The Day After

Staying up all night creating a blog may be good for the psyche, but bad for one's head. I paid my lack of sleep the next day with a pounding headache. I also haven't worked out since Sunday. Too tired and distracted. I hope I don't let my weight loss team down. For the past year I had been taking Benadryl every night in order to be able to sleep. Two weeks ago (as part of my 40-year-old plan), I quit cold turkey. Perhaps the timing wasn't the best. I hope this relapse will be short-lived, but I did break down and take some last night. I REALLY needed the sleep. I feel much better this morning.

I think my pity-party may be nearing its end. I have to start living again. I have a job and a family, who would all like me back, I am sure. The good news is I've stayed away from Google. Haven't looked up a thing in the past 24 hours. Yay for me! Now I need to stop staring at a blank computer screen and start being more productive. Maybe I'll start by going for a run today.

A friend/client of mine came in with her dog yesterday. We had a good chat about everything. She is also a cancer patient (victim? survivor?) who has had a much tougher haul. She is so upbeat and positive and claims that is one of the reasons she's doing so well. I have the right to feel sorry for myself, but I also need to know when to stop doing that. Which is today. Actually, today is a very good day for that because today is the day Lisa is having the hardest time. I don't envy her at all. Someone told me it is almost harder on the family members and I sort of believe it. If you're reading this, please reach out to Lisa! She's more private about her emotions, but I know she would appreciate thoughts being sent her way. Or maybe having someone to talk to.

As for me? Well, you all know I love talking about myself, so if you want to listen to me go on and on, please give me a call.

I've also changed the title of this blog, because life isn't all about boobs, is it? Although I will say that although I haven't really thought about them much until recently, I really do like mine. They've never caused me any trouble until now. They helped feed my boys when they were infants. They're not very big, which goes great with my athletic lifestyle - I feel bad for the women who have to wear 3 sports bras at a time in order to go for a run. Not me! Several people have told me that if it came down to it, they'd lop theirs off in a heartbeat. I, on the other hand, would like to keep mine around if possible. I have an MRI in Monday, which will hopefully show no more lesions, meaning I can keep them mostly intact.

Go call a friend (it doesn't even need to be me!), hug your kids, and for God's sake, get caught up on your preventative healthcare!

The biopsy results are in...

It wasn't until Monday night that I really started getting nervous. In less than 24 hours, I would know. Would my life be changed forever? Or was this just a cancer scare? Statistically, only 20% of BI-RAD 4B lesions were cancerous. And most of those that are calcifications, rather than a mass, are DCIS, which is really early cancer. Very treatable. But still, it's cancer. In all honestly, I had a gut feeling. I was pretty sure it wasn't benign. I don't think I told Lisa because didn't want to freak her out. The radiologist told me on Monday that if it was benign, a nurse would call me. If it was not, the surgeon (who I never even met) would call. I had my cell phone in my pocket all morning at work. I was expecting the call in the afternoon, so my stress level jumped up when the clock ticked noon.

I was sitting at my desk at about 12:30 when my phone vibrated. Hello? I said. Hi, is this Jami? Yes. Is this a good time to talk? Sure. This is so-and-so, a nurse practitioner from the Piper Center. Great! A nurse! That means good news! Wait. You're biopsy is back and I'm afraid it came back as cancer. Ductal carcinoma in situ. I was not surprised, but still, you never really want that phone call. She went on a bit about the next step, but I didn't really hear her. She had to repeat everything. I would need a bilateral breast MRI, then a consultation with the surgeon (again). The office would be calling me later to schedule. I got her to fax me the report -DCIS, cribiform, clinging, nuclear grade 2 of 3, no necrosis, not invasive, hormone receptor immunohistochemistry pending. So again, very treatable.

I called Lisa and my mom. I told my staff, and then announced it on my weight loss Facebook page. I sort of sleep-walked through the rest of the day. I scheduled my MRI for Monday, April 4 and my surgical consult for next Thursday. That's all I know. Well, I suspect that I will have a lumpectomy followed by 6 weeks of radiation treatment, but I don't know for sure.

Everyone deals with adversity in different ways. I have come to realize that I do best with the support of many people. Hence, my very public blog. I am grateful for the help of everyone in my life, and I promise to be as open as I can be. Lisa has been awesome. She's got my back. I think that if one of us should go through something like this, it's better for it to be me. Lisa is much more nurturing and supportive. I would just tell her to buck up, it's only cancer. She's also been very clingy lately, which I love! And she even asked if I wanted to talk about our relationship! I should get cancer more often!

And I know it's only stage 0 cancer and I have a very high probability of a cure, but it still jolts you a little, you know? I am defective. I contain cells that are behaving badly. I have a much higher than average chance of more serious breast cancer in the future, even with treatment. I probably couldn't get more life insurance now! I'm high risk! I have to have a piece of me cut out. I have many more doctor appointments in my future. I have something In common with all those ladies who wear pink ribbons. I have breast cancer.

Surgery? Well, not exactly...

Yay! It was Monday, March 28. My surgery day was finally here! Lisa took the day off of work, my kids' piano teacher made sure the kids got on the bus ok. I got up early, showered, removed all of my jewelry, didn't eat or drink, and we drove down to Abbott Northwestern at 8 am. Memories came flooding back to me, as the Piper Center was the same building where my perinatologist was, when I was pregnant with the boys.

The receptionist was super nice. The volunteer was super nice. They brought the patients coffee and tea in real china cups! All of the patients were in robes, not hospital gowns. I was led into the changing room and told to remove my shirt and put on... A hospital gown. Wait? Why not a robe like everyone else? I'll never know the answer to that question. Then Lisa and I got to wait in the Ladies' Waiting Room. No men allowed here! This room was special because.... It had magazines geared towards women! Wow. I'm still not sure why they had a special room for women. Its not like the patients were naked or anything.

We waited for quite some time while the radiologist examined my films. Then, I was called into a conference room to talk to her. Hmmmm. Guess what? She said. I think I can get the biopsy stereotactically. WHAT? Well, that messed everything up. I came here for surgery! I didn't eat this morning! I had researched the surgery so much I could practically do it myself! You can't go and change the plan at the last minute! And why could you get it when the other radiologist couldn't? Well, we see all of the difficult cases here. We're very good. If I can't get it right away, I promise you I'll stop and we'll get you right into surgery as planned. The thing that finally made me decide to let her try was that she said with this procedure I would have the results the next day. With surgery, it could take 2-3 days. Sold!

Suddenly, everyone was rushing around because they had to hurry in order to not miss the surgical window, if needed. I got up onto the all-too-familiar table and guess what? They localized the lesion in mere minutes! Then she injected my breast and used a suction biopsy machine to take 8 core samples. I only felt the last one, which went just beyond the numbed area. That made me jump. Then it was done! I swear the whole procedure took only 20 minutes. Oh, and one more follow-up mammogram for good measure.

Now what? Lisa had the day off work and I wasn't sedated and we were out of there by 10 am. So we had a fun little day of lunch at Panera, then clothes shopping. I usually shop at Target or Kohls, but this time we went to fancy clothing stores where the associates actually help you put an outfit together! I spent way too much money, but I got some fantastic new outfits.

I feel like the theme of the day was to be surrounded by helpful and supportive women. I need to embrace my feminine side more often!

Appointments number 4 and 5

I waited anxiously for a phone call from my family practitioner, who is also a friend. He finally called me later that day and told me he set up a consult with a former colleague of his, a surgeon who specializes in breast procedures. I looked her up and she seemed really nice in her picture. Her office called me and got me in ASAP, which was the following Tuesday, March 22. Six whole days! I was going to lose my mind! I was also armed with new information. I had asked the radiologist what my BI-RAD score was and he told me it was a 4. So now I researched every published article about BI-RAD 4 lesions. No new information, really. A score of 0-2 is benign. A score of 3 is likely benign, follow up in six months. A score of 4 is suspicious for malignancy, biopsy recommended. A score of 5 is probable malignancy, take appropriate action.

Finally, the day came for my surgical consult. By this time, I had put the surgeon up on a little pedestal. In her photo, she was smart and confident, and wore a really sharp suit. Plus, she was voted a Twin Cities top doc for women. I got my images and reports from the radiology department and tore into them. The report was kind of boring. BI-RAD 4B (on a scale from A-C), which was, of course, an intermediate risk. I stripped down into a paper gown and waited in the exam room. The surgeon breezed in, asked me the standard risk factor questions and said, Well, you've done everything right. So I can go now? I asked. Um, no. She did a brief breast exam, couldn't find anything, of course, and explained the surgery to me. First, a radiologist would localize the lesion and place a wire into it. Then I would be given an IV sedative and a local anesthetic and the surgeon would remove the wire and surrounding tissue. They would radiograph the tissue to make sure the wire was in there. Then I would be sutured up.

I would need a pre-op physical from my doctor and the surgeon's office would call me later today to schedule the surgery. Oh, and she told me she was on vacation next week. Then she breezed on out.

Aaaargh!

The surgeon's office called me later and I found out her first availability was April 8!!! Yeah, no. We're leaving for Hawaii the following day and I'm not going to have any swim restrictions and I'm CERTAINLY not going to wait another month.

Many phone calls, texts, and Facebook messages later (really!) and I arranged to have the surgery done by the her partner on the following Monday, March 28, 4 weeks to the day from my first mammogram/speeding ticket. I went in the next day for my pre-op physical, because apparently a surgeon is not capable of assessing whether a patient is healthy enough for sedation.

Stereotactic biopsy attempt = medieval torture session

I was all excited when I went in for my stereotactic biopsy on Wednesday, March 16. I sort of cheated; I wasn't supposed to work after having the procedure. But I only had to work half a day, and I knew I wouldn't do anything too strenuous. I remembered not to put on any deodorant (they make you wipe it off anyway as the aluminum can cause artifacts on the images). I checked in promptly at 9 am and I felt pretty darned special. Most of the other ladies were there for just a mammogram. I was getting a biopsy. Ha! Not everyone gets a BIOPSY! I sat down in the waiting room chair and heard, Hey, Dr. Stromberg! It was a client of mine, whom I recognized only a little. Small world! We chatted for awhile and then she was called in for her mammogram. I still waited.

I was finally called into the stereotactic room. The technician explained the procedure again, and the radiologist (a different one, a man - not that it matters, but why would a man go into the field of breast radiology? How many female prostate specialists are there?). I got onto the table, on my stomach with my face turned to the left and I immediately knew it was going to be a long morning. I was uncomfortable within 5 seconds. There is no support under your pelvis, so you have to lie with your back extended, right arm at your side, head to the left, left arm near your head. And, did I mention your boob is hanging through a hole in the table? I encourage you to Google images of the procedure to see what I'm talking about. Except in the pictures I've seen, the patient is smiling. Right. They raised me up, just like a mechanic would raise up a car to work under it. The technician groped and grabbed my right breast through the hole, and then squeezed it in between two plates. I couldn't see what she was doing; in fact I could only see the framed landscape painting on the wall. They didn't even have any relaxing music playing! She took one view, then another, then another, then shifted and grabbed and took more views. After each one she would call the radiologist back in and they would confer and decide it wasn't right and then there was more shifting and squeezing.

At one point the computer stopped working right so they called in two more people. All the while I'm in the stretched prone position with my right breast hanging through a hole and clamped in a vise. Awkward! Not only was that part of my body uncomfortable, but my lower back and shoulders were killing me. But I had to stay still, mind you. I was on that table for an hour when the radiologist finally said I could sit up. Wait, no biopsy was taken! I'm sorry, he explained, we can't do the procedure. They could not confidently localize the lesion with their machine, which really is the best machine around. I would need to have a surgical biopsy. What??? I won't get an answer this week? I spent an hour being tortured for nothing? Again, I sat there in a state of shock. This rarely happens, he explained. Usually they know ahead of time if they can't get the area, but there was nothing about me or the lesion that made them doubt their ability to get a sample. Maybe it's not really there? I hopefully asked. Oh, it's there, he replied. Do I really need a biopsy? Absolutely. It would be out of the question to even consider not getting a biopsy. He called my doc, who was supposed to call me to set up a consult with a surgeon. I knew this was going to drag out at least another week.

I drove to work in a daze. Yet another wrench thrown at me. This "routine mammogram" was really messing up my life.

Let's back up a little

In June I turned 40. A milestone that had the potential to send me into a tailspin of depression. Thankfully, I never got depressed, I just became introspective. I had a couple of goals, one being to lose about ten pounds. I'm not overweight (yet another breast cancer risk), but I wanted to go from the upper end of normal BMI to the lower end. Basically, I wanted to look like Jillian Michaels. It wasn't until December, however, that I got serious about weight loss. That's when I formed the Facebook weight loss group and really started dieting. Eight weeks later I was down 11 pounds and starting to feel pretty good about myself. For some unknown reason, I became introspective again and felt compelled to write Lisa a letter. The letter listed what I felt were my major accomplishments in life, as well as some new goals, both in the short term and the long term. Some of these were personal goals (like getting myself off of sleeping aids), some were professional (getting board certified), and of course, some were really personal and involved our relationship. Lisa LOVES relationship talk! That's probably why she didn't read the letter right away.

On March 5, I gave Lisa the letter (as she was napping, none-the-less) and headed onto our lake to go cross country skiing with the dogs. 30 minutes later I was in the water, having fallen through the ice trying to rescue one of the dogs who had done the same. It was about as close to a near-death experience as I've had in awhile. It all worked out ok (except for Cathy, who tore her meniscus while running down the bike path after receiving my panicked phone call). Two days later I had the second mammogram.

I wonder why I suddenly became so obsessed with the state of my life? Did I intuitively know something bad was going to happen? Normally, a close call is what sets off self-reflection, but I wrote the letter BEFORE I fell through the ice and BEFORE I started getting worried about my breasts! Maybe I'm not giving my intuition enough credit.

Stupid internet! Or how I nearly lost my mind

So after my talk with the radiologist I decided to research breast calcifications a little. Turns out you can spend hours and hours surfing the web about this topic. My research told me that 23-30% of breast calcifications that resulted in a biopsy were cancerous. The vast majority of these were ductal carcinoma in situ (DCIS), which is really stage 0 cancer. However, left untreated a certain percentage DCIS lesions become malignant tumors. I wouldn't stop at that information, however. Soon I was looking a mammograms of all sorts of lesions and comparing them to what I remembered about what my calcifications looked like. I read blogs, and studies, and more studies, and excerpts from textbooks. I think I could maybe pass for a third year medical student at this point. Of course, the only thing of this surfing accomplished was to cause me ever more anxiety. I developed stress colitis, and couldn't sleep, and was very unproductive at work.

I finally decided to move my biopsy date up a little, to Wednesday, March 16. That way I'd get an answer before the weekend. That's all I needed - an answer. Then I'd be ok. Three more days and I'd know.

Of course the radiology gods had other ideas for me...

My second mammogram

The day after my triumphant first mammogram, I was driving home from work and I saw I had a message on my cell phone. A nurse from the Breast Center at Westhealth called to let me know there was an abnormality on my initial mammogram and I needed to make an appointment for a follow up. It was after business hours so I couldn't call them back until the next day. Yep, it was confirmed, the radiologist wanted to take some extra views. Hmmm. Must have been an artifact. Or maybe they were blurry. Not too worried, I scheduled my follow up for the following Monday, March 7.

The technician at Westhealth showed me my mammogram films and pointed out a teeny tiny area of even teenier tinier calcifications in the right breast. That was what the radiologist was concerned about and they needed more views of that region. Like my first mammogram the week before, I had to fill out a questionnaire: Do you smoke? Drink? Have you been pregnant? When? Last period? First period? Mother with breast or ovarian cancer? Sister? Grandma? Aunt? Ha ha... Like I said, I have none of the risk factors.

If you thought my first mammogram was fun, you should have been there for the second. This time, the gown wasn't heated AND they took like 10 views, including a couple of magnified views that really smashed my boob. Funny, I never looked at them in that position because I thought it was undignified and I didn't want to embarrass them.

After I got dressed, the radiologist called me into her viewing room. That's weird, I thought. I've never spoken to a radiologist in person before. She introduced herself and was super nice and explained that the area of calcification was suspicious, not necessarily cancer, but could be precancerous or early cancer, or nothing, or... honestly, I didn't hear much of what she said after the word CANCER. I was truly surprised by the whole thing. As she kept talking, I began to realize that the story was not over. I needed a biopsy. Huh? Me? She explained that I was a good candidate for the less invasive stereotactic biopsy (rather than a surgical biopsy). She described the procedure, where I would lie down on a special table that had a hole cut in it for my boob to hang down. They would use special mammography machines to localize the lesion, and then inject a local anesthetic, then take several core biopsies. Then they would place a little clip into my breast to mark the area and I would get yet another mammogram afterwards. The procedure would take about 90 minutes start to finish and no real hurry but don't wait for months or anything. I was still back at Huh? Me? Biopsy? I was so thrown for a loop that I didn't even known what questions to ask. I scheduled the procedure for two weeks out, March 21, as I needed the day off of work and the following Monday I was going to be skiing.

I called my partner Lisa, who immediately wanted to vomit. Then she Googled "breast calcifications" and scared herself even more. I still didn't know what to think, so I didn't. Think, that is.