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The Courage to Say No

13 Aug

So today I called to cancel my doctor appointment for September.   It was a regular follow-up/check-up with my breast surgeon – a little over one year after my lumpectomy.

My doctor/surgeon wanted me to get another mammogram prior to the appointment.  She wants me to get them every six months, for the time being.  My girlfriend, Julia, a breast cancer survivor, said this is typical after a cancer diagnosis.

The problem is I know a mammogram every six months following a cancer diagnosis is the standard recommendation for the first year or two.  But I don’t like it.

I have already voiced my concerns multiple times in this blog about the problem of the primary diagnostic method in this country also being a risk factor for contracting the very disease it is supposed to be diagnosing.  It’s a little crazy, to me, that we could be endangering ourselves while attempting to diagnose ourselves.  But there’s another issue.

Every time there is a mammogram that shows a slight irregularity – ie, microcalcifications, or something that could be either a tumor or a cyst, they’re going to want to do a biopsy.  And many of these biopsies are somewhat invasive – at least from my perspective.  When there are microcalcifications, they must do a stereotactic biopsy in order to properly locate the problem area.  For me, this was a painful procedure.  Twice.  And it does leave a little scar.  I could be wrong, but I have some concern that there will be several times my mammograms are “concerning,” and then several times I’ll have to have a subsequent biopsy, and before you know it, I’ll have received several extra doses of radiation and several more scars on my breasts.

I know what you’re probably thinking.  If it catches cancer in time, then of course it’s worth it!

But here’s the thing.  Most of us carry a few cancer cells in our body at any given time.  This is actually normal.*  The problem is when they multiply.  But if we live right – ie, eat well, keep our stress level low, exercise, keep our weight down, and stay away from toxins, excess estrogen, and radiation(!), those cancer cells will likely not multiply.  What particularly interests me is knowing that most vegetables and fruits, as well as some other foods like seaweed, nuts, beans, and grains, can actually prevent those rogue cells from multiplying.

So my own personal choice is this:  get off the clinical hamster wheel.  I don’t want a steady succession of mammos, followed by biopsies, potentially followed by more lumpectomies.  It feels like it could happen repeatedly – and with each time I’m sure I would experience the resulting stress and fear – all of which can further cause dis-ease!!!  Instead, I want to TRUST that I know what to do within my own inner wise self.  And I want to trust that my beautiful wise body can fight off cancer when I live right and eat right.

 

And I can guess what many of you are thinking.  ‘But I know so-and-so, and she has been a vegetarian and a yoga practitioner for years!  And she got cancer!’  Well, who knows what other factors were present in her life?  Who knows what part genetics played in her health?  Who knows what kind of emotional stressors or psychological issues were at play?  And besides, that’s not the point.  I am talking now only about me.

FOR ME, at least for now, I will do occasional mammograms and check-ups.  But I am NOT going to obsess about it and do it every six months. FOR ME, the obsession adds to the fear factor and is counterproductive to my health.

For whatever various reasons, I feel healthy now.  I’ve been healthy my whole life until last year and I trust that I got the message, I heard the wake-up call, and I responded by making some changes.  I feel back on track.  I am trusting my feelings.  I believe that I am cancer-free right now.

 

My current plan is to get another mammogram in December or January.  That will be eleven to twelve months since my last one.  And if that’s good, I will probably get the next one two years later.

This may sound wayyyy too risky or crazy for many of you.  And I get that and I honor your opinions and choices.  But I know I need to listen to my inner voice.  And I believe in her wisdom.

 

My hope is that gradually, I will shift my lifestyle to one that breeds truly exceptional health.  As I get my ducks in a row – greater financial abundance, more exercise and yoga, more consistent exceptionally healthy eating, wonderful healing herbs and supplements, and a joy-filled, love-filled life, I trust that I will live to a very ripe and wise old age.

But in order to stick with this plan, I have to have the courage to say no to many of the recommendations of the medical establishment.  And believe me, it does take courage to stand up to these clinicians.  I am very blessed with a practice who, though somewhat traditional in terms of allopathic recommendations, also respects the right of their patients to make their own choices.  And even so, I have felt extremely nervous voicing my own opinions.

When I spoke with the office manager on the phone yesterday, she was very nice and very respectful.  And I still had knots in my stomach just from talking with her and “sticking to my guns.”  My very non-invasive, intuitive, first-do-no-harm, personal choice guns.

 

I know I will probably receive a few comments from some readers and friends who will be worried that I’m not being aggressive enough in keeping tabs on what’s happening in my body.  But I ask that you please respect my choices.  I am choosing a slightly more moderate, less fear-based road.   For now.  If I find myself getting too far off-track, or if my intuition or dreams start ringing alarm bells, I promise to make an appointment for a mammogram immediately.

 

May you be blessed and healthy and happy and well.

 

* “Cancer is a perfectly natural process. A very small percentage of cells in every person who has ever lived turn cancerous. And the body usually gets rid of those cancerous cells before they do harm. This process has been going on for eons. It is only when more cancer cells are being created than the body can get rid of that the problem comes. With increased toxins, viruses, carcinogens, etc. our immune systems have become significantly overworked and weakened.” (http://www.angelfire.com/az/sthurston/understanding_cancer_and_cancer_cells.html)

 

The Latest Results and… What Next?

9 May

For those of you who may not yet have heard the results of my most recent stereotactic biopsy (I just realized the whole world is not my Facebook friend)….

It was benign.

Yea!  I am so grateful.

I find that since that acknowledgement, I have been able to live my life with considerably less fear.  And for that I am very grateful as well.

I continue to modify my diet.  Sometimes I fall off the wagon and eat stuff I know isn’t good for me.  But then I simply get back on track and eat wonderful mostly vegetarian food again.  And I can feel my body being grateful that I am truly nourishing it.

I am also continually in the process of re-evaluating what I need to do to nourish my spirit.   Because, as many of us are realizing, physical diseases and discomforts are often a result of the needs of our souls going unaddressed for too long.

Being healthy is a process.  I got wayyyyyy off-track for a while.  (For maybe ten years or so.)  And now I’m in the process of living what I hope is a more radiantly healthy life.

Interestingly, people have been telling me lately that I have been glowing.   I figure that’s a good thing.  (And no, I’m not pregnant!)

Thank you, as always, every one of you.

May you be well.  May you be happy.

Facing another biopsy – not very calmly

16 Apr

April 16, 2012

So, today is my second stereotactic biopsy.

I realize a few things:

  1. I have been underplaying the significance to everyone who asks, saying, “I’m sure I’m fine.  I just want to make sure and then I can celebrate and be about my life.”
  2. I’m incredulous that I had called my doctor/surgeon to ask her some questions about the procedure a few weeks ago and somehow I missed her call when she called back and then I never called her back again! What the hell is up with that???  I just “forgot.”
  3. It was strongly suggested to me that because my last experience with this procedure was a bit traumatic (ie, very painful), that I should get Reiki beforehand  (and after) to help ease my body into a relaxed and healing state.  I didn’t do this.

I am really distressed with myself that I’m not following through on these important things.  It’s like I’m either sabotaging myself or that I’m  telling myself I’m not worthy –  of people’s concern, of having my questions answered, of having my body be at peace.

And because I’ve been underplaying this to everyone – including myself, I’ve been postponing the small anxiety that I feel this morn.  I haven’t let myself feel it.  I’ve been “being macho” and stoic about it. Darn it. I am nervous.  I am.

I probably did all the above because I’ve convinced myself I’m okay.  But the body feels what the body feels.  And mine feels a bit anxious.

Hmmm.  Maybe I need to do some visualizations of happy memories before they start sending that awful drilling needle into my poor breast.  (It’s not a simple needle biopsy.   It’s this scary kind of electrical drill kind of thing.  I can’t read about it again.  It’s pretty scary to read about what they actually do during this procedure.)

I’m thinking that maybe I can still ask my girlfriend if she’ll do some Reiki this morn.  I bet she would.  But there’s one more thing I have to do.  Or should do.  Whatever.

Yesterday I took the time to get some new sports bras.  You are absolutely advised to wear a sports bra after this procedure because 1) the breast needs extra support in order to heal properly, and 2) I imagine the compression helps manage the swelling.

The problem is they didn’t have my size.  There were racks and racks of sports bras there and they didn’t go up to my size.  (I’m not really that huge, am I?  I don’t feel like I’m that out of the ordinary.  Surely there are many other women my size!)  So I went one size under figuring it’s better in this case to be a bit more smushed than unsmushed (unsupported.)

I wore the bra to bed.   (If I go more than two nights without a sports bra on in bed, my breasts feel sore the next day.  Especially my right one.)  It barely contains me.  If I’m the slightest bit swollen, it is not only not going to contain me, it is clearly not going to adequately support me.

That means I should make that stop on the way, too.  (Fortunately there apparently is a Walmart right on the way to the doctor’s office/women’s health center.)

Clearly I should be doing some meditating this morning, but my anxiety is a bit high.  Perhaps I should have taken my friend’s advice and gotten some anti-anxiety medication just this one, since my body is, at some level, aware of its previous trauma.

Sigh….

Perhaps I should just go for a walk and see if I can get more clear-headed and calm. Maybe then the next steps will be clearer.

If you’re reading this, thank you.  You’re very kind to care about me in this way.  I find myself wanting to apologize, but I am conscious enough to realize that that’s inappropriate.

I find it interesting that I shield everyone about my concerns in person, but for some reason I am able to let it all out when I’m writing.

Anyway, thank you for being my allies and my friends.  Thank you for caring about me.

Six-month Follow-up Doctor Visit

14 Mar

March 12, 2012

 

So, last Thursday I went for my six-month follow-up appointment with my breast surgeon.

 

The first thing of note happened when I was updating my information with the receptionist.  She asked, “Is Dr. Kracht still your primary care physician?”  “Yes,” I replied.   “And _____________, _______________, and _____________?”  I stared at her blankly. “I don’t know what you’re talking about,” I said.   She said, “That’s odd.  They’re right here on your chart.”  I was puzzled also. Then she must have said something about oncologists and the light bulb went off.  I said, “Oh!  I chose not to go to them.”

 

When my doctor arrived to the examining room she was very warm and friendly but also surprised and a little disappointed that I didn’t at least go and talk to the oncologists.  (One was a radiation oncologist and one a hematology oncologist.)  I replied that I hadn’t been interested in either the radiation therapy or the anti-estrogenic drug and I knew it would be hard to stand my ground if I had been face to face with them.   I knew they’d be pushing for me to go the direction they thought was best.

 

(All things considered, I still agree with my decision FOR ME!  I needed to do my own research and come to my own conclusions and decisions before allowing “experts” to exercise their sway.  However, I do, OF COURSE, honor all those who choose differently from me.  We are each individuals and we have to make our own choices.)

 

Okay, back to the doctor visit.  As I suspected, she wants me to get a biopsy.  A stereotactic biopsy.   For those who have been following my blog, my experience with a stereotactic biopsy last August was NOT pleasant.  In fact, that was the most unpleasant of all my breast-related experiences to date.  However it’s not the fear of discomfort which makes me hesitate.  It is the following two factors:

 

  1. I worry about my body having to process additional radiation.  If I were to get this biopsy done in the next month or two, that would mean that during the course of one ten-month period, my body would have been subjected to about 15 x-rays (about  7 or 8 “shots” per set of mammograms) plus two stereotactic biopsies – which would entail at least two more x-ray views each time.  That’s a LOT of radiation.  And radiation, as you know, is a great risk factor for getting cancer!  (“According to Dr. Gofman, MD, PhD, in Radiation and Human Health: A Comprehensive Investigation of the Evidence Relating Low Level Radiation to Cancer and Other Diseases, ionizing radiation is a known carcinogen, there is no safe exposure level to ionizing radiation, and the effects of radiation exposure are cumulative throughout one’s life.”  http://www.holisticcarehawaii.com/Stereotactic.htm)
  2. There are a few articles which express concern about the wisdom of “poking around” surgically or otherwise in an area that already exhibits the presence of cancer cells or cancer growth. The very act of having more surgery at that site could potentially spread that cancer farther.

 

I expressed my concerns and she heard them.  Her concern is that the one calcification showing on my January films could mean something.  If I had had radiation therapy, that one calcification could be (likely would be) a by-product of the RT.  But I didn’t, so to be safe she feels I should check it out.

 

Of course, doctors have to anticipate worst-case scenarios, while I as the patient, want to be aware of them but NOT focus on them!

 

She did say she would like me to have another set of mammograms done before the next six-month follow-up appointment.  I asked her if there were ANY alternatives.   I again expressed my concern about the radiation involved with mammograms. She reiterated that thermographs aren’t able to find anything at this earlier stage of the game.  They are not an adequate early diagnostic tool.  She said they’re working on diagnostic ultrasound technology, but it’s not ready yet.

 

So, in a nutshell, it seems I have three choices:

 

  1. Do neither of these clinical/diagnostic options (neither biopsy nor mammogram) and trust that my natural course of treatment is sufficient.
  2. Skip the biopsy and get another set of mammograms in six months’ time.
  3. Get the biopsy and then go from there.

 

When I left the office yesterday, I was leaning toward Option #2.  However last evening and this morning, I’m leaning toward the last option.  Because if this calcification represents a benign condition, then I feel I can safely wait at least a year for another set of mammograms.  If it proves to be a spot of cancer, then it would be good for me to know this now, rather than later.  However I am choosing not to worry about those decisions until I know what I’m working with!

 

Okay, it sounds like I’ve just talked myself into the stereotactic biopsy.   I guess I’d rather know for sure what is going on in my body.  Or perhaps, if I’m very lucky, I’ll be able to have the opportunity to say, “See! I’m doing just fine!”   And that would feel very good indeed.

 

Thanks for listening.

 

PS  When I woke in the middle of the night the day of my doctor appointment, I found myself thinking about my right breast and what to do about it.  I must have dozed off because I suddenly realized I’d seen an image of my breast with a vertical knife next to it.  I think that perhaps that was a sign that some surgery (a biopsy) is a good idea.

GOOD NEWS!!!!!!

29 Aug

August 29, 2011

The Breast Blog #15

I HAVE GOOD NEWS!!!!!!!!

I called the doctor’s office on Friday and they still didn’t have the Pathology report.  I called again today and someone called back.  My heart was in my throat until I heard the words, “We have good news for you.”  (They must love saying those words.)    Apparently the “margins are clear” on the right, which I believe means there are no cancer cells left following the lumpectomy.  And on the left breast, the nodule was diagnosed as a papilloma, a benign condition.

I cannot express the relief I feel.  After that call, I felt immediately so much lighter.  I had thought I was, by and large, doing okay with everything.  I really thought I was handling things.  But when I compare how I felt this afternoon to how I’ve been feeling the last three months, I can tell you, it is clear now I was carrying a huge weight for these last few months.

I gave the news to a few of the more significant people in my life.  The first several times, I spoke the words, I cried.  I cried more sharing this good news than I did sharing the scary news!  Tears of relief and joy.

How do I adequately express my joy and gratitude????  Picture me doing a HAPPY HAPPY HAPPY HAPPY DANCE!  Picture me giving each of you who has prayed for me, sent me love, sent me Reiki, or given me any kind of healing session or comfort or food or money or any kind of kindness, being hugged with the most heartfelt of hugs.

You all have been my gift.  There have been many gifts, actually, but feeling your kindness and love, and getting back in communication with friends I haven’t seen or talked to in a long time, has been an enormous blessing.

I only received that short summary from one of the office people.  I don’t really know a lot of details.  I’m really curious to read the actual report.  To be honest, I’m kind of curious if the papilloma/nodule shrunk a bit from when it was first discovered.  So many prayers were sent on my behalf that I can’t help thinking SOMETHING changed as a result.

Well, I certainly have changed.   I know that I will be a significantly healthier person as a result of this.  I have already changed my diet in a good direction.  I have learned a lot – on both a medical and metaphysical level.  I have certainly processed a lot of emotions.  I hope to never take life for granted again, but I know that it’s hard to retain this level of euphoria and commitment over the long haul.  Let me just say I pray I will be very conscious of my choices from now on.  Life is indeed sacred.

I have a follow-up appointment with the surgeon on Thursday.  I’m sure I will learn more and have more to report after that.

Meanwhile, all I can say is THANK YOU.   Thank you, thank you, thank you.  And thank You, thank You, thank You, Mother/Father God.

Blessed be, one and all.

The Lumpectomy

26 Aug

The Breast Blog #13

August 24 and 25, 2011

Truth time.

So the truth is, in spite of all my loving and supportive friends, I am feeling a bit lonely.  The truth is that even though I “need” to worry about income, I don’t have a lot of energy for anything that “mundane” at the moment.  The truth is I feel a bit sad when I look at the scars on my breasts.  I know I’m lucky that I still have them.  And I still feel a bit sad.

The truth is I’m sleeping a lot.  The truth is I’m watching more movies than usual.  The truth is I’m “tuning out” a lot.  I find I don’t want to talk very much and I’m finding it increasingly hard to listen.  I’m sure all this will pass, but it’s where I am at this time.

The truth is I hate wearing a sports bra 24 hours a day.  I know I need the support while I’m healing (and yes, I caught the double meaning of those words as I wrote them) but I don’t like feeling continuously smushed.  (I am rebelling right now.  I’m giving my breasts a literal breather for a few minutes.)

The truth is I’ve been eating a vegetarian diet since my diagnosis, and generally I’ve been feeling better as a result of that change.  And boy, some ice cream would taste good about now!!! (Maybe I’ll get some Tofutti.  I need to do another shopping trip.)

The truth is I’m worried that my left nipple area is warm to the touch.  It could mean it’s “only” an infection or that it’s healing from the surgery.  But I thought I noticed warmth there before the surgery.  (My lover confirmed it.)  What does this mean?  I must remember to mention it to the doctor.  (Oh dear.  I just looked it up and found this: “A breast that always feels warm, sometimes hot to the touch is a symptom of inflammatory breast cancer, a dangerous and rare type of the disease.”) http://cancer.about.com/od/breastcancer/p/6symptoms.htm

The bad news is that inflammatory breast cancer is aggressive.  The good news is that I don’t seem to have any of the other symptoms.  I think I will choose not to do too much more research on it at the moment as it will just cause worry.  Tomorrow the results from the biopsy should be in and I can find out what’s going on for real.

Okay.  I am going to change gears now.  I want to tell you about the surgery so that I can document the process.  If I don’t write this stuff down, I’ll forget it.  And you won’t learn anything.   (I want to warn you that this may be a more boring entry than usual.  My heart’s not really into it, but I’m doing it anyway.)

Monday was the day I had bilateral surgery.  For those who are late to the party: a lumpectomy was performed on my right breast and an excisional biopsy of a dilated milk duct and small nodule was performed on my left breast.

A dear friend drove me to the hospital and sat with me as I got my first ever IV.  The nurses and technicians I met before the surgery were all great.  My surgeon came in to give me a hug and answer a few questions.  (Where would the incision be?  How long would it be?  Would I have a drain?  Will they know anything right then and if so, will they do any more aggressive removing of tissue while I’m under anesthesia?)  (Answers: Right breast – incision curved and kind of near the armpit – two to three inches long.  Left breast – incision along the edge of the areola.  No drain.  No, they won’t know anything until pathology examines the tissue samples.  We’ll have results in about four days.  And no, I had already signed a form saying I was not agreeing to a mastectomy at this time.)

As I was being wheeled on a stretcher to the OR, my doctor came to help guide us down the hall.  She introduced me to the OR nurses.  When I was in place, she guided me in a visualization of somewhere I wanted to be (I chose St. John’s) and then did some Reiki on me.  (Wish all doctors did this.)  Then the anesthesia was administered.

The next thing I remember is being extremely disoriented.  I was waking up and I couldn’t figure out where I was.  It felt surreal.  (It was very much like coming to after the first and only time I ever fainted, after a small motorcycle spill.)  The nurse who came to me at that point was very nice and attentive.  After a few short minutes, I was taken from the recovery room to the room I had been in originally.

Apparently I’d been in the OR for about two hours and in the recovery room for about two hours.

To be honest, from this point on, I felt disappointed in the care.  I felt like they were rushing to get me out of there.  I didn’t feel ready.  I was still feeling very groggy and tired.  The nurse assigned to me at this point was definitely not as compassionate or attentive as the others had been.  She gave me discharge instructions while I was not yet very alert.  I was brought something to drink and some crackers.  I had NO interest in eating.

Because the anesthesiologist had told me prior to surgery that I could get pain meds afterwards and that I shouldn’t hesitate if I felt the need, I did realize I was in discomfort and I asked.  (I had not been asked about my level of pain by the nurse.)  The surgeon had prescribed Dilaudid, and so I was given my first ever heavy-duty drug.  (I don’t take any prescription medicines.  I usually stay away from them.)

The nurse removed my IV and I was told to get dressed.  My friend returned to sit with me.  Shortly thereafter he was instructed to go get the car.  Right about when they brought me a wheelchair so I could be discharged, I developed extreme shivering and chattering of the teeth.  I asked if this was normal and was told it was probably a side effect of the anesthesia.  It was alarming to me, but no one else seemed concerned.

Before being wheeled to the car I said I better go to the restroom, as it was at least a 45-minute drive to my house.  The nurse pointed the restroom out to me but did not accompany me.  I thought that was unwise on their part.  I did not feel that steady on my feet.  They needed to wheel me out but could not take the time to be sure I could walk safely before sending me off to the bathroom?  I thought they were nuts.  I was disappointed in them.

I returned to the wheelchair.  My teeth continued to chatter all the way down to the car and for the next several minutes.  On the drive home, my friend was alarmed by how cold I felt.  It sure would have been nice to have someone be a bit more reassuring.  It sure would have been nice to have someone say, ‘This is perfectly normal.  It will pass.  You don’t have to worry.’  It would have been nice to have someone say, ‘If you have any questions or concerns, please call.  Don’t forget to take it easy and rest well.  Best wishes to you.’

I slept in the car.  We stopped at a drug store to get more pain meds, an expense I neglected to anticipate.  Fortunately there is a generic substitute – hydromorphone.  By 4:00 I was home and went immediately to bed and fell immediately to sleep.  By about 6pm, I was awake enough to very briefly and groggily call my parents and one other friend.  I took another dose of the medication, applied ice packs and fell back asleep for another three hours or so.  I realized my sister had called and I briefly called her to tell her my status.  Then I slept for the rest of the night – zonked out, only waking to go to the bathroom and take my third dose of pain medicine.

I was wearing a surgical bra, which they’d apparently placed on me after the surgery.  It’s a bit like a combo sports bra/corset/straight jacket.  It provides support, but it also like being constantly smushed in multiple directions – not as bad as a mammogram, but definitely not pleasant.  It was NOT comfortable to wear while lying in bed.  If I hadn’t had the hydromorphone, I would have been much more uncomfortable.  But that drug basically knocked me out.  As soon as I would lie back on the bed, I would be in another zone.

By 9:00 the next morning, I felt really good.  I was surprised how good I felt.  It is miraculous how much rest can help!  I’m sure the ice packs helped as well.  I was still uncomfortable, but I wasn’t in serious pain.   It also really helped to have a companion with me, to have someone caring in such a tangible physical way. It was also a good distraction.

I spent the next day sitting outside on a rocker, drinking fluids (including pineapple juice, which has bromelain and works to reduce swelling), making a couple calls when I felt like it, napping (taking one more dose of medication), icing my breasts, and – because it was such a stunning day, lying outside on a blanket under the trees.  It was a wonderful day, actually.  By 4:00, I was ready for my first meal.  We made a wonderful salad – with lots of veggies, hard-boiled free range eggs, and toasted almonds, and I had some leftover fried zucchini sticks.  (Yeah, I know that wasn’t the healthiest of choices, but at least it was vegetarian.)

I do feel better each day, physically, and I am also definitely feeling a bit withdrawn and lackluster.  I could probably use some more distraction.  Does anyone want to take me out to a movie or for lunch or something???

And there you have it.  You are now officially updated.  Tomorrow hopefully I will hear from the doctor.  I will keep you posted.

May you be blessed.

The Results (so far)

14 Aug

The Breast Blog #11

The Results.

August 10, 2011 and August 14, 2011

The long wait is over and the results are now in.  And the winner is….

Just kidding.   I don’t like to categorize things as “winning” or “losing.”  There is a glass half-full and a glass half-empty way of looking at everything.  The pathology results are: they did find ductal carcinoma in situ (DCIS) in my right breast.  The good news is this is the earliest stage of breast cancer and is highly treatable.

My gut reaction upon hearing the news was, surprisingly, that I was not surprised.  I actually found myself  a little calm and definitely relieved to finally have a diagnosis.  The surgeon herself called me.  I suspect she’s used to people being a little more teary.

Of course we don’t yet know about the left breast.  But now that I have a cancer diagnosis, apparently there is a program that will pay for me to have an MRI so that we can have a better idea of what we’re dealing with.  And I am happy to report that my doctor went out of her way to squeeze me in for an appointment the next day (during her lunchtime!) so that I could ask the myriad questions I have about the diagnosis and we could decide what to do.

The day I got the news was an exquisitely beautiful day weather-wise, and I found myself feeling quite happy.  And the following day, the day of my doctor appointment, was also really beautiful.  I truly enjoyed my appointment with her.  After she used an ultrasound to check the placement of the titanium marker placed within my breast during the stereotactic biopsy, we went into her office to talk about the diagnosis and the upcoming surgery next Monday (August 22nd) for the second biopsy (on the left breast) and a lumpectomy (on the right.)  She has a beautiful peaceful office and we sat side by side at a round table.  I had the opportunity to ask the 25 questions I had (yes, literally 25) and we went through them pretty quickly.  (However, even though I wrote my questions down, I still forgot one or two.  A friend had suggested bringing a tape recorder and I do concur that that is a very good idea.)  Then she gave me one of her books that she authored (The Healing Consciousness: A Doctor’s Journey to Healing,) a rose crystal heart with a pouch, and a big hug.  I really do like this woman.  How many doctors give their patients hugs, I ask you.  My kind of doctor.  (And she’s a top notch, well-known surgeon as well.  Dr. Beth DuPree’s skin-sparing mastectomies with plastic surgeon Robert Skalicky, D.O. were featured live on the Internet in October 1999.)

Those of you who were waiting to hear the news of my biopsy, are no doubt aware that I waited several days to post this news.  I allowed myself time to sit with it and digest it.

When I got the news, at first I did a flurry of research on DCIS.  But then I realized I needed to get off the laptop and sit outside and “be” a bit.  I also was feeling called to review my dreams again, because they give me a lot of guidance and information.  I cancelled two appointments I had later that day and truly gave myself some space.  I did not answer most calls or text messages.  I sat out on my porch and enjoyed the breezes, the wind chimes, the sun and the puffy clouds.  In the evening, I laid out on my massage table, played healing music, and invited angels and guides to be with me. I think all this helped me to retain a feeling of calmness.

Later the next day, after the doctor appointment, I swam for the first time since the biopsy.  I returned the calls of a few very dear friends.  But then I began to once again do research, and the news about the lumpectomy began to sink in.  My breasts as I had come to know them, were about to change.  My body was going to be operated on.  I was going to get an MRI.  I was going to be lying down in a tunnel while loud noises whirred around me.  I was going to get my first ever chest x-ray (and I am nervous about radiation.)  I was going to get anesthesia for the first time.  I was going to have scalpels cut into my tender breast tissue.  I was going to get more information about whether or not there were other spots of cancer.  I had to decide whether or not I was going to get radiation therapy along with the lumpectomy.  My calmness began to evaporate as all this began to sink in and I began to stress about the details.  An email from a friend (a cancer survivor) said, “I do get the sense to remind you to ‘breathe’. With so much going on during your days and nights I can imagine a contraction building in your chest…(no surprise..:)…and your gut… (no surprise..;)”

Thank you, Joyce.  Somehow I was unaware that I’d forgotten to breathe and that I was indeed getting stressed and anxious.  I know all these spiritual and healing tools and techniques – breathing, prayer, meditation, toning, tai chi, walking, journeying, art, etc. – and yet when I am in the midst of my fear, I can’t seem to focus on any of these tools!  Apparently I needed a friend to remind me to breathe.  So I breathed, and the next day I asked a friend to go to the shore with me.  Being in the water, bobbing in the gentle ocean, feeling the support and love of all that healing salty water, feeling the sweet sun upon me, lying on the sand… it was JUST what I needed.

The day after that was filled with good stuff.  Another good friend had very, very generously offered me a few acupuncture sessions, gratis.  (Bless you, Andie.)[1]  And while lying on the table with lots of very fine needles tucked gently into my skin, touching just the right areas to help adjust the flow of energy in my body, I had my first big emotional release since the diagnosis.  I didn’t indulge in full-blown wailing since my friend was right outside the door.  (Interesting how I still have this “protective” habit.  I did not want to distress her, but actually I didn’t want her coming in to offer comfort either.)  My body was wracked with silent sobs and one little keen escaped my lips.  I needed that emotional release, I know I did.  And I seemed to be experiencing other releases as well as my legs continued to “jump” while I was lying there resting.  (Oftentimes these “jumps” and jolts and mini-spasms happen when I am lying on my back receiving any kind of healing ministrations.)

After that I bought a couple sports bras.  I was told I would need them for support post-surgery.  Then I headed over to my friend Mel’s.  She’s another cancer survivor and a long-time dear friend.  Her path through cancer was a spiritual adventure and she emerged not only physically healthier, but more confident than I’ve ever seen her.  I was meeting with her so she could offer some insights to my dreams and also help coach me with regard to my diet.  (I’d already begun making big changes.  After the diagnosis, I began a vegetarian diet and I cut out all junk food.)

Then after my time with Mel, I went home to begin cooking a healthy meal for me and my friend, Cindee.  (Brown rice with chlorella, tofu sautéed with turmeric, garlic and an organic non-salt seasoning, and black beans over a bed of fresh arugula; homemade coleslaw; and local corn on the cob.)  We ate together, talked, howled at the rising full moon, and had the delicious pleasure of watching a movie outside, in the yard, moon shining brightly, with a bowl of home-popped and seasoned popcorn and the company of my housemate and his lady friend and her son.  I noticed one remaining lone firefly flickering off and on in front of the screen.

I had two full and delightful days filled with friends and Nature.  It was good for me to stop isolating and to get away from my obsessive thoughts.  I need to remember this balance.  Time alone is critically important.  And time with friends is essential, too.  Time in my home is cozy, and time “out in the world” helps shift my energy so I don’t become too despondent.  Balance, balance, balance.

Okay, now it’s time to return to the educational portion of this blog.

So… “Ductal carcinoma in situ (DCIS)

is the most common type of non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts, carcinoma refers to any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs, and in situ means “in its original place.” DCIS is called “non-invasive” because it hasn’t spread beyond the milk duct into any normal surrounding breast tissue. DCIS isn’t life-threatening, but having DCIS can increase the risk of developing an invasive breast cancer later on.

When you have had DCIS, you are at higher risk for the cancer coming back or for developing a new breast cancer than a person who has never had breast cancer before. Most recurrences happen within the 5 to 10 years after initial diagnosis. The chances of a recurrence are under 30%.

Women who have breast-conserving surgery (lumpectomy) for DCIS without radiation therapy have about a 25% to 30% chance of having a recurrence at some point in the future. Including radiation therapy in the treatment plan after surgery drops the risk of recurrence to about 15%. If breast cancer does come back after earlier DCIS treatment, the recurrence is non-invasive (DCIS again) about half the time and invasive about half the time. (DCIS itself is NOT invasive.)

According to the American Cancer Society, about 60,000 cases of DCIS are diagnosed in the United States each year, accounting for about 1 out of every 5 new breast cancer cases.”  http://www.breastcancer.org/symptoms/types/dcis/

Pathology Report

  1. I discovered that I had had an “8 gauge mammotome stereotactic biopsy.”

A breast biopsy using the Mammotome® Biopsy System can help a doctor make a highly accurate breast cancer diagnosis without the need for open breast biopsy surgery. Through the use of computer imaging (x-ray, ultrasound, and MRI), a breast abnormality can be clearly identified and mapped, even in its earliest stages. Digital imaging enables a physician to guide the Mammotome probe to gently collect tissue samples through one small ¼-inch incision.

With the Mammotome Biopsy System, a breast biopsy can be performed in an outpatient setting or a doctor’s office under local anesthesia. A doctor can make a precise analysis with minimal pain, scarring and recovery time. The entire procedure generally takes less than an hour, and patients can return to their normal daily activities immediately afterward.  (Cindy’s note: There were, in fact, some restrictions.  No lifting or massaging or vacuuming for 2-3 days and no swimming for a week.)  http://www.breastbiopsy.com/

  1. They discovered “Ductal carcinoma in-situ with lobular extension.”

Well, I’m trying to figure out what that “lobular extension” part means, but so far all sites are too technical for this layperson.  It sounds to me like it is starting to extend out into surrounding tissue, but then it wouldn’t be in-situ.  So I’m confused.  I will have to add this to the list of questions to ask my doctor.

  1. The “architectural pattern” is “comedo, solid.”

“Comedo type DCIS (also referred to as Comedocarcinoma) tends to be more aggressive than the non-comedo types of DCIS.  Pathologists are able to easily distinguish between comedo type DCIS and other non-comedo types when examining the cells under a microscope because comedo type DCIS tends to plug the center of the breast ducts with necrosis (dead cells).  When necrosis is associated with cancer, it often means that the cancer is able to grow quickly.  Necrosis is often seen with microcalcifications (tiny calcium deposits that can indicate cancer).” http://www.imaginis.com/breast-health/ductal-carcinoma-in-situ-dcis-3

  1. “Nuclear grade II-III”

Nuclear grade refers to the size and shape of the nucleus in tumor cells and the percentage of tumor cells that are dividing….  Based on the microscopic appearance of cancer cells, pathologists commonly describe tumor grade by four degrees of severity: Grades 1, 2, 3, and 4. The cells of Grade 1 tumors resemble normal cells, and tend to grow and multiply slowly. Grade 1 tumors are generally considered the least aggressive in behavior.  Conversely, the cells of Grade 3 or Grade 4 tumors do not look like normal cells of the same type. Grade 3 and 4 tumors tend to grow rapidly and spread faster than tumors with a lower grade.”  http://www.cancer.gov/cancertopics/factsheet/detection/tumor-grade

  1. “Necrosis: present, central”

See #3 above.

  1. “Tumor size (aggregate): 0.55 cm”

This is considered relatively small.

  1. “Tumor is present in four out of sixteen submitted tissue cores.”

I assume this is not bad.

  1. At the time of my doctor appointment, they had not yet determined “hormone receptor” status.

“Estrogen and Progesterone receptor status tests will show whether or not one or both of those hormones fuel your tumor. Cancer that is hormone-sensitive is slightly slower growing and has a better chance of responding to hormone-suppression treatment, than cancer that is hormone receptor negative. Hormone-negative cancer will respond to other kinds of treatment, and hormone-suppression may not be needed.”  http://breastcancer.about.com/od/diagnosis/p/hormone_status.htm

  1. The pathology report also did not reveal HER2 status.

“HER2, which is also called HER2/neu, and HER-2, is the acronym for human epidermal growth factor receptor 2. Knowing your HER2 status is an important part of your diagnosis.  HER2 is a gene that sends control signals to your cells, telling them to grow, divide, and make repairs. A healthy breast cell has 2 copies of the HER2 gene. Some kinds of breast cancer get started when a breast cell has more than 2 copies of that gene, and those copies start over-producing the HER2 protein. As a result, the affected cells grow and divide much too quickly.”  http://breastcancer.about.com/od/diagnosis/p/her2_diagnosis.htm

If HR2 status is positive, there is a better overall outcome as the cancer may respond well to hormonal therapy.

So folks, the upshot as I understand it is that I have Stage 0 cancer, which means it is highly treatable, and if treated properly, the five-year survival rate is 100%.  According to my surgeon, the information received from Pathology thus far (using the Van Nays Prognostic Index) shows that I have 6.5 – 8 (based on a 1-12 scale) which reflects a medium chance of a faster-growing, slightly more aggressive DCIS and that the recommendation is generally a lumpectomy plus radiation therapy, as opposed to only a lumpectomy (lower on the index) or a complete mastectomy (9-12 on the index.)

On Tuesday I receive my first MRI, a chest x-ray (unfortunately, mandatory so that they can be sure ahead of time there are no serious heart or lung problems,) and pre-testing (blood draws/testing) for the surgery.

“What is a Breast MRI?
Magnetic resonance imaging (MRI) is a noninvasive imaging technique that uses no compression, x-rays, or radiation. An MRI creates a detailed picture of the internal architecture of your breast tissue. Most MRI machines produce a digital image, which a radiologist can examine on a computer, or print out for study. This type of image can be done with or without the use of contrast agent.

Why Are Breast MRIs Used As Part of a Diagnostic Workup?
You’ve already had a mammogram, and perhaps an ultrasound and a biopsy. A breast MRI might also be done for some patients, to get more information about your cancer, or to see if tumors are responding to treatment. Mammograms are much less expensive than MRIs, and are good at detecting DCIS as well as calcifications. Breast MRI can image both breasts at once, and works well even with dense breast tissue. It is good at finding invasive breast cancer, imaging around breast implants, and detecting possible spread of cancer beyond the primary tumor. A breast MRI is also effective at finding unsuspected cancer in the other breast, which would allow for early treatment of both tumor sites at once. For women at high risk of breast cancer, an MRI would be a good way to fully screen the breasts and axilla.”  Breastcancer.about.com

I am hoping and praying for a clear MRI and a benign condition in my left breast.   I am praying that the HER2 and hormone receptor statuses are optimal.   If such is not the case, I’m sure I will be strongly encouraged to get radiation therapy, and/or drugs (to address the hormone receptor issue), and/or a mastectomy.

I desperately want to avoid a mastectomy, if at all possible.  What I am realizing is that IF there is more going on than is currently indicated, I probably need to ask the hospital to postpone the surgery a week or so, so that I have the time to come to a place of peace about my treatment options and make the right decisions for me.

I did read somewhere the following:

“Note: Though DCIS is a serious condition requiring careful attention, it is not an emergency medical situation. Women have a sufficient period of time to educate themselves and weigh all possible treatment and reconstructive options before any decisions need to be made. Women should maintain an open dialogue with their physicians to best understand the disease and the variety of treatment options.”  (I’m sorry but I forgot to write down the website.)

I have to remember that I HAVE THE RIGHT to make my own choices.  And this takes time.  I will, of course, educate myself as much as possible, ask questions of doctors and former breast cancer patients, and look at my dreams.  I will sit in silence and take walks and play music and give myself a bit of time to receive some divine guidance.  These are important decisions and not to be rushed into.

If you feel inclined, I’d be grateful for a “blessing of my breasts.”  And feel free to send some loving, healing energy my way.  And, of course, to all the dear people on this planet struggling with whatever are their particular issues.

I am aware that this is a growth opportunity for me.  I hope to change and grow and evolve throughout this process.   I hope to become more healthy – physically, mentally, emotionally, and spiritually.  If I succeed in that, then “it’s all good.”

May you be well!

Peace be with you.

Cindy


[1] Andrea Deardorff, Inner Garden Acupuncture.  (I recommend her highly.  And please don’t ask for any free sessions!!!)