What a Boob!

On the 8th I had the six month follow-up 3D mammogram as requested by the radiologist after the breast biopsy which was done on July 5th. After the test was done, I met with the radiologist to review the new scan. She is not the one who did my biopsy, but she works in the same breast healthcare center as Dr. H. She looked a little concerned, and proceeded to tell me that she thinks I should have a surgical biopsy done on the same spot that was detected six months ago. The same area (not a lump) that pathology ruled a stromal fibrosis. A fibrosis is not cancer, not even pre-cancerous, nor does it lead to cancer. So why another biopsy?

When I asked her that question, she answered in "what ifs". What if there are bad cells behind the ones that were taken? What if cancerous cells are hiding farther back? Really? The ultrasound-guided needle biopsy couldn't tell them that? When am I ever supposed to breathe a sigh of relief following a negative biopsy report?

She wanted me to go right down the hall and make an appointment with their breast surgeon for a consultation. She then proceeded to tell me how the surgical biopsy would go. I told her I would go home and check my calendar, then call the doctor. What I really meant was that I would take some time to think about it, and then make my decision. She had obviously planted seeds of doubt in my mind, so I knew that I would consult with a breast surgeon. But it would be one of my own choosing, not hers. Several of my friends have had breast cancer, so I talked with them and found they had all seen the same surgeon. After reading up on her and looking at online reviews, I decided she is the one I wanted to take care of me.

Jim and I met with Dr. J. yesterday for the consult. She had reviewed all of my mammograms and had met with the Washington University radiologists regarding them. They concurred that I need an additional biopsy. I asked her if there had been any change from the mammogram taken six months ago to the one taken last week, and she said nothing had changed. So why is everyone all of a sudden concerned?

Dr. J. explained that they were worried about the fact that the marker, which is left in the breast following any biopsy, was not placed in the exact location of the distortion that was seen on the mammogram. That indicates that perhaps the four tissue samples did not come from the actual distortion but instead were nearby tissue. That's when the lightbulb went off for me. No wonder the radiologist on Monday looked worried. But she didn't express her major "what if". What if Dr. H. took the wrong tissue???

Obviously I can choose to roll the dice and do nothing, but that is not how I want to play the game of life. Dr. J. offered two options - 1) have an additional needle biopsy done, this time a 3D mammogram-guided biopsy as opposed to an ultrasound-guided one, or 2) have a surgical biopsy done where more tissue would be removed. Obviously #2 is more invasive, and she said she really doesn't want to cut on me if she doesn't have to do so. She feels that a needle biopsy will be sufficient. And she added that if the results come back negative on this test, we can put this matter to rest.

So, I'm scheduled for the needle biopsy on January 30th. This time I know what to expect, so I'm not looking forward to it. Especially since my breast will be squished in the mammogram machine while they are taking six pieces of tissue out. On the other hand, the recovery time will not be as long, so there is that. Any positive thoughts and prayers you can send my way will be most appreciated!

Breast Biopsy Results

Early this afternoon the home phone rang, and caller ID revealed that it was St. Anthony's calling me. I thought that was odd as I had the mammograms and biopsy done at Missouri Baptist. I picked it up anyway, and it was my primary care doctor's office. She asked if I had been given my pathology results yet, and I said I hadn't heard a word yet. She said they had just gotten them, and that the results were BENIGN!!!! What a huge relief, and a blessing not to have that hanging over me the whole weekend. She asked that I call their office back after I heard from Missouri Baptist regarding what kind of follow-up they were recommending.

About a half hour later, Missouri Baptist called me with the same report. She said the biopsy had come back with the cells being identified as stromal fibrosis. Fibrosis refers to an increase in dense connective breast tissue. It is a very common finding, occuring in up to 7% of suspicious breast lesions examined by biopsy. According to the American Cancer Society, fibrosis does not increase your risk of developing breast cancer later on. More good news.

They do want me to come back in six months for a repeat mammogram and ultrasound of the right breast. When I asked why, since the biopsy came back negative, I was told it was to make sure nothing had changed. I have to admit that I am a little concerned about all the x-ray exposures on this one breast. There were the two views at the routine mammogram, three views at the screening mammogram, and two more views following the biopsy. It is something I will be asking questions about, especially since they established a baseline mammogram after the biopsy was performed.

But setting all that aside for the moment, I am one lucky lady!

Breast Biopsy

flowers from the breast care center

Yesterday morning I left the house at 6:35 a.m. to get to Missouri Baptist Hospital by the 7:00 requested arrival time. My biopsy was scheduled for 7:30, but they needed to check me in and all that. Due to it being a holiday week, traffic was light and I got there at 6:50. More time to wait - yippee...

The front desk gal checked me in shortly after 7:00, and I went back to a room for the nurse to go over my information again, and to repeat what was going to occur. Then I slipped on my beautiful pink ball gown, and waited for the radiologist to come in. We have known each other for many years as our kids went to school together. He is the same doctor who drained a couple of breast cysts, and he has been reading my mammograms through the years. I was grateful that he was scheduled for July 5th, and that he had an opening for my procedure.

Dr. H. stated that he wanted to do another ultrasound himself as he wanted to see exactly what the spot looked like. At that point I think he was still hopeful that it would turn out to be nothing, or that perhaps an MRI would do the trick instead of putting me through a biopsy. I didn't realize that was even a possibility, and it was probably just as well.

Once in the procedure room, the nurse and technician went over my name, date of birth and which breast we were looking at - for the third time that morning. As someone who was once Vice President of Marketing and Risk Management for a medical malpractice insurance company, I appreciated all their efforts to make sure they were a) treating the right patient and b) treating the correct body part on the patient. The doctor then came in and performed the ultrasound, and decided he need to go in after all.

While I was told that the local anesthetic could be likened to what you get in a dental chair, that it not exactly accurate. This one went much deeper into the tissue. I am used to needles and anesthesia due to all my skin cancers, but I'll just say that this smarted more than any of those have. On the plus side, it was not as bad as a cortisone shot, so there is that.

Under the guidance of the ultrasound, Dr. H. guided an instrument through the side of the breast to get to the area of distortion. He warned me that I would feel pressure, but should feel no pain. That was the case. Then he said I would hear a sharp noise, so I shouldn't be startled. I took that to mean, don't move. What he didn't say is that I would hear four sharp noises - one for each of the tissue samples that he removed. The sound reminded me of what the ear piercing gun sounded like.

After the tissue was removed, a ceramic marker was inserted into the breast so that any radiologist who reads my mammograms in the future would know that the area had been biopsied. Normally they would put a metal marker in, but since I have had allergic reaction to different metals in my earrings, they decided to be safe and go with ceramic. Then the nurse kept pressure on the entrance site for ten minutes to minimize bleeding. She said that I hadn't bled much during the procedure. Then she said I needed to go and have more mammograms taken. While they had told me I would have a followup mammogram, I presumed it would be after the biopsy site had healed. Not right after it was done! They assured me that rarely does anyone bleed nor does it dislodge the marker they had put in.

The mammography technician reassured me that she would not be putting as much pressure on the breast as she would do during a normal screening, and said this was just to give everyone a baseline of where the biopsy had been done and where the marker was located. While I was in there, I asked her to explain the difference between the 2D and 3D tests as it seems like they are done by the same machine. She explained that a 2D mammogram was like taking a picture of a lump of bread that had been squished. You might see something, but you don't know exactly where in the loaf to go and look for it. A 3D, on the other hand, offers slices of the loaf of bread, so if something appears they can go and look at that slice. I thought it was an interesting way to describe the difference. I had asked Dr. H. if he thought a 2D mammogram would have picked up the architectural distortion. He said, "No way." At any rate, the technician was correct. The squishing in two directions wasn't bad, and did not hurt.

The entrance wound was dressed with steri-strips and then topped with a gauze pad covered in tape. My instructions were to leave the dressing on for 24 hours, with no shower until it came off. They sent me home with two small ice packs to place inside my bra over the wound, 20 minutes on and 20 minutes off to minimize swelling and bruising. The nurse told me to take it easy and load up on Netflix for the rest of the day. Sort of lends a whole new meaning to the phrase "watching the boob tube", doesn't it?

ice pack

dressing

I slept pretty well last night, and removed the bandage this morning. There is a small bruise but no swelling, and not even a drop of blood on the dressing. I continued to use the ice packs off and on today as well since they seemed to help. I took it pretty easy, and should be back to most activities tomorrow.

They said two to three days to receive the results from pathology, and they will call me once they get them. I'm hoping since my test was so early in the morning, that Friday I will hear something. Otherwise, it will be a long weekend. I'm trying to stay off of Doc Google and relying on Doc H. instead.

Say Yes Ma'am to the Mammogram

A week ago Tuesday I had my annual mammogram done at Missouri Baptist, where I have been going for many years. I was given the option of a 3D mammogram versus the traditional screening. It is supposed to give better readings, especially for women who have dense breast tissue, which I apparently do. I was warned, however, that my insurance company may not pay the additional expense of the 3D test. The difference in cost? $60. That seems a small price to pay, and so absurd that the insurance companies do not feel it is worth that amount to catch breast irregularities early. I opted for the 3D test, though I can't say I noticed any difference in how the mammogram was done. The boobs still got smooshed two different ways.

The mammography office called me on Monday, which I knew was not a good thing. Normally they just send me a letter in the mail. The gal told me that they noticed a distortion in the right breast, which they felt needed to be looked at further. She scheduled me for a diagnostic mammogram, which possibly could be followed by an ultrasound. I have had fluid filled cysts in the past, so I've had the diagnostic test and ultrasound done before.

Later that day I received a letter regarding my mammogram results. It just said that the exam showed "an abnormality that requires further evaluation." Had I received the letter before the phone call, I would have seriously freaked out. I'm glad the office called so I could have the explanation to go along with the words.

Missouri Baptist Breast Health Care Center

This afternoon I went to Missouri Baptist Hospital (I have the annual mammograms done at one of their satellite offices much closer to my house) for the additional tests. The technician was hoping that the distortion would not show up with the mammograms she performed, but no such luck. The radiologist then requested the ultrasound. After reading those films (if they are even called that anymore since everything goes into a computer), the doctor came in to talk to me. She wanted to know if I had ever had breast surgery or experienced any trauma to the breast. No to both questions. She asked me if I felt a lump and I said no, and she said she didn't feel any either.

She then requested two more mammograms to try to get a better look at where the distortion had been pinpointed. Upon reviewing everything, she felt it was best to schedule a biopsy to see what we are dealing with just to make sure it is not a very early cancer growth. Three plus hours of multiple boob squishes, having it pressed upon by the transducer for 20 minutes, and lots of time sitting around pondering the "What ifs?" My biopsy is scheduled for July 5th, and then it will be 2-3 days before the pathology report comes back. More time to ponder.

With all the people you hear about getting diagnosed with cancer, do you ever feel like you are a ticking time bomb?

Update on Kirby's Cancer

Kirby at the clinic

On Thursday the 22nd we took Kirby to see the oncologist, Dr. S. It was our first visit to Veterinary Specialty Services, a clinic filled with board-certified veterinary specialists. So basically every animal that comes in there is in some sort of a crisis situation. I filled out the paperwork, and we had a short wait before the vet could see us. We found Dr. S. to be a no nonsense type of person, but with a wonderful bedside manner. We discussed Kirby's surgery and the pathology reports, and she suggested doing an ultrasound to see if there were any additional tumors in the belly area. If he was loaded with tumors then followup treatments would not make sense. We agreed that was a good starting point.

They took him in the back, shaved his tummy and did the test. It was questionable whether they would have to put him under for the ultrasound, but in the end a muzzle took care of the issue. We met again with Dr. S., who said that the good news was she did not see any new growths. She also did a needle aspiration on a lump on his leg, and that was just one of the many fatty growths he has on his body. Her recommendation was to do chemotherapy, whether through pill form or IV. That would be up to us. She explained that she hates mast cell cancer because it is so unpredictable, and the fact that he had it in a lymph node was very troublesome. We discussed the pros and cons of the pill versus IV therapy, and honestly my biggest concern at the time was that the pills are very dangerous to humans. You have to wear special gloves when you handle them. It makes sense to me to have them administer the IV in a controlled setting where they know what they are doing. The treatment would involve going in once a week for four weeks, and then every other week for four additional treatments. So three months, essentially. The pills, on the other hand, would be administered every other day for three months. Whichever way we go, Kirby's saliva, urine and feces will be toxic to us and other animals, so we'll need to exercise caution with that. His immune system would be compromised either way, and he would not be allowed around any other animals. Not even at the groomers.  After further discussion, we set up the first IV treatment for the next day, Friday the 23rd.

At 4:00 in the morning on Friday, Jim and I were both wide awake and fretting. I could not stop crying, worrying about whether or not we were making the right decision. We finally decided that if we were both concerned, then we should listen to our guts. We are not impulsive people who make major decisions without looking at all the facts and options, and I think that was part of the problem for us both. I called and cancelled the appointment, and asked for Dr. S. to call me. She returned my call a few hours later and answered all of my questions to the best of her ability. Basically, mast cell cancer cannot be cured. It will come back in Kirby, so it's not an "if" but a "when" situation. What you are hoping to accomplish with chemo is to destroy or disrupt the mast cells that have gone rogue in his system. Unfortunately there are no good statistics to help with the decision. It's not like she can say if you give him chemo, he can live for another 2-3 years. Or if he doesn't get chemo he will die in 3 months.  If he was five instead of going on eleven, that would make the decision easier.

We have since talked to a couple of people that worked in clinics that treated dogs with cancer, and they both said most dogs handle the chemo better than a people do. But all I can think is, if he is one that gets really sick, how in the world do I get his toxic waste out of hardwood floors and tile grout? Would he have to be kept in a kennel? Can we even take him on any walks if his waste is hazardous to other animals?

Lots of questions and no easy answers. At the moment, we are doing nothing other than keeping him on the medications he has been on since surgery - Benadryl twice a day, a Pepcid AC cut in half twice a day, and an Apoquel once a day. The mast cells release too many histamines in the body, causing itching and a chance of damage to the stomach lining, so these drugs help to keep that in check. I am taking him tomorrow for his grooming, which we do every two months and he is due for that. And Jim's parents want to see Kirby while he is still feeling good, so the two of them are going to do a road trip soon. Then we'll have to make an executive decision on which was to go. It is hard because Kirby has no say in this whatsoever. What decision would he make???