Massive Attack

biopsy and worry and wait

2009-02-02T13:36:00.000-08:00

This ultrasound machine and I have gotten rather familiar with each other.

It's finally biopsy time. I arrive at the wonderous imaging center yet again for what i'm hoping is the last time on this case. After a stern make sure you are here by 9:30 warning by the scheduler they call me back at 10:15. I change into their pink half gowns again. After a moment the ultrasound tech returns and I am so grateful that it is not the same one as last time. she runs me thru the procedure and it matches what I had read on the Susan G Komen site. She asks me to lie back and move the right side of the gown so she can find the mass before the doctor comes in. As she locates the mass she tells me all about the doctor who is going to be doing the procedure, how he his a nice gentle man who has been doing this for a long time. As it turns out he happens to be the medical director of the imaging center. In the prep of it all she verifies my latex allergy and makes sure that i can be in the same room as it. I tell her that's fine, it's an acquired allergy having been in the medical field for 9 years. we talk about shared experiences working in a hospital when the doctor comes in.

He is an older man wearing hearing aides accompanied by a blond woman who stands in a corner. The blond woman turns out to be a rep selling the new biopsy needle system who is in there in case there are any questions since i am the first person to get to use this device here. He swabs my breast with the brown betadine solution then lays the sterile drape. He reminds me to not touch the drape then says after that i already know all that being a nurse. He injects a lidocaine epinephrine bicarb solution into my breast and i don't feel it enter like they said I would. Out comes the scalpel and he makes a tiny incision for the needle to enter thru. He takes several samples, 7 in all, including one repeat where he believes he missed the mass all under the guidance of the ultrasound. Each sample is accompanied by a loud click of the tool. After all of this he inserts titanium markers into the mass, a way to remember what that mass looked like then in case there is ever a need to compare films and to make things easier for the surgeon should they need to be removed later. they apply steri-strips to the site and clean off the betadine and ultrasound gel. The whole process takes just minutes really tho it sure felt like a lifetime had passed.

After this I am ushered into the mammogram room where they take pictures to verify the markers placement.

and I am done. Ice pack on the site, steri-strips, and a bruise getting ready to happen and this part is over. Soon I'll know if it is the big C. They tell me it takes anywhere from 24 hours to 10 business days to have the results back. I figure nothing says love for Valentines like an answer.

So now begins the wait. I still don't wait well.

Biopsy Scheduled

2009-01-15T17:48:00.000-08:00

The biopsy appointment has been made for Feb 2.

I finally got a response to my BIRADS score. BIRADS is a way to standardize mammography readings. A score of 0 means that the radiologist needs more information, 1 means that there were no findings, like in a routine mammogram. 2 means that there is something there but it is certainly benign, such as a cyst. 3 is there is something there with the super high probability that it is benign, with a less than 2% chance of cancer, 4 is that this is suspicious with a reasonable probability of cancer at 3-94% chance, while 5 is this is so characteristic of malignancy that there is a 95% chance or higher that this is cancer.

Mine is 4. while that range is huge it seems that 25-50% of 4's turn out to be cancer.

So I'm getting a biopsy.

I'm preparing for the worst case scenario. those irregular borders on magnification with soft fuzz around it scares me a bit. it does. It doesn't help that I have a feeling. Now it could be me being a pessimist and an alarmist but I do. Add in that I noticed an indent the other day over the lump. It adds to the feeling.

So in the mean time i'm trying very very hard to stay calm. I try not to indulge the worry for long. I'm breathing and still hoping that this is ok.

Oh i learned something that has increased my fear of cancer. I had that ultrasound on 12-15 got the call on 12-16 that it was abnormal and I needed a biopsy and that they were getting insurance authorization for it and the insurance authorized it all on 12-17. It's the imaging center that demanded the mammogram first. No one told me any of this until just a couple days ago. Insurance companies are notorious for taking forever when things are less than serious as well. turns out they moved fast. It was the imaging center that dropped the ball. It's also the imaging center that only does biopsies 2 days a week is why its taking so long to get in. If I ever have to go thru this again I'm going to beg for another imaging center.

Sigh. Not a lot I can do until then. I just have to hang in there and breathe. I wear my pink Swarovski bracelet hoping that somehow the pink will keep me cancer free. Silly but it also serves to ground me back to other things. It reminds me too keep breathing. Well that and the pink xanax pills lol.

Resulting in... Take 2

2009-01-12T15:37:00.000-08:00

I don't do well waiting for results. never have, doubt that I ever will. Instead of doing nothing I called my doctors office and got to leave a message for the nurses station to call me back.

After waiting for about a lifetime for them to call me back the phone rings. It's my doctors office. The results are in.

Now either the person I spoke with doesn't know how to read a radiology report or the radiologist pretty much summed up the ultrasound, cause I got no information from her on it. Talking to this gal was so incredibly annoying. Oh I don't know or I don't see it on here when asking basic info on size and BIRADS category.

But what she does see is where it says strongly recommend biopsy.

I knew this. I did. These results didn't vary at all from what I had expected.

But my heart still sunk when that was the thing that it said. Silly huh? Like there was a sliver of hope that there was going to be super magical findings that said oh now we see there is nothing to worry about at all.

I knew that was the reading. Why am I so sad then?

Additional studies

2009-01-08T17:47:00.000-08:00

Another trip to the imaging center is not my idea of a fun afternoon.

A couple days ago I called to make an appointment for the "additional studies" that the letter spoke of and was rather surprised when they were able to get me in so fast. When I scheduled the ultrasound it was weeks before the next slot was open. So here I am, getting a mammogram.

Now the whole mammogram issue is annoying to me. It isn't a fun procedure at all, they already did an ultrasound that showed a tumor they already know that they need to stab me with a big needle to pull a plug of tumor out of me to decide if it's something to worry about. They know this, my insurance knows this but for some big unknown reason the insurance company wants to spend more money for more pictures of the scary white blob.

But anyway.

The familiar red brick building appeared out of what felt like nowhere along a rather busy street. The narrow driveway, the compact car parking all felt like it was small, confining, trapped.

I was very much relieved to see that all the garish Christmas crap was gone when I walked in the door. As I stepped in the door I realized that I didn't have the where do I go now feel. I knew what window is for my sort of imaging.

"Name? Insurance card? Doctor's Order?" An already familiar tune rang out in my ears as i turned over what I had and took my seat to fill out another excess of forms that I was sure that I filled out 2 weeks ago.

2 weeks? It feels like it was at least 2 months between the appointments.

Then began the waiting game. The clock ticked on and on until nearly 30 minutes after my appointment time my name was called. Waiting rooms are one of the circles of hell, complete with the screaming kids, the nosy elderly couple, and the sleeping people.

I wore scrubs to this appointment. If I came in looking like a nurse maybe the techs would treat me more like I was one of them instead of just another test. Walking back with this tech was more pleasant. She was sociable. She was nice. She looked me in the eyes.

After changing into the short gown I had a sticker applied to the lump site so they could find it easy. Then came the fun part.

Only a man would design a machine that miserable. Only a man would think that putting your boob on a shelf to be smashed to then be shot with radiation was a great plan. Over and over place squeeze smash.

In between smashings I could see the digital xrays. The tumor glowed white with its dense, calcified being. Enlarged for clearer film studies, I could see that while it had defined borders, the borders were irregular, cottage cheese like. It sits taller than wide with an additional tumor sitting right below the large mass.

There is no way for me to know at this point what this is. It is such a crap shoot as to if its just a fibroid or something more sinister. Google images show both sides of the coin.

Which is why I get to have a biopsy. There is a breast mass scale for radiologists to use. It's rated 0-5 with 0 being nothing in the mammogram to 5 being highly suggestive of a malignancy. To have a biopsy recommended and paid for by insurance companies you have to rate 4. 4 means that its about a 10-30% chance that its cancer.

I worry. It's what I do. And I worry well.

Simple slip of paper

2008-12-28T08:50:00.000-08:00

The mailbox overflows with ads for the Christmas and post Christmas sales. Mixed in with the junk lies a seemingly innocuous white envelope. That is, until I read the return address; Health care Imaging Center. I open the Christmas cards first. I check to see if Netflix sent the right movie. I don't want to open that one white envelope.

But I know I have to. I know that I need to find out if they have anything useful to say. With shaking hands I tear through the envelope and pull out a letter printed on more innocuous looking paper. White, cold, sterile paper.

The letter reads:

The results of your exam indicate the need for additional evaluation. This does not necessarily mean that there is a serious problem with your breast, but it should not be ignored. Please give our office a call to set up an appointment for your additional breast imaging study.

So I haven't a clue if this means the insurance has decided it might be a good idea to get this done. I'll give them a ring on Monday to find out what the imaging center has on file for me.

I just want this to be over, the waiting, the unknown. Is 2009 the year of collecting more scarves and start a wig collection and finally losing these pounds in the only diet plan that no one wants or do I start this new year grateful that this time it's going to be ok? Do I have to start making plans for trust funds for my son and talking to my friend that owns a mortuary to start a payment arrangement for my death or do I start making plans for summer vacation?

I just want to know one way or the other.

By the way, I know breast cancer isn't a death sentence always. My therapist is a breast cancer survivor. She beat it. I could too.

If I knew if I had something that needed to be beat.

but it can happen to me

2008-12-17T12:31:00.000-08:00

So at least the phone hasn't rung yet today. Good of the HMO to take their time with this sort of thing. (Hoping all can smell the sarcasm here)

When I look at the mirror I can't help but to wonder. I wonder if just below the skin lies something sinister. When I had a mole removed a couple years ago I could see it. I saw that it looks odd, not benign. When I had it removed the local labs were unsure of the contents of this sample and had it sent to Mass. I laughed to myself there. Here I am in skin cancer central, southern California and the sample had to go to Mass. It turned out to be just shy of turning cancerous. I don't recall the name of the cells, just that they always turn cancerous. Had to go back then to have more cells removed, get those pretty clean borders.

Stupid cancer.

That might be part of my terror this time. I've proven to myself that cancer can happen to me. I wish I could see what I was working with here. The only way is to do the mammogram and the biopsy, they are my eyes.

So I roll with it. That's all I can do.

biopsy and worry

2008-12-16T19:02:00.000-08:00

I'm trying to be positive here. I'm trying to think it's just a fibroid.

But the looming what if's still have a firm grip on me. Like what if I have cancer? What if it kills me? What if this my last Christmas with my son?

I am a pessimistic person. I always have been.

My brain is filled with thoughts of biopsies and cancers and how heavy this all is.

I think the hardest part of this all is just not knowing. I don't know if the reader of my ultrasound was some new grad who recommends he full 9 yards for everything. I don't know if this is standard procedure with solid chunks. I don't know.

And the not knowing is killing me. There's not a way to know until I just go through with this.

This isn't the first time this has happened. 11 years ago I had a couple lumps removed. They were very clear that the likelihood of them being cancer were incredibly slim. The ultrasound tech talked to me. She said what she was looking for. She talked about how nicely shaped they were. The doctor then called me herself and assured me that this is ok, that she was removing them only to make it so if I ever did have cancer I wouldn't mistake it for one of those. Then the results took several days.

It hasn't been the most reassuring go around this time. It got worse when the ultrasound tech printed out just one strip of several and hurriedly took it out of the room after telling me to get dressed having never looked me in the eyes. to get the call today that they need another test and a biopsy, well it just really revved up everything.

I think part of this right now is taking the chance to go ahead and be depressed over it all. If this is decided as being something it will be time to go on the attack and get things taken care of. If this is decided to be a nothing it'll be time to relax and be grateful that the bullet has been dodged.

right now it is the end of the world.

Resulting in...

2008-12-16T14:31:00.000-08:00

The faint chime of Davy Jone's music box rings out from my cell phone. I note that the number is (9XX) 7XX and so i disregard the rest. that's how my work number begins and I find myself not in the mood to talk to anyone at work. They only call when they need something anyway.

The voice mail alert softly goes, the volume set low as to not disturb others. I flip open its clam shell style opening, press the listen soft key and hear a voice I don't recognize. This is not work.

"Hello, this call is for J. Rudolph. This is Thomas over at Dr. M's office. We have your ultrasound results."

My head begins to spin. It hasn't been a week. It hasn't been 24 hours. They said 7-10 days. My throat runs dry, I try to swallow anyway.

"The radiologist needs you to have a biopsy and a mammogram."

Biopsy. the word echoes loudly in my brain. Its not some safe nothing tumor if he needs a biopsy. A mammogram? What he wants to map this further?

"The biopsy we need to get authorization for and we are working on that."

Stupid HMO bastards my brain spits out. Having to get authorization to decide if I have cancer of all things.

"the mammogram we have sent the order slip to out in the mail. Call us if you have any questions."

I softly close the phone and set it down on the glass coffee tabletop. The results are in. They need more clarification.

They moved so fast. How could they have moved so fast? Fast is bad. Its the slow results that you sit and stew over that are the good ones.

And while the results are worthless, its the radiologist saying I dunno effectively, my world rocked again, resulting in more turmoil. a biopsy.

This is when I rue being a nurse. I know that fast is a problem. I know what a biopsy will entail more likely than not, its going to be a huge movie style needle piercing my flesh and taking out a plug of the tumor to examine under a microscope to determine contents.

I want to step back into the warm blanket of denial. This is not happening to me. This is just a dream, I am faking this tumor that everyone could feel and see plain as day but the cold truth is out there looking at me in the face. I scream to myself 31 year old nurses don't get cancer. But they do. That is reality. I keep drawing on the odds that it is just a fibrous mass, that it is nothing at all.

But what if it's not? What if that's why the radiologist moved so quickly with his read?

Ultrasound

2008-12-15T15:44:00.000-08:00

It's raining today. Is that fitting or what.

I slept badly last night. Sleep was punctuated with dreams that I don't recall and waking up every couple hours. If I thought I didn't want to be at the doctor's office I want to do this appointment less. I cried last night, realizing that this was more frightening than not, even though it's just an ultrasound. I pray that it is just a cyst, just a water filled sac of nothingness.

Hubby and I find the place finally. Parking is poor due to the rain but we find a pair of spots next to each other arranged that perhaps 2 of those new small smart cars could park side by side but we have a full sized Ford F150. Hubby goes ahead and takes the 2 slots. Dodging the cold rain puddles best we can, we make it indoors. We go to the first window where there is a sign in sheet where we are greeted by some perky lady who asks me what study I'm here for. Ultrasound, I hear myself saying so she directs me to the ultrasound check in/waiting area.

The mantra of the employees greets me. Name? Doctor's order? Insurance card? Fill in these forms, just the highlighted area please. I hear them say this over and over til the words must lose meaning as other people file in behind me.

The crowded waiting area offers few seating options so we grab what we can get.

The waiting room is decorated in a garish manner. Christmas decorations are everywhere. The soothing paintings are wrapped in Christmas paper. Ornaments on string dangle from the acoustic ceiling tiles. It's as though they tried to make the office cheery, but failed leaving it even more sad than it was before.

I look around at the people in this waiting room. A very old couple sits next to each other, sharing a magazine. A teenager sulks while her mom sits next to her looking annoyed. Most people are reading a book or magazine, the others watch the morning news on the television, all are trying to escape from the big question-- did I get cancer for Christmas this year?

Finally my name is called so my husband and I gather up our stuff to go back. She begins to complain that only the patient is supposed to get to pass thru to the exam as though this door was some enchanted doorway. I say to her this is my husband, please, I am scared to death here. She sighs and allows him to go back.

She hands me a half gown and directs me to change my top and top put this on. She specifies that the gown it to be open in the front and I chuckle to myself for a moment thinking that she had to have learned over time that you have to spell stuff out for some people so just assume that all people are like some people.

she comes back after I am changed. I lie back on the table and she reaches for her bottle of goo for the study. I expect ice cold gel to fall all over me and am pleasantly surprised to find it warm. She takes several shots of the mass. She takes shots of other areas, returning to the mass for other shots. She then does the other breast. It takes much less time.

After she's done I ask the only question that she could answer. Is it solid?

As she walks out the room she says to me, yes.

It's not a cyst. It's not just a fluid filled sac of nothingness. I realized that she had left open my study and I coud see the various thumbnails. The very irst one is a perfect shot. it shows how dense it is and the shape is about what I feel.

It is solid. it is offically now a tumor and I have no idea yet what kind. Its a tumor.

I have a breast tumor.

Doctor doctor

2008-11-10T15:25:00.000-08:00

I don't want to be here. I don't want to have to be sitting in this doctor waiting room, just waiting until someone calls my name so he can confirm what I know, there is a lump. He is running behind today.

Watching the other people in the waiting room I wonder what they are here for. Are they waiting for confirmation too? a fussy baby cries a man in a wheelchair coughs. This room must have been designed by Dante as a circle of hell. I flip through a magazine trying to pass the time.

An hour later they call my name. The nurse asks me to get on a scale, a mortal enemy of mine then leads me to an exam room the size of a closet. Well, a closet of someone with more money than I have anyway. Pulse is checked, the blood pressure cuff gets velcro'd on and a steady hiss of air goes out as she gets her reading. All normal, as normal.

She leaves with a promise that he will be in soon. I don't believe her choice of words. Soon must be a fancy relative term in these parts. And so I wait.

After a short eternity he walks in, shakes my husband's hand, then mine. He asks me to hop up on the exam table. He asks what the problem is that brings me to him today. I start off with asking for new medications, some Cymbalta for this low grade depression and Xanax for the building anxiety that I've been feeling lately. He sends the rder to my pharmacy via this ncredibly nifty computer programme. And then I out with it, I also need to have a lump checked out.

He and I work together often in the near by hospital where I am a nurse and so he seems to be somewhat embarrassed that he s going to be feeling the breast of someone who he works with professionally while her husband is in the room. I dread those tupid gowns and I think he knows this, so he asks for me to slide off my bra over the area. He asks where it is and slides his hand up my oversized sweater and palpates gently and agrees, that is a lump. After he feels it he asks my age. 31. He looks at iscomputer and says oh, you're too young for a mammogram so instead he writes an order for an ultrasound.

And that is all that can be done for that day. An order for an ultrasound nd a years supply of refils for my cymbalta with a little Xanax on the side.

Findings

2008-10-22T14:51:00.000-07:00

Think Pink! Self exams! Do your mammograms! Donate to Susan G. Komen! Its breast cancer awareness month again. Breast cancer awareness is being preached to us over and over and over.

I realize that it has been a long, long time since I've done a self exam, since I stopped having a cycle since being on the depo-provera 2 years ago. I sigh, chide myself for being so lax, and make my way into the bathroom. I lift up my left arm and begin prodding about like a pimple faced prom date who has gotten his first chance to get to second base. There's a small little nodule that I've known about for years below the edge of the aerola. All quadrants covered, confident that i missed nothing i move to the right. Up goes the right arm and prodding commences.

And there I find it.

No, I think, that was my imagination. so I feel it again. And again. Its at least 5/8 inch long, thats 15mm to those that don't live in the US, and about half as wide.

And I don't believe it.

I finish the other areas, my mind still stuck on the lump. Its a lump. It's a lump. And I've been feeding it a regular suppy of hormones, hormones that these sort of things thrive on. A lump. A lump.

I take a deep breath and step out into the living room of my small 2 bedroom apartment, and walk up to my husband and ask for another opinion. "I found a lump" I tell him. Can you feel it too?

And of course he does. His rough mechanic hands, untrained in the medical arts palpates the area and hefeels it just as instantly as I do.

A lump.

A phone call goes out to the doctor and of course, he is on vacation. The receptionist asks if I want to see his covering doctor and I say oh, no, I'd rather wait for hi to get back. I make my appointment and wish desperately that I could make this just go away.