So yesterday was my needle/wire guided lumpectomy, sentinel node mapping and removal and Portacath (port) removal. The day started out at the Breast Diagnostic Center to have a needle/wire inserted into my right breast to show where the marker was left when they did the biopsy last September.
I checked in about 7:15 AM, and we waited and waited, and waited some more. Evidently there were three patients booked at 7:45 AM (you have to check in 30 minutes prior to your appointment) and there are only two mammography rooms for this procedure. Since the other two women had surgeries scheduled at 10:30 AM and mine was scheduled for 11 AM, I got to be last for the wire insertion and the tracer injection for the sentinel node mapping.
I was finally called back over an hour late to go through my procedure at the BDC. I warned the doctor and the nurse who were doing to wire placement that I have a very sensitive parasympathetic nervous system. I already deal with BP on the low side of normal, but when my body thinks something should hurt, even if it doesn’t, I go into shock.
We started the procedure to place the wire, at first they were going to have me sit on a raised chair so they could place my right breast in the mammography machine with a special paddle attached with a hole in the center of it so they can numb my breast and then place the needle once they have the location of the marker. Then the doctor called into the room to tell the nurse to set it up for me standing and they were going to go through the bottom of my breast as that was the shortest distance. Because of my neuropathy I can only stand still for about 5 minutes, and then I start rocking on my feet to relieve the prickly numbness. They had me sit until the very last moment and then I stood up against the mammography machine while they placed my breast between the modified paddle and the backing plate. Now the movable plates on the machine are upside down so the nurse and the doctor are working from underneath my breast.
Once they have my breast placed optimally for wire insertion to the marker they leave me squished in the machine while they then wash the area for the insertion site with Betadine, then the doctor numbs the area with Lidocaine, and then the wire is inserted with part hanging out of breast. Once this is done, they run another x-ray to make sure the wire is lined up right at the marker.
I did good until the “final” x-ray showed they didn’t have the wire placed correctly, it had missed the marker. It was the second attempt to get the wire exactly to the marker that my parasympathetic nervous system kicked in and I started going into shock. I told them I needed to sit down and the both looked up at me and quickly removed the wire and had the normal chair pulled over for me to quickly sit in and get my head down past my knees. They had ice packs ready to place on my chest and the back of my neck. They also called in another nurse the one of the breast cancer advocates to help monitor me as to when I would be ready to try the wire placement again.
Sitting wasn’t doing the trick, so I told them I needed to lie down. They had a blanket ready for just such an emergency and helped me down and we had my legs up on the chair. They kept checking my BP; it finally was getting back to my normal range of 100/65. They decided since I have no control over my BP once this happens and the neuropathy in my feet, to go in from the side of my breast even though it’s a longer distance to the marker, I could sit in the chair and they could work from the side instead trying to place the wire while sitting on the floor. Second attempt while I was sitting in the chair was a breeze. Then they injected the uptake tracer into my breast right behind my nipple. No numbing for that and that hurt. Again I started feeling light headed, nauseous and clammy. Back to the floor I went, but it only took a couple minutes for me to feel and look normal again. In the meantime one of the nurses called over to the hospital to let them know I would be running a little late.
They placed gauze and a clear Tegaderm Film over the wire sticking out of my breast and had me put my top back on so I could be shuttled over to the hospital. They had an escort for me, who accompanied me back out to the waiting room so we could meet up with Hubby so he could follow us across the campus to the hospital, he could park and then my escort would wait for him to enter the lobby so she could direct him to admitting where I was waiting.
I was pre-registered so I only had a couple forms that needed signing at Admitting, and as soon as hubby was there they escorted us to the waiting room for pre-op and family members wait for news of patient in surgery. Didn’t take long before they called me back to start prepping for surgery. Hubby cannot come back to sit with me until the IV is placed. I was taken to a curtained off bed in this long ward of pre-op and some post-op patients. They take my vitals, have me undress and get into a gown, settle me in the transport bed, cover me with a heat blower attached blanket to keep me warm and we start going over my medical history and ask questions about my allergies.
I’m not necessarily allergic to meds, but some meds have bad interactions with me – Vicodin – makes my heart and brain race while my body feels like it can’t move. It’s not a pleasant sensation and I cannot sleep, so no Vicodin for me. Also Zofran an anti-nausea drug, it makes me retain water so badly I stop urinating. They immediately called the anesthesiologist to come speak with me as General anesthesia does make me nauseous when I am coming out of it.
The nurse assigned to start the IV catheter came in and said this one would have to be in my left hand since the majority of the work was being done on my right side. She was good, she had everything prepped and had me hang my left arm over the side of the bed while she got on the floor to access a vein quickly. It was done before I could blink twice!
Dr. Ali-Jones stopped by and we chatted about the surgery, as well as the lymph nodes. I told her I had heard about the recent study results about 2mm or less cancer legions in a sentinel node did not warrant further axillary dissection. She agreed with me, not worth the risk of nerve damage and lymphedema.
Hubby was brought back and I told him Dr. Ali-Jones advised surgery would take about an hour and a half. Not the two to two and half I was originally told by her staff. Then the Anesthesiologist arrived and we discussed my severe motion sickness from a general anesthesia. He asked me if I’ve had scopolamine patch before. Nope, so he had one applied. This would be injunction with Compazine administered through the IV. Once that was completed they were ready to wheel me into the OR. Hubby kissed me goodbye in the corridor where he headed back to the waiting room and I was taken to OR.
No problems with transferring to the OR gurney and everyone in the OR was impressed at how smoothly I made the transition look. I was out in under 5 minutes.
I don’t know how long I was in recovery, a little over an hour maybe before I was actually able to be awake enough for them to bring Hubby back to sit with me while we waited for my room assignment for my overnight stay that the surgeons office was able to get approved by my insurance company. I was starting to feel pain right before Hubby was brought back, so my recovery nurse administered more pain relievers. I was nice and high and in no pain.
Dr. Ali-Jones had stopped by recovery and told me what she had relayed to Hubby, but I honestly don’t remember much. She did tell me that the second dye she injected prior to surgery to complete the sentinel node tracing is blue and is processed by the kidneys so I was not to be alarmed when I pee blue to even green urine for a few days.
I had a room assignment before hubby was even brought back to recovery. So he didn’t have to wait very long before I was being taken up to my room. Mostly uneventful night, and I am glad the surgeon’s office was able to get the approval as I don’t think Hubby would have managed so easily how much help I needed dealing with pain and going to the bathroom. It’s not his forte being a nurse, and I was very out of it and needed lots of help getting up, pulling down my underwear, having someone steady me on the short 3 step walk to the restroom. It wasn’t until this morning that I felt strong enough to get myself and the IV pole maneuvered into the bathroom and I still needed help with pulling down my panties to pee if I was at the end of the pain control cycle.
Hubby stayed until about 7 PM, then he went home to take care of The Toothless Wonder cat, who was missing me. Darling Daughter had come over to visit with me and arrived before 5 PM bearing gifts of really soft, squishy socks. She stayed until almost 9 PM and helped me to the bathroom several time during her stay so I wouldn’t have to wait for a nurse or nurse’s aid.
This morning Dr. Ali-Jones came in and said she was glad I had the overnight stay as they really wanted to monitor me closely because I took a much higher dose of anesthesia than most people to put me under. She would recommend I advise any future surgeons of this problem so they can schedule inpatient surgery. I’ve known I have this problem of needing higher doses of anesthesia; twilight drugs and pain relievers as most standard doses do not work for me, but no one has actually said they recommend a hospital stay even for what would be considered out-patient surgery.
I was released to go home shortly after her visit. She did tell me only 3 sentinel nodes lit up with the tracer and no cancer found in them. They did a quick scan of some of the edges of the removed breast tissue and no cancer cells were noted in the scan, so she anticipates the pathology report will come back clean as well, and I should not need any additional tissue removal. She did say she should have the pathology report for all the tissue and all margins by Wednesday and she will call me. She also told me she left a big “hole” in my breast and part of the healing process is for that hole to fill with fluid. If I hear sloshing coming from my right breast, this is normal and I should not worry. I have a waterbed for a boob…. 😀
I did notice this morning the swelling in my breast has gone down a bit, and I can already see the size difference in my boobs. Even in my spandex tank tops that squishes my boobs down.
Hubby arrived with my “tea” (Hot water, Lemon wedge and Honey); he is so good to me! I told him I was being discharged shortly. Nurse wanted to get my last round of pain meds in before she pulled my IV, and while I got dressed she printed up my discharge paperwork.
I’ve been sent home with prescriptions for Toradal and Percocet for pain management and swelling control, as well as a stool softener to try and keep me from becoming constipated from the Percocet.
All my nurses and nurses aids were wonderful. We were home before 11:30, even with stopping at two different pharmacies to get my drugs. First one didn’t have the Toradal and Percocet in stock. They could get it for me by the end of the week. Ummm, that won’t work, I am fresh out of surgery and that is what the drugs are for. We had to head to a second pharmacy to fill the Rx’s.
Now I am ready for a nap. I slept OK last night, but not the greatest. When the pain meds were starting to wear off about 45 minutes prior to my next scheduled dose it would wake me up. Then there were all the trips to the bathroom, which my night nurse – Ariana, commended me on how much water I was drinking without them even having to remind me. The saline solution for my IV was an extra slow drip so most of what I was eliminating was from my intake. After my last pre-midnight infusion of meds, Ariana unhooked the IV lines so I could move about easier when it was time to go to the bathroom.
Monday I will call Dr. Goldberg’s office and advise them what Dr. Ali-Jones said to me about the anesthesia and to see if that will be good enough to get approval from the Insurance company to authorize an overnight stay instead of outpatient for next Friday’s surgery. That and Hubby is worried about trying to care for me at home with what he saw yesterday afternoon/evening.
Life is waiting on the pathology report.