Wednesday, October 19, 2016

It Won't Hurt - Much


When I had a fine needle aspiration biopsy (FNA) of my thyroid nodule I was told “it won’t hurt, you’ll only feel a little pressure.” I had arrived totally unprepared expecting only an ultrasound of my neck but figured 'heck, this is a minor office procedure so no problem'.

Wrong! It hurt - a lot. 

People tend to think it’s the “needle stick” when the skin is pierced is what causes pain but that is relatively minor. Unless the underlying tissue in the area to be accessed can be anesthetized, merely numbing the skin does little to help. Using local anesthesia when my chemotherapy port was placed I experienced a lot of pressure but no pain and relatively little discomfort despite it being a fairly lengthy procedure.  

With the FNA, while the surface skin may be numbed, it’s doubtful that the underlying tissue can be anesthetized without causing more pain and trauma than the biopsy itself. For some it’s probably no more traumatic than a trip to the dentist or a flu shot. For others it may be extremely uncomfortable - which is the health care euphemism for painful.

As a nurse I have found that my patients have always tolerated procedures better if I’m honest up front that it might hurt. There is a tendency in order to make it “easier” for the patient to gloss over or minimize pain or other “side effects” of a procedure. In reality, I’ve found that if a patient is well prepared ahead of time not only do they tolerate the pain better but feel better about themselves after. If they’re not prepared, they may feel as if they’ve been victimized or lied to, lowering trust in their health care team. Kids and teens are especially vulnerable to being lied to about pain and are surprisingly resilient when they are adequately prepared. (And sometimes if it didn't hurt as much as anticipated, I became "the good guy".)

Health care practitioners are sometimes unaware of or callous to the emotional influences adding to a patient’s discomfort and pain during a procedure. When a biopsy is a defining moment in determining if we have cancer or not, it looms as a life-changing event - not simply a “little needle stick”. For many of us, simply hearing the doctor, nurse or other staff acknowledge this can go a long way with improving our comfort level and assuring us that they really see us as a person, not “just another case”. 

There are things you can do to make these procedures go easier.

Don’t go alone (my mistake). If you don’t simply fly through the procedure you want someone there to hold your hand and offer a hug afterwards. And a second set of ears to hear about preliminary results. I spent a half hour crying alone in the parking lot after feeling like I had been invaded and my condition trivialized. It doesn't matter how smart or strong we think we are, we all need an advocate.

Do take your normal “anti-anxiety” medication beforehand if you feel it will be helpful, or ask your doc for a one-time dose to take beforehand (and make sure you have a driver).

If you’re usually sensitive to pain, or if you have other conditions requiring pain medication, you can “pre-medicate” with your usual pain med. Be sure to time the dose so you will have the peak effect during and following the procedure - usually one to two hours after taking. (And make sure you have a driver if it's stronger than ibuprofen or acetaminophen.)

Have a written list of questions - when will you get results, who will the results be sent to, what are the possible next steps. There are no "stupid" questions.

And finally, if you’re uncomfortable with the doctor, go somewhere else. Due to insurance and other things this isn’t always possible but if you need to don’t be afraid to fire a doctor and find another whom you have confidence in. I fired four doctors before getting a proper lung cancer diagnosis which possibly saved my life. When I felt the surgeon who did my FNA was totally insensitive to my concerns I queried doctors and friends for recommendations until I found a surgeon who gave me his full attention and I had confidence in.

Patti in AZ