Dr. John Ruckdeschel, director of the University of Mississippi Medical Center’s Cancer Institute, discusses pain management.
Ann Carruth Jackson awoke one morning in late 2016 with what felt like a big knot on top of her breast. She knew right away: It must be cancer.
“I was shocked,” said the 74-year-old who lives near McComb. But a Jackson-based surgeon, Dr. Phillip Ley, removed the tumor without trouble.
Jackson headed home after the procedure with some opioid painkillers, and recalls still feeling discomfort for awhile — the type of lingering pain many people feel for days or even months after breast surgery.
Months later, though, the cancer returned. This time, Ley told Jackson, her entire right breast would need to be removed. And this time, the surgeon planned to use a new technique to prevent pain.
In the past Ley, who specializes in breast surgery, prescribed patients plenty of hydrocodone as they recovered in the hospital and after they went home. The potent opioid knocks down acute pain, but it comes with side effects such as constipation and dizziness, and can easily cause addiction.
So recently Ley has used a new procedure that requires little or no narcotics. Instead of reacting to pain after surgery with drugs, the procedure is meant to preemptively block it — targeting nerve endings in the chest that create the most severe discomfort.
Ley said he’s the only surgeon in Mississippi to consistently use this so-called “pecs block” procedure, which has slowly gained traction elsewhere in the country. Recent studies show its effectiveness in reducing patients’ perceived pain.
“It’s made a huge difference,” said Ley, who is based at Merit Health Woman’s Hospital in Flowood. “Patients, they’re scared. They’re anxious about having (breast surgery) done. And no one wants to hurt.”
Earlier this year, Jackson headed north for her second breast cancer surgery. She was anxious and wanted to get it over with.
Just as before, she was placed under anesthesia.
But this time, before surgery began, Ley’s team used an ultrasound to guide a needle into the areas where nerves emerge around the pectoral muscles in Jackson’s chest. She was given an anesthetic called ropivacaine and a steroid in a series of targeted injections.
The idea, Ley said, is that if you block these nerves in advance — before the pain fibers are stimulated — the patient won’t feel as much pain following the operation and will recover more quickly.
Jackson said she could hardly believe it: “I had no pain.” For this second breast surgery, a more serious operation than the first, she hadn’t needed any opioid painkillers.
Laurie Smith, executive director for the State Workforce Investment Board, had a similar experience as Jackson after her surgery last month.
The scariest time had come beforehand, she recalled. Ley called her on a Saturday to tell her MRI results showed cancer in her left breast. The mental stress was intense, she said, especially considering she’d never had any type of surgery before, even minor. Suddenly, she was preparing to have her breast removed and reconstructed.
“It makes you look at life completely different,” said Smith, 52.
But the surgery and recovery wasn’t so bad, she said, a result she attributes in part to the pain block. Smith left the hospital a day earlier than expected. “People will not believe this,” she said, “but I did not wake up to pain. I was pleasantly surprised with that.”
She received a painkiller prescription, but said she only needed a few. On Wednesday — about six weeks after her surgery — she was back to work and in Gulfport, preparing for a visit from Ivanka Trump focused on early childhood education and workforce training.
“I felt horrible for not doing this for patients sooner,” said Ley, who has taught other physicians about the pain block procedure. He said he hopes more in Mississippi begin using it.
Several studies have demonstrated its effectiveness in improving recovery and decreasing the requirement for opioids. Pecs blocks “hold great promise due to their simplicity and relative lack of contraindications and complications,” wrote one team of Korean researchers last year.
Ley said he and several other doctors are mapping out their own clinical trial, to track patient opioid use after surgery and see if the pain block helps.
“This has been very timely, because in the setting of this opioid crisis, (doctors are) under a lot of pressure from the state board of medical licensure to cut back our opioid prescribing,” Ley said. Gov. Phil Bryant’s opioid task force has made recommendations that include requiring doctors to use the state’s prescription monitoring program and clamping down on opioid prescriptions for non-cancer patients to last no longer than a week.
Smith urged women to get screened — and to double check with an MRI if there is any doubt about mammogram results, especially if they have dense breast tissue, like she did. She said she would not have caught her cancer, perhaps for another couple of years, if not for a well-timed MRI on the recommendation of Ley.
“Don’t avoid it just because you’re scared of it,” she said of getting tested.
Jackson, meanwhile, is simply relieved to be cancer-free, after two breast cancer scares, and more recently, a brush with thyroid cancer. She’s back to writing and painting with watercolors.
“You’ve got to believe, and you’ve got to not give up,” she said. “You have to know that you can beat it.”
Read or Share this story: https://www.clarionledger.com/story/news/2018/10/29/new-mississippi-breast-cancer-procedure-less-pain-opioids/1738496002/