Nothing is ever simple. I received most, but not all, of my pathology report today. To put the information into context, you'll have to gain some more medical knowledge, so let me do a little explaining.
We have yet to discuss DCIS in any detail here, but it's now become an important component of the story. Ductal Carcinoma In Situ (DCIS) is considered a precancerous condition. It develops in the ductal system of the breast, but won't harm the patient unless it breaks out, or becomes "invasive." The results of my biopsy a few weeks ago noted the presence of both DCIS and invasive ductal carcinoma. You're correct if you're thinking that one condition leads to the other.
Some women are diagnosed while they are still in the DCIS phase, because radiologists may detect it as microcalcifications on a mammogram. (Well, not on my mammograms, but now I am covering old ground.) The treatment for DCIS varies and depends on how aggressive the cells appear to be and on how widely it has spread through the ductal system. A very widespread occurrence of DCIS warrants a mastectomy.
Okay, enough background. Time to get back to the pathology report at hand. First, the very excellent news is that we continue to see no "metastatic carcinoma," or cancer that has spread beyond the breast. All of the studies of the lymph nodes continue to be negative, although one study looking for "micrometastasis" in the nodes isn't back yet. But no one seems concerned about this.
While no spread of the cancer is great, there may be a different worry. While the surgeons achieved good margins around the mass, they weren't as happy with the margins around the DCIS. Specifically, they didn't like the border on the south side, or in the 5 to 6 o'clock hour. Apparently, I had more DCIS than they anticipated. This is a little like the federal government doing a deportation sweep in Orange County so they can return the illegal farmworkers to Mexico, and then learning, after the raid is over, that they may have missed some farmhands who were planting in San Diego.
The plan now is to seek more expert opinion so we can decide the best course of treatment. Next week, I'm heading off to see a radiation oncologist at St. Joseph's Hospital in Burbank. Surprisingly, the breast surgeon at USC/Norris is sending me off campus, because he believes the radiation doctors at St. Joseph's are the best. One possible outcome is that the radiation group could decide that the margin we achieved is acceptable, as long as the area is radiated. Another scenario is that we all agree that the margin is too close for comfort, and several months from now, the surgeon re-excises, or takes additional tissue on the southern side. The final choice is to go back and do a mastectomy.
Information on the cancer's hormonal structure is still not back from the lab. This data, which is expected on Monday, will eventually be directed to yet another specialist, a medical oncologist. The medical oncologist decides whether chemo is in the cards, and if so, the type, dosage, duration, etc. The medical oncologist will also contribute to the discussion on the DCIS margins.
The short answer is that it's complicated. But then, medical decisions never seem to be easy. Risk is always the variable. What is an acceptable level of risk for recurrence? There is a weird irony to this story. Almost 20 years ago, I delivered my first baby at St. Joseph's Hospital. As a new mother, I appreciated that my body produced milk to feed my hungry infant. Now, my once reliable milk-delivery system is spinning out of control, and doctors at St. Joseph's will put energy (literally) into suppressing it. As parents, we worry about the risks our kids face all time, and we always want a safety margin in place. But how wide does it have to be? The odd thing is that I'm now the focus of this question, and it's a very peculiar place for me to be.
11/29/07
11/26/07
Holding Pattern
The surgeons looked at my incisions today. They agreed that I was healing well and seemed pleased with the results. I concurred that I appeared to be healing well, so we were all in agreement and well pleased with our handiwork.
Pathology drives the treatment now. But even pathologists take a few days off for Thanksgiving, which means that we don't have a detailed lab report yet. This report determines the next phase. It tells us what inspired the bad cells to grow and helps oncologists decide which weapons to use in the next wave of the attack. Radiation? Chemo? Both? One, but not the other?
Too much estrogen is a possible explanation for the cancer's growth. Estrogen triggers many breast cancers, but it's only one of several potential root causes. My situation may not be estrogen-related at all. We don't know yet.
The pathology report will also reveal if the surgeons achieved adequate margins. They obviously strive for clean margins between the boundaries of the cancerous tissue and the healthy tissue, but almost everything doctors do has some degree of uncertainty. I'm coming to understand that it's the nature of the business.
So, until pathology issues a report and doctors devise a strategy, we're in a temporary holding pattern. Picture a World War II movie (in black and white, not colorized) and the scene is of an airfield somewhere in England. The pilots are tuning up the engines of their fighter planes, they're sharing photos of their sweethearts with each other, they're playing cards around an up-turned wooden crate. The pilots know they will soon be sent out on a mission to attack a particular target. But exactly when they leave, the number of planes that will be deployed, the location of the hit, and the duration of the attack are all still being determined by the high-ranking officers, who are gathered elsewhere in a small, smoky room with reconnaissance photos in front of them.
The pilots wisely use the time to gather their thoughts, to get some rest, to eat well, and otherwise prepare for the attack. It's a moment for comfort food. Consider where I can score a large tray of excellent lasagna.
Pathology drives the treatment now. But even pathologists take a few days off for Thanksgiving, which means that we don't have a detailed lab report yet. This report determines the next phase. It tells us what inspired the bad cells to grow and helps oncologists decide which weapons to use in the next wave of the attack. Radiation? Chemo? Both? One, but not the other?
Too much estrogen is a possible explanation for the cancer's growth. Estrogen triggers many breast cancers, but it's only one of several potential root causes. My situation may not be estrogen-related at all. We don't know yet.
The pathology report will also reveal if the surgeons achieved adequate margins. They obviously strive for clean margins between the boundaries of the cancerous tissue and the healthy tissue, but almost everything doctors do has some degree of uncertainty. I'm coming to understand that it's the nature of the business.
So, until pathology issues a report and doctors devise a strategy, we're in a temporary holding pattern. Picture a World War II movie (in black and white, not colorized) and the scene is of an airfield somewhere in England. The pilots are tuning up the engines of their fighter planes, they're sharing photos of their sweethearts with each other, they're playing cards around an up-turned wooden crate. The pilots know they will soon be sent out on a mission to attack a particular target. But exactly when they leave, the number of planes that will be deployed, the location of the hit, and the duration of the attack are all still being determined by the high-ranking officers, who are gathered elsewhere in a small, smoky room with reconnaissance photos in front of them.
The pilots wisely use the time to gather their thoughts, to get some rest, to eat well, and otherwise prepare for the attack. It's a moment for comfort food. Consider where I can score a large tray of excellent lasagna.
11/24/07
The Dialogue
The recent weeks have been surreal. Was this my life I've been living? It's as if I stepped into a role created by another writer, and I was being handed a new script every day.
One of the most difficult parts of my new role has been telling people that I have breast cancer. I'm obviously not a private person, so that's not the problem. It's because the diagnosis scares people on so many levels, and I'm the one who's causing them to be scared. On the other hand, sharing my news has drawn me into conversations that I would not have imagined.
I found myself at a high school soccer practice the other day telling the coach that I wanted my son Nick to skip the team's trip to Arizona this year in the days before Christmas, because I wanted him closer to home. Those of you who are parents of an athlete will understand right away that a mother simply deciding that she wants her 16-year-old son to miss the out-of-state Christmas tournament carries zero weight. You'd better have some compelling reason.
So I turned to the truth and shared with the coach that I had breast cancer. Surprisingly, he pointed to the yellow Lance Armstrong wristband he was wearing, and shared his story of his own mother's cancer -- first in one breast and, later, the other -- and her long-term survival. Once practice was over and I had left the field, the coach took Nick aside and told him the same story he had told me.
I had another unexpected conversation when I phoned an attorney who I work for, but I've never actually met, to tell him that I couldn't help him for a while because I was having surgery. As we all know, attorneys ask probing questions, and I soon found myself laying out the breast cancer diagnosis. After a momentary pause, he told me that he knew three other women, all in their early forties, who were facing this disease. He also said that he believed strongly that if men developed breast cancer, doctors would be doing a much better job of preventing and treating it.
I don't know if I agreed with his opinion of gender-biased doctors, but I was touched by his real concern for me and for the women he told me about. In my particular case, my treatment seems first-rate, at least as far as I can tell. My hospital stay was fine, as those things go. But it's also clear that how you react to everyone and everything defines your experience.
The hours before a surgery are busy ones. Surgical patients are staged in a pre-op area, and each patient is assigned to a small cubicle, which is their homebase for a couple of hours. It's here that you talk to the anesthesiologist, that you get your IV, that you meet the surgical nurses, etc. From this cubicle, you're also shuttled back and forth to whatever pre-surgical procedures you need. Before my surgery, I was taken first to nuclear medicine, where a doctor injected the area of the mass with a radioactive material that would aid in identifying the sentinel node the minute the operation began. In an efficient use of time, the surgeon removes the sentinel node first in order for the pathologist to begin studying it, while the main part of the operation gets underway.
My next stop after nuclear medicine was to another radiologist to get my guide wires. These are fine wire markers that are threaded into place so the surgeon knows exactly where to cut. I know that the specific placement of my guide wires was agreed upon in advance, because I was present the previous week when my surgeon and the radiologist discussed it. Now, the same radiologist needed to put the wires in place. This procedure was a little challenging, mostly because my anatomy is quite literally tougher than you'd think. But with ample lidocaine and a little patience on both our parts, the radiologist got the placement he wanted, and I was returned to pre-op.
Meanwhile, my husband had been holding down the cubicle. He had passed the time visiting with the medical staff, mostly because they had mountains of consent forms for me to sign. He was also soaking up the scene, while pretending to read the newspaper. Because of the layout of the room, it's impossible not to hear what's happening in the adjacent cubicles. When I got back from my guide wire trip, my husband, with a wink and a nod, directed me to the discussion in the cube next door. A woman was loudly complaining to the anesthesiologist that she was not about to have any guide wires inserted without a full, general anesthetic.
In that moment, it was obvious that this woman's resistance, panic and fear weren't helping her. Her agitated conversation was not one that I wanted to have with any doctor. But easy for me to say, I already had my guide wires in place.
Breast cancer is scary. No one wants a pathology report like mine, nor do they want it to belong to someone they're close to, except there's no turning back from it. Those bad cells have to be confronted and eradicated. The choice is in deciding how to face it. I can go with the panic and the dread, or with as much good cheer as I can muster.
While it does seem surreal, this script is definitely mine, and I get to write much of the dialogue. So far, the conversations have played out in different ways with different people. Whether they've been matter-of-fact, emotional, funny, or surprising, all of the talks have been good ones. I look forward to many more before this story is finished.
One of the most difficult parts of my new role has been telling people that I have breast cancer. I'm obviously not a private person, so that's not the problem. It's because the diagnosis scares people on so many levels, and I'm the one who's causing them to be scared. On the other hand, sharing my news has drawn me into conversations that I would not have imagined.
I found myself at a high school soccer practice the other day telling the coach that I wanted my son Nick to skip the team's trip to Arizona this year in the days before Christmas, because I wanted him closer to home. Those of you who are parents of an athlete will understand right away that a mother simply deciding that she wants her 16-year-old son to miss the out-of-state Christmas tournament carries zero weight. You'd better have some compelling reason.
So I turned to the truth and shared with the coach that I had breast cancer. Surprisingly, he pointed to the yellow Lance Armstrong wristband he was wearing, and shared his story of his own mother's cancer -- first in one breast and, later, the other -- and her long-term survival. Once practice was over and I had left the field, the coach took Nick aside and told him the same story he had told me.
I had another unexpected conversation when I phoned an attorney who I work for, but I've never actually met, to tell him that I couldn't help him for a while because I was having surgery. As we all know, attorneys ask probing questions, and I soon found myself laying out the breast cancer diagnosis. After a momentary pause, he told me that he knew three other women, all in their early forties, who were facing this disease. He also said that he believed strongly that if men developed breast cancer, doctors would be doing a much better job of preventing and treating it.
I don't know if I agreed with his opinion of gender-biased doctors, but I was touched by his real concern for me and for the women he told me about. In my particular case, my treatment seems first-rate, at least as far as I can tell. My hospital stay was fine, as those things go. But it's also clear that how you react to everyone and everything defines your experience.
The hours before a surgery are busy ones. Surgical patients are staged in a pre-op area, and each patient is assigned to a small cubicle, which is their homebase for a couple of hours. It's here that you talk to the anesthesiologist, that you get your IV, that you meet the surgical nurses, etc. From this cubicle, you're also shuttled back and forth to whatever pre-surgical procedures you need. Before my surgery, I was taken first to nuclear medicine, where a doctor injected the area of the mass with a radioactive material that would aid in identifying the sentinel node the minute the operation began. In an efficient use of time, the surgeon removes the sentinel node first in order for the pathologist to begin studying it, while the main part of the operation gets underway.
My next stop after nuclear medicine was to another radiologist to get my guide wires. These are fine wire markers that are threaded into place so the surgeon knows exactly where to cut. I know that the specific placement of my guide wires was agreed upon in advance, because I was present the previous week when my surgeon and the radiologist discussed it. Now, the same radiologist needed to put the wires in place. This procedure was a little challenging, mostly because my anatomy is quite literally tougher than you'd think. But with ample lidocaine and a little patience on both our parts, the radiologist got the placement he wanted, and I was returned to pre-op.
Meanwhile, my husband had been holding down the cubicle. He had passed the time visiting with the medical staff, mostly because they had mountains of consent forms for me to sign. He was also soaking up the scene, while pretending to read the newspaper. Because of the layout of the room, it's impossible not to hear what's happening in the adjacent cubicles. When I got back from my guide wire trip, my husband, with a wink and a nod, directed me to the discussion in the cube next door. A woman was loudly complaining to the anesthesiologist that she was not about to have any guide wires inserted without a full, general anesthetic.
In that moment, it was obvious that this woman's resistance, panic and fear weren't helping her. Her agitated conversation was not one that I wanted to have with any doctor. But easy for me to say, I already had my guide wires in place.
Breast cancer is scary. No one wants a pathology report like mine, nor do they want it to belong to someone they're close to, except there's no turning back from it. Those bad cells have to be confronted and eradicated. The choice is in deciding how to face it. I can go with the panic and the dread, or with as much good cheer as I can muster.
While it does seem surreal, this script is definitely mine, and I get to write much of the dialogue. So far, the conversations have played out in different ways with different people. Whether they've been matter-of-fact, emotional, funny, or surprising, all of the talks have been good ones. I look forward to many more before this story is finished.
11/22/07
Negative Is Positive
Strike up the band. Sound the drum. The sentinel node was negative, which is really positive news.
I'm came home from the hospital this morning, and I'm doing really well. More details later.
Happy Happy Thanksgiving!
I'm came home from the hospital this morning, and I'm doing really well. More details later.
Happy Happy Thanksgiving!
11/19/07
Sentinel Post
Some of you (the perennial "A" students) have clearly been conducting your own research. I know this because I was asked a question about my "sentinel node," a topic I failed to blog on because it seemed a little too medical. But, if someone is posing the question, it follows that others may want to know.
As the name implies, the sentinel node is the soldier standing guard at the entrance to the lymph system resting under the arm. According to Dr. Susan Love, cancer cells, when they decide to spread out, almost always leave the breast via this lymphatic passage.
For doctors to decide the best post-operative treatment for a particular patient, they need to know exactly what she's facing. Has the cancer made a move? To learn this, during the surgery, doctors perform a sentinel node biopsy. The surgeon injects dye around the area of the mass, and the dye travels through the lymph vessel to the sentinel node. This node is then removed and biopsied on the spot. Studies have definitively shown that, if the sentinel has no cancer, the other lymph nodes will also be clear. If that's the case, the surgeon stitches you up, and you're done, at least until you begin radiation or chemo, or whatever they dream up for you.
But if the sentinel node is not perfectly clear, the surgeon will continue to take out lymph nodes to see what they reveal. This is how my particular surgery may go from being relatively easy to more complex. That said, based upon ultrasounds by two different radiologists at two different hospitals, my lymph nodes appear normal, which is a good sign. But you never know for sure until the doctors do a biopsy.
If the surgeon does remove more than the sentinel node, I've read that it may impact one's golf swing. No worries there. I have no golf swing, nor do I plan on needing one at any time in the future. (I doubt that I'll retire to a tract home with a commanding view of the ninth hole.)
And retirement is a long way off. For the immediate future, I plan on doing more research on the topic at hand, so keep those breast cancer questions coming. Information is everything. I know this first-hand, because I've spent the past 10 years working as a private investigator doing research for attorneys and other clients.
My current self-assignment -- to investigate this disease -- is no different. Only this time, I have a huge stake in what I learn, both for myself and for the rest of us. Someone has to be on watch, so we can all do better at prevention and treatment. At least for the moment, I seem to be a sentinel at the front post.
As the name implies, the sentinel node is the soldier standing guard at the entrance to the lymph system resting under the arm. According to Dr. Susan Love, cancer cells, when they decide to spread out, almost always leave the breast via this lymphatic passage.
For doctors to decide the best post-operative treatment for a particular patient, they need to know exactly what she's facing. Has the cancer made a move? To learn this, during the surgery, doctors perform a sentinel node biopsy. The surgeon injects dye around the area of the mass, and the dye travels through the lymph vessel to the sentinel node. This node is then removed and biopsied on the spot. Studies have definitively shown that, if the sentinel has no cancer, the other lymph nodes will also be clear. If that's the case, the surgeon stitches you up, and you're done, at least until you begin radiation or chemo, or whatever they dream up for you.
But if the sentinel node is not perfectly clear, the surgeon will continue to take out lymph nodes to see what they reveal. This is how my particular surgery may go from being relatively easy to more complex. That said, based upon ultrasounds by two different radiologists at two different hospitals, my lymph nodes appear normal, which is a good sign. But you never know for sure until the doctors do a biopsy.
If the surgeon does remove more than the sentinel node, I've read that it may impact one's golf swing. No worries there. I have no golf swing, nor do I plan on needing one at any time in the future. (I doubt that I'll retire to a tract home with a commanding view of the ninth hole.)
And retirement is a long way off. For the immediate future, I plan on doing more research on the topic at hand, so keep those breast cancer questions coming. Information is everything. I know this first-hand, because I've spent the past 10 years working as a private investigator doing research for attorneys and other clients.
My current self-assignment -- to investigate this disease -- is no different. Only this time, I have a huge stake in what I learn, both for myself and for the rest of us. Someone has to be on watch, so we can all do better at prevention and treatment. At least for the moment, I seem to be a sentinel at the front post.
11/13/07
Taking Time Out
Disorienting. That's the only word to describe an MRI. The technicians pose you exactly how they want you, and you 're not allowed to move even one tiny finger tip until the procedure is over. The platform on which you're positioned is then slid into a tube. You're provided with earplugs to block out the deafening noise, but it's still really, really loud.
But who's complaining. I will happily take time out to get my MRI next year. This tool has the potential to save my life. In reviewing my MRI, the radiologist detected another very small mass in the same area as the one already biopsied. She ordered me in for more ultrasound and confirmed what the MRI suggested. There was another pea-sized growth in the same quadrant, which is not unusual. (Can you tell that I'm avoiding the "T" word. They are what rats develop in scientific studies, and I'm not going there.)
My second growth was too small for anyone to feel by hand, which shows the value of my having an MRI. The experts also tell me that MRI will detect breast cancer when it is still confined to the milk ducts and is not yet "invasive." This is considered a "pre-cancerous" condition and is fully curable. In other words, if I had been screened with MRI a couple of years ago, my condition could have been detected before it posed any real threat. (Mammography detects this, too, but apparently not on my x-rays.)
Enough lecturing. Now back to the story.
I went to the Breast Center at USC/Norris. That's an impressive operation. They go at this disease as a team, with a chief surgeon, younger surgeons, a radiologist, and support staff all working together. After conducting their own exams and reviewing all of the data I brought, my new medical team failed to find anything else worrisome and scheduled my surgery for the day before Thanksgiving. The doctors decided on a breast conservation procedure, which is much less traumatic than masectomy and means I may be released from the hospital the same day, if all goes well.
As for the surgery, imagine the face of a clock. The surgeon will remove about 2 hours, roughly between 3 and 5 o'clock. Then the clock will be reconfigured to appear as if no time were taken out. Whatever works.
I just hope to be home in plenty of time to enjoy my family and my turkey and pie -- and, more importantly, to take time out for thanks.
But who's complaining. I will happily take time out to get my MRI next year. This tool has the potential to save my life. In reviewing my MRI, the radiologist detected another very small mass in the same area as the one already biopsied. She ordered me in for more ultrasound and confirmed what the MRI suggested. There was another pea-sized growth in the same quadrant, which is not unusual. (Can you tell that I'm avoiding the "T" word. They are what rats develop in scientific studies, and I'm not going there.)
My second growth was too small for anyone to feel by hand, which shows the value of my having an MRI. The experts also tell me that MRI will detect breast cancer when it is still confined to the milk ducts and is not yet "invasive." This is considered a "pre-cancerous" condition and is fully curable. In other words, if I had been screened with MRI a couple of years ago, my condition could have been detected before it posed any real threat. (Mammography detects this, too, but apparently not on my x-rays.)
Enough lecturing. Now back to the story.
I went to the Breast Center at USC/Norris. That's an impressive operation. They go at this disease as a team, with a chief surgeon, younger surgeons, a radiologist, and support staff all working together. After conducting their own exams and reviewing all of the data I brought, my new medical team failed to find anything else worrisome and scheduled my surgery for the day before Thanksgiving. The doctors decided on a breast conservation procedure, which is much less traumatic than masectomy and means I may be released from the hospital the same day, if all goes well.
As for the surgery, imagine the face of a clock. The surgeon will remove about 2 hours, roughly between 3 and 5 o'clock. Then the clock will be reconfigured to appear as if no time were taken out. Whatever works.
I just hope to be home in plenty of time to enjoy my family and my turkey and pie -- and, more importantly, to take time out for thanks.
11/12/07
Rest Assured
Some people knew that I was headed to the Breast Center at USC/Norris today. I wanted quickly to let everyone know that the appointment went as well as could be expected. Thankfully, there were no surprises, and I'm scheduled for surgery on the day before Thanksgiving. The doctors are going with a breast conservation procedure, so they anticipate that I will probably go home the same day. I'll provide more details later, but I wanted to get the good word out.
Thanks so much for all of the positive energy. Everyone has been so supportive.
Best,
Cathleen
Thanks so much for all of the positive energy. Everyone has been so supportive.
Best,
Cathleen
11/9/07
Un-brace Yourself
A few people have suggested that my getting braces was a sign of a mid-life crisis. Believe what you will. About 12 months ago, I asked my kids' orthodontist to straighten my disorderly teeth. You'd be surprised how many adults have braces. They're almost fashionable.
I appear to be digressing, but the braces are necessary back story. You recall that I needed an MRI, and I scheduled one for the following week. Meanwhile, I continued to research my topic, and found my way to good information on breast MRI. The website was very informative about how the technician injects the patient with dye to get a good read, and how the patient is positioned on her stomach, blah, blah, blah. All of this was good to know, and I skimmed the list of details, until one bit of information jumped off the webpage. This was a very clear instruction to remove all metal from one's body, because metal and MRI were incompatible.
My brain began to churn. Could no metal include the braces cemented to the enamel of my teeth? I dialed the hospital where I had scheduled the MRI. The woman I spoke to had no clue. "Are they titanium?" she asked. Was I supposed to know this? "Go ask your orthodontist if you can have an MRI," she instructed me. (Can I just say that my confidence in this medical facility was now trending downward.)
I did go to see the orthodontist. He confirmed my suspicions -- no MRI with braces. Now every adult who has braces wants them off yesterday, but we really don't want them off until our teeth are straight. To the untrained eye, my teeth looked great, but were they truly ready to be released from their restraints. And why was I considering this anyway. I had much larger issues to confront that trumped the alignment of incisors.
I confided in the orthodontist that breast cancer was driving the MRI. After his momentary shock subsided, he looked closely at my mouth, told his technician to strip my braces, and ordered a rush on my retainers. He assured me that I could finish my treatment with removable appliances.
So one good thing happened in a period of crazy developments. As I was leaving his office, the orthodontist whispered to me that he hoped getting my braces off would lift my spirits. And it did. I had my smile back.
I appear to be digressing, but the braces are necessary back story. You recall that I needed an MRI, and I scheduled one for the following week. Meanwhile, I continued to research my topic, and found my way to good information on breast MRI. The website was very informative about how the technician injects the patient with dye to get a good read, and how the patient is positioned on her stomach, blah, blah, blah. All of this was good to know, and I skimmed the list of details, until one bit of information jumped off the webpage. This was a very clear instruction to remove all metal from one's body, because metal and MRI were incompatible.
My brain began to churn. Could no metal include the braces cemented to the enamel of my teeth? I dialed the hospital where I had scheduled the MRI. The woman I spoke to had no clue. "Are they titanium?" she asked. Was I supposed to know this? "Go ask your orthodontist if you can have an MRI," she instructed me. (Can I just say that my confidence in this medical facility was now trending downward.)
I did go to see the orthodontist. He confirmed my suspicions -- no MRI with braces. Now every adult who has braces wants them off yesterday, but we really don't want them off until our teeth are straight. To the untrained eye, my teeth looked great, but were they truly ready to be released from their restraints. And why was I considering this anyway. I had much larger issues to confront that trumped the alignment of incisors.
I confided in the orthodontist that breast cancer was driving the MRI. After his momentary shock subsided, he looked closely at my mouth, told his technician to strip my braces, and ordered a rush on my retainers. He assured me that I could finish my treatment with removable appliances.
So one good thing happened in a period of crazy developments. As I was leaving his office, the orthodontist whispered to me that he hoped getting my braces off would lift my spirits. And it did. I had my smile back.
11/8/07
Next Step
During all of our years together, my husband and I have avoided HMOs. I grew up in the Kaiser healthcare system, which soured me on any HMO. While still in our vibrant thirties, we latched onto good health insurance and have never let go, despite the shocking deductibles and the high premiums. We vaguely said that one day one of us might need the best care, and we wanted the freedom to seek it out. Unfortunately that day arrived.
After a little Internet research, I knew I wanted an opinion from a hospital that regularly dealt with what I was facing. I e-mailed a friend who worked at USC for a referral. She responded quickly, and within 48 hours of my diagnosis, I was on the calendar of a leading expert at USC's Norris Cancer Center. The only glitch was that I had to wait a couple of weeks for my appointment. The doctor was out of the country.
In the meantime, I went to see the oncologist/surgeon who was in the same building as my OB-GYN. He was a grey-haired Chinese man, who had a quiet manner and sizeable accent. He studied my mammograms and then strongly advised me to get an MRI in both breasts. This was not because the mammograms suggested a serious condition. It was because the mammograms suggested nothing.
Enter the dense breast issue. Because of my particularly solid anatomy, my tissues appear white on an x-ray. But in an unforturnate bit of trickery, cancerous masses also appear white. Essentially, everyone in my mammogram is wearing the same color -- heathy tissue and bad tissue alike. This is a case where you can't tell the good cells from the sluts.
Maybe I'm overly focused on this, but couldn't some medical genius fix this problem, and convince one group of cells to wear a different color to the annual mammogram. I'm not the only person in this situation, after all. Lots of women, especially younger ones, have dense breasts.
Anyway, I agreed with the Chinese doctor that an MRI was an excellent idea. I wanted data soon, and I had to wait a little over two weeks before I could get into USC. Subjecting myself to an MRI seemed, oddly, like a good use of time.
After a little Internet research, I knew I wanted an opinion from a hospital that regularly dealt with what I was facing. I e-mailed a friend who worked at USC for a referral. She responded quickly, and within 48 hours of my diagnosis, I was on the calendar of a leading expert at USC's Norris Cancer Center. The only glitch was that I had to wait a couple of weeks for my appointment. The doctor was out of the country.
In the meantime, I went to see the oncologist/surgeon who was in the same building as my OB-GYN. He was a grey-haired Chinese man, who had a quiet manner and sizeable accent. He studied my mammograms and then strongly advised me to get an MRI in both breasts. This was not because the mammograms suggested a serious condition. It was because the mammograms suggested nothing.
Enter the dense breast issue. Because of my particularly solid anatomy, my tissues appear white on an x-ray. But in an unforturnate bit of trickery, cancerous masses also appear white. Essentially, everyone in my mammogram is wearing the same color -- heathy tissue and bad tissue alike. This is a case where you can't tell the good cells from the sluts.
Maybe I'm overly focused on this, but couldn't some medical genius fix this problem, and convince one group of cells to wear a different color to the annual mammogram. I'm not the only person in this situation, after all. Lots of women, especially younger ones, have dense breasts.
Anyway, I agreed with the Chinese doctor that an MRI was an excellent idea. I wanted data soon, and I had to wait a little over two weeks before I could get into USC. Subjecting myself to an MRI seemed, oddly, like a good use of time.
11/7/07
Reaction Shot
You need a little background to understand what happened next. I am not an outwardly organized person. The inside of my car is messy, my desk is cluttered, and my linen closet is beyond description. But I am internally organized. I have the ability to focus on a problem, plan a strategy, and set things in motion in order to get the problem fixed. I do this quickly and without second-guessing myself.
With that said, here's what unfolded next. My husband, my OB-GYN, and I are all in an examining room with the door closed. This doctor, who delivered both of my boys, is a sweetheart, and I know he is fond of me. He is clearly upset that he has to give me really bad news, and eventually both he and my husband start to get misty-eyed.
It would be natural for me to shed a few tears at this point. Most people would. Instead, my problem-solving gene kicks in. My reaction is that we don't have time to fret. I've just been presented with a monumental bend in the road that directly affects my quality of life. I have only one question. Next step?????
I need expert opinion, and I need it fast. After leaving the OB-GYN's office, with my pathology report in hand, my husband and I go upstairs to the office of an oncologist/surgeon. I grab the first available appointment, which is two days away. Then I head home to tell my kids and my immediate cirlcle of family and friends. I also need to teach myself how to interpret a pathology report. Those biology-type words are a code, and I need to crack it.
This is merely a detour, but I'm going to need an entirely new road map to get my life back on course.
With that said, here's what unfolded next. My husband, my OB-GYN, and I are all in an examining room with the door closed. This doctor, who delivered both of my boys, is a sweetheart, and I know he is fond of me. He is clearly upset that he has to give me really bad news, and eventually both he and my husband start to get misty-eyed.
It would be natural for me to shed a few tears at this point. Most people would. Instead, my problem-solving gene kicks in. My reaction is that we don't have time to fret. I've just been presented with a monumental bend in the road that directly affects my quality of life. I have only one question. Next step?????
I need expert opinion, and I need it fast. After leaving the OB-GYN's office, with my pathology report in hand, my husband and I go upstairs to the office of an oncologist/surgeon. I grab the first available appointment, which is two days away. Then I head home to tell my kids and my immediate cirlcle of family and friends. I also need to teach myself how to interpret a pathology report. Those biology-type words are a code, and I need to crack it.
This is merely a detour, but I'm going to need an entirely new road map to get my life back on course.
The News
I'm a 49-year-old white woman. I live north of Los Angeles in a neighborhood that is often dubbed "Mayberry." I have a husband, one teenager at home and one in college, and a black and white dog named Zephyr. For the most part, life is good. So when I felt a little mass of tissue in my left breast, I was alarmed, but only mildly so. For reassurance, I consulted my Merck Manual, which instructed me that most lumps in the breast are benign. But to be safe, the next day I scheduled a mammogram and made an appointment with my OB-GYN. Then I put it out of my mind and went about my life.
Fast forward a couple of weeks. The mammogram is negative, and my doctor tells me he is "100 percent sure" this is not cancer, but a cyst that may dissolve on its own. Again, I return to the every day stuff that I do -- laundry, dishes, cooking, and my part-time job.
Fast forward a couple of more weeks. The persistent little cyst doesn't disappear; I can still feel it. Again, I head back to the OB-GYN. This time, he decides I should have an ultrasound, just to be sure.
Now it's getting interesting. Immediately following the ultrasound, the radiologist, who is this really striking Asian woman, sits down with me and says she's ordering a biopsy. "Okay," I reply, matter- of-factly, "but it's only a benign cyst." She nods knowingly, and then sends in her assistant to schedule my procedure. Two days later, I have some tissue removed, which I'm actually happy about, because I can finally but this breast thing to rest.
Fast forward one more time. I'm having lunch with a friend, talking about possible travel plans for my 50th birthday, which is only a few months away. My cell phone rings, but I don't recognize the number, so I decline the call and continue to eat my crab cakes. I do listen to the message a little while later, however.
My OB-GYN had called, and he sounded a little anxious. So I go to my husband's office, which is near the restaurant, and I call the doctor back. He insists that I come to his office immediately, and he refuses to give me any more information on the phone. You don't have to be clairvoyant to see where this is going.
I tell my husband to put down his work, and we rush to the doctor's office. This is where I'm handed an ugly pathology report that has my name and birthdate on it. Apparently, that little peanut-sized matter was no benign cyst. I have invasive ductal carcinoma, aka breast cancer. Go figure.
Fast forward a couple of weeks. The mammogram is negative, and my doctor tells me he is "100 percent sure" this is not cancer, but a cyst that may dissolve on its own. Again, I return to the every day stuff that I do -- laundry, dishes, cooking, and my part-time job.
Fast forward a couple of more weeks. The persistent little cyst doesn't disappear; I can still feel it. Again, I head back to the OB-GYN. This time, he decides I should have an ultrasound, just to be sure.
Now it's getting interesting. Immediately following the ultrasound, the radiologist, who is this really striking Asian woman, sits down with me and says she's ordering a biopsy. "Okay," I reply, matter- of-factly, "but it's only a benign cyst." She nods knowingly, and then sends in her assistant to schedule my procedure. Two days later, I have some tissue removed, which I'm actually happy about, because I can finally but this breast thing to rest.
Fast forward one more time. I'm having lunch with a friend, talking about possible travel plans for my 50th birthday, which is only a few months away. My cell phone rings, but I don't recognize the number, so I decline the call and continue to eat my crab cakes. I do listen to the message a little while later, however.
My OB-GYN had called, and he sounded a little anxious. So I go to my husband's office, which is near the restaurant, and I call the doctor back. He insists that I come to his office immediately, and he refuses to give me any more information on the phone. You don't have to be clairvoyant to see where this is going.
I tell my husband to put down his work, and we rush to the doctor's office. This is where I'm handed an ugly pathology report that has my name and birthdate on it. Apparently, that little peanut-sized matter was no benign cyst. I have invasive ductal carcinoma, aka breast cancer. Go figure.
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