SA NM SENTINEL NODE INJECTION
Hi All,
I am scheduled for my BMX plus reconstruction next Tuesday. I noticed on my chart that I am scheduled for the procedure above as well. I assume this is to map the sentinel node(s). Can anyone tell me what to expect? My SO is unreachable in Alaska and I have been unable to communicate my questions to his office. We have a horrible COVID situation in our area..getting any medical care/asking questions is impossible at the moment. I am so grateful for this community!!!
Thank you in advance!!
Comments
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In some cases they do this part the night before, sometimes in pre-op before the surgery, and in some more rare cases they do it after you are under anesthetic. For me, it was shortly after I arrived in pre-op. I had bi-lateral sentinel node biopsies so received these injections in both sides, in clock hand positions noon, 3, 6 and 9 around each nipple. For me they stung, but it was not all that uncomfortable, and the discomfort was not lingering. I was instructed to massage a bit, and then they used a portable machine to make sure the tracer was traveling from the breast tissue toward the axilla. For those that have this done the day before surgery you usually go to radiology and they do this same process. It may be that your surgeon will authorize the use of EMLA cream, which has lidocaine and numbs the area. You put it on in a glob and cover it with plastic wrap about an hour before, then it is wiped off right before the procedure. Many have reported that this eliminates or lessens the stinging part of the injection. Obviously, if all of this is done after anesthetic you won't feel any discomfort, but surgeons are all different in their approach - some think doing it too close to the actual surgery time slot doesn't allow enough time for the tracer and/or blue dye to reach the nodes. Some people do also have blue pee for a bit afterward so if that happens don't be alarmed! Good luck!
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Hi Emin,
I am so sorry you feel alone. It is indeed a difficult time we are currently experiencing. It sounds as though you will be having a nuclear medicine injection which will allow a radio tracer to identify a sentinel node. That node is the first one to receive lymph drainage from your breast, which is why they want to biopsy it. It will be the node with the highest number of cancer cells, if any. This lets your physicians know if there is spread beyond the breast itself. You won't need to prepare for it at all. The injection and dissection of the lymph node is done once you are completely under anesthesia. Even though you will have no awareness, the area is injected with a local anesthetic since it can be painful. They don't want you to wake with pain from the injection or dissection even though it will be a small part of your surgery.
Best of luck next Tuesday. I hope you will have someone with you after your procedure.
Jane
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Hi Emin - I had the blue dye injected shortly before my surgery while I was already under the anesthetic. I had asked the surgeon to please do this as I had heard very unpleasant things about having it done while awake. He was happy to oblige, so I had no problems.
Good luck with all of this, it really can be hard, but doable! Take care.
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First of all, I know of at least three different tracers. I'll skip the SAVI scout because it sounds like that is not planned for you (it is new and not widely used yet). So I had two tracers. The first was done at the nuclear medicine department, not the operating room, and wasinjection of a radioactive tracer. The second was injection of "the blue dye" that makes your urine turn blue, and that was done while I was already under anesthesia and I knew nothing about it until the blue urine.
So I think your question is about the injection before surgery. It seems that how and when these procedures are done varies quite a bit. I would call the nuclear medicine department at your hospital and see if they can tell you how it is done there. The person who answers the phone won't really know anything and will need to pass you along to a nurse or tech.
For my own lumpectomy, I went to the nuclear medicine department several hours before my surgery. The nurse or tech truthfully told me that women usually come in terrified, but while I would feel a bee sting poke, it was not too bad. Here is the important part: At this hospital they do one injection and it is next to the tumor. I actually could feel the tumor and showed them exactly where it was. I did feel a poke but it was not horrible.
My relative, on the other hand, whom I accompanied on lumpectomy day, went to a different hospital and had a different and terrible experience. At that hospital they inject four places around the areola with no anesthetic and it was barbaric. If we had known we would have insisted that the surgeon schedule her at a different hospital. We got the idea that this place did it that way because it was more convenient for their scheduling.
I hope you are scheduled for the one injection near the tumor. I don't like it when people post horror stories, but in this case it helps you see what you need to find out in order to advocate for yourself. My relatives surgeon had explained none of this to us, and if he had she would have been able to negotiate a different plan. As it was it was a total surprise because I thought the way mine was done would be the way hers was done. I felt like I had let her down or misled her, but of course that was the surgeon.
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Mine was done prior to surgery, in pre-op. I had no anesthetic for it. It was a bit uncomfortable but I think I was still so shell shocked that I was actually having surgery that I mentally was numb to it.
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My injections, tracer not dye, we’re done the day before my bmx. I slathered my nipple area with EMLA as specialK described. I didn’t feel a thing but many do it without any numbing and are not bothered by pain. Others experience bad pain. If I can avoid pain, I do!
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"My relative, on the other hand, whom I accompanied on lumpectomy day, went to a different hospital and had a different and terrible experience. At that hospital they inject four places around the areola with no anesthetic and it was barbaric."
My experience was like the bolded. It was the single most painful moment of any part of my breast cancer treatment. Like others, I encourage you to ask in advance what the procedure will entail - in detail - and absolutely insist on the numbing cream if it isn't clearly going to be part of the protocol. I am still bitter toward the doctor who waved off my question about getting an anesthetic. Jerk.
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Note that numbing cream needs to be applied an hour beforehand, and globbed on in quantity rather than rubbed in. Cover with plastic wrap, not anything absorbent. A prescription is needed for Emla cream (lidocaine-prilocaine).
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Yes, what Shetland said. This is what resulted in my running to a bathroom at the elementary school I taught at with a box of plastic wrap in one hand and the EMLA in the other. I prayed that no one would come in and see me slathering my nipple with white cream and then plastic wrapping my boob 🤣.
There are many patients who say it’s not painful and numbing does not seem to be routinely offered. Just the idea of a needle entering my nipple was enough to make me sick . I explained this to my doc and gota prescription with no problem.
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I'm glad to hear that the EMLA cream works too. I had some lidocaine for my port and I could have used that, but think I'm still real glad it was done under an anesthetic. Just as exbrnxgrl said, just the thought of an injection in or around my nipple was unbearable to me. I had heard stories like those relayed above. I too thought it sounded barbaric and told my surgeon if it couldn't be done under anesthesia, I just might not be able to do it at all. I don't know if I had the radioactive tracer or the blue dye (I think it was the dye), but I never felt a thing since I was under.
Sunshinegal - What an insensitive doctor you had! You are right - jerk!
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Add me to the insensitive jerk of a surgeon who did not offer any anesthetic before the SN injection because he said it didn't hurt! Of course it didn;t hurt him but it sure as hell hurt me. It really was the most painful part of my surgical experience. So ask and get a response that is acceptable to you.
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ThreeTree, for what it's worth, that was the nuclear medicine doc who I only saw that one time for that procedure. Thankfully, all my other docs were far more attuned to my needs and comfort than that guy. Sheesh!
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Mine was done while I was under for my lumpectomy. I know it would have been a barbaric experience for me if I were not under as I have a very sensitive system. Of all the crap and sh...t we go through, why can't they just go the extra mile just in case it does hurt? Just in case is to big a deal? Gimme a break.
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Mine was done when I was under for BMX as well and I have no idea what did they use and how.
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Sunshinegal - Glad you had some positives in all of this! Many will go take those extra steps because we go through so much, but some must live on another planet or something.
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Thanks to everyone who responded. I’m glad I asked…this question but then I’m kind of not;-) It’s scary..I’m so sorry to hear about the crappy barbaric things women have gone through. It boggles my mind that anyone would go through this without any pain relief offered.. I spoke with someone in the Nuclear Medicine Dept. She said my SO typically does it after anesthesia is given. That’s really promising.I’ll talk to him first thing on Monday and find out for sure. Hopefully that’s enough time to get emla cream if that’s not his plan this time. I’m so anxiety-ridden about the whole thing..I just want want to be on the other side of it with good news from my path report and moving forward. I hate cancer.
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EMLA works like a charm! Definitely ask for it if the injection is done prior to surgery. Take care
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Well-done getting information, Emin. So far it sounds like it will be fine, and you will get to confirm with your surgeon on Monday. Emla cream is a common prescription, so it should be readily available.
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