Health and medical information

To find out which cause applies in your case your doctor should check for other symptoms. For example, if you are coughing yellow or green phlegm it is probably infection. If you are coughing blood, it could be cancer or blood clots on the lung. If you feel more short of breath when lying flat than when sitting or standing, your heart is probably not working properly. If you or your doctor can hear whistling sounds with your breathing, you probably have some partly blocked bronchial tubes-

Often your doctor will be able to tell the cause just by taking your history, examining you and arranging a chest X-ray, but sometimes other tests, such as a lung scan, may be advisable.

Once the cause is found, it may be possible to correct it. For example, pneumonia could be treated with antibiotics, clots on the lung with drugs to thin the blood (anticoagulants) and anaemia with a transfusion.

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You will probably be visited by an anesthetist on the ward before your operation.

An anesthetist is a hospital doctor who has been trained in the special skills of giving drugs which cause loss of sensation or consciousness, or both (anesthetics), and those which block feelings of pain (analgesics). Anesthesia is a vital part of any operation, and a great deal of time and trouble will be taken to make sure that you receive the anesthetic which best suits you.

The pre-anesthetic visit

The main reason for the anesthetist’s visit before your operation is to decide what type of anesthesia would be safest for you. This visit also gives you the opportunity to discuss any problems or worries you may have concerning your anesthesia.

The anesthetist will ask you several questions about any anesthetics you have had before, any drugs you are taking, and about your general health. It is important that you answer these questions as fully as possible. You should also mention to the anesthetist if you have any false or crowned teeth.

If you have had any problems in the past such as an allergy to a particular anesthetic, it will be helpful if you know the name of the drug concerned or the hospital where the operation was carried out. The appropriate records can then be checked to make sure another type of anesthetic is used for your breast operation. You should also tell the anesthetist if you know of any other member of your family who has reacted against a particular drug, as you may have the same problem.

The anesthetist may also want to examine you and to look at the results of any tests you have had. There are different types of anesthetic which can be used for breast operations, and some health problems will preclude the use of certain ones.

General anesthetic

Virtually all breast operations require a general anesthetic; the only exception may be for a biopsy, which can be performed in the out-patients’ department using a local anesthetic. A general anesthetic will put you to sleep, and abolish any feelings in your body. It can be given in two different ways.

1    Intravenous anesthetics can be injected into a vein via a plastic tube which is inserted into your hand or arm, and will put you to sleep within a few seconds.

2     Inhalational anesthetics are gases which you breathe in through a face mask and which act within 1 to 2 minutes. As the use of a face mask can cause some people to panic, it is not normally applied until you are asleep.

During the operation, the anesthetist will make sure you stay asleep by giving you more drugs as necessary.

Risks of general anesthesia

People with certain medical conditions, such as heart or lung disease, may not be given general anesthetics as they are potentially at greater risk.

Some people are afraid of being put to sleep by a general anesthetic because they fear the possibility of never waking up or of suffering brain damage. General anesthetics are very much safer today than they were even 20 years ago, because of the many advances in techniques and drugs. Therefore, their risks are small, although they do have to be borne in mind. If you are worried about this, you should discuss with your anesthetist the possibility of an alternative.

Local anesthetic

When the general anesthetic has taken effect and you are asleep, the anesthetist or surgeon may inject some local anesthetic into the area of the wound. This is the same type of anesthetic that a dentist uses to numb the teeth before a filling. The injection will provide you with pain relief after the operation, for about 4 to 6 hours.

Other medication

In some hospitals, a pre-medication drug (‘pre-med.’) is given routinely to patients to reduce their anxiety before an operation. A ‘pre-med.’ is given by mouth, as tablets or syrup, or by injection several hours before the operation, and will probably make you feel sleepy and relaxed.

You may be asked whether you would like to have a ‘pre-med.’, or you may have to ask for one yourself if you feel anxious and have not been offered one. You can, of course, also say that you do not want one if they are given routinely in your hospital. The anesthetist will be able to discuss this with you.

You may also be given any drugs that you normally take, such as diuretics (‘water tablets’) or drugs to reduce high blood pressure.

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