Pain after MOHS Surgery...

[keri125]

Good morning, everyone!
I did a search for the MOHS threads and found several that were encouraging, but didn't see anything addressing my particular question.
Literally close to exactly 48 hours ago (close to exactly? That doesn't make much sense! ) I had MOHS surgery performed on my nose. They removed a basal cell carcinoma spot. My spot was very small, but they did have to make two passes to get it all. Before they closed it up I snuck a look with my phone and was surprised by how much they had to take out - the hole was the size of dime. However, my doctor was able to cut the incision so that they could pull it together so that I will only have one thin scar down my nose, as opposed to looking like I am missing the entire tip of my nose! The procedure itself was pretty painless, one sharp pinch with the first needle and then literally nothing after that.
However, I am still experiencing quite a bit of pain today. When I left, the doctor stated that most patients don't experience much discomfort after and to take Tylenol and ice it if I experience pain. I did that the first few hours after the surgery, but I am a single working mother and had to return to work, where I can't just sit there with an ice pack on my nose! LOL I have been taking Tylenol but even with that it feels like someone is holding a burning match to my nose. I had ankle surgery at the end of May and didn't experience this much pain; however, that was a deep numbing that didn't really completely wear off for a week or so, so the incision was fairly healed by the time the numbing wore off. The past two nights I have had to take the codeine medication that was prescribed to me for my ankle surgery (that I never even touched after that surgery) just to be able to sleep around the pain in my nose.
Here is my question... I am a bit of a baby when it comes to pain... if I experience pain I always tend to think it is worse than it is. I am also trying to keep in mind that my nose has been sliced open, burned (cauterized) and has six external stitches (and I believe a number of internal stitches)... of course it is not going to be pain-free. In addition, it is amazing how much you move your nose without knowing it when you laugh, smile, talk, yawn, and eat!! So it is constantly moving around. That being said, for those of you that might have experienced MOHS surgery on the end of your nose, what was your pain like afterwards? If there are people who have experienced it on the end of your nose, I am particularly interested in hearing from you, as I would imagine the pain experience might be different if the surgery was in a spot that does not get moved much.
Thank you so much!

 

[jodybird511]

I haven't experienced this myself, but my mom has had this procedure multiple times on various places. She has experienced not-insignificant pain. My best advice for pain is to try and stay out in front of it. Don't wait for the pain to start before you take Tylenol, or whatever you're taking for it. Take the pain meds on a scheduled basis for the next few days--this is the best way to manage it. Though many believe that they're being "tough" by not taking the meds, if you wait for the pain to ramp up, you actually typically end up needing to take more meds than if you stayed out in front of it. Best of luck with your healing process!

 

[aprilgail]

My mom has had about 8 MOHS treatments over the past few years and goes for another next week. One of them was on her nose- so much that her nose is permanently misshapen but she never complained about any pain from any of them.

 

[Simba's Mom]

DH had MOHS surgery, also on his nose, and he had lots of pain for a lot longer than 48 hours. But they had to call him back in from the waiting room to do more about 5-6 times. I think the doctor said that it had spread underneath the skin. It was pretty good size because first they told him he could wait, but then just before he was due to have the MOHS, they found melanoma elsewhere, so the basal cell carcinoma waited even longer since the Melanoma treatment took precedence. Actually, DH says the MOHS on his nose hurt LOTS more than the melanoma surgery ever did.

 

[Christine]

I've never had the surgery, but I've had plenty of things removed from my skin much less invasive than MOHS. I have had moles removed from my back and arm and I swear that hurt for DAYS. The skin has a lot of nerve endings so I'm not surprised at all.

 

[keri125]

Don't wait for the pain to start before you take Tylenol, or whatever you're taking for it. Take the pain meds on a scheduled basis for the next few days--this is the best way to manage it. Though many believe that they're being "tough" by not taking the meds, if you wait for the pain to ramp up, you actually typically end up needing to take more meds than if you stayed out in front of it.

This! I think this is where I am going wrong... I am waiting until the pain is really noticeable before taking any pain medication, and then it doesn't really help. Today I took your advice and took my Tylenol at lunch before the pain could get too horrible and I am doing a lot better this afternoon.

Thank you all for sharing your experiences!! While I'm not GLAD you have all experienced pain with the surgeries, it is comforting to know that there is not something wrong with my incision, stitches, etc., and that the pain can be worse than what the doctor had indicated in the beginning. I feel much better now. Thank you again!

 

[kmb584]

My mom had a MOHS procedure done on her cheek area and her dermatologist had to go down 7 layers to get it all out. Not only did it take hers forever to heal, but she was in quite a bit of pain too for almost a week afterward. As another poster said, stay ahead of the pain. Don't wait for it to come on.

 

[Pea-n-Me]

When tissue is cut, there can be local inflammation for a few days, and inflammation causes pain. You have stitches in there and everything. Ice can help that, along with your Tylenol. It should begin feel better soon.

 

[cluvsdisney]

I had MOHS surgery last year and I don't recall having too too much pain. Maybe a day or two of pain then it was more discomfort. Mine was along that line from the corner of your mouth towards your chin which is great for masking a scar but terrible for things like eating, brushing teeth, etc.

I'm sure you'll feel better soon.

 

[Psychodisney]

I had MOHs on my chest in January and am scheduled next month for one just under my lip. The day of surgery, I thought it was no big deal since I was numb. It was worse over the next couple of days. I had quite a bit of discomfort for several weeks. I don't know if I characterized it as pain. Think about how much they had to stretch the skin to close the hole! For me, I had a hard time even moving my neck because it pulled so much and when I payed down it pulled too! The swelling should start going down soon and hopefully you will feel better. I'm pretty nervous about the lip!

 

[ronandannette]

When tissue is cut, there can be local inflammation for a few days, and inflammation causes pain. You have stitches in there and everything. Ice can help that, along with your Tylenol. It should begin feel better soon.

Hi Pea-n-me! Many of us here really appreciate your expertise in heath-related matters. Is Tylenol what you'd recommend for this kind of pain? Ibuprofen is my go-to for practically everything except fever now. How does one tell which OTC med is most appropriate?

 

[Pea-n-Me]

Hi Pea-n-me! Many of us here really appreciate your expertise in heath-related matters. Is Tylenol what you'd recommend for this kind of pain? Ibuprofen is my go-to for practically everything except fever now. How does one tell which OTC med is most appropriate?

Sometimes Ibuprofen is not recommended for surgical procedures because it can cause bleeding, whereas Tylenol doesn't. Ibuprofen can help with inflammation, but usually at larger doses, and some forms of inflammation more than others. In this particular case, Tylenol would be the go-to because it's what the provider who did the surgery recommended. Sometimes it's personal preference, and sometimes there can be reasons for choosing one over the other, such as the bleeding issue, or a person's medical history or interaction with other medications they're on. I keep both on hand at home. In the hospital, we do use Tylenol a lot more than Ibuprofen. I have heard in the past it's because hospitals get it for "free" (I'm not sure if that's true anymore, or if it was ever true), but I can say that providers are usually more comfortable prescribing Tylenol than they are prescribing Ibuprofen, with some exceptions. An example would be someone who has something like pericarditis. Treatment is usually NSAIDs round the clock for a few days to decrease the inflammation around the heart that is causing pain. But for most people with general pain, Tylenol is offered. I myself like Ibuprofen, but I will use tylenol too. I try not to use much of eithe if I can help it, as tylenol can be hard on the liver, and ibuprofen the kidneys. (But there is a time and place for usage and that is definitely after surgical procedures!)

 

[AquamarineSteph]

My mother had this surgery and significant pain afterwards. If you are still experiencing pain, call your doctor first thing in the morning (so that they can deal with the issue before they close for the day). It's not being a baby to say that it hurts if you have tried the OTC remedies and are still in pain.

 

[ronandannette]

Sometimes Ibuprofen is not recommended for surgical procedures because it can cause bleeding, whereas Tylenol doesn't. Ibuprofen can help with inflammation, but usually at larger doses, and some forms of inflammation more than others. In this particular case, Tylenol would be the go-to because it's what the provider who did the surgery recommended. Sometimes it's personal preference, and sometimes there can be reasons for choosing one over the other, such as the bleeding issue, or a person's medical history or interaction with other medications they're on. I keep both on hand at home. In the hospital, we do use Tylenol a lot more than Ibuprofen. I have heard in the past it's because hospitals get it for "free" (I'm not sure if that's true anymore, or if it was ever true), but I can say that providers are usually more comfortable prescribing Tylenol than they are prescribing Ibuprofen, with some exceptions. An example would be someone who has something like pericarditis. Treatment is usually NSAIDs round the clock for a few days to decrease the inflammation around the heart that is causing pain. But for most people with general pain, Tylenol is offered. I myself like Ibuprofen, but I will use tylenol too. I try not to use much of eithe if I can help it, as tylenol can be hard on the liver, and ibuprofen the kidneys. (But there is a time and place for usage and that is definitely after surgical procedures!)

Very informative - thank you!

 

[Shellsbutt]

I had Moh's surgery for a spot under my right eye last summer. I had to go in four times for them to get it all and I needed a skin graft. My doctor had prescribed norco(combo tylenol/hydrocodone). I'm quite nervous about taking medication, so I toughed it out the first night. The second night I took half a pill because I couldn't sleep! Some of the side effects I read were nausea and vomiting- I didn't want to be ill on top of everything else. I would definitely call if you are still in pain, and take it easy the rest of the week. I was also told not to do any bending or lifting, maybe that's just to do with grafts though. I also went through a few days of constant itchiness at the site as it was healing. It drove me crazy! Good luck to you.

 

[AquamarineSteph]

In the hospital, we do use Tylenol a lot more than Ibuprofen. I have heard in the past it's because hospitals get it for "free" (I'm not sure if that's true anymore, or if it was ever true), but I can say that providers are usually more comfortable prescribing Tylenol than they are prescribing Ibuprofen, with some exceptions.

I used to do ordering in a hospital pharmacy that was part of a huge chain of hospitals with a very good purchasing contract. We would buy a huge case of hospital/government priced Tylenol for very little cost. It wasn't free, but given the low cost of acquisition, the profit margin for the hospital on that one drug was good.

 

[Pea-n-Me]

I used to do ordering in a hospital pharmacy that was part of a huge chain of hospitals with a very good purchasing contract. We would buy a huge case of hospital/government priced Tylenol for very little cost. It wasn't free, but given the low cost of acquisition, the profit margin for the hospital on that one drug was good.

Ah, makes sense, thanks.

 

[keri125]

Update: Thank you all so much for your responses! I had my sutures taken out yesterday and she said it looks great! (No infection, thank goodness, which was a fear of mine). I asked her about the level of pain in the beginning and she basically reiterated what all of you lovely folk had already said... it is different for everyone. I told her that the doctor had stated I shouldn't feel much discomfort at all so it worried me when I had the amount of "discomfort" (read: pain) I had after he had said I would not have much. She just repeated what she had said earlier, that everyone experiences it differently. I told her I felt like the doctor should share that information instead of saying that I wouldn't experience much - kind of set me up for worry. She just laughed. Anyhow, while the incision site is still very tender, I am not experiencing any other pain and am completely off pain killers, and I feel much better. I just wanted to follow up on this thread in case anyone else has a similar experience. Again, all of you were very reassuring and saved me an expensive office visit by allowing me to relax and follow-up at my previously scheduled appointment. I really appreciate it!

 

[PrincessShmoo]

Update: Thank you all so much for your responses! I had my sutures taken out yesterday and she said it looks great! (No infection, thank goodness, which was a fear of mine). I asked her about the level of pain in the beginning and she basically reiterated what all of you lovely folk had already said... it is different for everyone. I told her that the doctor had stated I shouldn't feel much discomfort at all so it worried me when I had the amount of "discomfort" (read: pain) I had after he had said I would not have much. She just repeated what she had said earlier, that everyone experiences it differently. I told her I felt like the doctor should share that information instead of saying that I wouldn't experience much - kind of set me up for worry. She just laughed. Anyhow, while the incision site is still very tender, I am not experiencing any other pain and am completely off pain killers, and I feel much better. I just wanted to follow up on this thread in case anyone else has a similar experience. Again, all of you were very reassuring and saved me an expensive office visit by allowing me to relax and follow-up at my previously scheduled appointment. I really appreciate it!

Thanks for the update.

 

[Simba's Mom]

Glad to hear things have gotten better. I was interested reading this thread to discover that MOHS surgery is prevalent in other areas of the country. Unfortunately, around here we had to go to a major cancer center 350 miles away for MOHS. This is the first time I've been lucky enough to talk to someone else who had MOHS surgery besides DH. It's interesting that you went back for suture removal. DH had dissolving stitches, but maybe that was because we lived so far away-a long drive just to have stitches taken out.