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.
Showing posts with label biopsy. Show all posts
Showing posts with label biopsy. Show all posts
Tuesday, February 25, 2014
Wednesday, August 15, 2012
Good if not thorough news
Today the nurse called from Dr. Dermatologist's office with my biopsy results.
Biopsy #1: persistent shoulder rash. The nurse on the phone said that the doctor, "thinks its a rare form of eczema." He thinks? We biopsied this baby and someone still lacks confidence with the diagnosis? This is why it's better to get the results in person and read the pathology report with the doctor. At any rate, I'll see Dr. Oncologist next week after the PET scan, so I'll ask to access the skin biopsy report then. In the meantime, Dr. D. prescribed a strong steroid to motivate the rash to go away. We're to give it 2 weeks to be effective before we try other approaches.
Biopsy #2. black thigh non-scab. I was told that this was a benign growth. I like the word" benign", but not the word "growth". Again, I am keen to read the pathology report and get some more details on this odd growth that sprang up in the last few weeks.
All in all this is definitely good news, but I am greatly looking forward to learning more details about these conclusions.
In the meantime I will add more substance to this post with a teaser of our summer vacation photos. The next post will be the vacation photo essay.
Biopsy #1: persistent shoulder rash. The nurse on the phone said that the doctor, "thinks its a rare form of eczema." He thinks? We biopsied this baby and someone still lacks confidence with the diagnosis? This is why it's better to get the results in person and read the pathology report with the doctor. At any rate, I'll see Dr. Oncologist next week after the PET scan, so I'll ask to access the skin biopsy report then. In the meantime, Dr. D. prescribed a strong steroid to motivate the rash to go away. We're to give it 2 weeks to be effective before we try other approaches.
Biopsy #2. black thigh non-scab. I was told that this was a benign growth. I like the word" benign", but not the word "growth". Again, I am keen to read the pathology report and get some more details on this odd growth that sprang up in the last few weeks.
All in all this is definitely good news, but I am greatly looking forward to learning more details about these conclusions.
In the meantime I will add more substance to this post with a teaser of our summer vacation photos. The next post will be the vacation photo essay.
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| After dinner on a windy evening, the four of us hiked across the island to sunset rock. Here you can see me stepping over a log while the girls are ducking under it. The sun's glare through the trees indicates that we are near our goal. |
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| We discovered that the lake was calm at sunset rock (part of the rock is captured on the bottom right, with various of our garrments sunning on it) despite the wind on our side of the island. We stayed for a long time, throwing rocks in the water and running along the beach. |
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| My Azalea Bud. |
Tuesday, August 14, 2012
In the flesh, out of the flesh
I'll do another post shortly with pictures of our family vacation to northern Minnesota, but first a brief health update.
Let's begin by establishing the fact that I am wonderful. I am happy...no, no, that's not quite it...nearly ecstatic on a daily basis to be enjoying life (specifically summer life) with my daughters, husband, friends, and family. We have gone on bike rides and had sleepovers and listened to bands and grilled on the patio, and it has all been so wonderful. I have experienced many thankful moments in which I recalled my previous thoughts of not being alive for summer 2012. At diagnosis almost 2 years ago I faced the very real potential of not surviving this long. And here I am, in the flesh, enjoying every minute of it. My bathtub could use a cleaning, but let's not disrupt the grace of this paragraph with the extended list of neglected chores.
Speaking of flesh, mine has two doctor-made wounds in it. Last Friday I saw Dr. Dermatologist, on the recommendation of Dr. Oncologist, to check out two unusual areas on my skin. Near my right shoulder I have small patch of 5 contiguous raised bumps. They do not itch or hurt. I first noticed them when I arrived in San Francisco, so I presumed that my backpacked had rubbed during traveling and had caused an irritation. A week or so later I realized that they were still there, so I put some hydrocortisone on them. This is the stuff previously prescribed to me for my post-surgery eczema. But the hydrocortisone made the rash spread in a painful way. I remembered from a different, post-radiation chest wall rash that hydrocortisone aggravates fungal infections, so I treated my rash with the remaining anti-fungal from that episode. The hydrocortisone-induced rash disappeared, but the original rash remained. The I thought that maybe my supposed fungal infection was either resistant or insensitive to this antifungal, so I applied a different antifungal leftover from the childrens' diaper-rash days. When it was clear that this third attack was being ignored by the rash, it was time to call Dr. O.
You might be wondering why I did not call a doctor sooner. I elected to try my own treatments based on my own experiences because the first thing that doctors tell you is to watch the (fill-in-the-blank) ailment and look for changes. I do not as a rule recommend such cavalier patient behavior, but since my rash was not getting bigger or worse (hydrocortisone treatment excepted), I gave it some time to resolve so that I could report all of the data at the time of the appointment.
And that is what I was able to do. Less than two months after noticing the rash I sat in Dr. Dermatologist's office and recited the history of my rash. He said that it could be a rare form of eczema that occurs near joints (the name he rattled off completely evades me), but that he'll take a small sample (biopsy) to be sure.
Excellent! This type of firm decision-making via informed prescription or biopsy is exactly what I was looking for!
That is the story of biopsy number 1. The cause of biopsy number 2 is actually what motivated me to make an appointment (indeed, a different way to interpret the above story is that I was procrastinating taking action on the innocuous shoulder rash).
Cause #2 used to reside on the outer flank of my right thigh. I noticed it nearly three weeks ago when scratching an itch. It was raised and rough, like a scab, and the size of a pinhead. For a few days I thought it was a scab. But then I realized that it wasn't behaving like a scab by, you know, falling off. Upon closer inspection it was black in color rather than that rusty scab color. The one thing going in its favor is that it was quite symmetrical, and the ABC's of melanoma start with Asymmetry. At any rate, Dr. Dermatologist's possible explanation for this non-scab scab was that a cluster of blood vessels burst under my skin awhile ago, and now that the burst had reached the top it appeared black. But he decided to biopsy it anyway, and unlike the shoulder rash I think that the entire troublemaker was removed.
I'm moderately terrified that I will be embarrassed when I am obligated to post that the results of the biopsy indicate "blackhead", but I suppose it would be Dr. Dermatologist who should be embarrassed for biopsying said blackhead.
All in all this is excellent timing for my flesh samplings because the dreaded PET scan is next Thursday (8/23). Rooting for a second clean one, marking two clean ones in a row, which MUST be OUTSTANDING news for ME and my FUTURE after IBC. I suppose I'm also rooting for good flesh biopsy results, but at present I am (perhaps naively) unconcerned.
Let's begin by establishing the fact that I am wonderful. I am happy...no, no, that's not quite it...nearly ecstatic on a daily basis to be enjoying life (specifically summer life) with my daughters, husband, friends, and family. We have gone on bike rides and had sleepovers and listened to bands and grilled on the patio, and it has all been so wonderful. I have experienced many thankful moments in which I recalled my previous thoughts of not being alive for summer 2012. At diagnosis almost 2 years ago I faced the very real potential of not surviving this long. And here I am, in the flesh, enjoying every minute of it. My bathtub could use a cleaning, but let's not disrupt the grace of this paragraph with the extended list of neglected chores.
Speaking of flesh, mine has two doctor-made wounds in it. Last Friday I saw Dr. Dermatologist, on the recommendation of Dr. Oncologist, to check out two unusual areas on my skin. Near my right shoulder I have small patch of 5 contiguous raised bumps. They do not itch or hurt. I first noticed them when I arrived in San Francisco, so I presumed that my backpacked had rubbed during traveling and had caused an irritation. A week or so later I realized that they were still there, so I put some hydrocortisone on them. This is the stuff previously prescribed to me for my post-surgery eczema. But the hydrocortisone made the rash spread in a painful way. I remembered from a different, post-radiation chest wall rash that hydrocortisone aggravates fungal infections, so I treated my rash with the remaining anti-fungal from that episode. The hydrocortisone-induced rash disappeared, but the original rash remained. The I thought that maybe my supposed fungal infection was either resistant or insensitive to this antifungal, so I applied a different antifungal leftover from the childrens' diaper-rash days. When it was clear that this third attack was being ignored by the rash, it was time to call Dr. O.
You might be wondering why I did not call a doctor sooner. I elected to try my own treatments based on my own experiences because the first thing that doctors tell you is to watch the (fill-in-the-blank) ailment and look for changes. I do not as a rule recommend such cavalier patient behavior, but since my rash was not getting bigger or worse (hydrocortisone treatment excepted), I gave it some time to resolve so that I could report all of the data at the time of the appointment.
And that is what I was able to do. Less than two months after noticing the rash I sat in Dr. Dermatologist's office and recited the history of my rash. He said that it could be a rare form of eczema that occurs near joints (the name he rattled off completely evades me), but that he'll take a small sample (biopsy) to be sure.
Excellent! This type of firm decision-making via informed prescription or biopsy is exactly what I was looking for!
That is the story of biopsy number 1. The cause of biopsy number 2 is actually what motivated me to make an appointment (indeed, a different way to interpret the above story is that I was procrastinating taking action on the innocuous shoulder rash).
Cause #2 used to reside on the outer flank of my right thigh. I noticed it nearly three weeks ago when scratching an itch. It was raised and rough, like a scab, and the size of a pinhead. For a few days I thought it was a scab. But then I realized that it wasn't behaving like a scab by, you know, falling off. Upon closer inspection it was black in color rather than that rusty scab color. The one thing going in its favor is that it was quite symmetrical, and the ABC's of melanoma start with Asymmetry. At any rate, Dr. Dermatologist's possible explanation for this non-scab scab was that a cluster of blood vessels burst under my skin awhile ago, and now that the burst had reached the top it appeared black. But he decided to biopsy it anyway, and unlike the shoulder rash I think that the entire troublemaker was removed.
I'm moderately terrified that I will be embarrassed when I am obligated to post that the results of the biopsy indicate "blackhead", but I suppose it would be Dr. Dermatologist who should be embarrassed for biopsying said blackhead.
All in all this is excellent timing for my flesh samplings because the dreaded PET scan is next Thursday (8/23). Rooting for a second clean one, marking two clean ones in a row, which MUST be OUTSTANDING news for ME and my FUTURE after IBC. I suppose I'm also rooting for good flesh biopsy results, but at present I am (perhaps naively) unconcerned.
Thursday, April 7, 2011
Some good news...finally
The tissue that was biopsied on Monday is normal!!! Huzzah! What a relief! I didn't think I was that nervous, but I must have been because my relief knows no boundaries. Okay, well, the spine thing still has a hold on the negative side of my imagination, so I suppose that that forms at least one boundary to my relief. But I am nonetheless QUITE relieved!
I'm getting closer and closer to being normal. I quit taking the narcotic pain reliever today and did well. Now I'm back to the place where my left "breast" hurts more than my right, which is how it should be in my world. The right breast barely aches, and it looks surprisingly normal despite the absence of a walnut-sized piece. It doesn't have a crater or anything. Also, the nerve pain on the left side has started to subside, which is awesome. I quit wearing my special sleeve, and goosebumps no longer make me gasp. Another step in the normal direction is that I worked a full day of work and was moderately productive. With every day that I put between me and the serious drugs I expect to gain more and more productivity. I might even be able to drive myself to work tomorrow.
One new stage of my healing include itchiness. It's kinda weird, too, because I'll have an itch sensation near the rainbow incision, but when I go to scratch it I have trouble finding it because I don't have feeling in the skin around the incision. Same goes for the armpit area. Rather than scratching the itch with my hand I have started scratching the itch by wiggling my shirt around. This broadly-administered friction brings swift relief compared to the game of Marco Polo played by my fingers and the itch.
Tomorrow I have another physical therapy appointment. I am really enjoying the physical therapy because it makes me stay on task with the exercises, and the exercises are really improving my range of motion. Also, my therapist does some soft-tissue massage to help the scar tissue loosen up (i.e. stretch in more planes). It's one of those things that makes me sore right afterwards but feels so much better the next day.
Also tomorrow is my radiation simulation appointment. This is where my dimensions will be taken for the administration of the radiation. I understand that I will be getting a couple of tattoos so that I am always put in the exact same position for every radiation dose. I never wanted a tattoo, and I suppose I still don't want a tattoo. I must admit, however, that having any tattoo makes me feel a little bit cooler. Can you just see me at parties? "That's a great tattoo, Lauren! Where'd you get it? Sweet. I have a tattoo, also. See? I got it back in '11 so that my radiation treatments would be positioned properly. Yea, I totally had breast cancer. It sucked, but at least I got these sweet tattoos!" Talk about conversation killer!
I'm getting closer and closer to being normal. I quit taking the narcotic pain reliever today and did well. Now I'm back to the place where my left "breast" hurts more than my right, which is how it should be in my world. The right breast barely aches, and it looks surprisingly normal despite the absence of a walnut-sized piece. It doesn't have a crater or anything. Also, the nerve pain on the left side has started to subside, which is awesome. I quit wearing my special sleeve, and goosebumps no longer make me gasp. Another step in the normal direction is that I worked a full day of work and was moderately productive. With every day that I put between me and the serious drugs I expect to gain more and more productivity. I might even be able to drive myself to work tomorrow.
One new stage of my healing include itchiness. It's kinda weird, too, because I'll have an itch sensation near the rainbow incision, but when I go to scratch it I have trouble finding it because I don't have feeling in the skin around the incision. Same goes for the armpit area. Rather than scratching the itch with my hand I have started scratching the itch by wiggling my shirt around. This broadly-administered friction brings swift relief compared to the game of Marco Polo played by my fingers and the itch.
Tomorrow I have another physical therapy appointment. I am really enjoying the physical therapy because it makes me stay on task with the exercises, and the exercises are really improving my range of motion. Also, my therapist does some soft-tissue massage to help the scar tissue loosen up (i.e. stretch in more planes). It's one of those things that makes me sore right afterwards but feels so much better the next day.
Also tomorrow is my radiation simulation appointment. This is where my dimensions will be taken for the administration of the radiation. I understand that I will be getting a couple of tattoos so that I am always put in the exact same position for every radiation dose. I never wanted a tattoo, and I suppose I still don't want a tattoo. I must admit, however, that having any tattoo makes me feel a little bit cooler. Can you just see me at parties? "That's a great tattoo, Lauren! Where'd you get it? Sweet. I have a tattoo, also. See? I got it back in '11 so that my radiation treatments would be positioned properly. Yea, I totally had breast cancer. It sucked, but at least I got these sweet tattoos!" Talk about conversation killer!
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