The Biopsies (as long to read as it was to do)

August 27, 2009.  It's biopsy day, and I'm scheduled for two: one an ultrasound-guided core biopsy and the other a stereotactic biopsy.

Why two?  The stereotactic is to sample the calcifications, and the core biopsy is to sample the bigger tumor.

My husband asked if me if he should come, but I said no, I'd be fine.  He'd just be sitting in the waiting room anyway.  However, when I got there and saw that it was a place called the Breast Center, I realized he probably would have loved it.

What guy doesn't want to go to a breast center?

Anyway, my appointment was at 11:00 and I got there early and filled out the requisite paperwork and sat down.  As in all of these medical buildings, the TV was on and blaring, and not a soul was watching. I decided that if this was going to be my life, I'm going to invest in one of those TV remote control jammers so I can secretly shut it off.

God forbid I should have cancer AND be forced to watch The View.
 
At about 11:30, they took me back to a little room and had me take my top off and put on a cloth gown.  They gave me a locker key and  told me to put my stuff in there and lock it up.  They asked me to put my phone away too.  I told them I wasn't going to use it as a phone, just for internet, but she pointed to a sign that said "no phone".  So, being the docile being I am, I complied.  Then I sat and waited in a small room with no TV thank goodness, some old copies of People Magazine and oddly, Field and Stream.  There were bakery cookies and lemon water and hard candies, in case we were hungry.  There was an elderly Irish lady there with well-managed Parkinson's and we chatted a bit.  She was chomping those cookies like nobody's business too.

They were having difficulties with their equipment, and were running behind.  I was told it'd be a few minutes but it was two hours until they stuck the first needle in me.

At 12:00, I opened my locker and got my phone out.  I had tried to do what they wanted which was totally against my nature, but I'm done being the good patient.  They really can't expect me to sit there for hours without it.  Nobody said anything.  

Finally, they called me in.  The first test was the ultrasound-guided core biopsy. I  lay back on a table and they put betadine on my breast and then the transmitting gel.  The doctor came in and told me it would hurt, but it wasn't painful at all, and it was very interesting because I could watch it on the ultrasound. I could see the cancer clearly and I saw the needle go in with the medicine to numb all around it. Then they take a gun type thing and shoot a needle in to take larger core samples, and I could watch that too. It was really fascinating to see it go right through the cancer and take out a piece, and you can see the tracks it leaves. They marked the tumor is 2.4 cm x 1.3 x 2.1.. They had my other sonogram pictures there to make sure they got the same measurements and view.

Unfortunately, I bled pretty badly,  and they had to hold a LOT of pressure on for 20 minutes. I mean, that woman was pressing on my my breast with all her big-boned might - it was the most painful thing I'd done so far.    I now have a very large hematoma in that area - she said these tumors are sometimes very vascular. I asked how long that would last and she said for months, but probably would be taken out with my surgery which I guess means she, too consulted with Dr. Google and thinks it's cancerous.

Now, here is my first bit of advice for any woman who finds this blog who may go through the same thing: If, for any reason, you think you might want pictures of your breasts before a mastectomy - take them before your biopsy.  I had in the back of my head I'd be like Christina Applegate and take some good-bye pictures as soon as it was a 100% diagnosis,  but after what they look like after the biopsy -  not being a photoshop expert* - that's out.  You can always delete them if your biopsy comes out negative but if it's positive, your bruising and swelling may not be gone before your surgery.

Because I was shivering, and said I'd not eaten, the tech got very concerned about me and insisted I have some food.  They brought me nuts and juice.  I really was not hungry and was shivering because I was topless with cold gel and ice on my boob in a 60 degree room, but she would not be deterred.  I sipped some apple juice and ate a couple of nuts to appease her.


Then, I was taken back to the cookie room, wrapped in blankets and with ice on my boob. When the tech left,  I stashed the rest of the nuts in my purse.   I waited for the next test, the stereotactic biopsy. My iPhone was starting to run out of battery so I definitely need to get one of those charging cases.

In the stereotactic, they put you  face-down on this big table with a hole in it, and a sliding door thing in the hole. You put your affected boob through the hole and they use the slidey thing to keep your other boob up and out of the way.  It looks like something made in a high school shop class.

I think this could be very useful for prostate and testicular surgeries too, they should look into it. Har har.

Anyway, as your boob hangs through the hole, they clamp it with a mammogram machine and take pictures. Then the doctor comes in and drills - okay, vacuums out pieces of your breast with a hollow needlle.  You can't see anything with this one as you are lying in a torturous position and everything happens underneath you.. Once finished, they magnify the hunks of meat they take out of you, which was interesting but meaningless to me - I hadn't seen those online -  and make sure they got what they wanted, and you are done. Neither test was painful - I felt a 10th of a second bee sting type feeling but it was so fleeting it doesn't count.  The worst part of this one was you have to lie on the table in an uncomfortable position that hurts your neck and you can't move for 20 minutes. They also added some little clips inside my breast as markers.

I bled after this one too, so they made me wait until it was a trickle and then bound me up with tape like a Victorian woman.  I was instructed to put ice on it for 20 minutes every hour, and I was sent home.

I'm supposed to rest today and do nothing, and go back to normal the next day. The radiology physican said he'd get the results to my doctor the next day,  so I'll know for 100% sure then.














*No, you can't volunteer.

Seeing my GP

The day after my talk with the radiologist, August 19, I went for a regular yearly appointment to see my GP.  I'd been pretty calm though this entire thing, but walking into the waiting room I started to get shaky.  To this day, I have no idea why as I knew he had nothing new to tell me.  I've been seeing this doctor yearly because I suffer from pretty severe migraines, and he's been a nice guy and an understanding doctor.

But, walking in I felt like I was facing a bullet.

Maybe I shouldn't have said I didn't know why.  I depend on the medications he gives me for migraines to function.  Without them, I'd be a pain-wracked barfing ball unable to even get out of bed.  Maybe, somewhere deep inside, I was afraid he'd say, "You have cancer, you have to live without your Imitrex now."

He didn't.

He said he'd set up a biopsy for me, and I asked for a copy of my radiology report, which he gave me.  I have crossed out the harder medical terminology and replaced it with real words for you cancer-free folk.

Mammography
"A radiopaque X-ray blocking BB was placed on jammed into the right breast in the area of palpable abnnormality. lump that you can feel. The breast parenchyma  tissue is heterogeneously varied and dense, which decreases sensitivity the ability of the equipment to find boo-boos..   An irregular density funny shaped lump that looks like cancer lies in the right breast in the region of palpable abnormality same place you can feel it, approximately in the 7:00 position bottom right.  Associated calcifications Smaller potential cancer areas are noted.  The left breast contains several large, round, equal density masses, which most likely represent cysts. a cyst farm.

Ultrasound
Targeted ultrasound was performed of both breasts.  In the right breast, in the 7:00 position bottom right is an irregular solid mass with posterior shadowing. cancer. This measures 2.3 x 1.3 x 2 cm.  In the 8:00 position of the right breast are two simple appearing cysts measuring 2.4 x 1 x 1.7 cm and 1.5 x .08 x 1.7 cm.  The left breast contains multiple single appearing cysts  a cyst farm.  The largest in the 12:00 position top measures 3.4 x 1.3 x 3.3 cm.

Impression:  The palpable lesion in the right breast at 7:00 corresponds to an irregular solid mass which is concerning for malignancy.  Recommend an ultrasound-guided biopsy for definitive evaluation.  Simple appearing cysts in both breasts."  We think that lump is cancer.  Better get it checked out.  Ignore the cyst farm.

Oddly enough, a couple of days after my doctor's appointment, I got this wonderful notification from the radiology company, that stated, in part:

"The result of you (sic) Breast Imaging exam demonstrates a finding that requires cyst aspiration/biopsy at this time.  This does not necessarily mean that there is a serious problem in your breast, but immediate follow up is necessary."

Oh, really?

Telling the Kids

I have two fabulous boys.  One is not a boy anymore - he's 22, living on his own, has had a darling girlfriend for several years whom I love, and they are busy working out their future.  The other is 12, an 8th grade scholar/computer geek excelling in a rigorous IB program.

My older son is like me, poor kid.  ADD, dreamy, loving, tempermental, flighty, creative, funny, slightly rebellious of authority.   I'm worse than he is - at his age I had no plans beyond deepening my tan and then hitting cocktail hour - he is already steady, with a girlfriend and a life.  He has plans, and I never have.  I still don't know what I want to be when I grow up, and worse, I don't really much care.  I'm so proud that he's better than me.

My youngest is like his Dad.  Very smart, mathematically gifted, takes school seriously, has the amazing (to me) ability to plan and achieve.   He's the kid that gets all the awards, that never forgets to do homework, who always pulls As and Os, and who has a bright future in a field I could never understand in a million years.

I love them both dearly, more than life itself.

Weirdly, I couldn't wait to tell them.

See, that's what ADD does to you.  You never have the ability to keep things in the back of your brain - once it's manifested itself, out it comes.  I'm now 51 and learned a few coping tricks - so I didn't mention it despite my certainty with Dr. Google's confirmation.  I waited until I got a doctor's 80% confirmation.

My husband thought we should wait for the biopsy results and 100% certainty, but I know there was no way I could be that secretive for that long.   It would kill me, holding it in from the most important people in my life.

So, I told them both.  Easy, breezy mom.  "Hey kids.  Looks like I have breast cancer.  I  might get sick for a while depending on the treatment, but I'll be fine."

Both took it in stride, the way I expected boys to do.  Different as they are, the both had the same response:

"k"

That's why I love boys.

The Diagnostic Mammogram and Ultrasound.

Now that I made my own official diagnosis thanks to Dr. Google, I decided to prepare.  The internet comes first, so I picked this blog name, and I registered on a breast cancer forum.  I stopped shopping for clothes, not knowing what my figure would be like in the future.  I spent a lot of time on google checking out my options and learning the lingo.  I started reading breast cancer books, including the "bible" of books, the Susan Love book.

I guess bibles aren't for me in any sense, as I didn't care for it much.  I did find Meredith Norton's "Lopsided" hilarious though, I recommend it even if you aren't a cancer patient.

I start haunting the radiology sites to see what cancer looks like, so when I get my sonogram I'll recognize it.  I learned the Birads system.

I'm ready.

All that was left to do was get the official diagnosis.

August 17.  My appointments are for 2:00 and 3:00.  I arrive on time and redo the paperwork and sit down and play games on my iPhone.  In front of me are a gangster and his girl.  And, of course, a baby in a stroller they were ignoring.  Their conversation was revolving around somebody who'd been shot and killed the night before.  The girl kept shhhing him and looking at me, but I don't care if they want to kill each over opposing sides of the color wheel - none of my beeswax, I say.  Ya feel me?   My only concern about them is they not steal my phone.    I play Bookworm until my name is called.

First the mammogram, which fortunately, due to the day of the month, wasn't painful.  My first lucky thing in this whole situation - I get scheduled the day after my period when my breasts don't hurt. Then came the sonogram.

I couldn't help but make a lame joke about the last time I'd had a sonogram when I was pregnant, and asking if there was a baby in there?.  Yeah, I know, I was under stress, okay?

I did see the lump and it did look just like the cancer I'd seen on the radiology websites.  And, the cysts looked just like the cysts on the website too. The black circle on my sonogram below is a cyst.

The techs were very nice.  I made sure to tell them I already knew I had cancer.  They can't tell you anything but I wanted to make sure that people knew it wouldn't come as a shock to me (meaning, I didn't want the radiologist to give the news to my doctor first and make me wait another day for him to tell me.)  One of them said I had a "cyst farm" in my breasts,  and it was no wonder I'd not been concerned about a lump.

The radiologist came in, and said, "I hear you suspect you have cancer." and I said I did.  He told me that he was very sorry, but that the tests came back highly suspicious for cancer, Birads 4c.  He said that while he typically tried to give women some hope, he couldn't do that with me.  He thought there was an 80% + chance that it's cancer.

I could see that he'd read the book on how to break bad news.   He sat at my level, stared at me straight in the eyes and never blinked.  He was very warm and comforting, but so clearly not wanting to tell me this that I wanted to hug him.  I did reassure him that it was okay, I already knew.  He would have gotten a C on the "breaking bad news to patients" test because he actually said that "It was as hard on me to tell you as it was for you to hear" which I'm pretty sure is a no-no.  Then he backtracked, "Oh no!  I didn't mean it that way."

And, he didn't, he was very compassionate.  And, he was right in this case, I do think it was harder on him to tell me than me to hear it.  Dr. Google had already broken the news to me.

He said he'd fax the radiology reports to my doctor immediately.

I went out to the car and called my husband and told him my suspicions had been confirmed, and we discussed when to tell the kids: wait for biopsy confirmation and hope for the 20% chance of it being negative, or just admit it?  Then I called my sister - she's as into google as I am and she kept finding all these things that meant it wasn't cancer, and I kept saying it was, so being the big sister, I had to say ... 

I told you so.

Growing Suspicions

August, 2009

Being turned away for a regular mammogram sparked something in me, even though nobody had even seen my breasts.  I did call my doctor to get the right orders, then I turned to my old friend, google.

"hard breast lump, indentation, dimple"

6,740 results in 0.58 seconds and all of them landing on breast cancer sites.

I totally didn't like that result, so I add  "+cyst."  Still getting all kinds of breast cancer sites.

I try a new tactic and do a google image search (breast dimple) to find a picture of what my breast looks like so I can see other non-cancerous weird breast shapes.

I suggest you not try that search as there is some horrible hole you can get in your butt that shows up with those search terms, and I had to see those photos dozens of times before I found a picture similar to my breast indendation:

Here is what I see:

 

Except, it's on the right side of the nipple, but kind of in the same place. 

And yeah, that is from a cancer site. 

My lump is painful, which I find out is a good sign as cancer doesn't hurt. 

Except when it does.

Over the next week, I become obsessed with that lump.  I'm constantly feeling it.  I'm like a 14 year old male getting to 2nd base for the first time.  I'm pinching, squeezing, inspecting.  I google cancer symptoms then check:  is it movable?  No, it doesn't seem to be.  Squishy?  Nope.  Is it attached to the skin?  Hard to say, but I can't really pinch above the lump. Attached to the chest wall?  I dig around to try and find out.    I look at the skin close up, and it's darkened above the lump.  Is that because of my manhandling?  I don't know.  The skin appears a little bit dimpled, which I learn is called peau de' orange, or orange peel.  I'm not SURE if I  have peau de' orange or if I'm imagining it. The skin does look different though.

What I am sure of is I have cancer.  Just as I was 110% sure it was a cyst before my phantom mammogram -  after my hours of googling, I was 110% sure in the other direction.

I have breast cancer.

Mammogram Day

August 7 2009.  I show up at my appointment for the mammogram.

Now, let me sidetrack you a bit with more discussion of my breasts.  Since this will involve nothing interesting for you men, feel free to skip this part.  My breasts have been problematic for a few years.  When I hit my mid-40s and began perimenopause, I found they got very painful with my cycles.  They'd swell, they'd be super sensitive and painful.   I couldn't stand to take off my bra or face the shower.  Then I'd have my period and they'd be normal for ten days, until it started all over again.  As I got older, I got very little relief after my period, and was down to maybe two days of non-pain.  I had a nice little wardrobe of daytime and nightime bras going by that time.  So, I kind of skipped my mammograms as it was impossible to make an appointment during my pain-free days.

I have none of the risk factors for breast cancer - no family history, I'm thin, I eat healthy, I'm not a heavy drinker, I don't smoke.   Early mammograms showed dense, heavy breast tissue that made it very difficult to get an accurate reading, plus with all the cysts I had and all the pain, I just figured it wasn't going to be worth the extra testing I'd have to do since I'm not at risk.  Plus, the radiology company lost my baseline mammogram and if they weren't going to take it seriously, I wasn't sure why I had to.  I felt this particular bullet was going to skip me.  My intention was to have a stroke.  So, it's been more than five years since my last mammogram.

My bad.

Anyway, I walk in on the 7th and get the paperwork and fill it out.  I turn it in and ask the woman at the desk if they can drain the lump right there.

She looks up at me and blinks.

"You have a lump?"

"Yes, I told the guy on the phone when I made the appointment a month ago."

"And, he made the appointment?  He shouldn't have done that, you need a diagnostic mammogram and a sonogram."

I'd never heard of this, WTF?  A mammogram is a mammogram right?

I said, "Can you just do that now?"

She said that a doctor has to be there for these, and there are no doctors there during my appointment time, they all leave at 3:00.  She said that they can still do the mammogram but she knows for a fact that they'll make me come back for the diagnostic studies and it would be just a waste of my time.

The thought of having my sensitive and painful breasts clamped in a ice cold vice grip twice didn't appeal to me, so I accepted her proposal.

She says to call my doctor and get the orders for the diagnostic mammogram/ultrasound and she made an appointment with me for August 17th.

Before I left, I did ask her, "The doctor will be able to drain the cyst that day, right?"

She said yes.

Mammogram time

July 2009.

I work in a middle school, and the kids get out in June.  As you can imagine, it's one of the busiest times of the year for us.  As a school secretary, I have to plan for the ceremonies, the awards, do all the ordering, start planning for next year, close out many POs, pay final bills, etc.  It's a crazy time and I had no time to dwell on my breast lump.

I wouldn't have dwelled (dwollen?) anyway, as I was 110% sure it was another cyst.  When my cycle came and went with no change in the lump, I sighed, found the old mammogram order my doctor had given me 9 months back that I'd never gotten around to, and called to set up an appointment.

I told the guy on the phone I'd found a lump, and he asked me if there was any history of breast cancer in my family.  I told him my mother had been diagnosed recently but she was 77, and my understanding was that means there is no genetic correlation.  He agreed with me, smart boy, and set up a mammogram for August 7th.   I made this appointment in early July and was hoping I could take care of this before I went back to work August 3rd - but this was the best they could do, so I took it.

I spent July enjoying my summer off with my son.  We did all sorts of fun things together.  He's 12, and I know that pretty soon he'll be embarrassed at the idea of even having a mother, so I took full advantage.  With the exception of occasionally catching a glimpse of the dimple in the mirror and hoping they could drain the cyst immediately so my breast could go back to looking normal, I never even thought of the lump.