No fear

Today I went the distance to get a second opinion from Dr. Surgical Oncologist regarding my lumpish thing that's going on.  To recap, Dr. Radiologist in my town said not to worry, it's just a mildly inflamed lymph node, but Dr. Oncologist wasn't satisfied that evaluation and suggested I give my rockstar Dr. Surgical Oncologist a chance to check it out.

The clinic was unusually quiet today.  I barely had my coat off when I was called back into a room.  I handed over the disks of my recent scans, then I played on my new smart phone while waiting for the doctor.  She came in and rather quickly made the same evaluation as Dr. Oncologist and me:  there is definitely something new and unusual going on in there.  She said that she'd like to have another ultrasound, perhaps one where they did not focus exclusively on the lymph nodes.  Fortunately they could fit me in later in the day.  Pending the ultrasounds results, she presented three plans:  A)  perhaps the radiologists would like to use the ultrasound to guide a biopsy, B) if not, she would like me to come back to her clinic where she would perform a biopsy, and C) perhaps we'll just perform a lumpectomy on a later date, regardless of A or B.

I said that all sounded fabulous because of things:  1) biopsies are the best ways to get answers, even when they are inconclusive; and 2) I love her anti-wait-and-see strategy.  I've already waited, and I've already seen.  Given my previous bout with IBC, further waiting does seem to be nonsensical.

I had just over two hours to wait until my ultrasound appointment.  I decided to visit the hospital library.  On my way there I walked through an atrium that was resonating with some delicious music.  It was coming from somewhere below me, but mirrors and windows prevented me from seeing the source.  I changed course to better enjoy the music and was delighted to find a string quartet playing Beethoven.  They were brilliant.  It was unclear how often they performed in the hospital, but it's possible that it was a rare bit of marketing because at the end of their performance they invited everyone to attend their recital on Friday.  It was a lovely interlude in my day.

The ultrasound technician was friendly, talented, and quick.  Within minutes she had the pictures she wanted and was out the door to consult with Dr. Radiologist.  The technician returned to my side with both Dr. Radiologist and Dr. Department Head Radiologist, who all took turns exploring the live images.  They concluded that in addition to the lymph nodes identified by the previous scans, I had an additionally enlarged lymph node in my arm pit.  Only slightly enlarged, but noticeable.  Regarding the lumpish firmness that started me on this path, they determined that it is irregular and a shade darker than the neighboring tissue (by ultrasound), but that is all.  There is nothing really to see or say about it.

Just after 3pm they agreed that a biopsy would be a good thing to do, and yes they would go ahead and do it then and there.  They decided to perform a needle aspiration of the largest lymph node (armpit) and to perform a needle biopsy of the firmness.  I said yes to all of it.  Everyone left the room.  Then the parade began.

The technician came back and started prepping things for minor surgery.

Dr. Radiologist reentered and asked if I'd be part of a research study.

Dr. Research Study arrived and invited me to participate in a research study on whether or not the DNA and RNA of breast cancer are the same as in adjacent armpit lymph nodes.  Even if my results are benign/negative, I would be part of the normal (control) group of participants.  Naturally, I agreed to be a part of the study.

Dr. Department Head Radiologist entered and exited numerous times, apparently waiting to witness one particular aspect of the procedures.

Three pathologists arrived and set up a microscope just outside the room to analyze certain samples instantly.  This does not mean that I have results for you; this means that they needed to ensure that they had enough of my cells to perform their tests.  Here's how it worked:  Dr. Radiologist numbed up the area, then used the ultrasound wand to guide where she inserted the needle.  Once satisfied with the location, she sucked up a tiny amount of cells from the fluid part of my lymph node.  Then she sent the needle-full of my lymph node cells out to the pathologists.  She did this repeatedly until they said that they had a sufficient amount of my cells.  It took 5 needle samples.

Then Dr. Radiologist took a bonus sample of lymph node (the size of pencil lead is what they told me, but that's a touch ambiguous) and gave it to Dr. Research Study.

The pathologists left, then Dr. Department Head Radiologist came in and stayed for the lump biopsy.  Dr. Radiologist once again used the ultrasound wand to tell her where to stick her instruments.  Using a noisy little needle-punch contraption she took out 5 samples, all approved and indeed coached by Dr. Department Head.  Then she took one bonus sample for Dr. Research Study.  At some point during this phase of sampling, Dr. Surgical Oncologist stopped by to see how things looked.

I have nothing to fear as long as these women are on my team.

The penultimate task was to insert a little token into the lump.  They placed a sterile titanium clip to mark the area that they biopsied (this should tell you how difficult it is to visualize this lumpish thing--they had to permanently mark it with a metal shard).

Then the final step was a mammogram, to be sure that the clip is in there, and in the right place.  But putting a freshly biopsied breast in a mammogram compression is likely going to be bad for bleeding, you might say.  Ah, they have thought of that!  Before the mammogram they bandaged me up and used compression for 15 minutes to inhibit the bleeding.  They achieved this with a sandbag.  Yep.  Just like the ones my mom puts in the back of her pick-up truck in the icy winter months.  I laid there on the table with an enormous towel-wrapped sandbag over my chest for a quarter of an hour.  The sandbag was unexpected and completely disarming, and it was a relief to laugh out loud after the seriousness of the previous hour.

The lidocaine prevented me from having too much discomfort during the mammogram.  It was quick and no problem.  The clip is pretty cute in there.

We'll have the results on Thursday or Friday.  They said that Friday is more likely, and that if I haven't heard by 2pm then I should give them a call.  

I want to thank everyone for their support today (and always).  It was so awesome to use modern technology to receive all of your well-wishes all day long.  

I'm hoping for the best, but I'm not fearing the results.  I've got this, no matter what it is.  I've fought the good fight once and I can do it again.  No worries, everyone.  No worries.