Outpatient surgery not best for mastectomy patientsNo one...

SATURDAY MAIL BOX

November 23, 1996

Outpatient surgery not best for mastectomy patients

No one knows how mastectomy patients feel after this surgery. . . . This is the worst pain imaginable. You have tubes runing into the surgical site for drainage. You are unable to lift your arm, and you are taped and bound together.

I cannot believe the comments from Dr. Lauren Schnaper, who runs the breast center at Greater Baltimore Medical Center. She says, "My philosophy is that breast cancer surgery is more of a psychological trauma than it is a physical trauma." Is she joking, or what? Or has her busy schedule stopped her from being sensitive to our situations?

When I came home from the hospital I was devastated. I had two small children to care for; I was forced to get back to work even though I was dealing with a major catastrophe in my life. When I had my surgery I was in the hospital for one week.

I cannot imagine being at home with all the discomfort I felt mentally, emotionally and physically.

June R. Terry

Baltimore

Jonathan Bor's Nov. 15 article, ''Mastectomy hospital stays brief,'' failed to state strongly enough the abusive and damaging effects of outpatient mastectomy policies.

While it might be an option at either Greater Baltimore Medical Center or Johns Hopkins for a woman to remain in the hospital overnight or have her mastectomy done on an outpatient basis, Kaiser Permanente (which uses the facilities at GBMC) did not allow my friend to choose how the procedure would be managed. The amputation of her breast was done in the morning, and she was sent home that afternoon.

Unlike Dr. Lauren Schnaper, who runs the breast center at GBMC and believes that when patients go home the same day ''they are ensconced with their families in their own home . . . and get a better night's sleep . . .", my friend came home to a houseful of small children who did not give her a moment's rest. . . .

Dr. Schnaper states, ''The nurse comes into their environment and helps them deal with their environment . . .." Kaiser Permanente has no provisions for a visit by a home-care nurse; when my friend was required to change her bandage there was no professional to help.

Even if she had wanted to change the bandage (and after only a couple of days following the surgery she was psychologically unready to confront looking at her raw, maimed body), limited movement in her arm made the process difficult.

Worse, she had no idea how to change the dressing. When she called the doctor, her doctor's response was, ''But I told you how to change it three times!'' Pre-op instruction may be nice, but when a patient is in emotional shock, she isn't terribly receptive to information. . . .

Dr. Schnaper states, ''They will be tired, but I feel [encouraging them to do things the next day] will keep them from being depressed.'' But it won't keep them from feeling neglected, angry and anxious as a result of being spit out of a medical system more concerned with cost effectiveness than healing.

For women, a breast is not simply a body part. It represents nurturing and sexuality. One wonders if outpatient surgery would be done on a man suffering from testicular cancer.

Yes, there is life after breast cancer. But outpatient mastectomy does not aid in the recovery process, unless it is given as an option, not a requirement.

Galia Berry

Pikesville

If the mothers, wives and daughters of the heads of the health insurance companies and Dr. Lauren Schnaper (The Sun., Nov. 15) become victims of breast cancer and have the appropriate operations, then they can speak with authority, as I can, the spouse of a cancer victim.

Leonard H. Cohen

Baltimore

Deer hunting debate far from resolution

With regard to the deer bow hunt at Sandy Point State Park, whether you're for it or against it, one clear lesson has emerged from the controversy:

It is unreasonable to expect a division of a state agency that derives 92 percent of its revenue from a special interest group to make public policy decisions unclouded by the fact of that support.

The Nov. 10 article in The Sun cites Joshua Sandt, director of the Department of Natural Resources Wildlife and Heritage Division, as noting that ''virtually all of his $6 million budget come from sales of licenses or permits to hunters or through reimbursements to the state from an 11 percent federal excise tax on sporting arms and ammunition."

It seems to us that it would be a wise decision on DNR's part, at this point, to set up an independent Citizen's Advisory Council to have input in the agency's decision-making process regarding sensitive public policy issues.

The commission of such a group would ensure that all interests and points of view are fairly represented and heard. At the very least, it would expose DNR officials to a broader base of public opinion.

Given the current fiasco, this appears to be the kind of information that DNR should have.

Lora Junkin

Baltimore

The writer is executive director, William Snyder Foundation For Animals.

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