today in san francisco

protest
today in san francisco

it’s getting harder and harder to relate the world to my left breast, though i did post another picture today. salam, whether real or not, appears to still be ok, and i’m glad, either way.

today in san francisco.

geoffrey

geoffrey

geoffrey swept in and sent a wonderful note. those people up in buffalo don’t know what they’d be missing.

writing with geoffrey gave me the chance to identify this sort of odd state after the biopsy and the results. i said before that i had a sort of uneasy feeling of liking all of this surgical attention. now the attention’s gone, for all the best, benign reasons, and i’m in a sort of dull, nether state, tending to wound management and incision healing in the reality that this all was, in fact, not a party. i still would not have preferred any other way aside from the certainty of surgical biopsy, but can this be a sort of ‘buyer’s remorse’? will my left breast heal to normal, ever be the same size again, or has it permantly suffered the casualty of attention? do i care?

waves

waves

today my bruises streak green down my breast. i’ve had a real heaviness under the medial incision in particular and have had more pain than yesterday, though i didn’t take any tylenol or darvocet today (yet…). we cancelled going to thorsten’s birthday party because i thought i should go home instead. was i right! halfway up my drive home on 280, i started feeling sick. once i was turning off on san jose, i was feeling pretty nauseous, which navigating dolores with its ups and downs didn’t help. but the curious thing happened — since i had to drive, i think i also managed circumnavigate getting sick. the saltwater taste in my mouth passed, and then i felt like i was going to make it home and parked and up the stairs, which i did.

so therefore … i’m on the lookout for infection. susan love says if infection occurs, it’s usually one or two weeks after the surgery. my surgery was exactly a week ago. (she also says it’s more a nuisance than anything, and just takes a little antibiotics to clear up, if it occurs). nausea is only one sign, though, and it sounds like i’d have to be red and swollen and feverish too, which i’m not.

we’ll see how i feel tomorrow. perhaps i’m feeling just tired. perhaps i’m sick because of the pain (but the pain doesn’t seem that extreme). perhaps my body is rallying to fight an infection. or maybe it was something i ate! at any rate, dr grissom gave us explicit instructions about how to reach her or her staff, 24 hours a day, so we know what to do.

metric conversions

metric conversions for us americans!

the medial breast mass (top right area of breast) is 4 x 3 x 1.5 cm and weighs 12.5 gm. that’s about the size of a truffle from maison du chocolat — 1.5 x 1.2 x .5 inches and weighing in at half of an ounce.

the lateral breast mass (lower left area of breast) is 7 x 5 x 2.5 cm and weighs 47.6 gm. that’s about the size of a small bar of soap from l’occitane en provence (though not as heavy) — approximately 3 x 2 x 1 inches — and weighs 0.10 pounds (or a bit less than 2 ounces).

so send soap and dark chocolate truffles to moya!

pathology

pathology

a quite fascinating if brief “surgical pathology report” arrived in the mail today. it is just over one page long, and i quote:

CLINICAL HISTORY:
     Calcifications left breast
     Postop Diagnosis:  Same
     Operative Procedure:  Left Lu Bx with NL

TISSUES:
     1.  Breast Biopsy after Needle Localization Mass - medial
     2.  Breast Biopsy after Needle Localization - lateral mass
___________________________________________________ 

FINAL MICROSCOPIC DIAGNOSIS:

     Breast, left medial, needle localization biopsy
       -- benign breast tissue.
       -- calcifications identified within benign ducts 
          (slides G and H).

     Breast, left lateral, needle localization biopsy
       -- fibrocystic changes with focal ductal proliferation.
       -- calcifications identified within benign ducts 
          (slides K through N).

     Comment:  There is no atypia or carcinoma in either 
          biopsy sample.

___________________________________________________ 

ORC:  2 specimins received #1 -- medial area.  #2 -- lateral.  X-rayed.  
Clusters of calcifications identified in each fragment.  Surgeon notified.  
H. Kamal, MD

GROSS DESCRIPTION
     The specimen is received in two parts.

     Part 1 is received fresh from the Operating Room, is labeled "medial" 
     and consists of a 4 x 3 x 1-1/2 cm portion of fibrofatty tissue weighing 
     12.5 gm.  The specimen is unoriented.  It is inked entirely in black ink.  
     The specimen is serially sectioned and submitted entirely in 
     cassettes A through J.

     Part 2 labeled "lateral breast mass" is received fresh from the 
     Operating Room and it consists of a portion of fibrofatty breast tissue 
     measuring 7 x 5 x 2-1/2 cm and weighing 47.6 gm.  The specimen is 
     unoriented and it is entirely inked in black ink.  The specimen is 
     serially sectioned and laid out on paper.  The cut surfaces do not reveal 
     a distinct mass.  The slices are x-rayed.  The x-ray shows calcifications 
     in slices 1 through 4.  Representative sections are submitted in 
     cassettes K through W as diagrammed on the x-ray.  Cassettes K through 
     O contain areas of calcification.  Approximately 60 to 70% of the specimen 
     is submitted for microscopic evaluation.

and that’s it!

my initial thought on reading this was how well susan love describes this report, what it should contain, and what questions you should ask about it, in her breast book pp. 161-164.

my immediate thought thereafter (besides once again the relief at the “no atypia”) was: holy cow! 7 x 5 x 2.5 cm?? why that’s as big as … and then we went off to hunt for a centimeter ruler and could not locate one; in fact, we can’t find any ruler. but that sounds like a huge hunk-o-change to me.

leanne seemed more impressed that i collectively lost 60.1 grams (and no dieting!). we were just beforehand looking at my breasts and noticing the left breast seeming much higher. typically one of my breasts was slightly higher than the other, but i wonder.

there’s the part about definitely seeing the calcifications themselves on the slides they biopsied – which is good.

then, there’s the somewhat thrilling “gross description”.

and finally, there’s the matter of “fibrocystic changes”. as the report points out, neither sample showed any ‘atypia’, which is what susan love says is a good thing. but “fibrocystic changes” still — extra cells lining the ducts… how does it get there? what’s this all really about?

though i am curious about what it means to be “unoriented”, and i wonder why the difference between the lateral and medial pathology, i think i’ve asked all i know to ask and am at rest with the procedure and the results. but i’ll be on the lookout for more information as time goes on, that’s for certain.