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Help for painful wire localization
Although I have never previously had any psychiatric problems, I have suffered from flashbacks and night terrors ever since experiencing an excruciatingly painful and inaccurate wire localization which ended with a vasovagal reaction, followed by a large excisional breast biopsy for a tiny noncancerous cluster of microcalcifications located very posteriorly on my chest wall. Clinical studies have shown that 70% of women undergoing wire localizations with mammographic guidance experience moderate to severe pain, and about 7% experience vasovagal episodes. What do you recommend for patients like me? I have researched pain relief methods for wire localization and found these helpful studies:
(1) Benzodiazepine Premedication, Can It Improve Outcome in Patients Undergoing Breast Biopsy Procedures? by Janet van Vlymen, MD, FRCPC; Monica M. Sa Rego, MD, and Paul F. White, PhD, MD, FANZCA at the Department of Anesthesia and Pain Management, University of Texas Southwestern Medical Center at Dallas (Anesthesia, Mar 1999, Vol.90, No. 3: 740-747). This study demonstrated decreased incidence of moderate-to-severe discomfort during needle localization, as well as decreased vasovagal episodes, after premedication with 1.0 mg midazolam (Versed) or 2.0 mg diazepam emulsion (Dizac) given intravenously 5 minutes before the patient was transferred from the Day Surgery Unit (DSU) to the radiology department. In the radiology department, patients then received local injection of buffered lidocaine before the procedure.
(2) Another successful method of effective pain relief for wire localization is described in Paravertebral blockade for minor breast surgery by Terheggen MA, Wille F, Borel Rinkes IH, Ionescu TI, Knape JT (2002 Feb;94(2):355-9). This study found that patients with a paravertebral block who underwent a radiograph wire localization procedure experienced less pain during the procedure, had higher patient satisfaction scores, and were so happy with it that many of them later refused to undergo breast surgery without it. A case study using paravertebral block for wire localization is reported in Management of Breast Needle Localization Patients with Severe Phobia by Farzin Goravanchi, Steve Wang, Alicia Kowalski, Elizabeth Rebello, and Spencer Kee at the MD Anderson Cancer Center in Houston, TX. The patient had phobia of mammogram needle localization because of a previous painful, prolonged and difficult wire localization, and she refused surgery unless she was offered effective pain relief. Paravertebral block was performed in the sitting position under sedation with routine monitors and a nurse escort to and from the remote needle localization service, with a resulting “anxiety free and pain free breast needle localization.”
This discussion is related to Wire localization was PAINFUL.
(1) Benzodiazepine Premedication, Can It Improve Outcome in Patients Undergoing Breast Biopsy Procedures? by Janet van Vlymen, MD, FRCPC; Monica M. Sa Rego, MD, and Paul F. White, PhD, MD, FANZCA at the Department of Anesthesia and Pain Management, University of Texas Southwestern Medical Center at Dallas (Anesthesia, Mar 1999, Vol.90, No. 3: 740-747). This study demonstrated decreased incidence of moderate-to-severe discomfort during needle localization, as well as decreased vasovagal episodes, after premedication with 1.0 mg midazolam (Versed) or 2.0 mg diazepam emulsion (Dizac) given intravenously 5 minutes before the patient was transferred from the Day Surgery Unit (DSU) to the radiology department. In the radiology department, patients then received local injection of buffered lidocaine before the procedure.
(2) Another successful method of effective pain relief for wire localization is described in Paravertebral blockade for minor breast surgery by Terheggen MA, Wille F, Borel Rinkes IH, Ionescu TI, Knape JT (2002 Feb;94(2):355-9). This study found that patients with a paravertebral block who underwent a radiograph wire localization procedure experienced less pain during the procedure, had higher patient satisfaction scores, and were so happy with it that many of them later refused to undergo breast surgery without it. A case study using paravertebral block for wire localization is reported in Management of Breast Needle Localization Patients with Severe Phobia by Farzin Goravanchi, Steve Wang, Alicia Kowalski, Elizabeth Rebello, and Spencer Kee at the MD Anderson Cancer Center in Houston, TX. The patient had phobia of mammogram needle localization because of a previous painful, prolonged and difficult wire localization, and she refused surgery unless she was offered effective pain relief. Paravertebral block was performed in the sitting position under sedation with routine monitors and a nurse escort to and from the remote needle localization service, with a resulting “anxiety free and pain free breast needle localization.”
This discussion is related to Wire localization was PAINFUL.
Best Answer
I'm a 43 yr old mom of four who was diagnosed in feb of this year. I went through the same procedures. I had no pain although I have to say with the biopsies I hated that snapping noise the tool made. It scared the crap out of me each of the 11 times they snapped it for samples. If your still exp pain try a natural herb called black cohosh it helps with period related breast pain & may help this. If its not pain but just the nightmare memories. Ask your doctor for some klonopin it helps with panic attacks & is fairly quick acting.
When a doctor ignores your severe pain and makes you feel like a wimp it is not fair to you! I'm glad you posted about your bad experience, anyway. It is always easier to post about a good experience than a bad one, but you will make other women with bad experiences feel like they're not alone -- that someone understands them. I am glad that your second experience was better than the first.
The same thing happened to me when I had my first wire localization five years ago. This is the first time I've ever heard of this happening to anyone else. The doctor didn't even apologize....he acted like I was being a big baby and then took off and had another doctor finish the procedure. (Not that I would ever let him touch me again after that experience anyway.)
The following year I had my second wire localization with a different doctor and although it was uncomfortable it was nowhere near as bad as the first one.
Wish I could have been sedated. In my opinion, the surgery was a piece of cake compared to the wire localization and the biopsy.....both were pure torture.
The following year I had my second wire localization with a different doctor and although it was uncomfortable it was nowhere near as bad as the first one.
Wish I could have been sedated. In my opinion, the surgery was a piece of cake compared to the wire localization and the biopsy.....both were pure torture.
I'm so very sorry that you also had a very painful wire localization and that they refused to help you. I completely understand how you feel! May God bless you, comfort you, and heal you.
If you can, it is important to try to make changes at your facility by talking/writing to your surgeon, radiology department head, anesthesiology department head, medical director, and other administrative leaders. Describe the experience in graphic detail, so that they can feel your pain, and print out the information about pain relief from my post. You can find links to the pain relief articles at http://www.cancerguide.org/jane_story.html. You should also read Cathy's story at that site. Administration is concerned with keeping patients, so it helps to remind them that patients will either change facilities or abandon screening unless wire localizations and biopsies are made as pleasant and painfree as possible! Good care includes pain relief!
If you can, it is important to try to make changes at your facility by talking/writing to your surgeon, radiology department head, anesthesiology department head, medical director, and other administrative leaders. Describe the experience in graphic detail, so that they can feel your pain, and print out the information about pain relief from my post. You can find links to the pain relief articles at http://www.cancerguide.org/jane_story.html. You should also read Cathy's story at that site. Administration is concerned with keeping patients, so it helps to remind them that patients will either change facilities or abandon screening unless wire localizations and biopsies are made as pleasant and painfree as possible! Good care includes pain relief!
I too just had a mammogram wire localization and it was the most stressful and painful medical procedure I have ever had to endure. I requested a Valium and they told me no since I was so close to the surgery time for which I had general anesthesia. In this day and age, I don't believe any person should have to be subjected to something as painful as a wire localization. I had two children without pain meds and I would have had a third, but I will NOT ever have another mammogram wire localization without some serious pain medication.
I found that speaking out and helping other women have a better experience actually helped my PTSD, because I felt that my suffering had some kind of positive benefit. After 6 months, I now rarely have night terrors or vivid flashbacks, but I have a definite phobia of mammograms and mammogram wire localization. In spite of the changes at my local facility, I think I need to change to a larger and more progressive breast care center!
Great .... that's how changes are made .... I'm amazed that the institution where you had your biopsy was so far behind the times when it comes to proper sedation and pain relief. GOOD JOB !!! The "squeaky wheel" does indeed get the grease and you can be proud of your efforts.
Thank you. I'm really glad you didn't have pain during your wire localization.Good luck with your treatment!
Thank you! I wanted to help other women avoid the kind of painful experience I had. So I wrote letters describing my experience and then talked with my surgeon, the mammography department head, the anesthesiology department head, the director of nursing, and the medical director of my hospital. I then made suggestions to improve the problems I had experienced with painful mammography, poor communication of results to patients, and painful and inaccurate wire localization, which was routinely done without any anesthetic. I shared the pain relief methods I had discovered during my own research. My local hospital administration was very receptive, and changes are now being made in their mammograhy and biopsy procedures, including sedation and pain relief for women undergoing wire localization.
Hi Jane,
Thanks for posting these references.
They just might be possibilities for persons previously traumatized by a wire localization experience, who would refuse to undergo the procedure
again without some type of accomodation to their trauma and resulting phobia, be it hypnosis, twilight sedation, general anesthesia, or some version of the techniques described above.
Regards,
bluebutterfly
hy
Thanks for posting these references.
They just might be possibilities for persons previously traumatized by a wire localization experience, who would refuse to undergo the procedure
again without some type of accomodation to their trauma and resulting phobia, be it hypnosis, twilight sedation, general anesthesia, or some version of the techniques described above.
Regards,
bluebutterfly
hy
It seems to me from your lengthy post that you are making a lot more of this than need be ... just a quick observation. How about cutting back on the research and visiting a Pain Clinic. Let the Dr.s treat the patient .... not the patient. Seriously, Pain clinics and their Physicians can offer some very helpful treatments and/or ideas for many types of issues. Whatever you are finding thru research isn't something that you can use on your own as a rule so try to step away from your professional "self" and become that ordinary uninformed patient. Give it a try; you might be surprised at the results. All the best ......
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