Surprised by pain

I am a 51 y/o woman who has a hx of cysts in the right breast.  I had several needle aspirations a few years ago, and then a surgical excision.  It was a simple procedure under "twilight sleep"  anasthesia. An easy in-and-out procedure.

18 months ago after moving to another city, another cyst appeared in the same breast.  It was biopsied by a radiologist using ultrasound and found to be benign.  At a 12 month follow up mammo  the cyst had grown to the size of a pea,and the recommendation was to have it surgically removed.

The surgeon described the procedure, which I had last week.  Only now do I realize that the procedure was not excision of the mass, but a wire-guided biopsy.  Before today, I could not understand why the described procedure was so different from the one I had 5 years ago. I also understand now why I could not find info online prior to the surgery.  "Wire" and "excision" got no results.

The wire insertion, despite assurances to the contrary was excruciatingly painful, perhaps because I have large breasts and the wire needed to go deeper than the lido had gone.  In fact, a 7cm wire was not sufficient, so it was removed and replaced by a 10 cm wire. The technician was appalled I had received no sedation or pain meds.

My questions:  1. Why was the mass simply not excised?  2. Why did I receive no sedation or pain medication for this extremely painful procedure?

Lastly, the path results, to my surprise, were unclear.  They are being sent to another hospital  40 miles away for a second opinion.  Results will not be in for another week.  Why?  

[CCF-RN,MSN-rf]

Dear sarah4155:  If a lump cannot be clearly palpated (felt by the doctor), then it is very difficult (if not impossible in some cases) to remove it without some kind of guidance, wire being one of the best ways to assure that one is actually removing the lump in question.  It is difficult to speculate on the issue of sedation or pain medication as this is specific to the doctor and insitution performing the procedure; however, sedation is frequently given for excisional biopsies but is not usually given for the wire placement procedure as local anesthesia (such as lidocaine) will suffice for most patients.  With respect to the unclear pathology results, it is not uncommon for a result that might not be clear cut to be sent out to another pathology lab - perhaps one that can do additional testing.  Some of these tests may take time (staining etc).  A week is a fairly standard turn-around time for most pathology labs.

[AlaskaAngel]

I will comment on only one aspect of your question.

Over and over and over in breast cancer forums I have seen shocked complaints from breast cancer patients about the lack of pain control in performance of this procedure.

As someone who is a breast cancer survivor and who also has done patient care at many levels, it is clear to me at least that the lack of any professional standards for pain control with this procedure seriously need to be put in place.

I don't know if the problem of lack of reasonable pain control happens because this procedure is generally done in the radiation department and other medical staff with better experience in dealing with pain management are too isolated from the patient at the time, or what.

I only hope that those who monitor this forum will actively seek to consider and address the problem, as it remains much too common.

I am sorry that you and far too many others continue to suffer needlessly with this procedure.

[AlaskaAngel]

A very eloquent post about this topic that you might want to read is to be found at:

http://www.cancerguide.org/kjessen_story.html

While I was unable to contact the individual who posted that commentary as the e-mail address noted there returned my e-mail, by its specificity I would guess that it probably is genuine.

AlaskaAngel

[Cat Crazy]

I too had a wire localization excisional biopsy. I say it is without a doubt the MOST painful medical procedure I've ever endured. My opinion as to why more care isn't given to pain control is because WE don't demand it. And the medical profession has fear on their side.

[yogamom]

I am 3 days out of two wire localizations and excisional biopsies in one breast.  The wire localizations were so painful that I started to hyperventilate, broke out into a profuse sweat and almost passed out.  This was with a local!  I begged for something to help me relax from the time i got to the hospital and was only given something after the wire locs.

[Macela]

I am so sorry for the pain that has been experienced by some during a wire localization.  I am two week out of a wire localization and excisional biopsy and I have to say that I experienced no pain at all during the wire localization.  I told the exray tech that I hated pain and that they should give me a double dose of the lidocane.  I was a bit nervous during the proceedure but after the initial ***** from the lidocane shot, they did the procedure and I didn't even know that they had done it.  They took an xray and found that they had to move the wire a bit, and again, no pain.    My surgeon prescribed valium for me to take to calm me down for the proceedure as well. I hope my experience will help some be less fearful of the proceedure.

[healthcareguerilla]

A related discussion, Given benign pathology results, why biopsy? was started.