Monday, September 29, 2008

The Very Good News

University Radiology just phoned to say my results were benign. YAY!

Thanks to everyone who sent positive energy out into the universe, prayed, and sent their support. I really appreciate it.

Friday, September 26, 2008

The Actual Stereotactic Breast Biopsy Procedure and Afterward

If you've been following along, you may remember my last (and first) post on this topic mentioned that I was scheduled for a stereotactic breast biopsy yesterday. As it turns out, what the radiologist and the scheduler had told me would happen matched up pretty well. Although actually experiencing it is far different than having an intellectual understanding of what would happen.

Leading up to the procedure, I had been sharing with friends and family my anxiety and answering any questions they had. By the time yesterday morning rolled around, I was in a pretty good head space and ready to forge ahead, facing my fears. So many kind folks called to wish me well, and that was just the most helpful and loving thing they could do. Many others called afterward with love and kind wishes for my speedy recovery. It makes me a bit misty to think of all the love that's been shown to me during times of need. It's hard to express how grateful I feel for all of it. So, I'll just move on and tell you how it went without moving my left arm too much because I'm pretty sore.

John had taken a work-from-home day, and had been typing away on his laptop until we had to go. He packed away the computer and took it with him because the biopsy was expected to take about 2 hours. It took much longer than that. My appointment was at 12:30, but I didn't get into the actual room where the procedure would take place until 1:30. I was so nervous I must have peed at least 5 times while waiting. In fact, when I finally was called into the room, I had to go again.

When I returned, the two women who were assisting the radiologist (Cathy and Stephanie) asked me a few questions, set up the room, took my vitals, and had me sign a few forms. Then, in walks the same radiologist who had given me the bad news in Hillsboro, NJ, Dr. Paster. The facility where I had the biopsy was in East Brunswick, NJ, but the original mammogram was taken in Hillsboro. I was very comforted by the fact that it would be someone who already knew my history, had seen all my films, and had explained the procedure to me in the first place.

When it was time, I climbed up onto the table with the hole on it. The table isn't completely horizontal; it dips about an inch or so where the hole is. I had a feeling I'd be having back spasms later, and I was right. That hole was pretty uncomfortable for a hole. The edge of it was not cushioned, and it pressed up against my already tender ribs (the reason I started this mammogram business in the first place -- we still don't know why I have rib pain). Cathy told me that they were then going to take some images of my breast and that I'd have to get into a position that would help get the best images. I had to turn my head to the right and keep my left arm at my side. In that position, I faced a wall for the entire procedure. Mainly I just kept my eyes shut and tried not to move. I've never wanted to take a deep breath more than I did during the biopsy.

Image from Visalia Imaging.

Meanwhile, under the table, Cathy was positioning my breast between what seemed to be a vertical steel plate and a much smaller and thinner steel plate that looked like a window about 2 inches square. Her goal was to get my microcalcifications within that window so that the computer taking the images (essentially mammograms) could exactly position the needle for Dr. Paster to take the samples. This positioning involved compression, but it wasn't nearly as bad as any I'd experienced in mammograms. However, it was a bit unsettling to have a stranger moving my boob around through a hole in a table. But Cathy and Stephanie kept up a conversation with me the entire time, asking me questions about myself and telling me what they were doing as they were doing it.

Just as an aside, when I described the procedure to my friend Rich, it was he who said it must have been a man who designed the procedure. I replied, "An angry man."

After all the images had been taken for the first set of microcalcifications (there were two sets, so the procedure would be duplicated because the two sets weren't close enough together to fit them into the same window -- which is not to say they didn't try), and everything was ready to go, they called Dr. Paster back into the room. That's when my anxiety level spiked again. But she warned me about exactly what would happen, "You're going to feel a pinch and then a burn when I give you the numbing agent (lidocaine)."

It didn't hurt/burn anywhere nearly as much as I'd expected or experienced previously in all the dental surgeries I've had. However, because I have a reaction to epinephrine, Dr. Paster gave me the straight stuff, and a LOT of it. So much of it, in fact, that I could see the clouds of it in my breast later when Cathy took me for a post-procedure mammogram and I came around to her side of the machine to see the images. More about the lidocaine later...

After I was numbed up, they began the first biopsy. Now, I'm not sure exactly what happened because I couldn't see under the table. I told them that I wish I could have filmed it, but they said I wouldn't have been able to due to legal reasons. Oh well. But, what I do know is that once the coordinates were all checked and double checked, Dr. Paster used a needle like the one below to take samples of the calcifications and then used the vacuum setting to capture extraneous tissue afterward for a second or two.

Image from Ethicon.

When I told John about the needle, he said it was like an auger with a sheath around it. I'm not sure if that's how I would describe it, but my understanding is that the point is solid, but there's an inch-long hole on the top of the needle that has tiny blades within it so that it can cut and capture tissue when it's taking samples and vacuuming tissue. Either way, I was so numb that I couldn't feel it. I could hear the vacuum machine, but it wasn't that loud.

The procedure was repeated so that Dr. Paster could get samples from the second area of microcalcifications. During both procedures, she gave me a lot of lidocaine. Also, Cathy held my hand, and sometimes, Dr. Paster put her hand on my arm. Both were very comforting.

After each biopsy, Dr. Paster inserted a tiny (about 1/16 inch long and a millimeter deep) marker into each spot where she took samples. One marker was in the shape of an M and the other, an O. Cathy had shown me the M marker prior to the procedure, which I thought was pretty neat. Good thing I didn't have more spots to biopsy, I might have been able to spell something.

By the end of the procedure (which took about an hour and 15 minutes), I was having a tough time answering their questions. Meanwhile, Cathy had cleaned me up, put steri-strips over the 1/8 inch long incisions, and taped some gauze over my breast. I didn't understand why I was thinking alright, but couldn't put a sentence together until after I'd gotten up off the table. I had a tough time focusing my eyes and felt, well, high. More accurately, I felt drunk, but without the warmth and goofiness. Just the weird lack of physical control. I had felt a similar weirdness after my last dental surgery, but not to the same degree.

My lips and tongue felt numb. When I finally could go pee again, I nearly fell off the toilet from lack of balance. However, I played it cool because it was already 3 pm, and I wanted to go home. Suddenly, I was exhausted. Then, after I'd changed back into my clothes, Cathy recited the post-biopsy instructions and gave me a copy. I'm so glad she told me what to expect as far as bruising -- gravity will cause the bruising to show up in unexpected places, like under my breast. Finally, she told me I can't work out with weights for a week, although I can go walking. Then, she gave me a small ice pack to stick in my bra. That was a surprise. I was told that I needed to sleep in my bra and keep ice packs in there on and off for 30 minutes at a time. I thought I'd be braless for a few days. No dice. :(

I struggled to walk out to John because I just felt so weird, and told him so as soon as I saw him. He quickly saved the work he had been doing and got me out into the fresh air. I told him that I felt drunk and was very chatty the whole ride home, drinking as much water as I could. By the time we arrived home, I was ready to crawl into bed and fall asleep. But, I had to phone a few folks who were on pins and needles. Then, I turned on the TV and vegged out for a while until the lidocaine wore off. That when the pain started. It wasn't unbearable, but I had to send John out for some Tylenol. I wish I could have taken some Alleve, but that seems to cause bleeding, so no dice. I toughed it out, though, as I've done so many times with pain before.

This morning, I'm pretty sore and it hurts to lift my left arm, but I'm sure that will pass. I have one of John's homemade ice packs (a water-soaked washcloth frozen in a ziplock bag, warmed enough to shape into a breast-friendly pack) in my bra, giving me some comfort. I had a lot of trouble sleeping since (as I discovered in January when I had the foot surgery), I sleep on my left side, and that's where the biopsies were done. Otherwise, Stephanie has already called to check on me and to remind me if there was any bleeding to call them. I haven't checked yet, but my guess is that there isn't any because I would have seen it through the gauze.

So, that's the story so far. I should get the results either Monday or Tuesday. I'm sure that whatever the results, I'll be fine. In the meantime, I'm going to get some rest.

Thanks again to Cathy, Stephanie, and Dr. Paster, who made a tough procedure much less icky than it could have been, and who did a good job helping me through my anxiety. They get high marks in my Patient Survey. ;D

Thanks also to everyone who put John and me in their thoughts and prayers and who continue to send positive energy out into the universe about my results. I am truly grateful to you and am overwhelmed by your generosity of spirit.

Monday, September 22, 2008

Pancakes on the Grill, or My Neighbors Think I Have a Grilling Fetish

From co-op, vegan pancakes on the grill

I love the smell of grilled fake bacon and pancakes in the morning. It smells like victory. OK, it doesn't smell like victory, but it smells good enough to bring out the spying neighbors who always want to see what we're up to on the grill.

Just for laughs, John and I decided that we would have pancakes and Gunga Din (yes, the classic movie) breakfast as part of a very relaxing weekend. Actually, due to a bunch of things that had to be done first (plant watering, kitchen cleaning, etc.), the grilling was done a bit later, and it became brunch. All that aside, it was a good excuse to get out in the beautiful weather and enjoy my grill.

From co-op, vegan pancakes on the grill

To make the pancakes, I used the buttermilk pancake mix from Arrowhead Mills that we sell at the co-op. Usually I like to make these things from scratch, but I mentioned that we had it at the store, and that piqued John's curiosity enough to try it. Lucky for him, he liked it just fine. I'd prefer something more multi-grained, but at least the flours were organic.

I cooked the pancakes on a cast-iron griddle I picked up from Macy's a while back when Martha Stewart started offering her wares there. It cooks like a dream, especially on the grill. The pancakes were uniformly cooked, golden brown on each side.

I served the pancakes with some fake bacon that we both enjoy. We don't eat it very often, probably about once a month just for variety. The fake bacon grilled up very nicely (and quickly!), with crispy edges and chewy interiors.

Finally, I topped my pancakes with a little agave nectar, and John made a mixture of real maple syrup and agave nectar for extra sweetness. I highly recommend grilled breakfast, especially during these early fall days.

Saturday, September 13, 2008

A New Topic for Here and There: My Stereotactic Breast Biopsy

Well, I should back up a bit. In July, when I had my annual mammogram, I received a letter from the radiologist saying that their results were abnormal and that they recommended a diagnostic mammogram and ultrasound. Because the same type of thing happened to me last year, I thought I knew what to expect -- another more rigorous mammogram and ultrasound of the breast with the offending abnormalities, then another check in six months, and that would be that -- just like last time.

Unfortunately, things inside my left breast have changed. After the diagnostic mammogram and ultrasound were taken, I had a long wait for the radiologist. At the facility where I have my mammograms, they use a triple-check procedure. The tests are examined by two radiologists, then run through a computer test that finds whatever they don't. It's a pretty sophisticated system, so they tend to find things very early.

Things like microcalcifications. So, when the radiologist who examined my films called me into a dimly lit room with nothing in it but two chairs and a small table, I felt a little panicky.

She told me they had found calcifications in two areas of my left breast. Then, she explained that calcifications are normally benign, but because the ones in my breast are clustered in two specific regions, they would need to biopsy the two areas. Then, I glazed over for a while.

Eventually, I was able to focus on what she was saying and started writing things down. The first thing I'd need to do would be to see a breast surgeon. She recommended one right down the road from me at the Cancer Institute of New Jersey at the Robert Wood Johnson Medical School, UMDNJ. Then, I'd need to have the biopsies done. The radiologist began to explain how they would perform the biopsies at their other facility.

She said the stereotactic biopsy (see the photo at the beginning of this post) takes place in a sterile environment, but is not surgical. I would lie face down on a table, with my head turned to one side, while my breast would hang through a hole in the table and the interventional radiologist and her assistants would perform the procedure. While I'm on the table, they will compress my breast into a different kind of mammography machine that will pinpoint exactly where the microcalcifications are. Then, they numb my breast.

After the breast is numb, they will use the coordinates from the computer attached to the mammography machine to take the samples. First, they make a tiny nick in the skin. Then, using a hollow needle attached to a vacuum, they will take 10-12 tissue samples from each section of microcalcifications. Next, they insert tiny steel markers where they extracted samples. If the surgeon has to go back in and take something out, she'll know exactly where to find it. Then, they send the samples to the lab, and I'll get a call from the surgeon in a few days with the results.

I was pretty discombobulated when I thought about the procedure. My first thought: "That's so barbaric!" Then, I realized I'd have to make some calls. I had time though, since the radiologist had to make copies of all my films to take to the breast surgeon.

While she was making prints of the digital mammographies and ultrasound results, I went out to my car and called my awesome gynecologist. One of her nurses recommended the same breast surgeon the radiologist recommended, so I needed to find out if she was in our health plan. Next, I called John.

John was at work, but he did a lot of research while we were on the phone. He found me the info on Dr. Kirstein at the Cancer Institute and listened while I explained as much as I could remember from the radiologist. He also gave me alternatives in our health care plan if I was unable to schedule an appointment with her. I was fortunate though, I scheduled an appointment for a few weeks after my call.

By the time I'd finished using up my cel anytime minutes, the films were copied and I could be on my way. What I really wanted to do was go home, turn on my computer and find out exactly what this all meant. That, and cry.

What I found out was microcalcifications could mean a variety of different things including cancer, benign cysts, evidence of old breast injuries, or other benign conditions. Last week, when I met with the breast surgeon, she told me that as cells die, they leave behind calcium deposits. When many cells die and microcalcifications form (especially in clusters), we need to find out why they are dying. Hence, the biopsies.

All that to say, my procedure is scheduled in two weeks. And, I'm a bit nervous about it. First of all, I'm really afraid of needles. I've gotten more accustomed to people taking my blood since I've had quite a few blood tests this year (for another, very treatable condition). But it all still freaks me out.

Second, it's going to suck. Two hours of being uncomfortable, needles, potential hematoma (read: bruised, purple boob for a week), and discomfort afterward for up to 48 hours. Ugh.

Oh, and there's the waiting for the results. But at the moment, I'm more anxious about the procedure itself. The doctor was pretty confident that the results will be benign, and I'm with her. Positive thinking. Now, if I could apply that to the stereotactic biopsy, I'd be in good shape. I'm just not there yet.

However, I'm glad I know what's involved so I know what to expect. The scheduler at the facility said that they will talk to me the entire time, telling me what's happening and what will happen next. I found that profoundly comforting. These folks are professionals. They do this procedure all the time. I keep telling myself that.

John, very soundly I thought, pointed out that it's just two hours. I've been through much worse over longer periods of time. He's right. I need to remember that. In the meantime, I've made a commitment to share my experience on this blog. It's not just for me though. What I continue to find is that the more I talk about this, the more women say they've been through some measure of breast biopsy, lumpectomy, cancer, or other situation.

My cousin Cynthia explained that because mammography devices have become so sensitive, they are picking up much more than they used to and have increased the number of procedures exponentially. The good news is that if, God forbid, it does turn out to be the worst-case scenario, they will have caught it very early. At this point, my calcifications are tiny, only millimeters in size. And, early detection is the key to breast conservation and survival.

On that happy note, I'll close with one last thought. Self-examination is great, but you can't feel calcifications like mine. If you're like me, in your late 30s and think you might be too young for a mammogram, think again. Go get checked.

If you've been through this or anything similar, please leave a comment and let me know. I'd really like to hear your experiences.

Photo credit: Provena St. Mary's Hospital

Sunday, September 07, 2008

"Before" Photos of the Kitchen

From Before and After Photos of the Kitchen

The good news is that we're getting most of the kitchen re-done. The bad news is that the cabinets won't come in for another three weeks or so. In the meantime, I've taken a few "before" photos to remember how things have been for the last five years (with the exceptions of the stove, dishwasher, and kitchen island/bookshelf area).

The photo above shows the view of the kitchen walking in from the living room. You can see our (ehem) wonderful cabinets (gag), new stove, and old fridge. Our most-used appliances are there as well -- the toaster oven, which we use at least once a day; the microwave, which John uses more often than I do; and the rice cooker (on top of the fridge), which we probably use every other week.

From Before and After Photos of the Kitchen

This photo shows the sink and relatively new dishwasher. The sink also will be replaced with a larger, deeper model. Ours is only 7 inches deep, which leads to a lot of spill-overs when cleaning lots of dishes, deep pots, and cookie sheets. We will be glad to be rid of it. Freecyclers, keep your eyes open for it.

You can also see that we enjoy a half-wall between the kitchen and the tiny dining room. To the left is the doorway to the living room. On the empty wee wall between the living room and the kitchen is where the new spice cabinet will go. Can't tell you how much I'm looking forward to that! Right now, they eat up space sitting on a lazy Susan in the corner and in a drawer in the dining room.

Above the green dish drain, you can see the bag dryer that John made for me with his own two hands! I'm always impressed by his handiness. That comes in handy if you're like me and re-use ziplock bags.

From Before and After Photos of the Kitchen

This is how pitiful it is. I have to stack some of my favorite cooking items in a bookshelf in the dining room. Gotta love the slow-cooker! Some of John's fly-fishing stuff is on the bottom shelf because he has even less room for his items in the desk he made himself. He'll be getting lots more space when the new kitchen cabinets come!

What I really should have done was take photos of all the boxes in the garage and in storage of all the kitchen stuff I'm not using because we don't have room for it. I'm sure Mom would chime in that there are some boxes in her attic with my Grandmother's china in them as well.

From Before and After Photos of the Kitchen

Finally, here's the dining room, with the half-wall to the kitchen on the right. On the cabinet, I keep the AeroGarden (which is now growing delicious Italian herbs), snacks, and boxes of cereal and mac and cheese. Inside the Ikea cabinet is my pantry. I keep canned goods; jars of nut butters; bags of pastas, rices, and beans; John's favorite soups and snacks; baking ingredients that don't need refrigeration for long-term storage; spices; and teas.

To the left of the cabinet is a half-sized refrigerator that I used to use for all the Deb's Delectables ingredients that weren't chocolate. These days, it holds bags of flours, nuts, seeds, dried fruits, and other baking ingredients.

I'd like to have a full-sized extra fridge or freezer (especially an energy-star-rated one), but that will have to wait. Most likely for the second house.

Now that you've seen the before photos, you'll have to wait with me until next month for the afters. In the meantime, please show me your kitchen!

Monday, September 01, 2008

Garden Update: 1 September

Prior to my visit to Rutgers Gardens earlier this year for the plant sale, I wasn't a big fan of marigolds. However, this striped beauty changed my mind.

This year has been a year of changes for me in general -- try new things, reach out to new people, do things differently. For instance, I've never grown plants from seed outside before this year. Although most of the seeds didn't make it, thanks to the evil squirrels in my neighborhood, some really lovely seeds did. Take, for instance, these sweet peas. These ramblers have come up in lavender, bright purple, fuschia, red, and white. Because I had to move several plants due to our townhouse being painted, I now have sweet peas climbing up fencing that used to hold the clematis.

You can tell fall is on her way from all the buds on the mums in the front. These plants were hearty mums I'd picked up at the grocery store a few years ago for $3 a piece at the end of the season. They were scrawny characters, with little to show for them. A few years, lots of organic potting soil and water later, and these look more like shrubbery than the tiny end-of-season buys they were. Can't wait until they are in full bloom. The praying manti who live in our gardens love the mums.

I bought this specimen when our townhouse association told us that we couldn't have visible hose holders. So, I found a fern that was bigger than the hose caddy and kept it in front of the hose caddy until recently, when the powerwashers came to spray the house in preparation for the painting.

Here's another view of the fern.

During the painting, I'm sitting the fern in the garden -- most likely on top of some unfortunate forget-me-nots and columbines. They're pretty tough. I'm sure they'll recover when I move the fern next week. In the meantime, the coleus really enjoy the shade of the fern and the larger mums in the front of the bed closest to the house. It's been a while since those mums bloomed. So long, in fact, that I can't remember what colors they are!

Stay tuned. In a couple of weeks, all the mums should be wearing their fall finery. What's blooming in your garden now?