Cheap no longer am I

I have always been pretty frugal. OK, cheap. I am sure my Scandinavian ancestry has something to do with it and I feel I has served me well. For the most part. But one thing I have learned (the hard way, because that's how most big lessons in life are learned) is that being cheap sometimes means going expensive. For instance, I used to try to tackle every home improvement project myself. You know, to save money. But invariably it would take forever and look pretty crappy. And sometimes I would actually have to pay someone to fix my work. So now I reserve my home improvement ambitions to minor projects like hanging pictures.

Another lesson this applies to is boats. Anyone who has ever owned a boat knows this well. Our first boat was a 1950's era pontoon boat (and the motor was the same age!) that I had to sort of rebuild the deck to. We ended up spending a lot of money on a better motor, because a 50 year old motor doesn't work very well. Our second boat was a 15 year old speedboat that we sunk on the first day we owned it (hello, drainplug?). We spent a lot of money fixing the motor on that one too. Our third boat was another old pontoon boat but we didn't really pay for it - it came with our house. But yet again, we have put a fair amount into fixing the motor and the boat reminds us of an old river boat, like the African Queen. Our fourth boat was a new kayak. Now we're getting somewhere! No motor! No moving parts! And it's new to boot! I love it. Our fifth boat was a used sailboat that, upon further examination, had many broken parts. We had to get the whole mast rigging thing-a-ma-jig fixed. At an additional expense, of course. Our sixth boat was another new kayak. Again, new is good!
So, Lisa wants a new sailbooat. Not brand new, but new to us. So on Saturday we went to the boat place and found a really nice boat. It cost about 3 times what I was thinking of spending but it was nearly new - in great shape. After thinking about it for awhile, we decided to just spend the extra money and get it right the first time.

I am putting that to use in other areas. We just replaced our plastic lawn chairs with teak. We have an Amish-made dining room set. We now own two Toyotas that I am pretty sure will last forever.

So I am still frugal. I'll go to a nice restaurant but I'll bring a coupon. I am finding that value is much more important than the price.

My Next Big Thing

I am sitting here after putting the kids to bed, listening to the frogs creeking through my open window and I can't help but reflect on how a mere month ago I was doing the same in Hawaii. Except instead of frogs I heard the crashing of waves. And roosters. It seems like so much in my life has changed since that time. It is no longer cold and snowy in Minnesota; it is warm(er) and rainy. My lumpectomy surgery has come and gone, and now I don't have cancer anymore either. I still think about it daily, but not nearly every moment of every day. I was never really worried about dying, but I just couldn't think of anything but cancer cancer cancer for a couple of months. Now I am easing back into normal life, and trying to figure out again what my long-term goals are. It's not easy! One never really grows up, do they? They never really "make it". There is always some other pie in the sky.

What is my Next Big Thing?

I'm in my chosen career and I have a family (albeit not exactly the family I had planned way back when, but it is a family nonetheless). I guess I had never really thought beyond that. When you're in high school you don't really think about life after 40. You think you'll have your career and that's it. But many people don't exactly want to stay in their first career for 40 years. That's a long time, longer than most marriages. Or they may want to scale back on one career and pursue another. What do I want to do?

I love being a vet, but I can't imagine myself being one of those old docs who should have taken down the shingle long ago. I am planning for an early retirement. Not where I would stop working altogether, but one where I would have the option of working part-time, or taking extended periods off. Even before "retiring", I would maybe switch to a different field within vet med. Maybe someday I'll try teaching. Or writing. Or (gasp!) large animal medicine. Or what I'd really like to do is travel to less affluent parts of the world and volunteer my skills working on pets and livestock where needed.

But what else? If I only work part-time in the veterinary field, what other profession would I choose? I would love to work in a bike shop, actually. To clarify - bicycles, not motorcycles. Or maybe Home Depot - I love that store! Something with a little less stress and generally happy customers. Or (more likely), I would choose an equally high-pressure career, because that's what I do. I need a little stress in my life. And I'm not being sarcastic about that.

Actually, this blog entry is an example of what goes through my mind all of the time. I am always planning and processing, and it can drive a person a little nuts. Many people are happy where they are in life; why can't I be satisfied? Why does there have to be a Next Big Thing? Well, because I'm 40. And I've seen my mortality. And I feel that time is running out to do everything that I set out to do, whatever that may be (and it is a moving target, by the way). I'm almost panicky about it.

There are no easy answers. And I know that I'm not the only one who thinks this way. You would think that with age there would also come the wisdom to accept my limitations, but no. Not yet.

So how do the rest of you feel? Are you satisfied with where you are, or at least capable of being so? Or (like me) never satisfied? And if you are like me, what is your Next Big Thing?

Pain

Our refrigerator, not surprisingly, is covered with photos of our kids, mainly of them in their sports uniforms. This morning as I was getting some orange juice, I stopped to study them and I was particularly drawn to the pictures of the boys posing with their baseball bats. You know, where they are standing as if in the batter's box waiting for a pitch. Of course I felt a sense of wonderment over how handsome they've become, but the most striking feeling I got was that of: Wow. I bet it would hurt for me to swing a bat right now. Good thing I'm not playing ball.

Is that what it's come to, being 40? I am literally in a constant state of pain in some form or another. Right now it's particularly bad because I did a heavy strength workout yesterday and my muscles are killing me. But I also have my sore elbow, sore knee, bunion on my left foot... And a history of hip bursitis and god-awful back pain that, thankfully, are no longer bothering me. When did it start, this falling apart of my body, and why didn't anyone warn the 20-year-old Jami that this would happen?

Some may be surprised that I have these problems because I am so active. Others would not be surprised because they see how I beat up my body. Pain doesn't really prevent me from doing what I want (well, for the most part), but it does take away some of the enjoyment.

And my pain is pretty minor compared with the millions who suffer chronic debilitating pain. I have a client who lost her job due to pain - she simply couldn't work anymore - and appears to be jacked up on narcotics every time she comes in to the vet clinic. What kind of life is that?

I also have an 8 year old nephew who gets migraine headaches that send him to bed for hours at a time. Think of how much he is missing, having this condition. And he's only eight!

But what can be done?

I am very interested in the pathophysiology of pain, and in the next two years I plan on delving deeper in the topic of pain management in animals. This interest stems from my own experience with pain, and also the fact that it is such a hot topic in the human medical world. People are living through injuries and diseases that would have killed them a hundred years ago, but now many of them have to deal with the repercussions of what has happened to their bodies. Also, repetitive motion is much more common in these days of factory work or computer typing, or in my case, performing surgery and dental extractions that I feel are contributing to my elbow tendinitis. Rather than doing most or all of the tasks related to survival, we are now very specialized, and with that comes overuse injuries.

Unfortunately, with all that science and medicine can do, it still cannot come up with a reliable, relatively side-effect-free way to manage chronic pain.

This morning on NPR I listened to an interview with David Loxtercamp, a physician and author of A Measure of Days: The Journal of a Country Doctor. He listed 14 things that he feels he has learned as a doctor, and that he is trying to put to use now in treating his patients:

Health is not a commodity. Risk factors are not disease. Aging is not an illness. To fix a problem is easy, to sit with another suffering is hard. Doing all we can is not the same as doing what we should. Quality is more than metrics. Patients cannot see outside their pain, we cannot see in, relationship is the only bridge between. Time is precious; we spend it on what we value. The most common condition we treat is unhappiness. And the greatest obstacle to treating a patient's unhappiness is our own. Nothing is more patient-centered than the process of change. Doctors expect too much from data and not enough from conversation. Community is a locus of healing, not the hospital or the clinic. The foundation of medicine is friendship, conversation and hope.

Well, I am not sure how much that really has to do with pain, but I did find it profound, especially the part about the most common condition being unhappiness. Being happy sounds like a topic for another blog entry, but I do think that we all suffer with physical pain much more than anyone really thinks. How much of your life is dampened by pain? No fair answering if you're a young pup of 30. Just wait, is all I say.

Generalizations

It is our nature to make generalizations. For one thing, it prevents us from having to learn things the hard way. For example, if you have learned that lions can attack and kill people, you will probably not trust any lion, no matter how friendly it seems. Another example is that we can put away our winter coats in June, because it shouldn't get that cold. June is generally a warm month (2011 possibly not withstanding).

However, generalizations can come back to bite us. Take last Sunday, for instance. A tornado crashed through part of Minneapolis and some north and west suburbs. We are all lucky that more people weren't hurt because the tornado came as a surprise to many. Usually we think of tornadoes as occurring during hot, humid days. Sunday was cold and rainy. And for some reason we think they can't hit a large city. Wrong again.

We use generalizations a lot in vet med. We have to. Otherwise, we would be testing every animal for every known disease regardless of their breed, age, and symptoms. Example: a 2 year old golden retriever that is vomiting - think GI foreign body. A 15 year old cat that is vomiting - think kidney disease. So, my first diagnostic test would probably be abdominal x-rays on the golden, but a blood profile on the old cat.

However again, these generalization can get a vet in trouble. A few weeks ago I saw a 3 year old Lab retriever for front leg lameness that seemed localized to the shoulder. A muscle or tendon sprain seemed most likely, followed by a developmental defect in the cartilage of the shoulder (most common in young large breed dogs). Rest and pain medication didn't help, so I took shoulder x-rays, which were normal, and tested him for Lyme disease, which was negative. Since he was getting worse, I referred him to a surgeon, who found a tumor on the top of his shoulder blade! It was not visible on exam when I saw him a couple of weeks ago, and that part of the shoulder blade was not in the radiograph. However, maybe if I had palpated that area instead of focusing on the actual joint, I would have localized the pain better.

You see, older dogs get bone cancer, and I have seen it in the scapula (shoulder blade). But this dog is only three years old! Cancer was nowhere on my list of possibilities.

The owners have consented to removal and biopsy of the scapula (I guess he will still be able to use the leg without it). Depending on the type of cancer, his prognosis ranges from fair to poor. I'll keep you updated on what transpires.

Jeez, after doing this for 15 years, you would think I would have learned all of my lessons. Hardly.

Insomnia........

I have had insomnia on and off since I was a teenager, but it came out in force after I bought my veterinary practice in 2006. Owning a business brings a whole new set of stressors. The buck (or lack thereof) truly stops with me. The SBA loan is astronomically huge and there is also a lien on our house. In addition, there is a million dollar life insurance policy that I had to take out, listing the lender as one beneficiary. I pay a hundred bucks a month for that honor.

I am pretty sure the recession started the day after I signed all of the paperwork making me the owner of the hospital. So I started to stress about if the clients would bond to me, if the staff would stay on, and mostly if I could pay all of the bills. Of course I lost plenty of sleep over all of those things. But I also started to have these middle-of-the-night panic attacks over medical and surgical cases that never used to bother me. I would wake up with a start, wondering if I had miscalculated a drug dose. Or if a spay I performed earlier in the day was bleeding out. You know how your mind works in the middle of the night. I have even drove the 6 miles to the clinic in the wee hours to check on a stable patient more times than I can count.

Well, the anxiety resulted in many hours of lost sleep, which as you know, results in pretty crappy waking hours. I started taking prescription sleeping pills (Ambien), which worked great, but made it hard for me to get up in the morning, especially to work out. When the Ambien ran out, I switched to Benadryl. First one, then two. Then a few months ago I weaned myself off of sleeping aids but soon after was sent on the roller coaster of a breast cancer diagnosis. Back on the Benadryl, then Xanax. Is this how it is to be a typical American in 2011? We don't have to worry about being attacked by animals or other tribes, or where our next meal is coming from, so instead we drive ourselves absolutely insane with relatively minor concerns.

I think we need to chill out a little.

Or, be outside more. I sleep GREAT when camping, or when we were on the beach 6 hours a day in Kauai.

Or, get more exercise. There's nothing like total physical exhaustion to make for a good night's sleep.

Or, lay off the caffeine. I don't drink much of it, but I definitely have a harder time falling asleep if I have caffeine in the afternoon.

Or, meditate. OK, I don't actually do this one, but I wish I did. I even bought a book on it that I have yet to read.

Anyway, I am happy to report that it's been over a week since I've taken any medication to help me to sleep at night. So far, so good. And, I still have my business, and my house, and none of the patients I lost sleep over ever had the complications I was so afraid of. Now the only thing getting me up at night is my bladder, since I'm drinking like 100 ounces of water a day as part of the weight loss competition. See? There's always something...

Appointment 13 - Meeting the Pathologist

I know not everyone has a pathologist, but I will say that I have the BEST one. I am going to have her read all of my future biopsies, assuming I ever have any more. Today was the day we met with Dr. P (for pathologist) to look at my slides. Lisa and I drove back down to Abbott this morning and wandered around the basement of the hospital looking for her office. We somehow ended up in the actual lab itself because we were on the wrong floor. The lab tech told us Dr. P was on vacation. Yeah, I know. But she came in just to meet with us, I replied.

She's that good, I tell you.

We were escorted up to her office, which had no windows. When I commented on that, Dr. P said, There are no windows in pathology. Ooohhh, so nobody can see the dead bodies? I wondered to myself. But this was just her office. Only books and a microscope, no bodies.

So she whipped out my slides and gave me a microscopic tour. It was kind of weird, I admit. She was discussing them like you would a clinical case, except these were MY CELLS we were looking at. She showed me the areas of atypical cells from the first biopsy that could or could not be considered cancerous. She then showed me the slides from the surgical biopsy, which were much better behaved. She also gave me a copy of a very recent paper titled Bordeline Breast Lesions: Diagnostic Challenges and Clinical Implications, which highlights the fact that these cases can be difficult to diagnose. She also told me that the pathologist who originally called the biopsy DCIS still stands by her diagnosis. So, according to one pathologist I had cancer. Whatever. It's sort of water under the bridge by this time. Dr. P was still very sorry that she allowed the other pathologist to make the call (It was a moment of weakness on my part, she told me). I'm over it. I agree that these can be difficult cases. However, in retrospect they should have sent the original biopsy out for another opinion before giving me cancer, but these things happen. I told her that in vet med we NEVER have cases that you could call either way and we all had a good laugh over that sarcastic comment.

Dr. P also spoke to my surgeon just that morning and has already called my oncologist (whom I will meet in a couple of weeks) to explain the situation. It is great to have her on my side.

On a weird side note, we discussed our families and we found out that she has two adult daughters. I somehow ended up telling her about my frustration with spending so much free time driving my kids around and she said that she did the same thing, but is glad she did. One of them is in med school and one is pre-med. She attributes their success in part to all of the activities they were in when younger. So fine. I will continue to sit in the rain watching my boys play soccer. Because my pathologist said so.

Too many balls in the air

I am a very competitive person and an over-achiever. I admit it. I have been that way for as long as I can remember. It's not necessarily the best quality to have, but it is who I am, and even though Lisa won't play mini-golf with me anymore, I'm ok with myself. It was just a little friendly heckle! Get over it!

So I tend to be competitive when it comes to my free time as well. If I know of someone who works 40 hours a week and is going to school while raising 3 kids and being the Cub Scout leader, I feel the need to one-up that person. I'll work 41 hours a week and work on board certification while raising 4 kids and volunteering in the schools, church, and my kids' sports. So there.

And Lisa and I agree that we want our kids to be busy. You know, to keep them from doing drugs or joining a gang.

But Saturday I drove over 100 miles from soccer to piano to soccer to home to piano and sat through 2 soccer games in the pouring rain, feeding my kids lunch on the road, making my son change from a wet, dirty soccer uniform to a suit and tie in the car. While the stupid ENGINE HOT light kept coming on (yeah, the $267 didn't quite fix that problem, did it?), adding significantly to my stress level. I had kid/transportation duty because Lisa was at a church board retreat for most of the day. See, even she is super busy.

For what? I can't help but wonder. Is this what life, what being a parent is about? Are soccer and piano skills going to make my kids better citizens? Would my (and my kids', for that matter) time be better spent helping the needy, or building houses, or working to save the environment? A hundred years ago, my kids would be working. For real, not "working" on sports skills.

Another question - how can we keep this up? As our kids get older, they enroll in more varied activities. Add the pressure of our work and volunteer duties, and it is just not possible to do it all. We cannot be at two places at once. And it sometimes seems like we are just running from place to place, commitment to commitment for most of our "free" time. And doing a mediocre job at best. We should say no, but we wonder, if we don't do it, who will?

How does the Tiger Mom find the time? I can barely remember to get my kids to practice piano, let alone sit with them for hours each night while they do. Maybe you can't do it all while working full time and raising four kids. Maybe one or the other, but not both. But then it is left to others to pick up the slack, and I'm no slacker.

I do need to chill out. Lisa is pressuring me to get the kids more scheduled this summer and I am really pushing back on that. Last year, we had the boys in soccer and baseball at the same time and it was terrible. I want a life that doesn't involve frantically driving from one practice to another, even if it's only for the summer.

My New Jami rule - one sport per kid at any given time. And no piano lessons this summer. And I'm scaling back on some of my duties. I'm actually taking a couple of days off this summer FOR NO REASON. Yeah, that's right.

An addendum to yesterda'y blog - We bought the Prius! It's a 2005 model with 92,000 miles on it. 24 hours into ownership and we love it so far!

Ten miles! (Baby)

Today is Monday, the day I take on my nemesis - the weekly long run. After my disastrous run last Monday, I abstained from running at all this week, hoping to save my legs for today's run. The run was an adventure with all of the water and trees down on the path; I even saw a teeny baby snapping turtle trying to make its way across. Things were going pretty well until mile 9, when my knee started acting up again. But since I was so close to being done, I put on my favorite inspirational song (Hannah Montana's The Climb) and just kept going. I ran, rather than walked, home, albeit it with a signficant limp.

I feel ok about how things went, but I wonder if I will always struggle with the last mile of any run I do. Is it psychological? I don't think so. Can I trick my body into going farther by telling myself my run is a mile longer than I have planned? Perhaps a good experiment to try. Can I actually run 26 miles this fall? That is a definite maybe.

On another note, the mini-van overheated multiple times this weekend, so I brought it back in. The mechanic said something about a leaking head gasket, which I know is pretty much a death sentence. So we frantically shopped for used Priuses today and I may have found one. However, since making the decision to put the van out of its misery, it hasn't overheated once. ??? Figures.

On a third note, today we started another round of the Loser competition. There are now some 65 people in the group and 42 of them are competing. I have been slacking a little in the weight department so I need a new push to get off those last few pounds. This week's challenge is water and I've been drinking like a little fish today. It helps to run 10 miles to get a little dehydrated.

On a fourth note, Lisa made a little behavior board/chore chart for the girls, which includes things like keeping their room clean, listening, putting their clothes away, and doing homework. 24 hours into it and so far so good (for the most part). I'll update that later. The rest of the house, however, is still a mess and we need to pick it up a little before the house cleaner comes tomorrow.

Well, I may have just written the most boring blog ever and for that I apologize. But it's been that sort of mundane day. Just life, I guess.

How do I keep the house clean? Really.

I am not a neat freak. Really. But I do like some order to my home. Maybe not to have seven piles of papers on the kitchen counter. Or maybe it would be nice to actually have hand towels hanging in the bathroom, instead of finding them outside in the grass. Or I just get one room cleaned and I go into the next to find shoes and clothing and toys strewn about. My kids are like little whirling dervishes. Is that the term? Well, it sounds good. They can't enter a room without leaving it in significant disarray shortly after. I spent 30 minutes tonight cleaning up after dinner. You wouldn't know it. Then I went downstairs later to do some laundry and the girls had dropped or thrown (who knows with them) the entire contents of a bingo game all over the basement floor.

This has always been a stressor for both Lisa and me. Of course I don't lose sleep over it or anything, but just coming home to a messy house, or feeling like we will never be caught up, does tick up my cortisol level a notch. The funny thing is we actually have a house cleaner twice a month. She does a fabulous job, but it sure doesn't last! My friend and I joke that what we really need is Alice from the Brady Bunch - just to follow the kids around and clean up after them.

I know you're wondering why we allow this behavior. We don't. Or at least we try not to. We have daily conversations about cleaning up, and I have even thrown away or donated large quantities of toys that were lying around. But my kids don't seem to get it. And Lisa and I exhibit the classic signs of insanity - we keep trying the same thing over and over, hoping that it would eventually work. It won't. The girls seem to be particularly immune to any kind of punishment. And they will spend many hours and countless joules of energy NOT cleaning their room when asked. A 15 minute task can drag on for an entire evening. Aaaarrrgggg!

I need to find a way to reign this in. The New Jami is trying to have a less stressful life, and having a somewhat clean house would really help. Any ideas would be greatly appreciated. But do keep in mind that a) we parents are severely outnumbered and b) our girls are very good at not doing what we ask of them, and they are far more stubborn than Lisa or me.

Just so you're aware what you're up against.

People are mostly good. But some are really stupid.

Last summer our vet clinic had the pleasure of taking care of two dogs brought in by (as we found out later on the news) a criminal. Actually, the criminal part isn't the problem. It's his criminal stupidity that confounds us. You see, this gentleman bred two female dogs to his male dog because he heard he could sell the puppies on the internet for $1500 apiece. He was also experienced at dog breeding, he told us, having done it for 20 years. However, his male dog had died a couple of weeks prior from some ill-defined gastrointestinal illness. Now his two pregnant bitches were exhibiting the same signs - profuse vomiting, diarrhea, and lethargy. One look at them and anyone in the vet business could tell it was probably parvo.

Parvo is short for parvovirus, an extremely contagious virus that causes the above signs, with the added bonus of suppressing the immune system so that the victim has an even harder time fighting the infection. It mainly affects puppies, because their immune system is not well developed to begin with, but it can affect any dogs that has not been vaccinated against it. Yes, there is very effective vaccine against parvo. It is given to your dog every time it receives the "distemper" combination.

This owner/criminal was adamant that it wasn't parvo. Were these dogs vaccinated? I asked. Well, no, he replied. But I have been breeding dogs for 20 years and I have never had a case of Parvo. Right. Eventually he let me test for it and sure enough, they were positive. The treatment can range from intensive care hospitalization to outpatient fluids and antibiotics, depending on how sick the dog is and how much money the owner is willing to spend. These dogs were both quite sick (and also quite pregnant), but their owner didn't have a ton of money. Until he was able to sell the puppies, that is. So we ended up dispensing large quantities of injectable fluids, antibiotics, and anti-nausea medication. This guy called or came in almost every day for 2 weeks. Lucky for me, I was on vacation for much of that. I also warned the owner that since the unborn puppies were exposed to Parvo, they were at risk for developing potentially fatal heart defects.

The poor sick bitches both delivered about a week after the diagnosis. I think they had 13 puppies total. What a mess! Between the diarrhea from the sick adults and the poop and pee from all of the puppies, this guy had his hands quite full. I almost felt sorry for him. He brought them in with their moms once and my colleague tried to get him to surrender the puppies to a rescue organization because the owner really wasn't able to take care of them all. He was adamant that he was going to make money selling the puppies, and wasn't about to just donate them to a rescue.

A few months later, the owner called to tell us that he still had all of the puppies - he hadn't been able to sell any of them yet.

Fast forward to last week (a full 9 months later). He called to tell us that he still had five of the puppies. In addition, one of the puppies he sold had died suddenly in its new home (can you say heart defect?). But the real reason he called is that one of the puppies (now almost an adult) he still had was now showing signs of parvo. Had he vaccinated it like he was supposed to? Hell yes he did! He bought some vaccines from a guy at a Fleet Farm in Wisconsin that, get this, had expired in 2008. Really! And they didn't work?

I could be mad at this guy, but honestly, he tried. I know he had some arson and drug indictments under his belt, but I only knew him as a pet owner. OK, a breeder. Who was terrible at it. He just wasn't very bright and got in way over his head. But too bad his get-rich-quick scheme had to involve lives. Maybe he should have stuck to illegal ways of making money. At least then nobody got hurt. Just buildings and stuff.

Morals of the story (oh, there are so many):

Vaccinate your pet! And your kids too, for that matter! But have a licensed professional do it, please.

Don't expect to make a lot of money being a dog breeder.

If you do breed dogs, do it for the love of the breed, not because you see dollar signs. It's not fair to the animals otherwise.

Unless they stiff you out of money or are mean/rude to you or the staff, treat each client with respect, no matter how much you may disagree with their decisions. Refusing to treat a patient or reprimanding a client for their choices may only result in the pet not getting any veterinary care.

Be flexible. If a client declines or cannot afford plan A, there are probably plans B, C, and even D available.

Accept that not everyone is as brilliant as you are. And that we all make some dumb choices and may get in over our heads because of them.

Our minivan is dying

We are the proud owners of two minivans. With four kids under the age of 10, it is the logical choice for transportation. Our old van, the Chevy Venture, is almost 10 years old and has about 140,000 miles on it. It really is on its last legs, and I refuse to put any more money into it. We have to take it in for repairs about every 6 months and the bill is always $1000. No matter what the problem is, no matter where we bring it, the cost is $1000. So I don't bring it in until I am mentally prepared to spend... $1000.

At this point we are just trying to nurse it through the summer, because hopefully the Nissan Leaf will be available this fall. The Leaf is an all-electric car and we are on the waiting list for one. I think the earthquake in Japan has delayed the roll out of the car, and being in the Midwest, we will probably be the last to get it. But I still wait, and hope.

Anyway, the Venture has a rusted bottom, drips water on the driver when it rains, has no gas gauge, has a nail in one of the tires, a broken tail-light, and the check engine light is always on. It is a total trash car, with garbage and various children's clothing items and playthings and food strewn all over the interior. I can live with those problems. The latest problem, where antifreeze leaks everywhere and the engine gets hot, is one that probably should be fixed. Grrrr. For awhile I was driving around with a gallon of water in my car so that I could fill the coolant tank when needed. But now even that isn't working. So, begrudgingly, I brought it in today. A few hours later I got the call. Well, to fix everything that SHOULD be fixed (none of which is on that list, by the way), the cost would be $1500. Yeah.

Where do I stop? When is it the right time to end my van's life? For me, it is a purely financial decision. The van has served me well, but I know it's time. I just can't get my next car yet. Believe me, if I could I would euthanize the van now and start over with a new car, but my new car is still in Japan somewhere, probably in pieces that haven't even been put together yet.

I ended up allowing a $267 water pump replacement. Hopefully that will slow down the antifreeze leak. I feel sort of cheap, especially since the van has given me so much over these past 10 years. But I don't feel bad. Sorry, Venture. Your time is coming. Soon we will kill you to make room in our garage for a slick new car. Of course I could draw all sorts of analogies to old people or old pets, but that would be too obvious. I will just say that I will miss the van, but I am quite excited that we will actually be getting rid of it in the near future. I'm not that sentimental, I guess. No hugs over this one.

Why I love and don't love my job

It seems like everyone wants to or had wanted to or knows someone who wants to be a vet. I admit, it does sound like a cool and glamorous job. Lisa or I get asked to speak at our kids' elementary school at least twice a year on veterinary medicine as a career. We are very popular with this age group! Of course, as kindergarteners mature to tweens, then go off to college, vet med loses its allure. In some cases, people realize they don't have the desire or aptitude for all of the science and math involved in the schooling, or they don't want to go to school for the 7-8 years required to earn a vet degree. Others figure out that the vet field isn't all about playing with puppies and kittens, or working in the quaint English countryside a la James Herriott. And of course, many come to the realization (hopefully sooner rather than later) that's they won't make as much money as a vet compared with other science degrees.

However, I am one of the few who stuck with it. I did actually want to be a vet for as long as I can remember and my career path never strayed. I pushed through with a bachelor's degree in biology, then right into vet school in the fall, earning my doctorate of veterinary medicine degree in 1996. No regrets, except maybe I could have slowed down a little when I was younger and not been quite so career-driven. Maybe should have taken a year off the explore the world or something.

Anyway, 15 years later, I still mostly love what I do for a living. And the beauty of this profession is that if I didn't like small animal practice, I am fully licensed to work on any other species of animal, or work in research, government, shelter medicine, or I can do a residency and become a specialist... well you get the picture.

One of the things I like, and don't like, about my job is that I never know what's going to be coming through the door next. Take last Friday, for instance. It was a fairly busy day, but not overwhelming. Most of the cases I saw were fairly routine - wellness exams, ear infections, diarrhea. However, my last appointment of the afternoon was a 13 year old terrier with, as the owner describe on the phone, bloody stools. However, when she came in, she was actually bleeding from her mouth, and quite heavily. I would estimate at least a drop a second of bright red (read arterial) blood. This had been going on for a couple of hours, and a 20 pound dog can't keep up that blood loss for long. I was able to localize the bleeding to a small area in her gums just above her largest premolar tooth, but I could see no wound, tumor, or evidence of a tooth abscess. Her STAT cbc and profile was normal except for anemia. I submitted a clotting panel, which would not be back until the next day. Short of referral, the owner's only choice was to have me anesthetize her to explore the area, take dental x-rays to check for a tooth abscess, and possibly extract a tooth. I warned him that she could die even during the procedure if I couldn't stop the blood loss. After some consideration (and discussion with his wife), the owner gave me the go-ahead.

We started this dog on IV fluids and at about 4 pm (the time I and a large part of my staff are supposed to leave for the day) we gave her a pre-anesthetic injection. She immediately collapsed and her heartrate dropped to about 30 beats per minute with a marked arrhythmia. And her gums became very pale. I was very concerned that we were about to lose her, but I reversed one of the anesthetic agents and gave her atropine to increase her heartrate, and she slowly improved. Whew!

The good news now is that (perhaps because her blood pressure also dropped so low), the bleeding stopped. I took several dental x-rays but could not clearly identify an abscess or a tumor. She did have deep pockets around two teeth in the area, so I went ahead and extracted the two teeth. This is a job in itself - both teeth have 3 large roots each, and it took about 30 minutes and a lot of drilling to fully do the job. It appeared that she did have a fisula, or communication between the mouth and nasal cavity at one of the roots, making an abscess a likely diagnosis. I sutured up the gum tissue and also biopsied a tumor she had near her anus for good measure. She woke unevenfully and was sent home on antibiotics, pain medication, vitamin K (in case she had a clotting issue), and I gave the owner my cell phone number in case he had any concerns. I sleep a whole lot better if I know that I will be called if there is a problem.

Cases like this, where I get to use my brain to try to figure out the problem, as well as my surgical skills to fix it, are what I really love about my job. However, I left the clinic at around 6 pm, two hours later than I was supposed to leave. That's one thing I don't love about it. Many times (statistically it seems Fridays are the worst for this) I have stayed late to perform an emergency surgery. Or worked over my lunch hour. Or took a patient home with me for monitoring. The kids are cute when I bring a patient home and set it up in our bathtub with a fluid pump. The girls are always "visiting" the pet, or trying to help me with treatments. I don't get much sleep those nights either because I am always listening for the fluid pump to go off.

Anyway, the patient from Friday came back the next day for a recheck and she was doing great. Her clotting panel also came back normal, so I suspect that a tooth abscess had eroded into a large artery in the roof of her mouth. Not many people can say they saved a life on a given day.

I can.

Nine miles... sort of

According to my marathon training plan, this week's long run is 9 miles. Being that I my 7 mile run last week went so well, I was cautiously optimistic about today's run. The first 7 miles went great! I was even writing this blog entry in my head. It was titled Nine Miles, Baby! And it was all about the euphoria that one gets during a good run. And I was planning my next week's 10 mile run. The funny thing about running, however, is that we are all one step from having to throw in the towel due to injury, cramps, or hitting the proverbial wall. You never know when it might happen. I guess it could be a metaphore for life, right?

So, yeah, it happened. My stupid IT band (knee) injury reared its ugly head right at about mile 7. I stopped, stretched, walked, then ran again until it hurt again (which was about 100 yards). Then repeated several times until I made it home, defeated. Total mileage: 9.2 miles. Miles run: 8.0. DAMMIT! Betrayed by my stupid body AGAIN. Why? Why do you do this to me? I take pretty good care of you. I sleep 8 hours a night. I am fit. I don't smoke. I don't drink much. And other than my peanut butter/chocolate/Pepsi addiction, I eat pretty well.

I know you non-runners out there are wondering why I even bother. Why am I obsessed with running, when it is clear that there are better fitness options for me? Well, there are a couple of things at play here. The first is I don't like to be told that I can't do something. That makes me want it even more. It kills me that I signed up for the marathon a few years ago but had to quit training mid-summer due to this very IT band issue. The second is obvious to any runner. We don't like to not run! Biking and rollerblading just isn't the same! I guess there is something about the simplicity or purity in running. And the rhythm of putting one foot in front of the other over and over. A non-runner wouldn't get this. And when I say runner, I don't mean to imply a marathoner or anything. A runner is someone who runs because they want to, and has a better day because of a run. Most people hate running when they first take it up. But keep at it. In a few months, you too can become addicted.

I spoke to my favorite pathologist again today. I was trying to re-schedule our meeting so that she wouldn't have to come in while on vacation. We had another good conversation. She again re-iterated that although it happens periodically in other labs, this was the first time they had reversed a breast core biopsy diagnosis ever at this lab. I gave her my blog address so that she could see firsthand how that went for me. But I get it. She was at a conference over the weekend where she actually ran into the pathologist at Vanderbilt who read my third opinion slide. I'm getting around, aren't I? Well, at least my breasts are. At the conference she also went to a presentation on how difficult it is to classify low-grade breast cancer pathology. She is going to give me a copy of the paper, since, as she put it, I am the most well-informed patient she has ever talked to. So there.

I just found out today that Claire has not been doing her homework for  about 3 weeks, when I found all of the papers crumpled up in the bottom of her backpack this morning. I think I need to get back to being a more active parent, that's for sure. I wonder what else my kids have been up to in the past couple of months!

Life is starting to look good again. My leg still hurts a little and I don't know how next week's run is going to go, but at least I'm mostly healthy, my kids haven't done anything too terrible lately, and the sun is shining. And I have peanut butter and chocolate chips waiting for me.

I believe...

I belong to a Unitarian Universalist church. UU is a very liberal religion, where one can pretty much believe what they want and still be accepted. In our church there are Christians, Buddhists, Jews, atheists, humanists, pagans, you name it. I love it partly for that reason - it is so open. But that's also a source of frustration one can have with this faith. There is no creed, nobody telling us what to believe. A common joke is that leading UUs is like trying to herd cats.

This year I have been part of the teaching team for the Coming of Age (COA) class. This was a year-long curriculum geared towards 8-12 grade youth. We met for 2 hours approximately every other Sunday morning as well as a day long and an overnight retreat. Before you start thinking I'm being a superhero for commiting this amount of time, I will tell you that there were 5 leaders and we only needed two per session, so I didn't have to teach every session. Plus, I missed the overnight retreat because I was in Hawaii.

Anyway, I was a little apprehensive about teaching this age group because my only experience with teens is when I was one myself, and I'm not too keen to re-live that experience. But I really enjoyed teaching this class. They kids weren't as scary as I thought they would be, and they really did have some poignant things to say.

Tonight we had the closing ceremony. The youth and their families, as well as the leaders, minister, and interested members of the congregation were invited to the church for a dinner and celebration. During this time, each youth had a turn at the pulpit to read their Credo, or faith statement. This were something we'd been developing with them all year. It is important to have a Credo in this faith, because otherwise it is hard to articulate to others what you really believe. And you can be a UU and still believe. In something.

I am so thrilled and impressed with all of the kids tonight. Each Credo was well thought out and it was obvious that they had learned about their UU religion and themselves this year. The underlying theme was that to be a UU was to be helpful to others. Also, many of them don't necessarily believe in the afterlife, so most of them stressed how important it is to live each day to its fullest. Each statement was a couple of pages long, but here are some other noteworthy quotes from tonight:

I don't know who created the Earth. But it doesn't matter how the Earth came about, only what we are doing on it now.

Until the COA class, I didn't really know anything about the UU religion, except that I was the only kid in school who didn't go to church within 5 minutes from his house.

In school, we are taught a lesson and then tested on it. In life, we are tested, and the test teaches us a lesson.

I believe that God exists for each of us in whatever form we believe it to be.

I don't believe in heaven in the traditional sense, because I don't think there is enough room in the sky to comfortably hold all of the bodies.

Things happen for a reason, and even the bad things can teach us a lesson.

My faith is formed from my life experiences. And I have had some pretty rough life experiences, but I have learned about resilience and hope.


Anyway, I wish I had taped the Credo statements, because they were all very insightful. I took something home from each and every one of 16 kids that spoke today. And I was inspired by these youth to write my own Credo today. Here goes:

I believe in God not as a figure in the skies, whom we can talk to and who can judge us, but in a spirit that connects all living things, especially people. We can send positive and negative energy to each other or to the world in general.  In addition, we can choose which energy we want to accept. I am a scientist, so I am always searching for answers to the unknown. I cannot rely simply on faith.  There is a great deal about this world that we do not know, but I believe that at some point these questions will be answered by science. As the questions become fewer and fewer, traditional religions will play a smaller and smaller role.

However, there is energy, even in the form of thoughts, that can affect others. Hope works because people use it to take action. Prayer works because people feel that people care. I also believe in luck – good or bad. However, we can also make our own luck by our actions. Think about the times you have felt especially lucky or unlucky. Certainly you had at least a small role in the events. For instance, if you choose to repeatedly drink and drive, someday you may be unlucky enough to get pulled over, or worse. If you are successful in life, sometimes it is a matter of being at the right place at the right time, but you played a role in getting yourself to that place.

I also believe that the older I get, the less I know. I am learning things about myself and others all of the time, and these lessons can come from the most surprising places. Recent events in my life have caused me to re-think some things I thought I knew. I suspect that in a few years, new events will change me again. We never really grow up.

It is our connection to this earth and to other humans that is the most important. I do not believe in much of an afterlife. In fact, I am fairly ambivalent about it. Karma, as it were, does have a role (meaning that the energy you spend and send out will be matched for better or worse), but it does not happen after we die; it happens as we live. You may only have one shot at this world, so make it worthwhile. And never stop learning.

Or something like that.

Pathology

I think we all periodically go through things that change our lives. Graduation, wedding, birth of a child - those are all major events that we expect will alter the course of our lives. However, some of the most profound life-changers are unexpected - an accident, sudden illness, winning the lottery. I suspect that events like these probably affect us even more, because we don't have time to prepare for them. Also, while the "milestone" events outwardly change us, it's the unplanned events that will probably cause us to re-think our lives, and therefore result in changes in how we view the world, what our accomplishments have been, and what we want our future to be like.

I definitely have changed. I'm not sure it's a positive change, but I am a different person. The old Jami is aloof. Don't bore me with details about your personal life, don't invade my personal space, and don't expect any sympathy or a hug because I don't know how to do that. The new Jami has discovered empathy. And I am even figuring out how to show it! I practice on my clients. Just yesterday, a middle-aged blue collar gentleman and his 20 year old daughter came in with their 17 year old lab whom they decided to put to sleep. When I asked if they wanted to be present, the man burst into tears and said, Don't ask me that! We can't go through that! My daughter just died two months ago! The old Jami would have said, I'm sorry... and found an excuse to leave the room. This time I thought I'd try something new. I said, Was it sudden? Was it an illness? So he told me the whole story, about how she had a toxic reaction to methadone and her arm swelled and this is a common side effect that kills a lot of people. Then he even told me he just had a colonoscopy! Wow! If you allow people to open up, they will. I think that people really want to share their lives, even if it is with their veterinarian. I also feel sort of like an autistic person would, trying to figure out how to act in these social situations, since I'm not sure I intuitively know it. My techs at a previous job would joke with me about how to tell if someone needed a hug, because I never felt confident  in my ability to tell if one was needed. But you know what? I think everyone would appreciate a hug if they're dealing with a sick or dying pet. Maybe that will be my default from now on. Hugs for all.

I think I may be giving the wrong impression here. It's not that I don't care about my clients and patients and want to give them my best. It's just that sometimes it is all about bedside manner; the medicine is secondary. I believe that my clinic does provide top-notch care, but clients may not know it because they don't know what that means. All they know is the personalities of the staff, including me. If I can open up to them, and allow them to open up to me, there is more trust between both parties. Plus, it actually feels good.

It's not just at work that this is happening. I feel more empathy towards my friends as well. I think that it is because I have received so much unconditional support through this all. I am grateful for all that has been done for me, and I now realize that I should do the same for my friends when they are in need. Duh! Because I get it now. It took 40 years, but I get it.

I had another surreal medical experience today. The short story is that one of the pathologists that signed off on the original DCIS path report actually called me today from a conference she was at in another part of the country. She left a message with her cell phone number! She knew that the Vanderbilt third opinion report was due back today and she wanted to explain the thought processes that were involved with my original report. It turns out that she and the lead pathologist on the case were not in agreement with the original biopsy, but she acquiesced and allowed the other pathologist to make the DCIS diagnosis. When the surgery sample came in, she knew the original biopsy report was wrong. Basically, she said, we overcalled it. Oh, and she can't recall this ever happening before. She did say, however, that my case was borderline and that some pathologists would still call it DCIS, but the majority (including the experts at Mayo and Vanderbilt) would call it ADH. I am glad that she called, and cared enough to talk to me for almost 30 minutes. AND she is coming home from her vacation a day early in order to meet with us a week from Monday. Really. Although now I feel guilty about that so I'm going to reschedule the meeting.

Does that happen often? That the pathologist calls the patient to explain why they made the diagnosis they did?

Also, she did say that it did not change the fact that I needed the surgery I had and I will need careful monitoring and possibly Tamoxifen. But she is sorry for all of the emotional trauma I must have been through. You don't even know the half of it, I thought to myself. I do have an appointment with an oncologist in the middle of June.

So, I officially don't have cancer any more. And I am officially starting to leave the dark recesses of my mind. I really think that the conversation with the pathologist helped. I know that even though each pathology report only had like 5 words in them, many people thought and argued and pondered about those 5 words. See! People care! Even pathologists care about the patients they have never even met. Maybe I'll give her a hug when we meet.

Lessons learned part 2

I wear many hats as a business owner. It seems like the doctor hat is only worn about half the time, because even if I'm "in clinics" or "on the floor", I spend time between appointments in my office doing paperwork, paying bills, etc. (Or lately, staring off into space or scouring the internet). I actually shouldn't be in the office between appointments as much as I am, because in doing so I break one of my new cardinal rules about making people wait. Sometimes I just want to finish up what I'm doing on the computer before starting an appointment, but that's not right, is it? I want to get better at making my patients and clients my priority. One time (many years ago), I had to wait in the exam room for a doctor for a very very long time. I finally went out to the hallway to find out what the deal was and the nurse actually told me that the doc didn't know he had an appointment waiting and had been playing on the computer for the last 30 minutes! Aaargh! If you're going to make me wait, please don't tell me THAT'S the reason. Tell me he was saving a life or something.

Anyway, this morning I wore my lumberjack hat. Well, sort of. There is a large tree branch that has been lying in the front of the clinic building all winter. It's time to get it out of there. So I gassed up the chainsaw and came to work wearing my grubby clothes. Unfortunately, I couldn't actually get the chainsaw to work, and then it started to rain, so instead I spent the morning working on a Powerpoint staff presentation (in my grubby clothes). At least I'm getting things done. I am slowly working my way back to being a productive person. I pretty much took off the last month my life. Between my vacation and medical appointments and my mind warp, I dropped the ball on a lot of things. For example, I am one of the church youth group leaders, and I haven't done anything with the youth group for months. I am supposed to help out my sons' soccer team and I begged off that lately. I used to volunteer in my kids' classrooms on Mondays, but my free day has lately been filled with doctor appointments. I even skipped a meeting last week, using my surgery as an excuse, but it was actually because I just couldn't bring myself to go.

Keeping busy has helped, as has exercising. Because the weather has been relatively nice, I've been able to run or rollerblade almost every morning this week. Being outdoors is key to one's mental health, as has been shown in numerous studies. We need the bright light from the sun to re-set our biological clocks. Or something like that.

So, I promised to list some things that physicians and their staff can learn from vets. I will interject here by saying that not all vets do all of these things. And there are some physician's offices that do all of these things. Here goes:

Send reminder cards! My current family practice not only still uses paper charts, but doesn't send out any reminders for wellness appointments. It's a no-brainer - it can generate income and save lives. You should send out a reminder for a check-up every year, and add in things like cholesterol level, mammogram, etc. based on the patient's age. I don't know where we vets would be without reminder cards. And add in email reminders while you're at it. Oh, and don't make me fill out the address portion on my own reminder card to be sent out next year. That's just tacky and makes me think you don't even want to make the effort.

Be available. Sometimes I just want to talk to the doctor. I may have a question that requires a conversation rather than just a quick answer. Don't have the staff be so protective of the doc. Yes, 90% of the questions can be answered by a nurse, but some just can't, and I don't want to have to play this telephone merry-go-round game that actually wastes more time than if I was able to talk to the doctor in the first place. Most phone calls at my vet clinic are fielded by the front desk staff or a technician, but if someone really wants to talk to the vet, my associate or I will either get on the phone or call them back.

Have someone in the office call to check on all sick patients 1-2 days after their visit. Our clients really appreciate that, and it only takes a minute. Most of the time the person isn't even home, but they like that someone from the vet's office took the time to make sure everything was ok.

Make sure that there is a variety of magazines in the exam rooms and waiting areas. And they need to be current. There's nothing worse than sitting in an exam room for 45 minutes with nothing to read but a 2009 edition of Popular Mechanics. And while you're at it, have coffee and water available for the wait. (I love the Piper Center for that! And they bring it to you! And in a real coffee cup!)

Don't be such a specialist! I can treat a variety of ailments in several different species. Why can't you, a surgeon, make sure I don't have a heart murmur? Why does a patient have to have several different doctor appointments all over town for one problem? OK, I get it. It is standard procedure. But still... Although I happily refer complicated cases (when the owner will allow me to), I don't think my clients would appreciate going to the U of MN for an orthopedic consult, then having to bring their pet back to me for a pre-op physical before the U of MN surgeon can do the surgery. I am saying this now because I finally scheduled my elbow surgery (for June 23) and I have to have another pre-op physical - my third in three months. I love my family practioners, I do. But I am sure they're getting tired of seeing me!

Boy, this post is starting to look like a rant against physicians. It's not, really. I just think that the system could be fixed. Just a little.

What else? I called the path lab yesterday and told them to send all of my breast tissue slides to Vanderbilt University. I should have their final diagnosis in a week or so. I cancelled my first oncology and radiation appointments. It was awkward - Would you like to re-schedule? No, um, it turns out I don't have cancer after all. Bye! This saga will probably be over completely after I meet with the pathologists on May 23. Wait, after the final path report comes back, I do plan on meeting with a different oncologist. Then we'll be done until my breast exam this fall.

I am beginning to wonder if this blog is helping me or hurting me. I suspect it is doing a little of both. I may take a break from it for awhile. Or I may keep on blogging, but just change the theme. I'll play it by ear, I guess. So you may or may not hear from me tomorrow. But if you do, I probably won't be talking about cancer. I'm sure we'll all be glad for that.

Lessons learned

The sky is an icky shade of green and we're sort of in the basement because the tornado sirens have been going off. It reminds me of a friend/client of mine, who not only had her house demollished by a tornado a few years ago (while she was in it!), but was also diagnosed with stage 4 colon cancer two years ago at the age of 34. Crazy. Why does she get all of the bad luck? Why did my cancer turn out to not even be cancer, while she will be on chemo for the rest of her life? Why was my house spared and hers wasn't? These, of course, are questions we can never answer. Several of my friends have told me that my new diagnosis was possibly due to prayers and positive thoughts. Or that God had a plan for me and he needs me around for awhile. I don't buy it. I mean, I get that a person who knows that others are praying for them will do better clinically than one who doesn't know people are praying. The scientist (and non-believer) in me knows that it's because humans are social creatures and we thrive on energy from others.  Also, I refuse to believe that I am any more special than anyone else out there. It's luck. We can make lifestyle choices to minimize our risk, but at the end of the day, it's a crapshoot. What you do with your good or bad luck is a different story. What you do with your life in general is even another story. Are you living in a manner that makes you proud? At your funeral, will people talk about your "life lived well" and how full your life was? No? Well, there is still time to change it. Don't wait until tomorrow, because tomorrow may be the day you get hit by a bus. Hey, it happens.

Every time I have an interaction with the human medical community I look at it through the eyes of a veterinarian. Even though we are essentially working on similar creatures, with the same diseases and body parts, I believe our training and thinking are remarkably different. I don't know where it diverged, but somewhere in the evolution of medicine it did. I will always remember the time my son Jalen (at the age of about 15 months) was sick. He had been vomiting several times a day for about a week, and he would hardly eat anything. We called our pediatrician several times during his illness and they didn't seem to think he needed to be brought in. It was probably a virus and we just needed to make sure he stayed hydrated. Finally, we coudn't stand it anymore so we brought him in anyway. The exam was unremarkable (except he had lost some weight), and when I asked what tests she thought she should run, the doctor said, Well... maybe electrolytes. That's it! If he were a puppy who had been vomiting for a week, we would for sure recommend abdominal x-rays. And maybe even comprehensive labwork. Don't toddlers eat things they shouldn't? Maybe foreign object ingestion is a really uncommon cause of vomiting in one-year-olds. What do I know?

What I'm getting at here (albeit it not very eloquently), is that I am struck many times about how different things are between human and vet medicine. But I still try to learn things when I have the opportunity to cross over and experience the human side, even if it is as a patient. Here are some things that stand out. Actually, I knew these lesson already, but they were driven home again when I was able to see thing through the eyes of a patient:

Try to call a pet owner as soon as you get any lab results. Even if you, the vet, are not concerned, the owner may be. Sometimes when I run a routine test, the results may sit on my desk for a day. I may not think twice about it, but the pet owner may actually be stressing out. You don't know. Give them the courtesy of a prompt phone call. I actually disobeyed this very rule just last week when I was waiting for my own biopsy results. I had taken hip radiographs on a lame dog, and thought that one of the joints looked abnormal. Not just from arthritis, but possibly from a condition that would require surgery. I told him I would discuss the films with my colleague the next day and call him. I did discuss them, and she thought it was probably just arthritis. Well, I got busy and didn't call him the next day as I had promised. Honestly, I didn't think it was a big deal - there was nothing about this owner's demeanor that told me he was especially anxious about the x-rays. But two days later, he actually showed up at the office and wanted to know what I had found out. I told him they were probably fine and the dog wouldn't need surgery. He was so relieved! Thanks, Doc, he said. That is great news. But I wish you would have called me yesterday. I haven't been able to sleep for two nights. I, the patient, really appreciated how all of my biopsy results were relayed to me when promised and I regret that I didn't give this client the same courtesy.

Be honest. If you make a mistake, own up to it. If you don't know something, admit it. It's funny how a new vet will do everything they can to hide the fact that they don't know the answer. I was sure like that. As I've progressed through my career (15 years now), I've become much more willing to tell someone I don't know, or if I screwed up. Ironically, I think that comes with confidence and also makes the client more confident in you as a doctor. I got to experience this firsthand yesterday as a patient. The fact that the pathologists are willing to talk to me about what could be an error (I don't have the final verdict yet), makes me respect them so much more than if they tried to hide, or downplay the situation.

Don't make a client wait for their appointment. If the appointment is at one, they should be seen at one. Your time is not more valuable than the client's. You shouldn't be more than 10 minutes late seeing a routinely scheduled appointment unless there is an emergency situation. Being very thorough with all of your patients and thereby going over your allotted time is not a good excuse. If this is happening regularly, you need to re-vamp your schedule or learn to delegate. And if you do make a client wait, apologize! This lesson was driven home to me when I had to wait for an hour for my pre-op physical. Although my physician's assistant (whom I love) took her time and was very thorough with me, I started off the appointment bitter about the long wait, and that is what stands out about the experience.

Accept that the client may know more than you think, and that many clients feel better when armed with as much information as possible. In this day and age, our clients know a whole lot more than they did even ten years ago. This is the information age and we need to get used to it. I have a patient to whom I have been giving chemotherapy for much of the past year. Every time she comes in for labwork, the owner wants a copy. Why? Well does it matter? She wants as much info as she can, that's why. And she asks questions of me that I oftentimes don't know the answer to. She challenges me, and it forces me to learn new things. I appreciate the huge packet of  infomration the nurse gave me right after my diagnosis. And she also told me about other internet resources, The Breast Book, and gave me copies of my path report. Being the crazy analytical person that I am, I have spent hours researching breast cancer related topics on the internet. I am definitely an informed patient and I know that my healthcare team knows and accepts that.

Oh, I am sure there were more lessons I learned as a patient. Maybe tomorrow, I can impart some lessons I have learned as a vet that the human healthcare team could probably put to use! The first one (that is aimed at my primary care office) would be to get electronic medical records. Hey! It's the year 2011!

Appointment 12 - Of course it would happen to me!

Wow. I had the strangest doctor's appointment of my life today.

But first, let me tell you about my morning! I had big plans to kick that 7 mile run's ass today. Remember two weeks ago when I hobbled through the last 5 miles? Wow. Was that only 2 weeks ago? When I actually thought I had cancer and had my radiation oncology consultation? It truly seems like months ago. Anyway, I woke to a thunderstorm, so I decided to run at the gym instead. But it takes 10 laps on the gym track to run a mile and I very quickly suffer from boredom, so I only lasted about 3.3 miles. When I left the gym it was no longer raining, so....  I decided to try to run around the lake. (3.7 miles - how convenient to get to an even 7!) Please, with all I've been through, please let this be a good run, I kept thinking. Well, I made it around with only a slight knee twinge. Looks like I may be able to up my mileage after all!

Anyway, after lunch Lisa and I drove to Piper for what could be our last time for awhile. Again, I got a wrist band (another souvenir) and the nurse checked me in. Wow, she said. I just looked at your path report and, well, it's good, right? Although I imagine that emotionally it's probably been hard. Yeah, I acknowledged. Yeah it has been. Does it happen often? I asked. That the diagnosis would change like this? No, not often at all, she replied. I told her that I had a lot of questions for the surgeon, so she might want to prepare her.

Not long after, the surgeon came in, also with a sort of sheepish look. Hey, how are you doing? Fine. The incision's healing well. I didn't even need much pain medication. I sort of had a little speech planned out and I think I mostly pulled it off, and more importantly, without crying. Because that would be disastrous. Who would really listen to a crying patient? It would be so distracting! The gist my speech is: Today is the 10 week anniversary of my very first mammogram, and I tell you, I would never had dreamed I'd be sitting here today having gone through so much. I had a month of not knowing what I had, and then 5 weeks thinking I had cancer. It has been a pretty traumatic experience. Life changing. And some qualities I have that are great in other situations, may not always serve me well in this situation. I am very analytical, I think in many shades of grey, and I have no patience. I've learned a lot about myself and my friends and family, blah bla blah (I really did say blah blah blah!), but I also learned how to be a patient. You and all of the other staff are on my side and you only want what's best for me, but at the end of the day you go home to your lives and I'm left with mine. I have learned that I need to be my own strongest advocate, because nobody can care as much about me as I can. I feel like I've allowed myself to be led blindly through this process, because I didn't know anything about it. But now I need to take charge of my care and demand the best for myself. The surgeon nodded in agreement. So, I said, I would like to send the slides to a third pathologist for one more opinion. Absolutely reasonable, she replied. And I want you to be a part of that process, I said. No problem. We'll do what you want.

She also (and I will interject here by saying that my opinion of her went up 1000% today) owned up to the fact that everybody's human and can make mistakes. The doc even acknowledged how much it would have sucked if I had actually had a mastectomy for the alleged DCIS. Um, yeah! Although lucky for me, I didn't even consider it.

Then (and here's the surprising part), she asked if we wanted to meet with the director of the lab! Really??!! Of course we would!! Wow! So she spent quite a bit of time trying to get a hold of the head pathologist (the lab is in the basement of the building). Then, after hearing that we wanted to talk, they started re-cutting the tissue samples so that the first pathologist could re-read them - this may have been the first she heard about the whole situation. Right then and there! So they offered that we could wait 30 minutes for that to all get done, or to schedule another appointment where we could actually go down to the lab AND SEE THE SLIDES OURSELVES on a teaching microscope! How cool is that??? I'm not sure they would have offered that part if we weren't veterinarians. So of course (even though I am impatient), we elected to schedule an actual meeting/pathology slide review for later. Because of our work schedules, Lisa and I couldn't both be there until 2 weeks from today. Interestingly, it is the day I was to start my radiation therapy.

Anyway, because I asked, she gave me the name of the best oncologist she knew. I will schedule an appointment with him after the third opinion pathology report is back. Also, I need to have a breast exam in the fall (as part of my physical), and a mammogram/breast exam at Piper next spring. Then every six months after that I will probably have an alternating mammogram or MRI until I am through menopause. Wow, a whole year without a mammogram! Being that I've had 6 mammograms (plus the breast MRI) in the past 2 months, I think it is a well-deserved break.

I also want to add that even though this experience was rather painful in so many ways, I have had some wonderful interactions with the medical team, starting with my first mammogram up in Maple Grove. And the people at Piper have been especially awesome. Even though it's a drive and I have to pay for parking, I feel it's worth it to get that kind of care.

And you know what the other surprising part of the appointment was? I asked the surgeon if this kind of error or change in diagnosis or whatever happens often and she said No. It has actually never happened to a patient of hers in her ENTIRE CAREER. So, yeah, of course it would happen to ME.

More breast cancer talk

This has been a rough weekend. I still have regular panic attacks and Lisa is visibly upset about spending another Mother's Day without her mom around (she died in 2008). It is a bittersweet holiday for her, that's for sure. Plus, even though we beg and plead with the kids to JUST BE GOOD on Mother's Day (we don't need any gifts, we just want a peaceful house, please!!), they can't seem to handle the pressure and actually seem to behave even worse on this day. Ugh.

I have been thinking a lot about my diagnosis and also how I am processing it. I know there are several different things at play here. I will admit that some of them are selfish. But's that's the way it is, isn't it?

1. I spent 9 weeks being led through a medical experience that involved a dozen appointments, eight doctors, lots of invasive tests, surgery, and waiting for a conclusion. The journey itself was quite traumatic.

2. I spent over 5 weeks as a cancer patient. I had to wrap my brain around that diagnosis and be able to come to terms with it. It is a life changing event. Then, without warning, I no longer have cancer. It's all over. You can go home now. Um, ok.

3. For awhile I was a cancer patient and now I'm not. This is the selfish part of me talking. I was special for awhile. My friends were super nice to me. I had the support of hundreds of people. I could wear a little pink ribbon and talk about how I, too, had breast cancer. (Although I never did. Wear the pink ribbon, that is.)

4. I have only had surgery a few times, but I tend to feel let down afterwards. It is such a cool experience, and then it's over and I have to go back to my daily life.

5. I am not sure how much I trust the medical community at this time. I was all rah, rah for awhile. They saved my life! They're looking out for me! But now, I realize that while everyone was trying to do their best by me, they can still get it wrong. The radiologist couldn't get a sample on the first try, which resulted in a surgery that never transpired and turned back into a regular biopsy. Then, two pathologists read my initial biopsy out wrong. Two of them! Or did they? Maybe the third and fourth pathologists were wrong. Whom do I believe?

6. I'm a little scared. I might not have cancer now, but I have a 4-6 times higher risk of developing invasive breast cancer than the average population. This translates into about a 25% chance in the next 15 years. That's really high, isn't it?

OK, I know this is totally whacked and thousands of cancer patients everywhere would give anything to change places with me. By writing this in a public blog, I am taking a bit of a risk here that everyone will see me for the attention-seeker that I really am. But sometimes you can't help how you feel, right? And by writing this down, hopefully I will get over these feelings sooner. I am a flawed human like everyone else out there. I think I am just a little more vocal about it.

So what now? Well, I have my follow-up appointment with the surgeon tomorrow. Also, I wrote to a breast cancer expert at Johns Hopkins and this person said I should absolutely keep my appointment with the oncologist. The one thing I can do to lower my risk is take Tamoxifen, so I need to talk about that. I also need to get a plan for monitoring. I'm not sure who will be in charge of my future breast health. The surgeon? The oncologist? My family practitioners? Also the expert said I should consider having the slides sent out to a pathologist group at Vanderbilt University. This group is considered the national expert in the fields of ADH (atypical ductal hyperplasia) and DCIS (ductal carcinoma in situ). My understanding is that it can be very difficult to distinguish between the two (obviously). I may feel a little better if I do get one more opinion.

I am healing, physically and emotionally. My incision feels pretty good, although it did remind me it was there after I played soccer this morning. And I am starting to be able to talk about this last week without tearing up. I am not yet celebrating like I should be (and like everyone else is), but I know that time will come.

I will  probably keep up with the blog. I get 80-100 page reads a day, so obviously people are still interested. And I enjoy writing it. I still want to write a breast cancer summary because I think that many people don't have enough, or the right, information. That will be a future blog entry. I also have a few more appointments in the near future, so I will write about that. Otherwise, I need to find a new focus. Or not. I would like to feel like I am helping the greater community in some way by sharing my life. But maybe I'll just write about my day, and if people want to read about my mundane life, then so be it.

Now what?

I am doing better today, but I still can't talk about anything related to my breast without choking up. So don't bring it up to me in person. It's funny how the mind can suffer, isn't it? Most of us can handle quite a bit of physical pain, but emotional pain is so much worse. I don't have a chronic mental illness, but there have been several times in my life where I have had profound acute depression/anxiety and it sucked. I'm going through a little of that right now, but it's not too bad. Mostly because I have been through it before and I know I'll get through it again. And also because of the Xanax.  :)

Many many years ago (I guess it would be about 11 years ago), I was trying to get pregnant and it too was a huge medical ordeal. Funny how, like this time, the doc would chase one diagnosis, which would lead to a different diagnosis, and on and on. I ended having many dozens of doctor appointments, several vaginal ultrasounds, a contrast study of my uterus (ouch, by the way), exploratory laparoscopic surgery, at least 10 intrauterine inseminations, and, of course, several different hormonal fertility medications. After my surgery, I did GREAT for 2 days, but then  I had a meltdown. I literally could not stop crying for 12 hours straight. I actually had to call in sick to work because I was crying too much! My doc made an emergency appointment with a therapist, which was great. I only needed to see her once and hear from her that it was ok to feel all of these emotions, which included helplessness, sadness, emotional letdown after a big event like surgery, and hopelessness that I was ever going to get pregnant. It took a few more days to be completely back to normal, but I got there. And I know I'll get there this time as well.

The Breast Book (which Lisa hates, by the way) has a whole chapter on what happens when treatment is over. Many patients do have feelings similar to post-traumatic-stress disorder, as well as survivor's guilt. And they almost don't know what to do with themselves because something that has taken so much of their time and energy is suddenly over. And then there's the worry about it coming back. I feel a little of all of that.

I have received many messages of support since starting this blog, and also messages of gratitude. I think the blog has opened some eyes to several issues, breast cancer notwithstanding. I also hope that by sharing my story, it will make others feel less alone as they work through whatever struggles they may have. Not everyone is as open as I am (obviously), but if you're out there and need help, just make it known and an army of friends will come your way. You have more people rooting for you than you think. I have certainly learned that in the past few months. One thing I can't promise you is a hug from me. Well, unless you REALLY need one.

So what am I going to do now? Well, I have a follow up appointment with the surgeon on Monday. I have canceled my genetic appointment. I may keep the appointment with the oncologist because I really want a second opinion on my future cancer risks and what follow up I would need (and also if I should consider Tamoxifin). I still have my elbow to worry about, now that I don't need radiation. That's where it all started, as you may recall. My elbow.

I also need to re-focus on my family. I have been distracted beyond belief lately and they deserve more of my attention. I also need to be more productive at work, or my boss may fire me. NOT! I am the boss! Ha ha! And I need some new things to dive in to. Training for the marathon, getting the garden going, making a bunch of small household repairs, blah, blah. Actually, I am mentally not ready to consider any of that yet. Like I said, give me a few days.

And this blog? I enjoy writing it and I think people enjoy reading it. I would obviously have to change the focus of it now if I continue with it. And since I'll be 41 next month, I may need to change the title as well. We'll see.

Good news!?

I've been a wreck for the past few hours. I've been holding back tears and wiping my nose and telling all of my clients it's allergies. Yeah, I don't have allergies - I'm just on the verge of a breakdown, that's all. The surgeon called. Well, she said in her low, calm voice. I have good news. The final path report was Atypical Ductal Hyperplasia. They went back and looked at the first path slides as well and changed the initial diagnosis to match that of the surgical path slides. That means you don't have cancer and you can cancel all of your appointments (radiation, oncologist, genetic counselor). You do have an increased risk (3-6 times normal) of developing breast cancer in the future, so you need to be seen every six months for follow up. I'll see you on Monday for your post-surgical appointment. I didn't even know what to say, bumbling idiot that I am.

Of course, I have been researching ADH for the past 24 hours, and I know it's a step below DCIS on the breast cancer spectrum. It is easy for pathologists to call ADH DCIS and vice versa. It's just that ADH doesn't have the word cancer associated with it. So why am I upset? Actually, I've held it together for 9 weeks. Nine weeks of testing and procedures and surgery and uncertainty and anxiety. I was bound to have a breakdown at some point. Why not now?

First, you don't give someone a cancer diagnosis and have them sit with that for a month and come to terms with it and steel themselves against it and then tell them they don't have cancer and not expect there to be some emotional repercussions. I'm sorry. I'm human.

Also, for those of you who are reading, don't tell someone who is going through the above emotions, for the previously stated reasons, that they should be happy. Because then they feel even worse for feeling not-so-happy.

I'll be fine. I am a strong person but I need this time. For what? To grieve the lost 9 weeks. To re-formulate my near future that doesn't involve daily radiation appointments and doctor exams. To face the fact that I will forever be known as a high-risk patient, with (I calculated) a 44% chance of developing breast cancer at some point in my life. To figure out my next project, since this one has abruptly come to a close.

Let's play Monday morning quarterback for a minute, shall we? What if I never had that mammogram? The calcifications may have been perfectly happy staying as ADH for years, and I could have postponed this episode. One of the reasons yearly mammograms are not recommended for women under 50 is the high percentage of false positives. And the anxiety and expense that is incurred because of it. I guess it's not really a false positive, since I do have a diagnosis of atypical precancerous cells, but they may have never amounted to anything. Also, what if a different pathologist had read out the initial slides? Maybe it would have been ADH. Although they were read by two pathologists who agreed. Or, what if I had decided to go with the surgical biopsy instead of the second stereotactic biopsy? The surgical biopsy is more accurate and they probably would have read that one out as ADH and I would have known it 5 weeks ago. I went to Hawaii thinking I had cancer! I read the whole 700 page breast book! I had people praying for me, and healing rituals, and I told my kids all about breast cancer.

At least I didn't have an unncessary surgery - I believe that removal is still recommended in cases of ADH. Just not radiation (and as I said in an earlier post, radiation may not be indicated in mild forms of DCIS either).

I am not mad at anyone in particular. No mistakes were made. Everything was done according to protocol. We all (me, my family, the healthcare team) did their jobs. These things happen. (Heck, I've read about women who have complete mastectomies only to find out later that they didn't have DCIS either. Yes, it could be worse.)  I'm not even mad, really. I am just emotional. It's crazy. Sort of like (I imagine), war veterans must feel when they come home. They are supposed to be all happy because they are no longer in a stressful environment, but it's hard to adjust from that to normalcy in a short period of time. Maybe I have PTSD?

So I may need a few days. If you try to call me tonight, I may not be able to talk without bursting into tears. I need some time to debrief. Is that what it's called? Then I can celebrate my new diagnosis as a cancer-free person.

Back on the roller coaster

I'm all dressed and ready for work, except I don't want to go in yet. Good thing Wednesday morning is my office/paperwork time, so I'm not expected there at a certain hour.

I'm tired of this. It has been a long two months and I've had such a wide swing of emotions that I'm surprised I'm still considered sane. I remember the other day when my breast was squished between two mammograph plates and the radiologist was injecting it with lidocaine, and I thought, I don't want to play anymore. It hurts, it's humiliating, and it's scary. And if I was able to forget about this disease for periods of time before, now I am constantly reminded due to the ache at the surgery site.

I'm waiting for the other shoe to drop. It's a little disconcerting to have your surgeon say (right before your operation!) that you will have a 10% chance of needing a double mastectomy depending on what the biopsy and genetic testing shows. I didn't sign up  for this! I am tired of all of the appointments, of all the uncertainty, of the sympathetic faces from friends and family. I just want to be normal again. Me and my tennis elbow (which, by the way is feeling so good I may not need surgery on that after all). My little 40-year-old aches and pains. Not cancer. No, I didn't ask for that.

On the other hand, I am also looking at this experience through the eyes of a scientist and of a health care consumer. I am amazed at what doctors can do these days, but equally amazed at their limitations. It's a world of statistics and probability and no good answers. We make choices in our care based on probability and risk aversion, and what may be right for one patient won't help another, but often times there is no way of knowing who will be helped by what. One of my most vivid memories of watching the mini-series "John Adams" was when his daughter was diagnosed with breast cancer and had a mastectomy (the only available treatment at that time, well, other than maybe leeches). This was done with NO ANESTHESIA. How barbaric! But it was the best that could be done at the time. Think of how far medicine has come since then! But think of where we'll be in another 200 years. They'll look back at us and wonder why doctors kept lopping off breasts when there's now (in 2200) a pill to prevent all forms of breast cancer. Or not. Maybe we'll never figure it out.

    ************************************************************************

OK, it's been a few hours since I wrote that post and since then I received a phone call from the surgeon. It seems like the surgical pathology doesn't match the initial pathology. The initial path report (which was read by 2 pathologists) showed DCIS. The surgical report shows only atypia (which is possibly a precursor to cancer, but not cancer itself.) She is sending all of the samples to a breast pathologist at the Mayo clinic for verification. If it turns out to be atypical cells only, then I obviously would not need radiation. Good news, right? Yeah, I think. To be honest, I am very conflicted about that. Like I've been through so much and have steeled myself for the worst only to find out the diagnosis was wrong. And I've broadcast my story to the world and I have received so much support and now I don't have cancer after all. Actually, I don't know anything yet - the results won't be back for a day or two.

I am kind of in the medical field, so I get that it is more of an art than a science. I don't expect things to run perfectly, and I think that my medical team has only my best interests in mind. But, jeez, how many appointments have I had over this? How many sleepless nights? How many invasive procedures? I'm not angry, just a little anxious and also confused as to why I am not jumping up and down with joy right now. I guess that time will come. I guess I really should just wait for the Mayo report. Oh, good. More waiting. I do that so well.

Post-surgery

OK, yeah. I went to work today! What's wrong with that? I asked my surgeon and a nurse independently and they both said it was ok to go back the next day with restrictions. So I made sure I had a light schedule and lots of help. I felt pretty good this morning. I only took 4 Advil all day and my incision feels fine. But I did start to feel pretty crappy at about 3. Sort of like a low-grade flu or something. So I came home at 5 and fell asleep on the couch for about 15 minutes until the girls came in from outside covered in mud. What's with that? I swear, if there's mud within a hundred yards of them, not only do they step in it, but they fall in it. And then roll around a bit. So mud is once again tracked all over the house. Ugh. I don't have the energy to deal with this! I did make them shower and they are grounded from the outdoors for the rest of the day. I'm afraid of what the bathroom must look like.

The poor girls are eating saltine crackers right now because I'm too tired to prepare dinner. And I'm watching Seinfeld reruns because I dont want to watch the news anymore. I'm also playing my new addictive game - Words with Friends. My username is jamstrom if you want to take me on. Where is Lisa? I need her to come home and take care of me! And feed the girls!

A good friend of mine came over to help out last night. She brought me the best card. It said, Cancer sucks. But it could be worse... At least you're not married to John Edwards. Awesome!

As far as going back to work so soon, that is the mentality of an employer vs. an employee. An employee with benefits would probably take today as a sick day and the employer would eat the cost, either with decreased productivity or by paying someone to cover the shift. An employer is less likely to take a day off unless it is really necessary because the decreased productivity or paying someone to cover comes out of their pocket. So I weighed everything and decided that if I was going to pay a relief vet $500 to cover my shift, I would have to really be sick or really having a good time (like going to Hawaii!). I'm not complaining, I'm just explaining since so many people have asked why the heck I went back to work today. Plus, what else am I going to do today? It's not like I can do anything fun!

No word about the biopsy, so I guess I'll hear tomorrow. It's 7:30 and I'm about ready for bed.

Appointment 11 - Surgery

Wow, I have a lot to write about today. I will start by saying that I think you all misunderstood my previous post about hugging. I don't LOVE getting hugs; I just tolerate them better now. I don't go around asking people to hug me, but I won't run away from one like I have been known to do in the past. Got it? Good.

I just woke up from a Vicodin-induced fog. It was awesome! I can see how people can become addicted to this stuff! Actually, it makes one unable to function, so I don't know if I would want to be taking it all of the time. I would be a walking zombie. I may take one or two more tablets today (they gave me a vial of 30!) but that will be it. I have to get on with life starting tomorrow.

The day started at about 5 am - I couldn't sleep anymore. I actually had a dream/nightmare that one of my co-workers  made this really good blue (?) cake of some sort and it ended up at my house and I ate a piece before I realized that I wasn't supposed to eat before surgery so I tried to spit it all out. So I got up and showered and removed all my jewelry. Our friend Cathy drove the kids to school and Lisa and I were on our way to the hospital by 7. Traffic was really light (perhaps everyone was staying home to watch bin Ladin news coverage) so we got there 20 minutes early. I was much hungrier this time around, for some reason, even though I pigged out last night. After gowning up (this time they gave me heated gowns and a heated blanket!), I was brought into the room where the radioactive seed was to be implanted. The radiology technician was from Poland, and since I actually visited Poland a couple of years ago, we had a pretty good conversation about  it. She described the procedure and kept talking about how they would give me frequent breaks and I should let them know if I felt light-headed, plus there were all of these packets of smelling salts taped to the equipment, so I got a little nervous about fainting. How often does that happen, anyway? I was left alone in the room for about 5 minutes while she got the radiologist, so I decided to explore. The Geiger counter was an oddity because it looked like a relic from the 1950's - it was old and even rusty. The radiologist came in and I made a comment about it and she got all defensive! No sense of humor! She's like, It works just fine, but I can get you another one. Do you want me to get a different one? Jeez, no! I was just trying to lighten things up! I wish I had the radiologist who did my stereotactic biopsy. She was funny! She would have got the joke!

Anyway, the procedure is like this. They have you sit down while they squeeze your breast in a mammogram machine from the top and bottom. Then the radiologist looks at the image and marks the coordinates of the metal clip that had been implanted after the biopsy. Then the radiologist injects a local anesthetic and then places a needle so that it is near the clip. Then they switch the machine to squeeze from the sides (you know, to get a 3D view), and adjust the needle so that it is near the clip from all dimensions. The entire time, the tech wouldn't let me look at the needle. Probably because they thought I would faint if I saw it sticking out of my boob? When the radiologist is satisfied with the placement, she injects the small radioactive seed (it is the size of a pencil tip, I was told). Then a couple more views to confirm placement, and THEN the ancient Geiger counter was used to make sure the seed did give off radiation (it's a super small amount).

Shortly after, Lisa and I were led to another part of the building for surgery. I had to take off all of my clothes except for underwear and put on a paper Bair Hugger gown. I will interject here by saying that my hospital wristband was checked at least a dozen times today, and I was asked to state my name, birthday, and procedure being performed at least that many times. The nurse took my vitals, reviewed my history, and placed an IV. That damned IV - you know how I hate them! By this time, my mom and Lisa were allowed in the prep room. I was there for almost an hour and during that time, I was introduced to the anesthesiologist, anesthesia tech, and visited by the surgeon. The surgeon talked to me about genetic testing. I had called and made an appointment, but couldn't get in until July. She said it would be better to get in earlier, before starting radiation, because if I tested positive for the BRCA genes, it would probably mean bilateral mastectomy instead. Yeah, right, I said. What are the chances of me even having the gene? Like one in 10,000? No, she replied, more like 10%. Really? Obviously, she is a breast specialist so she knows a whole lot more than me, so I'll go with her recommendations. Although I don't really believe the risk is that high. The anesthesiologist and I (and Lisa) had the best conversation, since we told her we were vets and discussed the similar drugs we use. Finally, I was walked to the OR. We opened the door and behold! Bright lights! The surgery table prepped for me! It was weird because it had two "wings" to put my arms out to the sides, and it looked like a cross. So close to Easter... Anyway, I got a little excited at that moment because I am a little narcissistic and it hit me then that all of these people were here and ready for ME. For the next 45 minutes, I was the center of their universe. Just being honest here.

They had me lie down and almost immediately I could feel a burning sensation in my arm. That was the propofol going in. They could have warned me! I chatted with the team for about 30 seconds and then woke up back in the prep room 40 minutes later. So weird! I love anesthesia! I've been under a couple of times in the past and it is always such a trip. In fact I may even have said that I could see how people get addicted to plastic surgery because the anesthesia is so cool. And the anesthesia tech also told me afterwards that I announced in the OR room how cool it was to be the center of attention. I said that out loud??? Oops!

The procedure (as it was described to me) is that the surgeon anesthetizes the breast with lidocaine. Then she makes an incision and uses a small Geiger counter to find the radioactive seed. She removes a pingpong ball size piece of breast tissue around and including the seed, which is then x-rayed to make sure the clip and seed are in it. Afterwards, the incision (which is maybe 3 inches long) is closed up. No external sutures.

The anesthetic that was used, propofol, is the same one that killed Michael Jackson. I hate using the stuff on animals, because in my experience thay are either awake or they are so deep they stop breathing. The anesthesiologist said the same is true with people, so I was monitored very carefully. It is tricky, she said, so it's generally only used by boarded anesthesiologists.Well, I have to admit, it was a good drug in this situation.

I started feeling a little painful after waking up, which was weird since I was given a local block and that should last several hours. So the nurse gave me a Vicodin tablet at noon. We left by 12:30 and I told Lisa I was ready to go shopping! But then I started tripping about halfway home and crawled into bed for a 2 hour Vicodin nap. Now I'm awake and feeling pretty good and Lisa left me (against doctor's orders to have an adult with me for 24 hours) so that SHE could go shopping. Well, just to get milk. And peanut butter and chocolate chips for me.

A few minutes ago the Piper Breast Center called and told me my genetic counseling appointment has been rescheduled to next Monday, and my surgery follow-up would be right after. I guess my surgeon has some pull with the counseling department! Also, the final pathology report will be back late tomorrow or Wednesday. My surgeon said she'd be the one calling me. I'll let you know.

So that's my day. I hope I do get painful again so I'll have an excuse to take another Vicodin...