All's Well That Ends Well

{Spoiler alert... this does have a happy ending so don't freak out like I did!}  

Last week (now two weeks ago) was a crazy week (actually it was less than 24 hours but it felt a lot longer)!  I had another regular 6-month check-up scheduled with Dr. Bridges (my medical oncologist).  MSTI had called a while before the appointment to ask if I would mind seeing his nurse practitioner instead, as he needed to see some other patients currently undergoing treatment... of course this was fine with me so I saw the NP.  I'd actually seen her one other time when I was doing treatment and liked her.

Normally when I see Dr. Bridges he doesn't do a physical breast exam - I think because I am also still seeing Dr. Kuhn and she has been doing the exams - not sure how that will work when I don't see her anymore (which I think she said I wouldn't need to after this year).  I will continue to see Dr. Bridges because he manages my medication (the Tamoxifen that I get to take for 10 years... hey, only 8-1/2 more years now!).  Anyway, the first nurse asked me to change into a gown this time so I could have an exam.

The nurse practitioner came in (she was a little late because her patient before me was an older gentleman who was memory-impaired and there had been some confusion).  She did all the normal stuff... ask if I was having any problems or concerns, listen to my heart, etc. and then did the breast exam.  All was great until she said she felt a small lump... "at 3 o'clock, right below the midline" (this was on my same cancer breast but opposite side of where I had my lumpectomy.)  WHAT!!!

She put my finger on it and asked could I feel that... I said, "Oh my goodness, yes!"  And then she said, "Your finger isn't in the right spot."  To which I answered that it feels lumpy everywhere to me so I guess I don't know!

I managed to stay calm while she typed up her notes and put in the orders for me to by get a mammogram and ultrasound (and biopsy if necessary) at the breast center.  It seemed like it took forever for her to type everything but she finally finished, said goodbye and that I was doing great.  I wasn't so sure about that since she'd just told me she felt a lump... in my cancer boob!  My boob that has been radiated and had a lumpectomy with clean margins barely 2 years ago... not to mention the chemo that rocked my entire body and the Tamoxifen I take every day.  There should not be any lumps anywhere... this didn't seem to be great in any way.

I debated if I should go home and tell Juan immediately.  I had planned to run some errands and so I decided I should go ahead and do that first.  As I drove to Target I started to totally freak out.  I was crying and not just boo-hoo crying... more like full-on sobbing where the sounds coming out are barely human.  I considered pulling over into a parking lot because I was starting to lose control (not of my car, but possibly my sanity!).  I managed to pull myself back together.  I kept telling myself that I was sure it would be nothing.

I went into Target and I was kind of like a zombie.  I kept forgetting what I was looking for (shower curtain! towels!).  I made my way to the home/bathroom aisle and stood there barely able to process what I was trying to do.  It was a really weird feeling.  I managed to find the things I was looking for and make a decision about which items to buy.  I checked out and on to my next stop, Fred Meyer for some groceries.

Just as I was getting in line to check-out at Fred Meyer, St. Luke's Central Scheduling called my cell phone (they handle all the scheduling so I knew it was someone calling about the mammogram/ultrasound).  I got out of line to take the call.  It never fails that things get mixed up along the way... the scheduler was super nice but some of the information in the orders the nurse practitioner had sent over didn't make sense.  After putting me on hold a couple times, she said she needed to get some more clarification and could she call me back.  She was really sweet and worried they might not be able to see me if we didn't get it exactly right.  So of course I said that was fine.  I paid for my groceries and by the time I got to my car she was calling me back.

We got the appointment scheduled to do a mammogram of the right-side only followed by ultrasound, and lucky for me they had an opening the next day - Wednesday, February 8 - at 8 a.m. at the downtown location.  "I'll take it!" I told her.  The sooner the better.  My mind was already thinking if I had to have a biopsy maybe going in the morning would speed things up and get results before the weekend.

I went home and Juan was on a work call, so I put away the groceries and then, feeling exhausted (mental anguish must cause that) I curled up on the couch.  I remember back when I was diagnosed with cancer and then going through treatment I took a lot of naps and I think that is why.  When Juan got off his call and came out to say hi, of course he could tell something was wrong.  I started crying and told him what was going on.  I kept saying I was sure it would be fine, but how could I not freak out after what happened the last time?  I'm sure he was freaking out too but he was mostly quiet and listened to me.  I kept saying after all my treatment the chance of cancer returning was unlikely.  But it happens... I don't know the stats but I think it happens more than I would like to know.  I was stuck in this endless loop of this can't be happening... but wait, it can and it does and I am no more special than anyone else... but no, it can't happen to me!  And the practical side of me was thinking... ok, we're going to Hawaii in March so if I have to have surgery it's gonna have to be ASAP.  And then I thought about how terrible it would be to have to tell my kids I was sick again.  And then I told myself to stop worrying and thinking about those things because probably everything was going to be fine.

I didn't tell anyone else because (a) I didn't want to freak anyone out for no reason and (b) I don't think I could have even gotten the words out of my mouth.  Except I did tell my neighbor, because I also needed to tell someone who was a girl and she made me a cocktail and listened to my endless loop of thoughts which I appreciated more than she can know.

I'd decided that I would be fine going to the mammogram and ultrasound appointment by myself (Juan and Lynsey both offered to go with me).  I've had several mammograms and a breast MRI by myself now.  I decided even if they have to do a biopsy, I know what that's like too and having someone there isn't going to change the outcome either way.  Also, I knew they couldn't give me a definitive answer while I was there anyway.

I didn't sleep well (surprise).  At the breast center, I tried to relax while I waited for them to call my name.  There were a few other women there.  Everyone looked sad and/or nervous.  I don't think any of them were there for regular screening mammograms unfortunately.  Finally a tech named Katie called me back.  She was awesome.  I told her I was barely holding it together but would try (which I have to tell you, I did hold it together!).  After she took my films, she pulled them up to show me.

She's not a radiologist so of course couldn't officially tell me anything, but she showed me what they look for in the mammograms.  She pointed out all my dense tissue... which shows up as white on a mammogram.  That's why dense tissue is more difficult to analyze, because possible cancer also appears white.  I had a 3D mammogram this time and it was interesting to see how they analyze those films versus the 2D ones... scrolling through the 3D images and watching for things to "move" a certain way.  She pointed out several little bright white "V"-shaped things which are tiny clips inside me marking the lumpectomy site and also the site of my second biopsy (the one with no cancer).

She even pulled up my old films, including the initial ultrasound with the "inconclusive" black hole.  I said to her how I always wondered if the radiologist actually could tell it was cancer even before the biopsy.  She said, yes, they can (or could in this case at least) but that legally, they cannot give a diagnosis until there is a verified pathology report.  She pointed out how the edges of my tumor on the ultrasound film were not clearly defined, how when you looked close it was sort of sucking the other tissue in.  That's a bad thing.

I find all the medical technology pretty fascinating so it was really nice of her to take the extra time to explain things to me.  I think it helped me relax some, too.  Next I had to wait for a different tech to perform the ultrasound.  It is standard practice (to my knowledge and personal experience) that when there is a palpable lump they perform mammograms (at least 3 angles) followed by ultrasound.  Someone told me ultrasound isn't a good tool unless there is a palpable lump so they know where to look.  One thing I find interesting is no one at the breast center ever actually felt my breast with their fingers to locate the so-called lump.  I don't remember if they did that the other time.

A tech named Mary took me in a different room to do the ultrasound.  It was smaller than the room I'd had that done before but had the same pot lights (the ones that remind me of when I had the ultrasound to identify my ectopic pregnancy).  I laid there with a pillow-wedge under my back and my arm stretched above my head... my hand going cold and numb.  It seemed like it took a long time.  We chatted a little bit but I don't remember about what... my history I think.  Mostly it was quiet and I closed my eyes or looked at those lights.  After a while I kept stealing glimpses of Mary's face.  Would I see a look that was a clue to what she was seeing?  (I'm pretty sure she legally can't tell me anything either.)  Her face was pretty blank... they probably teach you that at ultrasound tech school.  Finally she finished up and said to just lie or sit there until she came back while Dr. White, the radiologist, reviewed the films.  That maybe the radiologist would come in to take some more pictures or talk to me, or maybe just she would come back.

After a bit Mary came back by herself and said the magical words, "Great news... Dr. White doesn't see anything concerning on your mammogram or ultrasound."  It was quite an amazing feeling.  Then there was some confusion about when I should have my next mammogram.  I was already scheduled for my regular 6-month mammogram in April and so the radiologist thought I was off schedule for my "2-year lumpectomy protocol."  I explained (not for the first time that day) that I was only there today, February 8, because of the nurse practitioner feeling a lump in my breast the day before.  After Mary clarified all this with Dr. White it was recommended that I cancel the April mammogram appointment and just come back in October (my next, and last of the 2-year protocol, mammogram).  She also said I should follow-up with my clinician.  (I wasn't really sure who that is... which doctor?)

It worked out well because I actually had my regular scheduled annual check-up with Dr. Fealko (my OB/GYN) on Monday, February 13.  I was interested to see what she would feel in my breast.  Katie, the mammo tech, had asked if the nurse practitioner who felt the lump had ever done a breast exam on me before.  When I said no, she mentioned sometimes when someone does an exam for the first time, especially post-radiation, they might be more likely to think something feels wrong compared to a doctor who has done exams before (not that they remember everything either).  Another thought I had was that although the nurse practitioner surely has given lots of breast exams, and even does them on a regular basis (truthfully, I have no idea) but I also know she must work with all kinds of cancer patients (like the memory-impaired gentleman before me).  She's certainly does not give as many as Dr. Fealko who probably performs multiple exams each day, or as Dr. Kuhn.

So I went to my appointment on the 13th with Fealko and told her about my crazy week.  She really is an awesome doctor... so easy to talk to, makes you feel comfortable, and 100% competent in everything she does.  We were chatting like normal when she first started my breast exam... then I showed her where (I thought) the nurse practitioner had felt something and she was very quiet and said she wanted to be very purposeful about my exam.  She palpated the area I pointed out... and checked and re-checked everywhere multiple times.

She said she couldn't feel anything that seemed out of the norm.  Another huge sigh of relief!  I had felt so much better after nothing showed on the films, but having Dr. Fealko also not be able to feel anything made me feel even more at ease.

So moral of the story... all's well that ends well, I suppose.  Unfortunately, it's probably not the last time I have to go through something like this.  Hopefully I only ever have to go through "this"... hopefully I never have to go through the other path it can take again.

I will say, even though that 20-some hour period last week was incredibly scary and stressful, I would much rather have a doctor (or NP) err on the side of caution.  I would much rather go through 20 hours (or more) of stress, only to find out nothing is wrong and I was worried for nothing, than have someone think they feel or see an abnormality and say, it's probably nothing, let's not worry about it.  No thanks!  I'll take a false-positive any day... I know from experience how much worse an actual-positive is, and there is absolutely no comparison.