It recently occurred to me that I have been talking up my success stories at work, but I haven't said much about my missteps. And there are plenty. Thankfully they are becoming less frequent the longer I am in the profession (as the saying goes, you learn something every day), but they happen nonetheless. I was reminded of that today, when I made a judgement call that didn't work out as hoped.
At about 10 am I saw a 2 year old male cat who couldn't pee. This is a surprisingly common occurance and I see about one of these guys every month or two. This problem is usually caused by plug of crystals and mucus that forms in the bladder and gets lodged in the urethra on the way out. If left untreated, the cat's kidneys will shut down and it will die within a couple of days. So emergency intervention is needed.
The standard protocol for these guys is to stabilize them if possible (and if needed) with IV fluids and treatement if their electrolytes are out of whack. Then you sedate the cat and attempt to pass a catheter into the urethra (starting at the tip of the penis) to he bladder. Usually you have to push or flush the plug into the bladder in order to relieve the obstruction. In the past, it was recommended to sew the catheter in for a couple of days in order to allow the bladder to heal from being stretched and the swelling in the urethra to go down. However, sewing the catheter in can be a pain. It can become kinked or clogged, the cat has to wear the cone of shame 24/7 in order to keep him from pulling the cath out, and it is a good way to introduce a urinary tract infection. So I believe that we are sewing in fewer catheters these days. Well, at least I am. I have had some pretty good success relieving the obstruction with a catheter but not keeping it in.
Anyway, this cat was difficult to catheterize and I cause quite a bit of swelling "down there" as I forced saline into his urethra to relieve the obstruction. However, once the obstruction was gone, he had a great stream of urine and the catheter passed super easy. I flushed his bladder several times and each time I pressed on it after filling it with saline, a nice stream of saline/urine came out.
So, time for another judgement call. Leave the cath in? Take it out? I decided to take it out and see if he was able to pee on his own. Every couple of hours I checked on him. No urine in the litter box (and he was on a high rate of IV fluids at this point). I could not express any urine when I pressed on his bladder. This dance continued until I left the office at 4:30 pm, knowing that I would have to come back later because he wasn't going to pee. Stupid cat.
Sure enough, when I came back (after running my kids all over town to their activities), there was still no urine and I still couldn't express his bladder. So I sedated him AGAIN and tried to express urine - no luck there. Couldn't blame it on urethral spasms at this point. He must have re-obstructed. So I passed a catheter AGAIN, but there was only a little bit of resistance until I was able to push through the obstruction. Again it became easy to catheterize him, but he didn't have quite as good a urine stream when I expressed his bladder. I guess I had to sew in the cath at this point.
Sometimes I'll take these guys home with me for the night and let them hang out in my bathtub so that I can check on them. But tonight I had to go straight to a meeting and couldn't leave him in the car. So he's at the clinic and I have to hope that he behaves and doesn't pull his catheter out, and that that catheter behaves and doesn't get clogged or kinked in the next 12 hours. Because if any of the these happen, it can further stratch and damage his bladder and we will probably have to start all over again.
And you wonder why I take Xanax every night to get to sleep?
Tuesday, December 27, 2011
Friday, December 23, 2011
Monday, December 19, 2011
Judgement Call
I am not a surgeon. I am not a radiologist. I am not an internist. I am a general practitioner, which means that, for better or worse, I know a little about a lot. This can sometimes get me into uncomfortable situations.
Last Friday a patient of mine came in for vomiting. The poor dog was vomiting large volumes of bright yellow fluid several times an hour, and had been doing so (off and on) for about a day. Other than him being a little dehydrated, I couldn't find anything wrong when I examined him. His belly didn't even hurt. I admitted him to the hospital for some diagnostic testing and IV fluids. His abdominal x-rays showed a very distended stomach - filled with some gas and a lot of liquid. I didn't see any foreign object or other evidence of obstruction, although the dog did have a tendancy to "eat anything and everything". His labwork was normal. I got a couple of second opinions (I took a digital photograph of the x-rays and texted them to Lisa, and also a friend of mine, who is a veterinary internist, was at my clinic with her kitten and I showed them to her as well). Well, you do what you have to when you're in general pactice by yourself! There was no consensus on whether the dog had an obstruction, so I elected to re-take the x-rays in a few hours. That led to a contrast dye study of his GI tract at 6 pm Friday. The dye started to leave his stomach pretty quickly, but then it kind of just petered out. But not in the typical "gee there's something stuck in your gut" pattern. It could be an obstruction. Or maybe just ileus, where the GI tract just decides not to move things through.
Hmmm... Now what? The dog was looking better and hadn't vomited in a few hours, so I sent him home with instructions to bring him back the next morning for a follow-up x-ray. The owner came in at 10:45 am as instructed. The dog had done great all night, but vomited a little just before coming to the clinic. I took an x-ray and it looked exactly the same as the last one we had taken the night before. The stomach was still filled with barium (the dye that we used). Crap.
At least it was now a no-brainer. I make some quick mental calculations. It was 11 am. I needed to be at a doctor's appointment 15 miles away at 1 pm. Could my two techinicians and I prep, anesthetize, operate, and recover the dog in 90 minutes? Of course I offered to just send the dog to an emergency clinic (E clinic) for the surgery, but the owner really trusted us and wanted us to do it. And it was sort of a win-win for both parties. Our surgery fees are much less than an E clinic's fees. And in the slow winter months, my clinic could really use the added income that an emergency surgery brings. I figured it would be a quick incision into the stomach to remove the offending object, then wake him up and send him to the E clinic for post-op care.
Well, you know I wouldn't be writing about this if it was that simple, right? First, when I had one of my techs pass a stomach tube in order to empty the stomach of all of that barium, most of the stomach contents (ie barium and bile) started to come out if his mouth rather than the stomach tube, putting him at risk for aspirating the liquid. As you probably don't know, barium in the lungs is a very bad thing. However, the dog was anesthetized and had a tracheal tube in place, which hopefully would keep the liquid from entering his airways.
THEN, the damned foreign body wasn't in his stomach after all, but his small intestine! A more difficult surgery, but also one that gave me a dilemma. The piece of plastic or whatever it was (the owner couldn't figure it out when we showed it to her either) was probably sitting happily in his stomach for quite some time, But then it decided to make its way into his duodenum, which had to stretch in order to accomodate said object. The 10 or so inches of intestine that the plastic has thus far passed through was very dilated and had a red/purple/black splotchy color. It was angry. But was it damaged beyond repair?
That is the million dollar question. That is when I wish I was a surgical specialist who has done hundreds of these surgeries, rather than a GP who does maybe one or two intestinal surgeries a year. Then I would maybe know if it was ok to leave the mad intestines in, or if they required surgical removal (intestinal resection and anastomosis). Guessing wrong could have dire consequences. Three years ago, almost to the day, I did a FB surgery on a dog who had decided to eat her blanket. I removed the blanket pieces, but not any intestine. Her whole small intestinal tract was damaged, and I really didn't want to remove all of it (because as you can imagine, that would also cause problems), so not knowing what parts would be ok and what wouldn't, I left it all in. And crossed my fingers that it would all be work out. In this case, it didn't. The next day her intestines started to leak in 3 areas, requiring a second surgery. But because she was now septic, she couldn't heal well, so I sent her to the U of M for a 3rd surgery, which she did not recover from. She died on Christmas Eve.
So fast forward back to Saturday. I'm stadning there with an open abdomen and a decision needs to be made. Leaving the damaged intestine in would be quicker (selfishly allowing me to make it to my own appointment on time). Taking it out would be safer. Well, sort of. Because the part that I would have to remove would be the most difficult portion of the GI tract to do surgery on. It is adhered to the abdominal wall near the spine by a large ligament, making it difficult to isolate and operate on. There is also the pancreas that empties into that part of the intestines, and you really don't want to mess with the pancreas. Because I am not a surgeon, the only other time I attempted surgical removal of that part of the GI tract was the second surgery in the dog I just described. And we know how that went.
So I left it in.
And called the E clinic 3 times in the next 24 hours to get an update. Did he have aspiration pneumonia from the barium? Did he have a septic abdomen from a leaking gut? When could I sleep at night knowing that he was finally out of the woods??
Today is Monday, 48 hours after surgery. The dog was doing great yesterday and was discharged from the E clinic. He was doing great at home today. I figure one more day and I can breathe a sigh of relief. I would hate to have to re-visit the Christmas of 2008 again.
I'll let you know tomorrow.
Last Friday a patient of mine came in for vomiting. The poor dog was vomiting large volumes of bright yellow fluid several times an hour, and had been doing so (off and on) for about a day. Other than him being a little dehydrated, I couldn't find anything wrong when I examined him. His belly didn't even hurt. I admitted him to the hospital for some diagnostic testing and IV fluids. His abdominal x-rays showed a very distended stomach - filled with some gas and a lot of liquid. I didn't see any foreign object or other evidence of obstruction, although the dog did have a tendancy to "eat anything and everything". His labwork was normal. I got a couple of second opinions (I took a digital photograph of the x-rays and texted them to Lisa, and also a friend of mine, who is a veterinary internist, was at my clinic with her kitten and I showed them to her as well). Well, you do what you have to when you're in general pactice by yourself! There was no consensus on whether the dog had an obstruction, so I elected to re-take the x-rays in a few hours. That led to a contrast dye study of his GI tract at 6 pm Friday. The dye started to leave his stomach pretty quickly, but then it kind of just petered out. But not in the typical "gee there's something stuck in your gut" pattern. It could be an obstruction. Or maybe just ileus, where the GI tract just decides not to move things through.
Hmmm... Now what? The dog was looking better and hadn't vomited in a few hours, so I sent him home with instructions to bring him back the next morning for a follow-up x-ray. The owner came in at 10:45 am as instructed. The dog had done great all night, but vomited a little just before coming to the clinic. I took an x-ray and it looked exactly the same as the last one we had taken the night before. The stomach was still filled with barium (the dye that we used). Crap.
At least it was now a no-brainer. I make some quick mental calculations. It was 11 am. I needed to be at a doctor's appointment 15 miles away at 1 pm. Could my two techinicians and I prep, anesthetize, operate, and recover the dog in 90 minutes? Of course I offered to just send the dog to an emergency clinic (E clinic) for the surgery, but the owner really trusted us and wanted us to do it. And it was sort of a win-win for both parties. Our surgery fees are much less than an E clinic's fees. And in the slow winter months, my clinic could really use the added income that an emergency surgery brings. I figured it would be a quick incision into the stomach to remove the offending object, then wake him up and send him to the E clinic for post-op care.
Well, you know I wouldn't be writing about this if it was that simple, right? First, when I had one of my techs pass a stomach tube in order to empty the stomach of all of that barium, most of the stomach contents (ie barium and bile) started to come out if his mouth rather than the stomach tube, putting him at risk for aspirating the liquid. As you probably don't know, barium in the lungs is a very bad thing. However, the dog was anesthetized and had a tracheal tube in place, which hopefully would keep the liquid from entering his airways.
THEN, the damned foreign body wasn't in his stomach after all, but his small intestine! A more difficult surgery, but also one that gave me a dilemma. The piece of plastic or whatever it was (the owner couldn't figure it out when we showed it to her either) was probably sitting happily in his stomach for quite some time, But then it decided to make its way into his duodenum, which had to stretch in order to accomodate said object. The 10 or so inches of intestine that the plastic has thus far passed through was very dilated and had a red/purple/black splotchy color. It was angry. But was it damaged beyond repair?
That is the million dollar question. That is when I wish I was a surgical specialist who has done hundreds of these surgeries, rather than a GP who does maybe one or two intestinal surgeries a year. Then I would maybe know if it was ok to leave the mad intestines in, or if they required surgical removal (intestinal resection and anastomosis). Guessing wrong could have dire consequences. Three years ago, almost to the day, I did a FB surgery on a dog who had decided to eat her blanket. I removed the blanket pieces, but not any intestine. Her whole small intestinal tract was damaged, and I really didn't want to remove all of it (because as you can imagine, that would also cause problems), so not knowing what parts would be ok and what wouldn't, I left it all in. And crossed my fingers that it would all be work out. In this case, it didn't. The next day her intestines started to leak in 3 areas, requiring a second surgery. But because she was now septic, she couldn't heal well, so I sent her to the U of M for a 3rd surgery, which she did not recover from. She died on Christmas Eve.
So fast forward back to Saturday. I'm stadning there with an open abdomen and a decision needs to be made. Leaving the damaged intestine in would be quicker (selfishly allowing me to make it to my own appointment on time). Taking it out would be safer. Well, sort of. Because the part that I would have to remove would be the most difficult portion of the GI tract to do surgery on. It is adhered to the abdominal wall near the spine by a large ligament, making it difficult to isolate and operate on. There is also the pancreas that empties into that part of the intestines, and you really don't want to mess with the pancreas. Because I am not a surgeon, the only other time I attempted surgical removal of that part of the GI tract was the second surgery in the dog I just described. And we know how that went.
So I left it in.
And called the E clinic 3 times in the next 24 hours to get an update. Did he have aspiration pneumonia from the barium? Did he have a septic abdomen from a leaking gut? When could I sleep at night knowing that he was finally out of the woods??
Today is Monday, 48 hours after surgery. The dog was doing great yesterday and was discharged from the E clinic. He was doing great at home today. I figure one more day and I can breathe a sigh of relief. I would hate to have to re-visit the Christmas of 2008 again.
I'll let you know tomorrow.
Wednesday, December 14, 2011
Yes, the freaking lump is still there. So what?
Cancer can make you crazy. I think anybody's that been touched by the disease in any way would probably agree. Even my most sane-appearing cancer-survivor friends have moments of temporary insanity. And although it diminishes, the fear never really leaves. If you've had a relative die of cancer, you know you're genetically marked and could develop the same disease at any time. If you yourself have had cancer, or are considered high-risk, you're always on the watch for it to rear its ugly head again.
How has it affected me? Well, 99% of the time, it hasn't. I go about my life as always. I had my nervous breakdown last spring and I'm over that part. But, as you know, I am vigilant now, so I started doing breast self-exams and exactly 16 days ago (not that I'm counting) I felt a lump. I didn't panic at first, but I did end up going to not one, but two doctors in the next week or so. Both told me not to worry but to recheck in 6-8 weeks. So at first I didn't worry. But then I noticed that the lump was changing, and it certainly wasn't going away. It was more firm and starting to be a little painful. Is that a good sign? Statistically, yes. Pain is usually associated with benign conditions. But 11% of breast cancer presents itself with a painful mass.
So last week I called my surgeon. The tone of her voice was just a little on the annoyed side, as I'm sure she gets phone calls like this a lot. No, Jami. It is not going to hurt to wait the 6 weeks to have it checked again. Studies have shown that. Coming in sooner will not help, and may result in an unnecessary biopsy.
My poor primary physician. He is married to a friend of mine (and fellow veterinarian). Because I've become a little crazy, I've been having conversations with his wife that go like this: Can I come over to you house and I'll even bring beer and your husband (and even you if you want, since the more opinions the better) can feel me up again? Or (from her), how about I bring our kitten into your clinic for vaccines and I'll bring my husband and he can check you in your office?
Isn't that a little nuts?
The irony is not lost on me. Last spring all of my tests were doctor-driven. I was in a state of shock for much of the time and just let them lead me from one procedure to next. I didn't have a lump or any symptoms, so the whole thing was a bit surreal. I almost didn't believe it was happening. This time around, I found a lump, a tangible sign that all is not right. Because it sort of hurts, I am reminded of it often, even if I've stopped obsessively checking it out. I am the one wanting to be more aggressive. Heck, if the surgeon told me she wanted to take it out, at this point I'd jump right into the operating room. Yes! Take it out! Do SOMETHING!
However, I am actually in a much better state of mind this week than last. I can be patient (although it is not one of my stronger suits). I can wait the 34 days until my next doctor appointment. I can do this. I am not crazy. For now.
How has it affected me? Well, 99% of the time, it hasn't. I go about my life as always. I had my nervous breakdown last spring and I'm over that part. But, as you know, I am vigilant now, so I started doing breast self-exams and exactly 16 days ago (not that I'm counting) I felt a lump. I didn't panic at first, but I did end up going to not one, but two doctors in the next week or so. Both told me not to worry but to recheck in 6-8 weeks. So at first I didn't worry. But then I noticed that the lump was changing, and it certainly wasn't going away. It was more firm and starting to be a little painful. Is that a good sign? Statistically, yes. Pain is usually associated with benign conditions. But 11% of breast cancer presents itself with a painful mass.
So last week I called my surgeon. The tone of her voice was just a little on the annoyed side, as I'm sure she gets phone calls like this a lot. No, Jami. It is not going to hurt to wait the 6 weeks to have it checked again. Studies have shown that. Coming in sooner will not help, and may result in an unnecessary biopsy.
My poor primary physician. He is married to a friend of mine (and fellow veterinarian). Because I've become a little crazy, I've been having conversations with his wife that go like this: Can I come over to you house and I'll even bring beer and your husband (and even you if you want, since the more opinions the better) can feel me up again? Or (from her), how about I bring our kitten into your clinic for vaccines and I'll bring my husband and he can check you in your office?
Isn't that a little nuts?
The irony is not lost on me. Last spring all of my tests were doctor-driven. I was in a state of shock for much of the time and just let them lead me from one procedure to next. I didn't have a lump or any symptoms, so the whole thing was a bit surreal. I almost didn't believe it was happening. This time around, I found a lump, a tangible sign that all is not right. Because it sort of hurts, I am reminded of it often, even if I've stopped obsessively checking it out. I am the one wanting to be more aggressive. Heck, if the surgeon told me she wanted to take it out, at this point I'd jump right into the operating room. Yes! Take it out! Do SOMETHING!
However, I am actually in a much better state of mind this week than last. I can be patient (although it is not one of my stronger suits). I can wait the 34 days until my next doctor appointment. I can do this. I am not crazy. For now.
Tuesday, December 6, 2011
Appointments 17 and 18 - Was that a lump I felt?
OK, let's review here a little. First mammogram ever was done last February. Found an abnormality, which led to more mammograms and biopsies and an MRI and surgery and a teeny mental breakdown when I went from being told I had cancer to being told I probably didn't. Started the evil drug tamoxifen, but stopped it after it made me crazy.
So, now that I'm a high-risk patient, I thought I should start doing breast self-exams. But I didn't start right away. I can't really describe it, but I was angry for awhile. Angry at the situation and angry at my breasts for betraying me. So I ignored them. Finally, in the middle of the summer, I decided to end the breast silent treatment and start doing self exams.
*** Please note: The following text contains descriptions of BREASTS and other WOMANLY STUFF and may not be appropriate for the squeamish!***
So, every week or so, when lathered up in the shower, I would check them out. And just like the book says, they do change based on where I am in my menstrual cycle. So it was good to do the exams every week, so I could follow the normal hormonally-caused changes. I'd done maybe 20 or so self exams and they were all normal. A week ago last Sunday, however, I lathered up and palpated my boobs like always except this time... hmmm... there was a weird knot thing in my lower lateral left breast (not the one where I had surgery, BTW). It was the size of my finger tip and blipped in and out of my fingers. Stay calm, I told myself. You are due for your period any day now and the glandular tissue tends to get larger and more firm at about this time. But I had Lisa feel it too (well, you're the one who decided to keep reading!) and she concurred that it did not feel like the rest of my breast tissue.
So the next day I left a message for my primary doctor, who called back and said if I were his wife he would want me to get in right away. Before he called back, I also spoke with a nurse at the Piper Breast Center, who told me to wait 1-2 weeks and have my surgeon check it out.
Well, I decided to go in earlier to see my primary doc three days after I initially felt the weird lump. It was a frustrating visit because I (like always) had to wait almost an hour to be seen. Grrr.... AND neither of us could feel it! But it was just there this morning! WTF??? Well, he said, I don't want to you to be worried about it, so we can schedule an ultrasound just to be sure. Nah, I said. I'll wait and see what happens after my period is over.
Well, a couple of days later it was still there, so I went ahead and made an appointment with the breast surgeon. The timing was good - 8 days after the start of my menstrual cycle, when the breasts are the least tender and lumpy. But because of the false alarm I had at the first appointment, I became a little obsessed about this lump. Every day
I checked it in the morning (always there). I checked it at noon (sometimes not there). I checked it at night (always there). I even checked it several times while driving the car - well it's not like anyone can see that you have your hand up your shirt when you're driving! Right?? I would say that I felt the lump about 80% of the time, and it didn't seem to be getting any smaller. I wish I could have had some of my friends check it for confirmation, but I suppose that crosses a line. I could have had Lisa feel it a couple of times, but I also didn't want to bring it up a lot and worry her. Even though I was afraid of cancer, I was more afraid that the doc wouldn't be able to find the lump and then I would really think I had lost my mind.
So I had the appointment with the surgeon this morning. Checked the lump in the shower. There. Checked it in the car. There. Got to the doctor's office and they took me right in. (See? That's how a doctor's office should run!) Disrobed the upper half and checked again. Still there. The surgeon came in minutes, yes MINUTES later and did a pretty thorough exam and couldn't feel anything. DAMMIT! So I tried to point it out to her and I started to panic - I couldn't find it either! Aaack! I really am insane!! But I calmed myself down, took a deep breath, and finally located the lump. THANK GOD. Yes, I was actually thankful for finding a breast lump. That's what I've come to.
She told me it felt like a ridge of glandular tissue, so it was likely nothing to be worried about. But we could order an ultrasound... What do you think, I asked? After pondering for a second, she said she'd call downstairs and see if they could get me in right now for an ultrasound. Yes, they could get me in right away. This place was not the Piper Center; it was the place where I had my failed stereotactic biopsy attempt. But my surgeon assured me that they would be perfectly capable of doing an ultrasound. OK. She also told me that if the ultrasound was normal she wanted to see me back in 6 weeks and if it got any bigger, we'd just take it out. What? I wasn't sure I heard her right. You know, remove it, she replied. Of course. Once a surgeon, always a surgeon. Should I have expected anything different from her?
The ultrasound was pretty uneventful. It was noted (as always) that I have very dense breasts (a trait for which I am extremely proud), but no discernable mass. Whew.
Looking back, here are the stats:
9 months
18 appointments
7 mammograms
6 clinical breast exams
And guess what? We're not done yet.
So, now that I'm a high-risk patient, I thought I should start doing breast self-exams. But I didn't start right away. I can't really describe it, but I was angry for awhile. Angry at the situation and angry at my breasts for betraying me. So I ignored them. Finally, in the middle of the summer, I decided to end the breast silent treatment and start doing self exams.
*** Please note: The following text contains descriptions of BREASTS and other WOMANLY STUFF and may not be appropriate for the squeamish!***
So, every week or so, when lathered up in the shower, I would check them out. And just like the book says, they do change based on where I am in my menstrual cycle. So it was good to do the exams every week, so I could follow the normal hormonally-caused changes. I'd done maybe 20 or so self exams and they were all normal. A week ago last Sunday, however, I lathered up and palpated my boobs like always except this time... hmmm... there was a weird knot thing in my lower lateral left breast (not the one where I had surgery, BTW). It was the size of my finger tip and blipped in and out of my fingers. Stay calm, I told myself. You are due for your period any day now and the glandular tissue tends to get larger and more firm at about this time. But I had Lisa feel it too (well, you're the one who decided to keep reading!) and she concurred that it did not feel like the rest of my breast tissue.
So the next day I left a message for my primary doctor, who called back and said if I were his wife he would want me to get in right away. Before he called back, I also spoke with a nurse at the Piper Breast Center, who told me to wait 1-2 weeks and have my surgeon check it out.
Well, I decided to go in earlier to see my primary doc three days after I initially felt the weird lump. It was a frustrating visit because I (like always) had to wait almost an hour to be seen. Grrr.... AND neither of us could feel it! But it was just there this morning! WTF??? Well, he said, I don't want to you to be worried about it, so we can schedule an ultrasound just to be sure. Nah, I said. I'll wait and see what happens after my period is over.
Well, a couple of days later it was still there, so I went ahead and made an appointment with the breast surgeon. The timing was good - 8 days after the start of my menstrual cycle, when the breasts are the least tender and lumpy. But because of the false alarm I had at the first appointment, I became a little obsessed about this lump. Every day
I checked it in the morning (always there). I checked it at noon (sometimes not there). I checked it at night (always there). I even checked it several times while driving the car - well it's not like anyone can see that you have your hand up your shirt when you're driving! Right?? I would say that I felt the lump about 80% of the time, and it didn't seem to be getting any smaller. I wish I could have had some of my friends check it for confirmation, but I suppose that crosses a line. I could have had Lisa feel it a couple of times, but I also didn't want to bring it up a lot and worry her. Even though I was afraid of cancer, I was more afraid that the doc wouldn't be able to find the lump and then I would really think I had lost my mind.
So I had the appointment with the surgeon this morning. Checked the lump in the shower. There. Checked it in the car. There. Got to the doctor's office and they took me right in. (See? That's how a doctor's office should run!) Disrobed the upper half and checked again. Still there. The surgeon came in minutes, yes MINUTES later and did a pretty thorough exam and couldn't feel anything. DAMMIT! So I tried to point it out to her and I started to panic - I couldn't find it either! Aaack! I really am insane!! But I calmed myself down, took a deep breath, and finally located the lump. THANK GOD. Yes, I was actually thankful for finding a breast lump. That's what I've come to.
She told me it felt like a ridge of glandular tissue, so it was likely nothing to be worried about. But we could order an ultrasound... What do you think, I asked? After pondering for a second, she said she'd call downstairs and see if they could get me in right now for an ultrasound. Yes, they could get me in right away. This place was not the Piper Center; it was the place where I had my failed stereotactic biopsy attempt. But my surgeon assured me that they would be perfectly capable of doing an ultrasound. OK. She also told me that if the ultrasound was normal she wanted to see me back in 6 weeks and if it got any bigger, we'd just take it out. What? I wasn't sure I heard her right. You know, remove it, she replied. Of course. Once a surgeon, always a surgeon. Should I have expected anything different from her?
The ultrasound was pretty uneventful. It was noted (as always) that I have very dense breasts (a trait for which I am extremely proud), but no discernable mass. Whew.
Looking back, here are the stats:
9 months
18 appointments
7 mammograms
6 clinical breast exams
And guess what? We're not done yet.
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