tomorrow

tomorrow

it’s all set – i pre-registered by phone (with ‘winnie’) on tuesday. i just got off the phone with ‘mitzi’, the surgical nurse, this morning. mitzi had a battery of health questions for me, covering seemingly any conceivable disease or disorder: “any heart disease, any glaucoma, any diabetes…how much do you weigh?” my favorite: “any female problems?”. does fighting with my girlfriend count? no actually – leanne is quite my guardian angel in this, and has gifted and project-managed me quite well. all that’s left for me is to show up.

  1. 10:30 am: show up at 3698 california
  2. register and dole out insurance card at the desk downstairs
  3. get sent to the third floor
  4. wait
  5. 11:30 am: needle-localization. get mammogrammed and get needles inserted for dr grissom to target (eve said they look like guitar strings…)
  6. wait some more
  7. at some point, get administered monitored anesthesia
  8. 1:30 pm: surgery with dr grissom
  9. 2 or 2:30 or so: get rolled all woozy in a wheelchair to leanne, mom, and dad who then prop me up, take me home, and carry me up three flights of stairs!
  10. afterwards:
    • start with clear liquids, crackers, or toast if you
      are nauseated- but i’m already craving a burrito just
      thinking about starving myself overnight
    • darvocet is the most commonly prescribed medication
    • you can expect some bruising and swelling around
      your incision and sometimes involving distant parts of the breast
      or chest – use an ice pack on and off
    • the outer gauze dressing may be removed 24-48 hours
      after biopsy. leave on the steristrip (small white tape strip) in
      place for 7-10 days; it may be removed then or left to fall off
    • occasionally patients are wrapped with an ace wrap to
      help decrease bruising and swelling – this may be removed after
      24-48 hours
    • after the (outer) dressing is removed, you may shower
      and get the incision wet, but don’t get in a tub for 10 days
    • pathology reports should be ready by next tuesday –
      friday at the latest

and that does it. everyone is saying ‘keep calm’, or ‘the anesthesia is the worst’, or ‘the waiting is hardest’; perhaps because i’ve never gone through it, i don’t have any anticipatory dread, and i’m feeling just fine. the whole thing seems like it should be a big medical experiment for me. i might as well remain naive as long as i can. besides, i rode my bike to work today and onto the train, so i feel a bit like i’ve gone on a trip to a foreign country.

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suggestions for the weekend (thank you, abbe!)

suggestions for the weekend (thank you, abbe!)

  • buy crushed ice (it molds better to shape of breast for icing painful spots) and ziplock bags
  • wear a loose button-up shirt on friday — easier to put on after surgery
  • sometimes the nurses/doctors/etc will give information about “most patients” which might not apply for women with large breasts so ask if there are things to keep in mind for large breasts (such as stitches stretching from weight)
  • nurses/doctors might urge you to leave earlier than you feel ready, but you don’t have to leave if feeling dizzy or nauseous from the anesthesia — suggest … sticking around in the hospital bed til you feel well enough to walk up all those stairs to get home
  • take the wheelchair!” says abbe
  • if incision is under breast and weight of breast makes it ache, it might help to hold arm folded under breast to support it
  • might have bruises from the surgery — could ask if might be bruising
  • and notes for leanne … … respect, suggest, don’t tell or demand, and procure chocolates and cheese. yum.

voicemail from dr grissom

voicemail from dr grissom

my biopsy is in exactly a week, and i called and left several questions for dr grissom today on her voicemail. she called just a little bit later with all the answers i asked for — it’s all on voicemail:

  • i gave you the DCIS chapter because you never know -- there's that 10% chance that it could be, and i always think it's good to be prepared, and then it won't happen!
  • the calcifications very rarely disappear -- i've never seen them disappear actually, although it's talked about in literature
  • biopsy should not affect your mammogram in the future. sometimes you'll have a little scar tissue for awhile, but it goes away, and they can pretty well see everything again
  • you don't really need to prepare your skin
  • sports bra is pretty good, but get one that's a little loose. if possible, something that fastens in the front is easier, and just gives you a little support
  • i don't know exactly where there going to put the needles until they get there and they get it in, so i don't know where i'll put the incision exactly until we get there
  • i will call you with the results and you can tell me on the day of surgery how to get a hold of you. usually you get them in two working days, so if you're having it on friday, usually you get it on the tuesday afterwards; although pathology has been very slow -- i've had some results not come out till friday this week
  • on the day of biopsy, you're there for about four hours and you're sitting around probably for about three, so bring a book - both of you!

(yes, i left off the question about the sushi and the tissue bank – and the cancer and the breastfeeding, feeling both a little premature!).

then, dr. grissom said she’d talk to me next week and if there was any problem or more questions till then just to let her know. it’s really great to have such a responsive surgeon. leaving that list of messages on her voicemail i felt a bit silly and sheepish, but her message, which addressed all the questions, made me feel not foolish at all. that’s awesome.

i saw a little note by leanne’s side of the bed this morning to get little bendy straws for me — “so that i can get my liquids”! it’s a little odd to be expected to be an invalid!

it’s been the most decorated valentine’s day i can remember. we received valentines from everyone from my parents to delancy street movers! die familie enders sent along a lovey hand-made valentine. and leanne– leanne got me the spicy dark chocolates i craved from donnelly in santa cruz. in fact, she requested them from richard directly! jane siberry wrote with global wishes of healing and light; then there was the 50th anniversary gala for del and phyllis last night – a sweet movie and a drink afterwards with sylvia and karin. all-in-all, a great week, even if leanne and eve were looking at me as if i’m about to be devastated. i feel we’re in great hands; the world itself should be so lucky — but is left this week to rely upon duct tape and plastic.

leanne just walked in with a package decorated in glitter that says: “healing beauty for moya’s left breast”!!!

questions for dr grissom

questions for dr grissom

  • why did you recommend me to read susan love’s chaper on DCIS — are you thinking there’s more of a chance i’ll have it?
  • do calcifications, if benign, ever disappear, or are they permanent?
  • how does the biopsy affect future mammograms? does it itself leave calcifications? how many additional biopsies can i look forward to in the future – how can i tell when to need to biopsy any calcification that remains?
  • what affect does having a biopsy have on breastfeeding?
  • what can i do in advance to prepare my skin?
    • is it true if you coat your skin all week in advance with olive oil the scars will be minimized?
  • where are my scars going to be?
  • what bras do you recommend as most comfortable while the incisions heal
  • how will you contact me with the results? cell?
  • how is the biopsy day scheduled? (how much idle time can i expect to wait, and when)
  • thanks to komen.org, “If cancer is found, who will tell me the results and discuss treatment options? How soon do I need to make a decision on treatment choice? Where can I get more information?”
  • what happens to the tissue you remove?
    • after you are finished with cloning me, can you save the leftovers in a tissue bank?

susan love says they’re trying to encourage the use of tissue banks for future research on my own little tissues. eve says they look like sushi. mmm.

of course, since it is five a.m., i had just awoken from a dream. in it, several people i know are suddenly getting mammograms and biopsies. in my dream, though, i knew i was somehow ‘special’ amongst them – and there it is, my fear of cancer. so all the questions stack up from my ‘bedtime reading’ – a mere five hours ago – of dr susan love’s tome, and i must excise them and biopsy them themselves before i can safely return to sleep.

obviously, i need different bedtime reading.

lisa

lisa

and lisa wrote to leanne with some good information:

... So sorry to hear of Moya's up coming surgery. It is horrifying
and depressing no matter what your odds are going in. I actually had 2
surgerys. The first in April 1999, then had the same open surgery on
the other breast in April 2001. The first time there was just one "fibro
adenoma" ( benign fibrous tumor) removed the second they removed 5. Of
course they did not know that they were fibro adenomoas until the
pathology came back. I had a great  breast surgeon as well, one of the
top in the field. The surgeries went great. They used conscious
sedation instead of general anesthetic, which means a quicker recovery as you
are not as deeply sedated. The pain was very minimal for me, only took a
couple of vicodin with the second surgery. With the first I tried to
take ibuprofen, which is my pain reliever of choice. But oops, also a blood
thinner, so needless to say I panicked when I began gushing blood from
my dressing. I also had a really hard time healing. Throughout both
procedures we found out the hard way that I am allergic to every type
of suture material. So my breasts kept filling up with blood and fluid,
then it would force the stitches out of my breast. I had to go in every
couple of days for 2 weeks after both surgeries to have fluid drained off with
a needle. Dr. Johnson and her collegues were very impressed with the way
my body was just spitting out the sutures. They were supposed to
dissolve, but no way. My scars are not noticable, she made the incision just
along the aereola, so scarring was not an issue, I just used vitamin e oil
for a month or so after I finally healed. The hospital will give her an
ice bag. Just remember that ice to any area of the body for over 30
minutes at a time can cause rebound swelling = pain. So break from the ice
every 30 minutes or so.


I am sure that Moya will get through this fine, but probably not without preceeded anxiety and fear. I am certain that you will pamper her throughout her recovery. The waiting for the results of mammograms, ultrasounds and pathology was much harder on me than the surgery itself. I will be thinking of her in the next couple of weeks and will be sending thoughts of benign results her way...

note for leanne:


"I am certain that you will pamper her
throughout her recovery." 

ted

ted

ted sent some sweet words last week:

I heard from your woman about the surgery. I know two (2) women down 
here who have had similar procedures with very little fuss or muss, so I 
hope you are not troubling your pretty little head about it too much. 
Magnificent breasts such as yours require periodic maintenance, like a 
powerful yet temperamental Jaguar coupe, it is all to be expected.

is there any doubt his book will be a great success?

dr. nima grissom

dr. nima grissom

i went to see the breast surgeon today. it’s great to have the first appointment of the day, when you don’t have to wait and you feel you’re the only one your doctor needs to deal with at all. for nima grissom, that is certainly not the case. she must be one of the busiest surgeons in the world; she must see tons of breasts every day. maybe literally! i understand she is a “diplomate”. i wonder what it’s like to be a breast diplomate.

leanne came with me; we were whisked almost immediately into the exam room by the receptionist who wore surgical gloves (i tried not to let that make me feel infected). for fashion, dr grissom’s office gives you little short halter-top smocks, open in the front of course. i looked like a cross between some bad britney wannabe and a football player. i asked leanne to take notes, and said immediately that i wanted the fashion commentary in the logs.

dr grissom arrived right away and was noticeably better dressed. there was no surgical gown or white smock. there was a comforting thick navy cardigan. it was cold. i was hot. she was direct and yet attentive. i had a quick lie-down on the table, quick breast exam, then i got to say goodbye to the halter top and get back into italian polyester as she addressed what to do about my left breast.

to the point: my calcifications are very small, and she recommended “stereotactic needle-localized biopsy”. here are some of leanne’s notes – in their fairly raw form – about what dr grissom said:

  • calcifications are quite common: 20% of all women
  • of those 20%, 10% are malignant but not necessarily invasive (DCIS)
  • my calcifications are too faint to biopsy with the ‘computer version’ of biopsy
  • stereotactic, open surgical biopsy:
    • do in xray
    • under sedation
    • pinpoint and remove in strips with needle
    • is most accurate
    • normal duct doesn’t have dead cells in center
    • take out piece of tissue to look at
    • littlest chance to miss
    • can’t see or feel – rely on needle placement from xray
    • an xray after will immediately check what was removed to make sure it has the calcifications in it
    • the majority are benign
    • a mammogram thereafter in 1 year might still have calcifications – not a big deal
    • just a little sedation, not general anaesthesia

it strikes me today that i felt like i received a lot of information, in a short time, while feeling listened-to at the same time. that’s an excellent quality: to pay attention while talking. dr grissom expained things in a very attentive way, looking directly at me, being clear and level but with a good sense of humor in spite of my interruptions with awkward jokes. obviously quite experienced yet accessible, happy to answer questions and to plow through my pile of research from the Internet, even writing notes for me on my papers. i hauled out my chart from imaginis.com – link quoted in below entry. she explained that this was the same as the “open surgical biopsy” last on the list at that link. that link definitely does not put this procedure in a good light, yet dr. grissom scoffed at the “golf ball” sized description and “two-inch” incisions. it takes me aback slightly that there will be two incisions (one for each area of calcification), and that there will be about a half-inch “permanent scar” for each, yet contrary to the imaginis document, it will not make future mammograms difficult to read, says she. dr grissom also assured me that there will not be any divets left in my breasts. in additon, she went over the reasons for making incisions as close to the sites as possible. it’s clear she’s done this kind of thing before…

the thing to rule out is this DCIS. ductal carcinoma ‘in situ’. it again makes me feel special to speak latin. i understand that the ‘in situ’ – if that is the case – is the important part about it. the upside is the highest rate of certainty in the results. the additional if ironic upside for me is the sedation. i think it’s better i do these sorts of things under sedation. i tend to faint at the sight of any needle, so i might as well be sleepy already and lying down. i’m only concerned what sorts of babbling i might do under sedation. i hear it can be quite embarassing…

dr. mulder says it’s not surprising dr grissom opted for the needle localization since she’s known for getting quite “to the point” as soon as possible about biopsy. she’s glad dr grissom opted for that course of action. the results will be the most conclusive and convincing.

the date is set for friday, february 21. in advance, dr grissom recommended, like nearly everybody else i’ve ever met to speak about breasts, dr. susan love’s breast book. she says i should read the part about calcifications and DCIS, and skip the others, and she doesn’t even know i’m a hypochondriac. i have lots to learn and understand in the next two weeks. perhaps most understandably, dr grissom’s day is nearly empty next friday, on february 14th — i suppose it’s not everybody’s idea of a good valentine’s date. i would have just as soon done it then, but this sort of biopsy is meant to be no rush, and i have myself booked in the “bw reporting and analysis” class all week next week anyway. i know, i’m the envy of my block with that one.

on the way out, a peculiar lite-rock version of “freebird” was playing on the office radio. as leanne left, she was weeping in advance for the scars in my breasts. i hadn’t really considered that yet. from what i understand, this is the best way to be 100% certain and early, which is the best way to preserve my breasts and me entirely, so i hope she loves them just the same! when i got home from work tonight, dr susan love’s breast book was waiting on the couch.