The Truth is Out There
Today I had my 10 am appointment with the surgeon at the Breast Care Center. It took a while for them to find the films from yesterday's mammogram, so I had to wait. The only size of gown they have is way too small for me. Yesterday, in radiology, they told me that they ordered larger ones and didn't get them. The tech said, "I don't know, maybe UCSF hasn't paid their bill." Today I sat on the exam table, ineffectually trying to pull the edges together, waiting. They have you put on the gown with the opening in the front and let's just say that makes it look all the more embarrassing. With my breasts scrunched together and my cleavage exposed, I looked like some Renaissance Faire wench with a really bad costume.
When the surgeon came in, I shrugged and said, "All attempts to preserve my modesty will prove futile, so I'm giving up on this." I mean, really, I better get over it now.
The surgeon did a physical exam. She, too, had a hard time finding the lump. I guess when it is your lump it's easy to find, but it's not so obvious when it's on someone else. She gave me a binder of information on breast cancer, with tabs for the different topics on which they may later give you handouts (surgey, radiation, chemotherapy, etc.). I've nicknamed it my "You've Got Cancer!" binder, because that's what I think of whenever I see it. And, yeah, I say "you've got cancer" with that weird AOL voice from the old commercials.
Going over my options of mastectomy or lumpectomy, she pointed out that the survival rates are pretty close no matter which you choose. With a lumpectomy I would need 6-1/2 weeks of radiation. I'd already read up on this and knew I wanted a lumpectomy. Honestly, I pretty much wanted her to whip out a calendar and schedule the surgery on the spot, but that's not how it went.
This particular surgeon is nice, all smiles and encouragement. She we'll do the surgery, check my lymph nodes for cancer, I'll get the radiation, and I'll be just fine, nothing to worry about. I understand that she is trying to reassure me, but I'm funny about that. I get a little edgy when people tell me I'm fine before we have all the data. I suppose most people want to hear they have nothing to worry about. But in this kind of situation, I just want data. And data, of course, is what we don't yet have. We have questions.
She asked about my family history. Because the breast cancer history is so strong and there is a possible history of ovarian cancer, she wants me to see a genetic counselor right away. The genetic counselor will take the details of my family history as far back as I can give it (cancer-related) and possibly test me for BRCA-1 and BRCA-2 genetic mutations. The goal is to evaluate whether or not I'm at "extreme risk" for recurrence (for example, a 50% risk of getting cancer n the other breast) as well as at risk for ovarian cancer. The surgeon asked me to schedule with that department as soon as possible, as they would recommend a mastectomy (bi-lateral) if I was carrying a gene mutation. Oh, my!
My other breast is also of concern. The reason they did magnifications on that breast when I had the mammogram yesterday is because there is an area of micro-calcification, right in the area where I had the fibroedenoma removed. She said that sometimes there are pre-cancerous cells hiding out in calcifications. I don't think there's any cancer there, but funny, no one wants to take my word for it. She scheduled me for a core needle biopsy in the imaging department at 12:30.
And that was that. They scheduled me to come back next Wednesday and then Kathy and I pretty much just had time to head over to imaging for the biopsy.The tech from yesterday rushed me in back, had me change, and then sat me down in the waiting area to explain what they were about to do.
The thing, is, she was talking very softly so as not to have all the women sitting next to me hear, and as a result, I could barely hear her. She explained that this biopsy was guided by digital mammograms and used a thick needle that removed several tissue samples from my breast. I knew all this from the handout I had quickly skimmed, moments before, but sometimes she'd mutter something that I didn't catch, as she was speaking so low. When she whispered something followed by smacking her fist against her flat palm, and telling me "be sure not to move" I had to wonder what that was about!
She asked what I had eaten and I confessed that I hadn't had a bite to eat all day. That worried her, so she rushed me into a mammogram room and gave me a bagel and a bottle of water. While rattling off information about the biopsy and asking questions about what medications I had taken, she kept pausing to say, "Keep chewing! You need to eat now!"
A nurse then came to take me into the biopsy room. Now this was strange. They had me climb up on this big table that was covered in white cloths. It had a hole in the center of the table. The nurse said to position myself so that I could slip my right breast into the hole in the table. I couldn't help but feel like a milking cow at a corporate dairy! I had to lie in a specific position so that they could flatten my breast in a pair of digital mammogram paddles. One of the paddles has hole that they can insert the needle through (and then into my breast). They raise the table up high, then the nurse and a doctor move underneath the table to do the biopsy.
The idea is that with the paddles they can take digital mammograms, which are available instantly, helping them locate the exact area they need to biopsy. They position the paddle so that the hole lines up with the biopsy target. Once they are sure they have the right spot, then they punch the needle in to get tissue samples. (Apparently, that was what the tech meant with her first and her open palm!) More mammograms confirm that they are getting tissue from the precise location they want.
It's all fascinating technology in retrospect (and I think it's just a few years old) but it's really weird when you do it. Thank goodness there is lydocaine involved! The doctor who did my ultrasound was the one who did the biopsy. She was very good about making sure I was numb enough before beginning the procedure, and she kept checking in with me to make sure. The whole thing goes on for at least 45 minutes (maybe longer) and you have to stay very still, so I just imagined that I was a spy. If I moved at all, I was in danger of blowing my cover. No way was I moving!
Problem was, with all this talk of core samples, my mind started drifting to...the geologic core samples that so fascinated me when I was a kid. I recalled the educational movies where they'd show scientists extracting long tubes of muddy gray soil from the earth. Ooh, no, mind like water! Mind like water! Then my mind drifted to the X-Files, remembering Scully running while carrying core samples from the arctic. Was it an alien bounty hunter who was after her? Didn't she have cancer that season? Hmmm.
When it was all over, they held my breast in compression for a while, then had me press against it. The nurse and the doctor kept telling me what a great job I did, how I was amazing. I thought, "Do I get an A? Will my surgeon see the grade?" Then I thought about it more and wondered, "Hey, did I have an option NOT to be amazing? Could I have been, oh, screaming, instead?"
So, I'm bandaged up and have my list of what to do. Ice 15 minutes on 45 minutes off, if you listen to the nurse; 20 minutes on/20 minutes off if you listen to the doctor. Tylenol only; no Advil. For 48 hours, no exercise, no lifting, no baths.
At this point, I'm tired and I'm hurting. I really wanted to learn some answers today, but I came away with the opposite. I think I need to sleep.
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