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	Talking To Your Medical Team Robert Wascher, MD, FACS, Ernest Rosenbaum, MD, Alexandra Andrews, Charles M. Dollbaum, MD, PhD, Karen Ritchie, MD, Sarah Schorr, RN, BSN, Francine Manuel, RPT, Jean Chan, BA, MA, SEd, Richard Shapiro, MD

The effects of cancer and its treatment endure long after medical treatment ends. Some changes may actually be positive (i.e., you may have a better appreciation of life, or you may have become closer to your family and friends). Other negative changes (e.g., lingering pain, neuropathy, fatigue, scars, lymphedema, cataracts, etc) may serve as constant reminders that you have been diagnosed with cancer. When fatigue, neuropathy, painful or uncomfortable symptoms persist, you may sometimes have interactions with others that appear to be lacking in sufficient compassion and empathy. Friends and family, and even health care personnel, may appear judgmental or skeptical regarding your concerns, because fatigue, neuropathy, and/or pain are not always visible and can't be easily measured.

There are neuropathic changes associated with surgery, chemotherapy, radiation therapy, bisphosphonate therapy and hormonal therapy. Chemotherapy drugs commonly associated with peripheral neuropathy include vincristine, viblastine, vinorelbine, cisplatin, paclitaxel, docitaxel, carboplatin, oxaliplatin, cisplatin, etoposide, tenoposide, thalidomide, bortezomib and interferon. Any breast-associated surgery (e.g., mastectomy, lumpectomy, lymph node biopsy, breast implant placement, and breast augmentation or other types of breast reconstruction) may result in complications. Scar tissue that forms after surgery is not as elastic as healthy skin, and may entrap nerve fibers as the incision heals. Any healing complications such as an infection may further increase risks. Abnormalities in the healing of divided sensory nerve fibers (e.g., neuromas) may also lead to chronic pain in or near incisions.

It is normal to have tightness around the incision (and under your arm if you have had lymph nodes removed from the armpit region) during the first few months after surgery. Moreover, sensory nerves are often intentionally cut during surgery to remove the lymph nodes. This generally results in a tingling pins and needles sensation in the upper inner arm area during the first few weeks after surgery, as the brain attempts to compensate for the loss of innervation of this area. Later, numbness of the affected area usually ensues, and for the vast majority of patients, is not unsettling or uncomfortable. Severe burning or stabbing pain, or severe itching, near incisions, or in the upper inner arm, months after surgery is unusual, however, and may indicate the development of chronic pain. If pain interrupts your sleep at night or significantly impairs your daily life, or if wearing clothing is uncomfortable, then you should ask your physician to refer you to a physical therapist and/or a pain management specialist.

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