Wednesday, September 25, 2013

A Funny Thing Happened on the Way to My Date with the Breast Surgeon

Let me start out by clarifying that by "date," I mean "appointment."  It's just that the blog title was already sort of long and "date" sounds more intriguing.  There's only one fellow with whom I actually have dates, and he's been amazingly sweet and supportive throughout the past couple weeks. Well, truly, throughout the past nine months -- just realized tomorrow is our nine month anniversary! But especially with all this fun stuff. And for that, I am quite thankful!

Anyway, as those who've been following along know, I explained last week why Now is the Time, and earlier this week why there are times When 0 > 1. I'm going to continue with my kudos to Breastcare Center #1 and the Nurse Coordinator Lisa - she got me set up with an MRI yesterday and an appointment with the breast surgeon today. That's some fast work! 

I've never had an MRI before.  And, to be honest, never really imagined having one for my breasts, as opposed to my knee or back. Or head. (It really probably warrants a thorough examination.) When Lisa called to set it up, she walked through all the preliminaries -- made sure I wasn't claustrophobic (nope!) and didn't have any metal in my body (nope!)  Oh. Wait.  Oops.  (Mom, don't read this part. Or don't be shocked.) I do have a belly ring. And it's of recent enough vintage that I wasn't entirely comfortable with the notion of removing it. Not to worry!  The tattoo/piercing place where I got it done has these nifty little plastic insert thingies which Mr. Technician was kind enough to swap out for me for the low-low price of $5. 

So, off to the MRI place I went yesterday morning. They got me in quickly, prepped me for an IV (for the contrast) and ushered me into Magneto Land.  The machine looked pretty much like what you see on TV. Only it was set up for me to be on my stomach, rather than on my back. I was really concerned about the prospect of having to lie still for 30 or 40 minutes with my head turned to one side, but wonder of wonders - they did have the little cut out for your face like massage tables do! And instead of having my arms down by my side, I got to hold them up above my head. So it was kind of like I was flying. While surrounded by jackhammers.  Man, is that thing LOUD! The tech warned me that even with the earphones piping in music (I chose classic rock - yes, I got scanned rocking out to Billy Squier and AC/DC), the machine would be loud. She wasn't lying! Once I was in there, I started worrying about moving too much. I didn't want to breathe too hard, then realized I was holding my breath and that probably wouldn't work out all that well.  I tried to relax, but then I was worried I might have to cough.  Or that I'd start to fall asleep and twitch.  Or that I'd have a weird reaction to the dye.  Thankfully, none of the above happened, and I was only in the machine for about 30 minutes.  

Once out, the tech handed me a CD with my MRI scans on it to take to my appointment today. They'd forward everything over to Breastcare Center #1 and I'd get a call in the afternoon with the results. Sure enough, Lisa called early in the afternoon. What she said was somewhat encouraging: The MRI looked "good," although the reading was a little complicated by the fact that I'm at a "high hormone" phase of my cycle. (So don't piss me off!)  This phenomenon apparently causes one to "light up like a Christmas tree" when magnetized, which is why they optimally schedule MRI's for a different time. BUT, she explained, when they do have a diagnosis of cancer, they don't like to wait. She didn't think this would require me to undergo another MRI in a week or two, but I'd need the results confirmed with the surgeon when I met with him.

Okay. Good enough.  I'd take that as positive news and see what Dr. Surgeon had to say. The appointment was set for 10:40 this morning, and I initially toyed with the idea of going into work early, then going to the appointment, because, you know, work is what pays the bills (in theory)! I nixed that idea when I started feeling icky late yesterday afternoon -- my throat was sore and I had a fever. Bleh! Alright, so I'd stay home and rest this morning, then go to my appointment, then go to work if I felt better.  

I left the house on schedule, but was worried I might not make it to the appointment on time because I lucked out and got stuck behind Mr. Snail on Clayton Road. Finally got past him and made it to MoBap with about a minute to spare.  Hurried up to the sixth floor, walked into the doctor's office and thought, "Hmmm....this place looks....familiar."  Well, there's a reason for that.  Turns out it's the same place I went for my mammogram four years ago that didn't take my insurance.  The place that made me be all stubborn about getting one rescheduled. (No, truly - the place didn't make me be that way - I was that way. Still....)  Well, I thought, they already had all my paperwork and info and no one had sounded any alarm bells, so maybe all would be well. I filled out the remaining paperwork, gave them my ID and insurance card, and had a seat.  To occupy my time while I waited, I tweeted some, checked e-mail and Facebook and texted David. Me: "Also - in a strange twist of fate - this doc office I'm in is the place that didn't accept my insurance 4 years ago when I tried to come get a mammogram...." Him: "Cue Twilight Zone theme....Keeping fingers crossed for you this morning for good news on multiple fronts." Me: "Oh I'm just waiting for them to come out and tell me they still don't accept it so I can't see the doc....."  Thirty-five minutes later.... Me: "Called it."  

Yes, yes indeed.  Turns out that, while this place accepts Coventry, I have an extra special version of Coventry which they don't accept after all.  In fairness, I can kind of understand the confusion. And the nurses who talked to me were very nice and apologetic.  Dr. Surgeon even came in to talk to me and apologize.  He was very nice and handed me this snazzy canvas tote they'd already made up for me with all sorts of breast cancer related goodies in it. (I'm using that term rather loosely - mostly, it's literature re: various aspects, treatments, etc.  But there was a little pillow thingy in there.  Oh hell - I just Googled "breast cancer pillow" and discovered that this is a special pillow designed for people suffering from uncomfortable pain due to mastectomies and such. I'm going to remain optimistic and hope that's something they give to everyone who's been diagnosed.  Not just surgical candidates.)  He also wanted to reassure me that Ductal Carcinoma in Situ (DCIS), which is what I have, is "very treatable."  Which sounds good and encouraging. Except that it sounds like it involves "treatment" rather than mere monitoring. 

Guess I'll find out more next Tuesday. Which is when my new "date" with new Dr. Surgeon -- who does take my insurance -- is set.  'Til then, I certainly won't object to any prayers or good thoughts sent my way. Because it's been a helluva week already. And it's only Wednesday! 

Sunday, September 22, 2013

When 0 > 1

Last week, I did my best to gently nudge my female friends to stop procrastinating and make those mammogram appointments they've been putting off.  As I explained previously, turned out mine was a wake up call I hadn't really expected. It revealed some calcifications in my right breast, which often signify nothing but sometimes can spell trouble. These are itty-bitty things that one would never feel or be aware of in the slightest absent the wonders of modern day technology.

In order to rule out their being something more than nothing, I underwent a "stereotactic" biopsy this past Thursday. If you're like me, you probably don't know what "stereotactic" means, so I'm including the handy dandy Merriam Webster medical definition here for you:
involving, being, utilizing, or used in a surgical technique for precisely directing the tip of a delicate instrument (as a needle) or beam of radiation in three planes using coordinates provided by medical imaging (as computed tomography) in order to reach a specific locus in the body (as a tumor in the brain or breast)  <a stereotacticbiopsy>   <a stereotactic surgical probe>
Basically, they use a modified mammogram technique to visualize the area of concern and then use that to guide this hollow ("core") needle to it in order to extract several strips of tissue for further examination. Sounds easy enough, but it does have its tricks: For starters, they have you lay down on a special surgical table, face first. It has an opening toward the top for your breast to - theoretically - hang through, and a pillow above that on which you rest your head, facing one side or the other. Then they elevate the table and the nurses and technicians get you all positioned just so and take several different films in order to pinpoint the calcifications - it's pretty much like getting a horizontal mammogram. The mammography unit then holds you firmly in place so the radiologist can perform the biopsy.  The table they have you on is padded - somewhat like an ironing board - so it isn't terribly uncomfortable. What is uncomfortable is that you have to lie very still while all this is going on, which means you can't move your head or neck at all - for as much as 30-45 minutes. 

I, of course, further complicated things by managing to have calcifications in the upper outer portion of my less-than-ample boob - which made actually getting the things visualized and me positioned properly for the procedure rather awkwardly difficult. Finally, the fine folks who were working with me quite apologetically asked me to get down off the table so they could remove the padding from it in hopes that this would then allow the target area to hang through adequately enough. Thankfully, it did. (Never thought I'd consider the fact that gravity has very little effect on my breasts a bad thing, but in this case, it was - who knew?!)

At long last, we had visualized calcifications and properly-positioned Susie. Next came the requisite prepping of the biopsy site with antiseptic swabbing and then local anesthetic. (Yes, this involved a needle - no it wasn't all that bad - pretty much just a pinprick.). Then the radiologist went to work and extracted several tissue samples from the afflicted area. They had to run them to the next room real quick to examine them under a microscope and verify they'd gotten the calcifications, which - yay! - they had. (Yes, I actually said, "Yay!" when this was confirmed.)  The biopsy itself only took maybe 5-7 minutes. At that point, they freed me up and it was merely a matter of applying pressure to the incision site and then, after I rolled over (much to the joy of my stiff neck), applying Dermabond surgical glue to the incision - which was about a quarter-of-an-inch - and then a dressing over that, which the nurse did quickly and efficiently. 

I cannot stress enough how absolutely professional, kind, caring and warm the staff was throughout this experience. Everyone I dealt with at the breast care center was great, and in particular, Lisa, the nurse who explained the procedure before, who bandaged me up after, and who stood by my side and talked to me and reassured me during the procedure, occasionally reaching over to pat my head or rub my shoulder, was phenomenal. Also, Dr. G, who performed the biopsy, actually was kind enough to massage my neck while we were in a holding pattern at one point during the process. Moreover, they do their best at this facility to make it feel not-so-clinical.  There are numerous feminine touches throughout the offices and exam rooms, lots of pink and positive messages. And during the procedure itself, the lights were dimmed and there was soft music piped in - it almost made it seem spa-like.

Almost. Point being that as much as I wasn't there for a facial and a Swedish massage, what might otherwise have been an uncomfortable and slightly scary experience really wasn't all that bad. 

Afterwards, I sat with Lisa in her office while she went over my discharge instructions: that jittery feeling I had was residual from the epinephrine which is included with the lidocaine they use for the local anesthetic and would go away once I went home and rested/napped for four hours; bandage was to stay on for 24 hours; no lifting more than 10 lbs, and no torquing-type motion with my arms for a few days (there went my grand plans of vacuuming and lawn mowing this weekend!)  My Mom was kind enough to be my driver that day, so she took me home and I did as I was ordered.  Okay, I did respond to the dozen e-mails that had invaded my work e-mail Inbox that morning, but after that, I rested. And have done a fairly decent job of taking it easy since. The incision is small and healing fine, there's only minimal bruising, and I'm only mildly sore. 

They told me I'd either hear back regarding the pathology results on Friday or, more likely, Monday. When Friday came and went without any word, I pretty much put it out of my mind for the weekend. I wasn't overly concerned. I remained optimistic that the news would be good - the calcifications would be benign - and we'd all go on our merry way. 

To my surprise, the radiologist called me on Saturday.  She had the results and said she didn't want me to have to wait out the weekend. Unfortunately, she wasn't able to be the bearer of good news - though, it wasn't terrible news either.  I have "carcinoma in situ" - which is an early form of cancer that is defined by the absence of invasion of tumor cells into the surrounding tissue. They classify it as "Stage 0". Which is, of course, better (greater!) than Stage 1 or 2, and way better than Stage 3 or 4. Basically, Stage 0 means there's no tumor, no lymph node involvement and no distant metastasis. I just had some nasty little cells hanging out in there that would very likely turn into something worse if left untreated. next step is to have an MRI of both breasts. This will thoroughly scan for any other nasties. If none are found, then no further treatment will be necessary at this time. If some are, I may have to undergo another biopsy, or, depending on the extent, a lumpectomy and radiation. Obviously, I'm partial to the first option. The good thing about the MRI is that even though it will require me to lay still on my stomach once again for around 45 minutes, per Dr. G, they shouldn't have to remove any padding to scan me.  Sure would be nice if they had it set up like one of those massage tables so I wouldn't have to keep my head turned to one side the whole time, though!

Dr. G was very apologetic for calling to give me the news she did.  Though as my friend Cari described it - it's the "best bad news" I could have hoped to get. Dr. G did say that it was really fortunate that I got my mammogram when I did - it basically enabled them to catch this at its earliest stages. So I'm looking at this yet again as my opportunity -- and responsibility -- to nudge others to not put off those mammograms any longer. And that goes for men and prostate exams, and for everyone and colonoscopies, etc. -- get tested and scanned when it's recommended. Don't be a procrastinator when it comes to your health. Hopefully, all will be well, but if not, think of how much better it is to catch these things and squash them when they're zeroes. 

Monday, September 16, 2013

Now is the Time...

I'm a terrible procrastinator.  Or....maybe I'm a terrific one.  Whichever adjective best describes one who procrastinates in most all arenas....that one's me.  For instance, I have an office in my house. It's a nice space (converted bedroom), with a desk, computer, printer and filing cabinet, book shelf, and an electric piano. Given its function, it has become the repository for all paper -- bills, tax returns, school records, six years of school art projects, EOB's, old photographs (remember when they used to be printed out?!), etc.  This may not come as a surprise to you, but even one-and-a-half people can generate a lot of paper.  (And laundry - but that's for another time.)  

So, over time, the office filled up with paper I kept meaning to get to and sort through and pitch and organize....but never did.  And since it was already such a mess, it started becoming the place to toss all other items for which I couldn't find a proper place.  And I started keeping the door to the office closed whenever we had guests so no one could see what a pigsty it had become.  I'd get to it.  Eventually.

"Eventually" finally got here last weekend.  I set out with the very unambitious goal of simply sorting through a couple stacks of things which were essentially blocking my access to the closet (which houses various gift wrap/tissue paper/gift bag supplies, along with my business suits and dresses.)  Once I started in, though, it was hard to stop.  And pretty soon, a room which once had required a very careful tiptoe through a maze of stacked papers and assorted things-to-be-pitched-or-donated, returned to its former glory.  Well, almost. There are still several stacks around the edges which need to be addressed.  And several folders of different sorts of paperwork which actually need to be filed in the appropriate file folders.  But it's infinitely more presentable than it was. 

One of the items I came across in my random fit of organization was the envelope containing my old mammogram films.  When I say "old," I mean "old."  These date back to 2000.  Which might seem strange because if one were to do the math, one would realize that way back then, I was only 31-32.  And most 31-32 year olds don't have mammograms.  Well, I did, because way back then, I found a lump in my right breast and had to have it checked out.  It turned out to be nothing.  Just a harmless cyst which eventually went away, thankfully.

So, when my 40th birthday rolled around and at my next yearly check up, my doc wrote a scrip for a mammogram, I took it in stride.  Which, in Susie Speak means "procrastinated."  I wasn't in a real rush to set it up.  I'd had one before.  We didn't really have a history of breast cancer in the family.  It certainly wasn't anything urgent.  Eventually (there's that word again!) I got around to scheduling one.  For some reason, I felt compelled to try out a new place which was in the same location as my OB-Gyn.  And since I'd already had one done, they asked me to retrieve my films from the original place.  Which I dutifully did.  But when I showed up for my appointment and finished filling out the requisite paperwork, I was suddenly advised that this new place didn't actually take my insurance.  (Might have been nice to figure that out before the appointment.)  Since I was already there and scheduled, they'd happily go ahead with it, but that would be $300 out-of-pocket.  Yeah - no.  Forget that! I'd just go back to the original place.

Which would require actually calling and making an appointment.  Which I knew I'd get to....eventually. Have I mentioned that I'm also a little obstinate?  For some reason, the insurance fiasco prompted in me a stubborn resistance to getting around to making that call.  Each year, I returned for my annual check up, my doc would write out another scrip for that mammogram I still needed to go get.  And I'd add it to the stack of papers in my office that I knew I needed to get some point.  I even had it written down on several different "To Do" lists floating around my home and even electronically in my Microsoft One Note personal notebook. 

Well, the newfound sense of freedom and motivation that followed from my office organizing last weekend prompted me to actually get off my duff and follow through on several of those "To Do's," including finally calling to schedule that dang mammogram.  The "old" place welcomed me back with open arms and had an appointment happily waiting for me last Thursday.  I went in with my old films in hand and filled out the updated paperwork.  I'd been through it before (albeit, thirteen years ago), and knew it wasn't a dreadful procedure.  Just a few moments of (as I've heard it described before) feeling like your boob is smooshed in the refrigerator door.  

All went well and I felt pretty good about finally checking that box off the ToDo list!  Sweet! Wouldn't have to worry about that for another five years.  Except that they called me back on Friday to say they needed a Mulligan on the right breast.  Something looked a little off and they just needed to be sure.  Ever the optimist, I chalked it up to the fact that I don't have a lot to work with to begin with and so getting me positioned just right and getting a good image I'm sure is no easy feat.  

So, back I went again today for more smooshing.  And then an ultrasound.  Because, it turns out, it wasn't just an imaging issue.  There isn't a mass of any sort, but there are calcifications lurking in there. Itty bitty things, which most of the time turn out to be benign little nothings.  (These are known as "macrocalcifications.")  However, sometimes, especially if they're clustered together or arranged in a pattern of sort, they can be indicative of a sort of pre-cancerous process going on.  These "microcalcifications," again, most often, turn out to be benign.  But not always. And, in order to be sure of that, they require a closer look. up is a biopsy.  That comes this Thursday.  And I'll know something by Friday or Monday.  (Thankfully, the folks at the breastcare center don't procrastinate. Unlike someone I know....)   And hopefully, what I'll know is that they're just benign little boogers.  And even if not, the good news is this is early and will be addressed accordingly.  

So...why am I sharing all this?  I mean, it is kind of on the personal side.  (Right, like nothing else I've ever written is.....)  Well, I'm sharing it because it just so happens that October (which is just around the corner!) is National Breast Cancer Awareness Month - which is the perfect time for all those of you who, like me, tend to procrastinate to go ahead and make that call and set up that appointment you've been putting off. Because chances are, you're fine, and you'll get the peace of mind of that reassurance and of checking one more "To Do" off your own list. And even if you're not 100% fine, by getting checked out now, you'll know, and be better off tackling that b-word sooner rather than later.  

Now is the time!