Monday, April 4, 2011

Location location location

I mentioned to my good and gentle anesthesiologist that it was four weeks ago to the day that I had a left mastectomy.  I never knew a German accent to be smooth, but his was, and with it he said that the timing was a good omen.  I believe him.

Now that the needle-localized biopsy is over I can finally say that I understand it.  The answer to the riddle is that the upper paddle has a 3x3 inch square hole in it.  I'll back up and explain.

Ian and I arrived at the operating check-in at 7am.  I was whisked away for the gowning and the IVing.  The nurses and I decided not to use my port because it is on the right side, the side of the biopsy, and none of us quite understood the mechanics of how the needle/wire placement was going to work.  We didn't want the needle in the port to be in the way.  With the IV in my right hand I was wheeled on a bed to mammography.  Upon arrival I got out of the bed and sat in an office-style chair.  I explained to the radiologist, resident, and technician that I am not a wimp, but my previous mammogram sent me and my port to the top of the pain scale.  They told me to speak up about my pain and not let that happen again because the previous pictures were informative and such compression was unnecessary today.  This was excellent news, particularly because I learned that my breast would be in compression throughout the needle-localization procedure.

What is "compression"?  For any mammogram one's breast is placed on a height-adjusted, smooth, flat table while the patient sits or stands.  A second smooth, flat surface of variable dimensions is positioned parallel to the table and is brought down on the the breast to achieve extraordinary compression.  The result is a breast that is sandwiched between the two planes, much like a sandwich on a George Foreman grill, minus the ridges.  The upper, compressing surface is called a paddle.  The key to the needle-localization procedure/riddle is that for this procedure, the upper paddle has a 3x3 inch square opening in it, granting the radiologists access to a portion of the compressed breast.  This was my "ah-ha" moment for the day, possibly for the week, because I did not know that paddles could have holes.  I had imagined that the radiologists would be placing the needle/wire from the side or from above my breast (i.e. near my port).  Neither of these imaginings were favorable to me.  A window in the paddle, however, makes excellent sense.  I plan to teach all of my medical caregivers about paddles with windows so that future patients do not suffer such ignorance as I have.

So...I'm seated, my breast is compressed, and they take a picture.  They decide to go in and mark quadrant G9 based on how my breast is situated in their grid.  While compressed and through the 3x3 window, I get a right breast poke with some numbing juice, then a big right breast poke that's headed for quadrant G9.  They decompress the breast and reposition the table and paddle to check on the needle position at a different angle.  They re-compress and snap a picture, discovering that the needle is in the perfect position.  Huzzah!  Now they inject some methyl blue dye to mark the spot.  They also insert a very thin, pliable but firm wire through the needle to ultra-mark the spot.  Then they remove the needle, reposition one more time for one more picture, and at last relieve the compression for good.  They dye and wire remain in the breast.  I'd say that the whole thing took less than 20 minutes.  Know that it was much less uncomfortable or painful than the spine biopsy, although from my post-spine-biopsy notes it would seem that I was in no pain at all.

That was only the first half of the procedure, but the second half is largely unknown to me because I had general anesthesia.  After the wire was localized I was wheeled on my bed back to the operating area, and from there to the operating room (OR).  Then, night night.  The surgeon told Ian that everything went well.  She removed a piece the size of a small walnut and will have the pathology results in a few days.  Oh, and I did have a breathing tube; I now have a sore throat and swallowing is just on the good side of unbearable.

One of the biggest differences between today's recovery and the post-mastectomy recovery is the location of the post-operative care.  Oh my goodness, it was so much better this time!  I stayed in the operating department (named Ambulatory Care Services, ASC), and the nurses were kind, thoughtful, and attentive.  I don't even know the name of the department in which I stayed for overnight recovery last time, but I would not ascribe any of those words to it.  By the way, I think I forgot to mention that I'm home already.

Interestingly, although I am only four weeks out from my left mastectomy, I need to learn to treat my right arm as "injured":  no lifting 10+ pounds for two weeks.  Also, I am to do my physical therapy exercises with both the left and right arms.  At least I don't have drainage tubes, and I got great drugs this time (hydromorphone).  No more Tylenol 3 for this reformed pain scale user!  While on this drug I'm not supposed to drive or do anything that requires me to think. Should be interesting.

Thus far I have discussed three important locations of the day:  my location in time, a location in my right breast, and the location of recovery.  The last location I would like to present is the location of today's post-operative meal:  the Hamburg Inn No. 2 in Iowa City.  It is a diner, and diners are usually a vegetarian's nightmare.  However, this diner offers meat-free sausage and meat-free bacon.  At 2 pm today I was in a private corner booth eating the best greasy-spoon breakfast I've ever had.  Let's also admit that I've had two pieces of pie in the last 24 hours.  What can I say, it's Amish country over there; their pies are ridiculous.

Poke tally:
port  28
right arm 11
tummy  6
left arm  6
right breast 1+
left breast  1+
superior vena cava 1
T9 vertebral body 1

Some crocuses for Becky:


  1. And yay for the Hamburg Inn No. 2! If you ended up there, then I'm not sure how much better the day could have gone. Of course, the most important location is that you're home. My only question: how are you, Dr. Allen, going to swing this not-thinking thing?

    PS, speaking of locations...well, I'll email you

  2. Hamburg Inn No. 2?!? Excellent choice--I drink my coffee daily from a Hamburg mug...

  3. So you're saying it's like a hooter panini? :)

  4. Glad you're feeling better, and I'm very greatful that you re-thought your pain-scale. A pain of "3" after a mastectomy just doesn't seem right :) Glad you changed your "3" to a "6" this time by remapping your scale and got some better drugs. Now RELAX and enjoy the princesses :)

  5. The Crocuses are so pretty! They look a lot like tulips. Cute, cute, cute!

    I'm glad that the whole procedure wasn't near as bad as you thought it was going to be - and that you got to have a yummy lunch. :)


  6. What a freaking great post! I was wondering how they were going to get that biopsy...good info. Hope i never have to be glad I knew it. Glad to see you are getting some better drugs - hope they do you good.

  7. I'm glad the procedure was not as bad as you were expecting. And I, also, am thrilled to hear that you ate at the Hamburg. Now, if they could do a vegetarian Reuben omelet, I think that would have made your victory meal even better!

  8. Wow! Talk about a play-by-play! I think you are inspiring me to start a journal. Have I mentioned, my memory sux! Maybe that will help. :) Keep on pluggin on!