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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.

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Healing post-lumpectomy – 3 months later

13 Jan

November 16, 2011

Surgery takes its toll, as I’m sure anyone who has gone under the knife will tell you.  With a lumpectomy, it’s not so much the outer scars  which feel like an issue right now as the stitches inside my body.  I can monitor the external scars and address them as I see fit, but I can’t visualize the inner wounds/stitches/scarring.  These are the ones I worry about a bit.

This past weekend I did a really long drive and near the end of it I was worried because my breasts were hurting quite a bit.  I thought there was a good chance the pain was caused by a combination of more heavy lifting than usual accompanied by wearing a bra that wasn’t sufficiently supportive, but I was still concerned enough to finally call my surgeon’s office and leave a message.

On Monday I got a return call from the physician’s assistant.  I learned something new.  I had had “twinges” of pain that I would feel from time to time.  They were intermittent but concerning.  She informed me these were normal and could be expected for up to a year.  They are indicative of the healing of damaged nerves.

What a relief.  Too bad they didn’t tell me that earlier so I wouldn’t worry.  Don’t you think that would have been helpful to know?

I do wish there had been more information given about what to expect post-surgery.  I mentioned this to the P.A.  She told me that they did give quite a bit of info to those who have had mastectomies, but apparently not to those who’ve only had lumpectomies.  And that’s why I’m glad I’m doing this blog!  So you all can learn through my experiences!

I went online to see what I could discover about healing following lumpectomies, and the truth is there really isn’t much information out there.  I looked both online and in the books I have about breast cancer and nowhere yet have I discovered anyone talking in detail about recovery from lumpectomy surgery after the first couple of weeks.  Everyone in the clinical field seems to think recovery will be pretty quick and easy.  But looking at discussions on the breastcancer.org site, it appears there are many women who have swelling and discomfort for several months after the surgery.

For instance, they suggest only that one refrain from heavy lifting or jogging for a couple weeks.  That’s absurd!  Especially for women with larger breasts.  Even with a good support bra, I’d be extremely afraid of jogging.  My breasts still feel way too fragile for that.  My goodness, I still can’t even give good bear hugs without hurting a teeny bit.

What I have discovered is that a sports bra or the surgical bra they put on me in the hospital gave support to the breast tissue, but also created a lot of sensitivity in the nipple area.  Nipples are obviously sensitive areas anyway, but when they’ve been impacted by surgery, they are even more so.  Thus, supportive bras will feel good to the breast itself (especially for larger-breasted women) but may not feel good to the nipple.  My nipples didn’t stop being hyper-sensitive until about two months after the surgery.

As far as lifting and heavy physical activity, I think we need to tune into our intuition.  Among other things, I am a massage therapist, and I was very wary of doing massage again because my right arm/hand is dominant and deeper work most definitely uses muscles in my chest!  The site of my incision is pretty much directly lateral to my right nipple, therefore it is a little lower than most of the pectoral muscles.  However it would most definitely impact the serratus anterior muscles which are involved with a pushing kind of motion.  I was also aware the lifting and pulling motions would impact my breast tissue.

This intuition was born out a few times recently.  I moved at the end of September and into the early part of October.  I tried not to do too much hugely heavy lifting, but I certainly lifted my share of boxes and smaller furniture.  I tried to remember to keep my arm close to my chest so as to not overly stress the chest and underarm muscles, but occasionally I would be caught up in doing things and would be less conscious.  In addition I moved to a place in the country and my landlord asked me to assist with the raking and some other activities that did put some stress on my arm/chest/breast area.   After these activities I started feeling more shooting pains in the underarm area, as well as fatigue/discomfort in various places in my breast.

Apparently any “shooting” or tingly intermittent pains are related to the regrowth of the nerves.  It’s called neuropathic pain.  It makes sense that there would be odd sensations during the regrowth and healing of nerves.  But again, couldn’t they have freakin’ warned me of this so it wouldn’t be a surprise?  What’s up with that???

Other aches in my underarm area I believe are more muscular in nature as my body adjusts to using muscles that I’d been resting for a few months.  I read about one woman who obtained a prescription for physical therapy.  She said the physical therapists were extremely helpful and knowledgeable and spent quality time with her answering questions and making suggestions.  So for any of you larger-breasted women who have physically active or strenuous lives (including things like looking after toddlers or working on a farm), you may want to ask about physical therapy.

All in all, I’d say I’m healing well.  The lumpectomy scar is lighter now and the hardness of the tissue underneath the scar has diminished significantly.  As far as my left breast (where they had removed a milk duct as well as the nodule inside it), the scar is barely noticeable, as the color of the areola disguises it perfectly.  There is a very slight indentation where the milk duct was removed, and the nipple lists ever so slightly toward the scar, but unless you were looking for it, I doubt you would notice these things.

I am really grateful to have had such a skilled and conscientious surgeon.  And once again, I am so grateful to have my breasts, scars and all.

And, oh yes, I’m glad also that I appear to be cancer-free.  Let’s not forget that!  I guess sometimes I’m afraid to count that chicken.  (Is that the right metaphor?)  I don’t want to let my guard down and become complacent.  But for now, oh am I grateful.  May I use this experience to get healthier and healthier and healthier.  There is a lot of life yet to be lived!

Be well, my friends.

45-days Post-breast-surgery

15 Nov

The Breast Blog #17

October 13, 2011

It’s been one and a half months since my breast surgery and I thought I would update you on how things have been. The good news is that the anxiety has largely passed.  I now “believe” the pathology reports.  I believe that the lumpectomy was successful in removing the cancer in the right breast and that there is nothing cancerous in the left one. However, having said that, I must admit that once one has received a cancer diagnosis, I don’t think it’s completely possible to not worry about it a little bit.  Will it recur?  Will it manifest on the other side?

We don’t live in an environmentally pure world, and though my diet is vastly improved, it is not perfect.  There are yet risks.  However the fear has gone farther below the surface.  I can now focus on other things in my life.  I have more energy for more things than I once did.  I am ready to be more of service again and not so focused on my own navel (read: breasts, mortality, etc.)  This is a great relief.

My breasts feel much better now.  For several weeks I was unable to go for more than a half hour without a bra on.  I could feel the pulling (mostly on the internal stitches) and it felt physically uncomfortable and emotionally stressful worrying about whether or not I was impeding the healing.  I have been blessed with slightly larger breasts and I imagine my healing process is a tiny bit more involved than that of someone with a smaller cup size.

My surgeon had  told me not only would I need to wear a sports bra during the healing process but that it would be unwise for me to go without a bra ever.  This was somewhat distressing to hear as I had always found it uncomfortable to wear a bra during all my waking hours.  Many is the day that when I got home from work one of the first things I would do is take off my bra.  For larger breasted women, NOT wearing a bra all day is not comfortable, but wearing one all day is not comfortable either!  So imagine wearing one 24 hours a day!  Ick!

Recently I passed a milestone.  I was able to go all night without a bra on.  YEA!!!!  Freedom!!!

The first night with my lover sans bra, I could feel his delight in having the opportunity to once again “look and touch.”  We had had to be so careful for so long.  It was so wonderful to not feel so fragile.  It was so wonderful to be touched again.  He had been so reluctant to touch my breasts before because he was afraid he’d hurt me.  And I’d also been afraid of feeling pain because my breasts were truly super sensitive for a while.  I was also afraid of causing distress to my healing tissues.  Truthfully the latter worry has still not disappeared.

As we were lying there together, I felt myself welling up with gratitude that I still had breasts at all.  I truly had not wanted to lose them.  I love being a woman.  And I really was and am fond of my breasts.  My breasts are one part of this changed and changing middle-aged body that I am not embarrassed about.  As I let myself feel the emotion of gratitude for still being a breasted woman, I began to feel great sadness for all the women who lose their breasts due to breast cancer.

During this tearful episode of gratitude, I had a startling image come to my mind of a great crowd of women without breasts, or perhaps with only one, and off to the side I saw this big trash heap filled with discarded breasts.  What a disturbing painting that would be.  I know women choose mastectomies in order to increase their longevity on the planet.  Given the choice of living without breasts or not living at all, almost everyone would choose the former, right?  However, isn’t it sad that this is necessary?  Can you even begin to imagine the loss these women feel?  This culture equates breasts with physical beauty and sexual attractiveness.  Imagine what a struggle it must be to continue to feel attractive without breasts.  Imagine also if the option of breastfeeding a newborn were no longer an option.  (This is, after all, what breasts are really for.)

Of course many women choose to get implants, and thankfully insurance now covers this. But that has its own share of problems and emotional and physical adjustments as many women who have had reconstruction will tell you.

One dear girlfriend had a double mastectomy a few years ago.  She now has gorgeous looking pert round model-like breasts, but she said her husband doesn’t even touch her breasts anymore.  Her breasts feel cold and lifeless to him and there is no sensation to her so he figures what’s the point?  She said her breasts often feel disconnected from the rest of her body. Without someone to touch them, there is little opportunity to help incorporate them.  (“Incorporate” means literally “bring into the body.”)  As her massage therapist as well as her friend, she has asked me to please touch them/include them in the massage and help to integrate them energetically with the rest of her body.  (I have never before or since touched a woman’s breasts so much!)

Anyway, suffice it to say I am MORE than grateful to still have my breasts, scars and all.  As one social worker friend said, those scars mark me as a warrior.  I have, thus far, survived the battle against breast cancer.  I guess I am now a veteran of this war.  But it’s not a fight that will ever truly be over.  It’s not a war from which one can retire or go AWOL.  One must remain continually vigilant.

And for those of you who are reading this now who have been blessedly healthy and free from cancer, please don’t become complacent.  Do everything at your disposal to live a healthy lifestyle.  Each person I can help to get well or keep well will make this a worthwhile experience.  (And actually, it already has been worthwhile in many, many ways.  As are most of the experiences in my life.)

Be well, everyone!  Be vibrantly exuberantly WELL!!!!  Celebrate each day!  Life is good!

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.