threads on opioids and toradol use during surgery that are interesting:
https://community.breastcancer.org/forum/73/topics/835291?page=1#idx_14
https://community.breastcancer.org/forum/73/topics/833612?page=1
but I should say here that I'm not totally convinced that morphine plays a role in recurrence (see my comments in that thread). Also note that the use of Toradol is controversial because of increased risk of bleeding. My BS would not use Toradol and I trusted her judgement on this matter.
Comments
-
grandma3x
I often wonder how much of my post anesthesia nausea if a little hypoglycemia. fasting 15 hours before a start time is a little ridiculous. That's what happened for me a few months ago for a gyn procedure. crazy!.
gatorade a few hours prior would have been quite helpful.
thanks for the info
-
Grandma3X - Thank you so much for sharing your experience. I am currently in neoadjuvant hormone therapy but will eventually have a unilateral mastectomy. (probably late June or early July) I have never had surgery before or even an IV so I am very apprehensive about it. I appreciate your feedback and the information on propofol and paravertebral block. I will definitely ask my surgeon about it when I see her next month. I have always been very active and healthy so I am hoping to be proactive in medication choices during and after surgery. Your quick recovery is wonderful!!! Do you run as well as walk? I am hoping I can resume running fairly quickly after surgery too but I will absolutely settle for walking initially.
-
Lunderwood - no, I'm really not much of an athlete! I blame it on my bad knees, but I just don't have the motivation required to be a runner. Walking, on the other hand, I can do all day! I hope my surgical experience can help ease some of the anxiety that comes with having breast cancer. I pored over the message boards for weeks prior to my surgery, trying to find those that were not experiencing great pain. I did find a few, but they seemed to be in the minority and there was not a great amount of detail about how their surgery differed from the others. I hope this helps you and would love to hear about your experience after surgery as well.
-
grandma3X - You are still an inspiration and knowing how well your recovery is going gives me hope for the future. I will keep you posted as I get closer to surgery. Please let me know how it is going for you too and don't hesitate share any and all experiences that you think may be helpful. As far as running, I am mainly a trail runner and it's quite acceptable to walk as needed. Walking 5-6 miles per day is great!! By the way how are you doing with the TE and eventually will you have silicon implants? Because of my small stature and lack of body fat (this is according to the PS - I believe I have plenty), implants may be the best reconstruction choice for me as well. As with the hormone therapy and surgery, I have read many experiences both good and not so good. I am trying to sort my way through all the options to decide what is best for me. Thanks again for your positive comments!!!
-
Lunderwood - my PS used a Mentor CPX4 tissue expander. According to their web site it was designed to be more comfortable. I had only 60 cc's added during surgery and have had 2 fills, 50 cc's each time. I don't feel the TE at all and most of the time I forget it's there. I have had no discomfort, no tightness that others have noted on these discussion boards (BTW, don't read the TE Troubles thread! It will scare you silly!). I plan to have a prophylactic MX of the right side in May and then exchange to implants this fall.
Asante - I think you're right about the fasting! My surgery was originally scheduled for 7:30 am but I did not go into surgery until about 1:00 pm! I'm pretty sure I would have died of hunger or thirst if I had to fast that long
-
bumping for April surgeries
-
bumping for April surgeri
-
bump
-
grandma3x - how are you doing? Are you still continuing to recover with minimal issues? Do you have a date for your April surgery? I have saved all of your comments about anesthesia and pain meds to discuss at my next appt. with BS in April. It still looks like an early July surgery date for me. Waiting (and worrying about surgery is so hard) I tried to convince my medical team to move the surgery up but they have convinced me that it will be beneficial to shrink the tumor before surgery. Fortunately I have had only minimal side effects from the meds and injections and the tumor is starting to shrink so I know they are right. Please keep us posted! Your very positive journey gives me hope for the future! Take care!
-
Hi Lunderwood
I'm doing well! I just returned from a short vacation in FL with my DH. We drove and I had no issues driving, carrying suitcases, or any activities while we were there. I'd say I'm about 99% recovered. I've recovered full range of motion and full strength on my MX side. Every once in a while my incision from the sentinel node biopsy starts bothering me, but I wouldn't call it pain - it's more of an irritation from my bra rubbing against it. I'm scheduled for my PMX on May 18th, so still a ways away.
I think that if your tumor is shrinking, it is a good idea to delay the surgery. I wish that I had known how large my tumor was before surgery - I probably should have had neoadjuvant treatment to try and shrink it. I worry now that some stray cells may have been left behind.
Let me know what your BS thinks about the anesthesia regimen. I read a paper from the Mayo Clinic for patients undergoing DIEP reconstruction where they followed the same regimen. I can dig up the reference if you think it would help. -
Grandma just saw this, sounds like you did great! Congratulations
Would you mind doing a link on falleaves thread-Blocks and opiods and mine Toradol. Noticed you didn't do Toradol? Sheesh, wish I could walk as far as you kiddo.................. -
I am so glad you started this thread and I am very interested in the DIEP article. I planning for a bilateral Mx and am hoping for immediate reconstruction using DIEP. I've had surgery before sock not scared of that part but am very interested in the pain management and killer cells effect of the anesthia regime. Wow
-
Here is the link to the paper by Hutchins about improved patient outcomes for DIEP surgery
http://www.gotoper.com/publications/ajho/2015/2015...
I thought it was Mayo Clinic but it's the Mayo Memorial Bldg at University of Minnesota
Here is another one by Wu et al. for colorectal patients. Dr. Wu is at Johns Hopkins where I had my surgery. He put me in contact with my anesthesiologist who was more than willing to use the same regimen for my surgery
http://www.ncbi.nlm.nih.gov/pubmed/26404073
-
thank you so much - greatly look forward to reading these
-
Hi Sas-Schatzi! I posted the links above - thanks!
I talked with my BS about Toradol but she was very much reluctant to use this because of the risk of bleeding. I didn't push it, and was just happy to have an anesthesiologist who was willing to use an opiod-sparing regimen.
-
Grandma I just received this from Dr. Retsky. Hope it doesn't create undo concern on your part. But it's important. Dr Sukhatme does a beautiful presentation of the research done by Dr Forget.and Dr Retsky.
https://community.breastcancer.org/forum/73/topics/833612?page=19#post_4684309
my last post there today on the Toradol/Ketorolac thread
__________________________________________---
Hi, All, received this from Dr. Retsky
Look at this video from my coauthor Vikas Sukhatme. He is academic dean at Beth Israel Deaconess Medical Center at Harvard. A very smart guy. OK to circulate.
Michael
https://www.youtube.com/watch?v=H8zVrYEW8vE&feature=youtu.be
____________________________________________________
This is an amazing video presentation. The fella is brilliant and he makes the info so easy. What's sad is the story of Jennifer. Spoiler alert, Jennifer is his wife.
Every concern that we went through in the summer and into the fall for our small group, is addressed in this video.
What I think anyone trying to digest this info should request of their doc to review this video.
Folks with the knowledge that we gained last year, by talking it out, and flying by the seat of our pants came to the same conclusions that Dr. Retsky, Dr, Forget, and Dr. Sukhatme, we did good. Our research and conclusions were good. Yes, it needs to be confirmed by a prospective study. I hate the thought of a prospective study when the results mean that recurrence could be avoided by a simple < 10$ IV push pre-op.
Way back when I said that being on the right side of the change when change is occurring is the side we want to be on.
Dr. Forget has a study going in Belgium. Dr. Retsky is working on getting something approved in two other areas.
As Dr. Retsky has said feel free to share the link.
-
Thank you for posting sas. I'm not at all concerned about the anesthesia regimen I had for my last surgery. I bruise pretty easily, so I think the BS was right to be worried about bleeding, especially with the length of time I was under.
I hope to have the same regimen for my surgery in May.
My reason for starting this thread was to hopefully alleviate some of the anxiety we all have approaching our surgery date. I remember combing the surgery threads trying to find one person who maybe didn't find it all that bad. Your posting in the January surgery thread about propofol with a paravertebral block was what I took to my doctor, and I am so grateful!
I hope that as other women have good outcomes with their surgery they will also post here.
I was joking with my husband earlier today, saying that I was looking forward to my next MX - I have plantar fasciitis which went away completely for about 6 weeks after my first MX and now is back. The pain from that is much worse than my mastectomy was, and I'm hoping to get some relief after my next surgery
-
Hi grandma3X, I thought I was the only one with pain from plantar fasciitis being worse than the breast pain!! I am hoping it'll go away soon because it's really quite painful and I am struggling to walk comfortably. Like you, I'm also a grandmother of 3 and, I'm a biochemist as well by training. We have a lot in common.
Walk carefully!
-
Jacklin - wow! We do have a lot in common!
I actually wasn't joking about the plantar fasciitis - I noticed relief from the pain immediately after my mastectomy and it was wonderful. I thought at first that it was the compression things they put around your calves - that maybe it helped increase blood flow or something, but I think now it was probably the pain meds. Whatever it was, I'm looking forward to it happening again when I have my PMX in May!
-
Hi Grandma, In a future time we know they will get this solved. Now though it's a walk through cowcakes. We avoid one and step in another one. I posted on your surgery thread and it was with misgivings. Misgivings b/c those that don't search and only follow what the doc says can be fine, they also, can end up damaged or dead. It's such a troubled time. You I think were the only one that sought out the info that we worked on in 2015.
?, do you know of any others?
For those that seek info. The threads that I alerted you to, should be good for a couple of years as a basis to get someone going. Some want to research, some don't. I think you have them all linked in your topic box. I suggest, please, that you put in the topic box Dr. Vikas Sukhatme's video. He does such a great job explaining about the importance of Ketorolac/ Toradol.
It comes from Dr. Retsky's publication as the primary researcher which is highlighted in my thread and a previous thread done by Falleaves.
Every reason for not using it is covered in the Toradol thread, but, also, every reason to attempt to get your doc to use it is covered.
Cowcakes. I say cowcakes b/c as a child running through the fields in bare feet, thinking I have great happiness, then my foot would enter something gooshy and warm. Then ewhhhhh. As a city kid visiting the farm it was a lesson
That really is what life is like at times.Also, please, update the three threads regarding your progress.
Will you continue to alert new surgery threads? If that is part of your mission, that would be great. I'm 7 years out and wearing down. Been advocating for so long, but now wanting to slide out a bit.
Many blessings that all goes well.
-
Plantar fasciitis-------Birkenstocks .........Did all the exercises, stretches, and injections. Every thing that was recommended. For me it was Birkies that changed my life. If I'm not in Birkies, I'm in SAS shoes (San Antonio Shoes). But I was in SAS shoes for along time before I got my first pair of Birkies, they only partially helped. Day one in Birkenstocks, I thought I was in nirvana. BTW I'm not the shoe SAS, my SAS are my initials
OH yes, anti-inflammitories help fasciitis, as inflammation is a big part of the problem. But the proper cupping of the calcaneus with the Birlkie allows for reduced pressure. The reduced pressure allows for healing. The whole support of a Birkenstock shoe base loves the foot.
-
It appears from your description that you did not have chemo or radiation? Am I correct? Was that due to your low oncotype score?
-
Welcome to the community splendrous! We are glad to have you and happy that you reached out. Let us know if we can help in any way to keep you connected here on the boards The Mods
-
splendrous - hi! I had lobular cancer which does not respond well to chemo. My sentinel lymph node was negative and I was also >95% ER+ so my MO put me on letrozole only. My RO did not think I needed rads because I had clean margins and even though I was borderline, I was within the T2 size limit (5 cm). I'm a little uneasy with not getting more aggressive treatment, but I feel a little better knowing that my oncotype is low
-
bump for May surgeries
-
I am scheduled for a prophylactic NS MX next week and have been able to line up the same surgical team (BS, PS, and anesthesiologist) that I had in January. I'm hoping for the same good surgical experience as last time
I will be sure to post here about any differences in how I feel compared to my first MX!
-
Best wishes to you! I will keep you in my thoughts and prayers. I am scheduled for a unilateral mastectomy on June 15th. Unfortunately not an option for skin sparing or nipple sparing but I am okay if this will remove the tumor with clean margins. Definitely feeling very anxious. Your good experience and advice has helped me so much. Take care!!!!
-
Thank you Lunderwood! Best wishes to you in June
-
Hi everyone! I just had a prophylactic MX of my right side and happy to report that the outcome was the same or better than the one I had in January! I asked for the same regimen as last time and they followed it to a T, including the same amount of fill they put into my TE. I have to admit I was a little apprehensive going into this surgery because the last one was such a good experience - I thought it must have been a fluke and there is no way I'd have the same experience again. If anyone is looking for a good surgical team, go to Johns Hopkins and ask for Melissa Camp (BS), Michele Manahan (PS) and Rob Thomsen (anesthesiologist) and tell them you'd like a paravertebral block and an opiod-sparing anesthesia regimen
You won't be disappointed! -
I'm now 2 weeks postop and wanted to give an update. I think I have bounced back a bit faster this time compared to the MX I had in January, with a bit more energy. The pain has been minimal, but did spike to a 3 a couple of times, mostly due to shoulder pain. This may be because I'm right handed and I tried to use my right hand more than I should have. When the pain spiked, it was after using my computer. I think that using a mouse, in particular, put a lot of strain on my arm. I have since purchased a rollerball mouse, which I can keep in my lap and don't need to move my arm to use. It solved the pain problem.
I also started simple exercises a few days after surgery, such as shoulder rolls, but be sure to check with your PS before doing anything.
I had my first fill yesterday, which was pretty much painless. The nurse offered to do it last week after removing my drains, but I was still sore from the drains, so thought I should wait. I'm glad I did, because those few extra days made a big difference.
Categories
- All Categories
- 679 Advocacy and Fund-Raising
- 289 Advocacy
- 68 I've Donated to Breastcancer.org in honor of....
- Test
- 322 Walks, Runs and Fundraising Events for Breastcancer.org
- 5.6K Community Connections
- 282 Middle Age 40-60(ish) Years Old With Breast Cancer
- 53 Australians and New Zealanders Affected by Breast Cancer
- 208 Black Women or Men With Breast Cancer
- 684 Canadians Affected by Breast Cancer
- 1.5K Caring for Someone with Breast cancer
- 455 Caring for Someone with Stage IV or Mets
- 260 High Risk of Recurrence or Second Breast Cancer
- 22 International, Non-English Speakers With Breast Cancer
- 16 Latinas/Hispanics With Breast Cancer
- 189 LGBTQA+ With Breast Cancer
- 152 May Their Memory Live On
- 85 Member Matchup & Virtual Support Meetups
- 375 Members by Location
- 291 Older Than 60 Years Old With Breast Cancer
- 177 Singles With Breast Cancer
- 869 Young With Breast Cancer
- 50.4K Connecting With Others Who Have a Similar Diagnosis
- 204 Breast Cancer with Another Diagnosis or Comorbidity
- 4K DCIS (Ductal Carcinoma In Situ)
- 79 DCIS plus HER2-positive Microinvasion
- 529 Genetic Testing
- 2.2K HER2+ (Positive) Breast Cancer
- 1.5K IBC (Inflammatory Breast Cancer)
- 3.4K IDC (Invasive Ductal Carcinoma)
- 1.5K ILC (Invasive Lobular Carcinoma)
- 999 Just Diagnosed With a Recurrence or Metastasis
- 652 LCIS (Lobular Carcinoma In Situ)
- 193 Less Common Types of Breast Cancer
- 252 Male Breast Cancer
- 86 Mixed Type Breast Cancer
- 3.1K Not Diagnosed With a Recurrence or Metastases but Concerned
- 189 Palliative Therapy/Hospice Care
- 488 Second or Third Breast Cancer
- 1.2K Stage I Breast Cancer
- 313 Stage II Breast Cancer
- 3.8K Stage III Breast Cancer
- 2.5K Triple-Negative Breast Cancer
- 13.1K Day-to-Day Matters
- 132 All things COVID-19 or coronavirus
- 87 BCO Free-Cycle: Give or Trade Items Related to Breast Cancer
- 5.9K Clinical Trials, Research News, Podcasts, and Study Results
- 86 Coping with Holidays, Special Days and Anniversaries
- 828 Employment, Insurance, and Other Financial Issues
- 101 Family and Family Planning Matters
- Family Issues for Those Who Have Breast Cancer
- 26 Furry friends
- 1.8K Humor and Games
- 1.6K Mental Health: Because Cancer Doesn't Just Affect Your Breasts
- 706 Recipe Swap for Healthy Living
- 704 Recommend Your Resources
- 171 Sex & Relationship Matters
- 9 The Political Corner
- 874 Working on Your Fitness
- 4.5K Moving On & Finding Inspiration After Breast Cancer
- 394 Bonded by Breast Cancer
- 3.1K Life After Breast Cancer
- 806 Prayers and Spiritual Support
- 285 Who or What Inspires You?
- 28.7K Not Diagnosed But Concerned
- 1K Benign Breast Conditions
- 2.3K High Risk for Breast Cancer
- 18K Not Diagnosed But Worried
- 7.4K Waiting for Test Results
- 603 Site News and Announcements
- 560 Comments, Suggestions, Feature Requests
- 39 Mod Announcements, Breastcancer.org News, Blog Entries, Podcasts
- 4 Survey, Interview and Participant Requests: Need your Help!
- 61.9K Tests, Treatments & Side Effects
- 586 Alternative Medicine
- 255 Bone Health and Bone Loss
- 11.4K Breast Reconstruction
- 7.9K Chemotherapy - Before, During, and After
- 2.7K Complementary and Holistic Medicine and Treatment
- 775 Diagnosed and Waiting for Test Results
- 7.8K Hormonal Therapy - Before, During, and After
- 50 Immunotherapy - Before, During, and After
- 7.4K Just Diagnosed
- 1.4K Living Without Reconstruction After a Mastectomy
- 5.2K Lymphedema
- 3.6K Managing Side Effects of Breast Cancer and Its Treatment
- 591 Pain
- 3.9K Radiation Therapy - Before, During, and After
- 8.4K Surgery - Before, During, and After
- 109 Welcome to Breastcancer.org
- 98 Acknowledging and honoring our Community
- 11 Info & Resources for New Patients & Members From the Team