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Saturday, July 18, 2009 TexasOlGal, Community Member, asks

Q: Pain after mastectomy

I do not tolerate pain meds well. My bilateral mastectomy will be much more serious than the lumpectomy I had (day surgery) in June. Although I had 3 incisions, I left the pain pill at the hospital prior to discharge in their cute little barf bag. I took a Tylenol at bedtime, one the next day, and that was it. Most pain pills make me crazy, dizzy, or sick. Anyone have any recommendations?

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Answers (5)
PJ Hamel, Health Guide
7/18/09 7:01pm

Hi again Texas - I think you'll need some pain meds for a couple of days. Although, considering the invasiveness of the surgery, it's surprisingly "comfortable," I think you'll still need to take something. Please tell the surgeon and anesthesiologist ahead of time about your issue with pain meds; I'm sure they've had patients with this challenge before, and know of something that won't make you sick. Good luck - PJH

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TexasOlGal, Community Member
7/18/09 7:06pm

Thanks, PJ. I had a very bad toothache last week, took antibiotics, but couldn't handle the pain pills. Got that problem taken care of 3 days ago, with a root canal. But not looking forward to my "drive-through" double mastectomy next week. Go in Tuesday, get kicked out Wednesday! Will have to stay at sister-in-law's for a couple of days, and don't want to throw up on her freshly-ironed sheets. Soon as I can get home, will have home health care to do what has to be done with the drains. . . yuk!

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PJ Hamel, Health Guide
7/18/09 8:31pm

Ridiculous, kicking you out the next day... talk about the need for health care reform. Anyway, I think with a little preliminary communication with the docs you'll be taken care of. As for the drains - heck, they're not as bad as they sound. They're not messy, they're all contained, and just drain into a little bulb. Hurts like a sonova when they yank 'em out, but it's quick - like a bee sting or a shot. Hey, best of luck, OK? YOU CAN DO THIS, I know you can. We're with you - PJH

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sue dyer, Community Member
7/18/09 8:39pm

You may not even need pain medication after your op. In my view, medication is only needed when pain is intolerable and it can be over-used. I had a mastectomy last January and used no pain medication at all, much to the nurses' astonishment. I was sore, but it was bearable and I took a very philosophical approach to it. As the pain lessened, I knew I was healing.

 

Your health insurance companies in the US must all be run by men. To suggest that a woman only needs an overnight stay in hospital for a double mastectomy is ludicrous. How on earth do they think a person can manage four drainage tubes and bottles on her own? My insurance company here in Australia paid for a week's stay for me. When the insurance companies are less powerful they can be made to shoulder their responsibilities as well as pocketing your cash. You really need health care reform in your country!

 

Best of luck with your surgery.   Sue

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TexasOlGal, Community Member
7/18/09 10:41pm

Hey, Sue. You're right. We need health care reform. But . . . the plan being proposed by our new president says. . . if people are of a "certain age," maybe they just should recognize that health care needs to be for younger people. He said, certain procedures might not even prolong life or improve health, so older people might as well just "take a pain pill." At my age, I might not even be a candidate for mastectomy under the health care reforms being considered by this administration. It's frightening! My late husband was 71 when he had coronary bypass surgery, with Medicare (governmental coverage) and supplemental coverage (private insurance). It was a blessing. He lived and worked for 12 more years, and at age 83, he was recommended to have an implanted defibrillator. He said, "I don't think I want jumper cables in my heart." I told him that it was his decision. He went for his daily 2-mile walk one morning, and collapsed. Unfortunately, a neighbor called an ambulance, and after about 3 hours, I finally was able to get into the hospital room and stop all their efforts. This whole thing cost the government about 95 thousand dollars. It was unnecessary, it was ridiculous. But the legal system required that they do all those things. He had made his decision 3 hours earlier. God had agreed with him. There was not a need to spend that kind of money, but we don't have that choice. The government, lawyers, and insurance companies are in control. "Drive-through" mastectomies are a result of this ridiculous system that will NOT get better when it's taken over totally by the government.

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sa, Community Member
9/26/10 8:34pm

You can always make a dnr order. This way if you do not want cpr, intubation or meds they will let you die when your time comes.

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TexasOlGal, Community Member
7/18/09 10:41pm

Hey, Sue. You're right. We need health care reform. But . . . the plan being proposed by our new president says. . . if people are of a "certain age," maybe they just should recognize that health care needs to be for younger people. He said, certain procedures might not even prolong life or improve health, so older people might as well just "take a pain pill." At my age, I might not even be a candidate for mastectomy under the health care reforms being considered by this administration. It's frightening! My late husband was 71 when he had coronary bypass surgery, with Medicare (governmental coverage) and supplemental coverage (private insurance). It was a blessing. He lived and worked for 12 more years, and at age 83, he was recommended to have an implanted defibrillator. He said, "I don't think I want jumper cables in my heart." I told him that it was his decision. He went for his daily 2-mile walk one morning, and collapsed. Unfortunately, a neighbor called an ambulance, and after about 3 hours, I finally was able to get into the hospital room and stop all their efforts. This whole thing cost the government about 95 thousand dollars. It was unnecessary, it was ridiculous. But the legal system required that they do all those things. He had made his decision 3 hours earlier. God had agreed with him. There was not a need to spend that kind of money, but we don't have that choice. The government, lawyers, and insurance companies are in control. "Drive-through" mastectomies are a result of this ridiculous system that will NOT get better when it's taken over totally by the government.

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Connie Jackley, Community Member
7/18/09 9:46pm

I don't think you should be too worried - - the pain after the double mastectomy, for me anyway, was minimal.  I agree with what Sue said about trying to bear with the discomfort and try and substain from taking pain meds.  I know I really did not take anything once I left the hospital for pain - - and really tried to take very little while in the hospital.  It seems true that sometimes the pain meds bring on so many more problems.  I know, for me, this was the easiest surgery I have ever had, having colon and pancreas surgeries.  As my one surgeon put it " a walk in the park' compared to what I had been through.  Of course, many of you have not been through a surgery at all, except for maybe the lumpectomy, so, of course, reasons for your apprehension.  I hope you will do OK on your own without having to worry about getting sick from pain medicatiion.  Also, I cannot believe you will be in and out of the hospital overnight?  I was in for 2 1/2 days, which was ample time for my condition.  Yes, the drains at home are a nuisance, but I would rather have dealt with them in my comfortable home versus having to be hospitalized for a whole week - YUK. I have been in the hospital 3 weeks at a time for other surgeries and trust me, you do not want to go there.  I wish you luck with the pain and with the drains and the whole procedure.  It is tough at the time, but once you get to the other side it is all worth it to be rid of the cancer.  If you chose the reconstruction, hopefully you will be as pleased as I am with the results.  GOOD LUCK

C.J.

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PJ Hamel, Health Guide
7/18/09 9:52pm

Thanks, Connie and Sue. So, Tex - are you feeling better, after these encouraging words? I didn't even ask about reconstruction - are you considering it? Like Connie, I love mine - had a tram-flap (body tissue - from the belly), so the tummy tuck was a great bonus! PJH

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TexasOlGal, Community Member
7/18/09 10:17pm

Hey, PJ. I really, really hoped for the flap procedure. Thought a tummy tuck and maybe a facelift at the same time would be great!! But, NOT a candidate! My age, my diabetic history, and weight (oh,  I have LOTS of abdominal fat that could be moved!) precluded this. After discussion with plastic surgeon, and recognizing that beginning reconstruction immediately would include a more complex surgical procedure, increased risk of infection, longer recovery time, etc., I opted to just GET THE CANCER OUT OF ME! I'll consider reconstruction later. After all, I am not in need of great boobs and cleavage at this point in my life. Ain't trollin' for a new man at this point! Following the lumpectomy, the discovery of an additional cancer in the left breast, and knowing I had to have it removed, I opted for the removal of both breasts, so I wouldn't be walking in circles. But it'll be strange not having that big ol' shelf for my cat to perch on!!! She and I will have some major adjustments to do.

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PJ Hamel, Health Guide
7/18/09 10:32pm

Just remember - if your health coverage pays for mastectomy, they're froced, by law, to pay for reconstruction, if you want it. Also for lymphedema treatment, if you get that (hope you don't - be SURE to get PT to help prevent it!!) So you and your cat can settle in for awhile, assess the new "topography," then make a decision. Bet the cat votes "no." They're so easy to please! Tongue out PJH

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anita, Community Member
8/10/09 2:13am

what do you mean by -be sure to get PTto prevent it

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PJ Hamel, Health Guide
8/10/09 6:10am

Anita, getting physical therapy after a mastectomy helps prevent a whole lot of shoulder and arm problems down the road. PT helps you get your range ofmotion back; and it helps prevent you from hunching protectively over that side of your body. It gets everything moving in the right direction. And all of that helps prevent lymphedema. PJH

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Phyllis Johnson, Health Guide
7/19/09 9:07am

I didn't have a double, but like some of the others you have heard from, the pain from my single mastectomy was more in the discomfort range than the severe range.  

 

I wanted to comment about the hospital stay.  I have learned that often when insurance gives a certain number of days for a hospital stay, the doctor can overrule it if the patient has problems that preclude sending her home.  Twice my doctors have admitted me after same day surgery because I was still nauseated from anesthesia.  The doctor and I had talked about that possibility ahead of time, but they had to schedule it as same day surgery for insurance purposes and then admit me later.  Let your doctor know that you have concerns about being sent home before you are ready and see if there are some loopholes if you still need nursing care.

 

I couldn't wait to get out of the hospital once I stopped throwing up from the anesthesia.  I did have people at home to help me.

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TexasOlGal, Community Member
7/19/09 12:09pm

Thanks so much to all of you for your good responses to my concerns. I know that I will have home health care to handle the drains, for at least 2 weeks. I believe that I can tolerate discomfort (even pain) much easier than I can the pain meds, so I will grin and bear it for however long it takes. I had no nausea from the anesthesia last month, only from the pain pill I was given pre-discharge. I will be spending a couple of days at my sister-in-law's, so will have someone with me if necessary. She and her husband live in a gorgeous retirement center here, and since it is a life-care facility, there is medical staff on campus 24/7. If I needed it, I could get it, but my insurance would not cover it. But I want to get home as quickly as I can. That little lap-cat will be very lonely. A friend will stop by to feed and scoop, but the cat hides during those visits, so will not have the human touch she's used to.

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Angi, Community Member
7/19/09 5:21pm

You "should" be able to stay over night.  Not all mastectomies are actual "drive-thrus" even though they are pushing for it.  If you are in discomfort your doc will likely request to keep you over night, and nearly all insurance companies will approve the stay.  He'll also do this if you get out of surgery late in the day.

When I had my 1st mastectomy I was in horrid pain, crying for 3 straight hours until they switched my meds from demerol to morphine.  Demerol does nothing for me.  I was also kept in the hospital for 2 nights. When I had my 2nd mastecomy with reconstruction it was a bit different.  I only stayed overnight and though I was in lots of pain, it was no where near the pain I experienced with my first.  I think the difference was that my first was a modified radical which removed a portion of my chest muscle.  My second only removed the tissue, nipple, and skin.

Though everyone's tolerance for pain is different, do keep in mind that this is a mjor surgical procedure and you will likely experience pain greater than what you're used to.  Also remember that it is pretty common for a pain pump with morphine to accompany recovery.  Speak with you doctor and find out what the protocol is post surgery regarding pain management.  It's better to wake up with pain meds in your system working to dull the pain than it is to wake up to screaming, nagging pain and have to wait for the meds to kick in.  You want to be comfortable, and there is nothing comfortable about the mastectomies.  The surgery itself hurts, the drains are uncomfortable and moving is painful.  In my experience with 10 breast surgeries, I can say that for at least 5, I was in moderate pain for the first week.  You'd think over time it would get easier, but it doesn't.

Good luck to you!

Angi

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TexasOlGal, Community Member
7/19/09 5:36pm

Oh, Angi! I don't believe I could handle 10 breast surgeries! This will be my second. Maybe if I were as young as you, I'd do better. I will be in the hospital overnight, but I'll be released the next day, if there are no complications. I'm not anticipating any setbacks this time, so am going in with a positive attitude, and about a gazillion people praying for me! I will handle it fine, and down the road I may or may not decide to start the reconstruction process, but will not do it immediately. First things first. I want the cancer out of my body. I will deal with the inconvenience of being boobless later on. You are to be admired for your persistence and ability to "keep on keeping on." Thanks for your advice.

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By TexasOlGal, Community Member— Last Modified: 03/21/11, First Published: 07/18/09