Twenty-six With a Bullet

Stressing tonight about Sunday’s MRI redux, I Googled “MRI and claustrophobia”. A dozen URLs later, I found myself downloading an MP3 that, with luck, won’t make the 25 Most Played list on my iPod: 23 minutes of sound from inside an MRI machine. Between now and then, I’ll do my best to simulate the experience, in order to stick with it, this time.

To play along at home, click the MRI MP3s URL on the Quack-free Reading list at right, download the file, get naked, lie face down on a hard surface, cover yourself with a sheet or towel, plug in your earphones, close your eyes... and try to relax.

Instant Family History

A useful chat with Mum's doc (who rather resembles Kris Kringle in "Miracle on 34th Street"!) revealed today that she has a scirrhous form of breast cancer -- not particularly aggressive and, if my initial research is accurate, potentially a DCIS offshoot.  On the upside, that means it may well not be the cancer that kills her.  The downside remains... well, the downside.

The personally relevant part of the conversation confirmed that my inclination toward a mastectomy, rather than a lumpectomy could well be on the money.  A 10cm lesion is large, according to Dr. Kringle and, while he can't tell me what to do, he suggested I have a full conversation about the surgical strategy with The Dutchman.

My do-over on the MRI has been scheduled for Sunday -- the bells, the bells!  That means those results should be in The Dutchman's hands before we meet next week, as well.  And I've booked a half an hour on the big brown couch with the Mood Mechanic.  It's all coming together.

Ups and Downs on the Cancer Coaster

The Dutchman’s assistant called, yesterday, with a fist full of information. First – and most fabulous – a surgery date: January 26. Sooner than I’d expected, which is dynamite. And more than two weeks in advance of my planned Olympic departure, which is even better.

Second – and far less exciting – an order for another biopsy. ANOTHER biopsy. A THIRD fucking biopsy.  Four months in on Monday, and they're still sticking pins in my breast-shaped voodoo doll.  If the strategy is to perform a lumpectomy five cores at a time, they’re on the right track. I thought we’d done all of that we needed to, but this go-round they’re apparently looking for evidence of invasive cancer (i.e. something other than DCIS). If it’s found, my surgery will be adjusted to include a sentinel lymph node biopsy (http://www.cancer.gov/cancertopics/factsheet/therapy/sentinel-node-biopsy), in order to determine whether the cancer has spread. My third date with The Dutchman is set for January 7; no dinner and a movie, just biopsy results and a confirmed plan for surgery.

So, back on the table, but this time at Princess Margaret Hospital. I’ve now sampled the biopsy suites at three facilities: PMH wins, hands down. They were able to squeeze me in (pardon the mammographic pun) today, rather than make me wait ‘til the new year. I hated that idea, yesterday, but now, on the other side of the procedure and a lousy night’s sleep, I’m glad it’s over.

Third – and most annoying – I’ll be scheduled for a do-over on the dreaded MRI. But, this time, I’ll go armed with a sedative. Crap, I hope it’s a strong one.

I Got an F in the MRI

No more than 5 minutes in the machine and I’m frantic to get out. Face down, eyes closed, breasts in a cage, forehead resting on an inverted face cradle, ears plugged against the horns and sirens and buzzers, breathing only through my nose, arms extended above my head, feet first into the machine, commanded to be still.

I have an IV needle in my left arm into which dye will be injected at the 15-minute mark, and a rubber ball in my right hand with which to call for help, if I need it. And I need it. I want out. Now.

I’d open my eyes, but there’s nothing to see; it’s dark and I’m only three or four inches away from the sled on which I’ve been fed into this contraption. I’m afraid if I open my eyes, I’ll raise my head, and bang the back of my skull on the top side of the capsule, which will truly make me panic. I’m breathing deeply through my nose – unable to breathe through my mouth, which remains pressed against the white sheet covering the top of the cage in which my breasts hang like pale puddings.  My heart is hammering.  It’s cold, but I can feel sweat pricking my skin from scalp to toes.

I’ve already listened to the machine cycle a complete series of whatever it’s doing – warning bells, sirens, silence, buzzing, more silence, whirring, silence again – and it’s begun a second set. I’ve no idea how long a cycle takes: two minutes? three, tops. So, a dozen more before the dye, and fifteen more after that. I can’t do it. I can’t stay.

I’m faint. If I was vertical, I’d be woozy. I’m frightened. And, apparently, I’m a quitter. I don’t know whether I’m supposed to squeeze the ball, or press down with my thumb on what might be a button on its upward end. So, I do both. Repeatedly. The technician asks me if I need help, and I tell her I need her to take me out. When she does -- almost quickly enough -- I’m weak and wobbly and chilled and on the verge of vomiting. And I can’t imagine another 30 minutes in the machine. Children can do this; why can’t I?

I capitulate. I apologize. I leave.

Blindsided

Mum has breast cancer. I didn’t see this coming. Last month, she crested eight years in the nursing home. Her doctor says she’s lasted five years longer than the typical Alzheimer’s patient. And now, it seems it’ll be cancer that kills her, not the disease with which we’ve all made an uneasy truce.

All of a sudden, it turns out that I do have a history of breast cancer in my family. All those forms I’ve completed in the last four months made untrue just by reading an e-mail.

Of course, Mum can’t bear up to the rigours of surgery and treatment – or even testing – so Dad has decided to have the nurses simply manage her pain, rather than fight the disease. It’s the right thing to do. I only worry that, as she’s been such an uncomplaining patient all along, she somehow won’t communicate her pain effectively enough to be adequately freed from it.

And now I can’t imagine telling Dad my own situation. I’d intended to share the details with him, once surgery was scheduled, but now it seems cruel to add worry about his daughter to the burden of losing his wife. It wasn’t supposed to happen this way.

Peggy Lee Was Here

The Dutchman has spoken: I have DCIS. Which isn’t cancer... yet. So, out it comes. Sometime in February, I’ll have a wire localization lumpectomy (http://www.health.harvard.edu/diagnostic-tests/wire-localization-biopsy-of-the-breast.htm) to remove a lesion 10cm long. It’s day surgery under general anaesthetic, and I should expect to be off work for a day or two. And there’ll be no heavy lifting or spinning for two to three weeks. I’ll have radiation after surgery, but I’ve dodged the chemo and tamoxifen bullets. And I get to keep most of my right breast.

Is that all there is? All this waiting, and all these procedures, and I don’t have cancer. But, I’m having a lumpectomy and radiation. Yet, I don’t have cancer.  So why do all the breast cancer sites list DCIS?  I’m not sure whether to feel relieved or short-changed; it’s the most underwhelming payoff. All the hassle and the emotional roller coaster without the actual disease.  An anticlimax of the first water.

More Tests I Can't Study For

Second verse, same as the first.  Another ultrasound (warm gel, this time -- you can always tell the finer establishments by their upgraded amenities), and another biopsy.  I had expected this biopsy to be done during a mammogram -- kind of a catch and release program -- but it was done under ultrasound, just like the last one.

It seems pretty evident that there's lots to look at under the magic wand -- other than the obvious, I mean.  And I'm told I'll be scheduled for an MRI to follow.  My research indicates that's all about lymph nodes;  it's hard to know whether they saw something they'd like to follow up on, or whether that's all about ruling things out.  Naturally, the docs (two radiologists, this time -- both broads) and technicians (only one of those) won't have a meaningful conversation with you.  When I asked what they were looking at so intently, the response was that they were deciding on the optimal location for the biopsy.  I refrained from a "well, duh" response, as the doc was the one with the needle in hand!

On the upside, they got what they were looking for;  there are definitely microcalcifications in the samples, this go-round. They put a rush on the analysis in the hope that The Dutchman will receive the results by the 17th -- our second date.  If that doesn't happen, I imagine there won't be much to talk about.  I hate those awkward silences.

So, I'm now the proud owner of two identical adjacent puncture wounds in my right boob. If I didn't know better, I'd think I was part of a soft core version of the Twilight saga.

What's in a Name?

Breasts, AKA tits, titties, knockers, rack, boobs, boobies, jugs, hooters, fun bags, sweater meat, sweater puppets, hogans, gazongas, the girls, tatas, melons, casabas, mams, norks.

Tough Talk in Tumor Town

A room full of men are talking about my breasts. Well, my breast. Okay, maybe there are women there, too. And it’s probably not a large room. So, not as salacious as it first sounded. I suppose I’d better get used to that.

A tumor board is a group of doctors, each expert in a different oncological specialty (surgery, radiology, etc.), who meet to discuss the medical condition and treatment options of cancer patients. And they’re talking about me. Did I mention I hate being the centre of attention?

It’s been a week since I met The Dutchman. And now he’s plotting the course of my treatment with a posse of colleagues. A week hence, he’ll reveal the master plan to my anxious ears. Not soon enough for my taste, I can tell you.

A Phrase I Never Expected to Use

This morning, I met with my surgical oncologist.  My surgical oncologist.  How peculiar.  Three weeks ago, he was just a cancer surgeon:  now he's mine.  I'll call him "The Dutchman".

I waited for him in a functional windowless room, in a gown that must have been a refugee from the paediatric ward.  (J-Lo's plunging green Armani had nothing on this racy little number!)  The man is less than punctual.  My appointment was at 9:30;  he showed at 9:55 -- and left at 10:00.  Bang zoom.

My mammograms show him cells highly suspicious of breast cancer (probably DCIS –  http://www.breastcancer.org/symptoms/types/dcis/), and he wants to do a further biopsy, in order to more precisely design the surgical approach he’ll use.  So, not straight to excision as I'd hoped.

Every Thursday, the ‘tumor board’ meets to discuss cases for the week.  My case will be on The Dutchman's list for presentation next week (today being Thursday, I’ve missed this week’s cutoff).  Apparently, cases that go to the tumor board are often fast-tracked to surgery.  I suppose I could be concerned about his desire for speed, but I've chosen to be delighted about it.  As my screening mammogram was done at the end of August, I'm good with speed where diagnosis and treatment is concerned.

I have a follow-up appointment with The Dutchman on December 10 (damn, I’ll have to miss the Global Credit town hall!) at which time, he’ll schedule the biopsy -- and maybe surgery, too -- and I'll sign OR paperwork.

So, though I was prepared for more, I came away with no real news to report.  Except that I’ve had a man look at my breasts for the first time in weeks.  Ya gotta take the small victories where you find 'em.

Tom Petty is a Prophet

The waiting really is the hardest part.
http://www.youtube.com/watch?v=GLCJEYLIBQY

The first time I waited, I didn’t even know I was doing it. After my annual physical in the summer, I was sent for a regular (AKA screening) mammogram on August 27. Been there, done that. I remember thinking how lucky I am to have large breasts, as the process is only uncomfortable for me, not painful, as it can be for smaller-breasted women. In was in and out, and never gave it another thought.

When I got the call from my doc to request a magnification mammogram and ultrasound, I wasn’t freaked. I just went back and started over. This time, just the right side: two views. September 28.

I knew it was microcalcifications they were looking at, and I saw the film on the light board while the technician was out of the room. A yellow grease pencil had drawn an untidy box around the cells in question. A constellation of tiny white specs. Not a lump. And not uncommon. Only 15% of occurrences turn out to be malignant. Pretty good odds, I thought. Don’t worry, ‘til there’s cause.

Then off to the ultrasound. I’ve had those, too: cold gel and the magic wand. Not the magic wand at the airport (the one that picks up the underwires and the rivets in your jeans), but a wand nonetheless. You always know when the technicians have found what they want to look at, as they go over and over and over it again. And when your technician elects to call a friend, it’s hard to disguise that there’s something going on. I think it’s fair to say that when health professionals tell you not to be concerned, it’s time to get your worry on. But, who’s got time for that? Two days after my second tit sandwich in a month, I flew off to Turkey with instructions for the doc to call me as soon as the results came back.

Ya know, it doesn’t matter how busy you are – and I was some busy in Istanbul – when you’re waiting for a phone call that’s taking its own sweet time, the clock seems to slow down, and the calendar pages don’t turn as quickly as they usually do. You’d think with the men in my recent life, I’d be better at accepting that: apparently not. But the call did come, and with it the news that I was to be scheduled for a biopsy. Shit.

After a week away, and another week after I got home, I was back at the lab naked from the waist up. This time with a South African – Christiaan Barnard of the boobs – making small talk with a swab in one hand and a needle in the other. It was never among my fantasies to hear a man with his hand on my breast say, “And now you’ll feel a little prick”, but I digress. After four or five cores (it’s hard to keep track when you’re trying not to think about the needle in your breast), the little prick left and I wobbled off to tape an ice pack inside my bra and head back to work like nothing had happened.

Two weeks ‘til the results. Shit, again.

This afternoon -- two weeks and two days later -- my doc reviewed the pathologist’s report with me. It turns out the biopsy didn’t pick up any of the microcalcifications, so the next step is either another biopsy – stereotactic, this time, so they’ll be sure to get what they came for – or an excision, which amounts to a lumpectomy. Either way, I’ll know once and for all if the atypical cells are benign or malignant. But in the meantime – until the consultation with the next in my parade of doctors (set for November 26)– more waiting.

Sing it, Tom.