what's it like to have needle localization and surgical biopsy?
leanne's observations

Starting at 10am on Friday, February 21, just before we left to go to the hospital, our dear friend Michael Hackett arrived bearing tulips and chocolates and music and movies (Foxes starring young Jodie Foster and Bar Girls, which is just the distraction needed when healing from surgery!).

We arrived at CPMC at 10:30am and parked in the parking garage which had an entrance right to Floor 2 where the breast center is (maybe this is too many details? I took copious notes!)

registration
Moya registered on the 1st floor then went to the 3rd floor where she was assigned to room 384 and promptly instructed to strip and clothe herself in a flimsy gown and sock-slippers with non-slip bottoms. We take pictures of Moya in said flimsy gown (perhaps we'll post a photo album later!) and Moya inquires, "how's my hair?" (it's gorgeous). She wore one of her new sports bras to the hospital -- it doesn't fit super well. We have had a difficult time finding sports bras to fit Moya since she has a small chest size and a large cup size. Almost all sports bras for "larger-breasted women" only go up to cup size DD or DDD ... or they expect you to have a large chest if you have large breasts. There's a market space that is practically empty -- sports bras for sizes like 34FF.

waiting
We were sitting and waiting for further instruction when Ali called to see how we were doing. Ali, the rock star gal that she is, was in Houston on her way to Belize for scuba diving and will be in San Francisco briefly on Thursday and Friday. We miss Ali (she moved to NYC a couple years ago and lives in Brooklyn now with her sweetie Elise). While on the phone with Ali, a nurse arrived at 11am and accidentally whacked me on the head with her clipboard -- turns out I was sitting too close to the curtain ("closed door" says the nurse). Oy!

IV trouble
Moya's blood pressure was taken (104/78 - "perfect" says the nurse). Nurse goes away to get something and Moya takes a look at her chart (whoops, we learn later after being chastened that we aren't supposed to read her chart -- liability and all). Nurse starts the process of inserting IV needle and Moya's calm and doesn't feel the needle but starts getting lightheaded. So she lies down. She gets clammy and the nurse wraps her up in blankets and fetches some valium and says "You're diaphoretic" -- that's our new word for the day. Moya looks really miserable -- having gone into a bit of shock from the needle. Nurse removes that IV (from Moya's left hand) since it didn't get in a vein, and tries to put an IV in the other hand. She can't find a vein, the needle is just under Moya's skin, her skin bubbles up as the fluids from the IV bag go in. Nurse removes it and says she'll let the anesthesiologist get the IV needle in. Now Moya has bandages on both hands and a swollen area around one of the bandages (that finally went away by the next day).

bad bedside manner nearby (not for us!)
The woman sharing the room is being yelled at by her doctor because she didn't stop drinking water at the right time. The doctor is reasonably upset that she didn't follow the pre-surgery rules but his attitude and behavior are lousy. I'm glad he's not Moya's doctor.

the worst is almost over
By this time I'm feeling a bit helpless -- Moya's been in shock, stuck unsuccessfully in both hands with needles, had some valium, and she hasn't even had the needle localization yet!

That was the worst part -- it all gets better from here.

off to needle localization
11:30am arrives with Sofia the CRT who talks with us about what will happen during the needle localization and says they'll do the lateral "easy" needle first (underneath and to the left of the nipple) and see how Moya does and then do the more difficult medial needle. I inquire about whether or not Moya wants to listen to music on my MP3 player (no, she doesn't, she wants to be alert!) and Sofia looks at me quizzically -- I explain "MP3 player."

Sofia thinks she knows Moya but isn't sure where they've met before (I love San Francisco). She explains that the 2 spots are far apart (where the calcifications are) and that she'll take mammogram pictures and there will be a hole that Sofia will mark and then the doctor will put some Novocain there and insert the needle, some blue dye and the wire. We ask if I can come along and Sofia says of course. Wow! I've never seen a mammogram before and didn't realize they'd let me be in the room while they did the mammograms and inserted the needles. I think it gave Moya some extra comfort and distraction.

Take the wheelchair! I recommend to Moya. Sofia brings a wheelchair and Moya wraps herself up in blankets and curls up in the chair. We go from the same-day surgery area on floor 3 to the breast health center on floor 2.

mammogram, needles, mammogram, repeat
By now it's Noon and we're in a mammogram room with a chair for Moya to sit in facing a window that looks out on California St. Not a fantastic view but better than a view of an alley or another building. And the fresh air from the open window feels good.

Nadine, the director of the breast health center checks in to see how Moya is and introduces a volunteer who is there to hang out and keep us company and help Moya from fainting from the needles. Dr Susan Denny comes in to say hi and "I'm the one who got you into this mess" (she read Moya's last mammogram and recommended biopsy). We adore Dr Denny.

So it's a needle localization party -- Sofia, volunteer, Nadine, Dr Denny, Moya, me, and, later, Aida!

The volunteer holds some ice on Moya's forehead and neck. Moya looks out the window. They take mammograms, develop them, examine, mark Moya's breast with a blue pen, and Moya sits calmly with her breast smashed in the machine. She says it doesn't hurt ( the volunteer says it really hurts but she has small breasts so what does she know about Moya's experience anyways).

I'm fascinated and I'm so glad Moya's not bothered by the needles going into her breast. Dr Denny puts in the first needle (lateral) and then they mammogram to see if the needle is in the right place. Then she inserts blue dye and the wire. Then they all talk about how to get the medial needle in -- since the spot is above and to the right of Moya's left breast, it's hard to mammography (is that a verb?)

A little clear plastic cup is taped over the lateral needle and wire to protect it while they wedge Moya's breast into another position to put in the medial needle.

is that really my breast?
There's a lot of "wait, don't move, relax" while Moya's breast is wedged in between a plastic piece (with a rectangular hole in it) and a sheet of metal. It's something like mammogram, mark, needle, mammogram, do over.

We took a lot of pictures of the mammograms (Moya says she didn't realize her breasts were so large before she saw them in photos!) and the needles and wires because we didn't know what a needle localization would look like before this happened ... so we'll post the pictures sometime soon with warnings on the links about what they are.

no time for waiting
By 1:05pm I'm caffeine-deprived and hungry and hadn't realized we'd been at the hospital for 2 1/2 hours because it's so incredibly neat that they let me watch the mammogramming and needle poking.

By 1:30pm both needles are in and it's time for surgery. We'd been warned by the doctors and by friends that there would be a lot of waiting around. So I packed a carryon bag for the flight. Oh, well, it felt like I'd packed for a flight (lots of waiting). I had MP3 player with fabulous playlist queued up, 3 magazines (literary, semi-trashy, very trashy), a book of short stories, and my treo gadget with web access and games in case I was really feeling antsy. But, as you can tell, we were busy busy busy from 10:30am til 1:30pm with needles and shock and more needles and mammograms and more needles!

off to surgery
Jerry had a bed for Moya and he pushed her into the elevator and brought her down to surgery on Floor 1. I followed her down and kissed her goodbye before she went through the double doors. She still didn't have an IV -- turns out that the anesthesiologist got it in on the first try with no trouble. I was feeling so bad for her that she had been poked so many times already.

1:45pm: Up to floor 3 to the same-day surgery waiting room where I found her parents (Norma and Richard) and rediscovered my hunger and caffeine deprivation. We whisked ourselves up the street to Peets Coffee and flowers at Bryants and then to A.G. Ferrari for a sandwich and Pelligrino and back to the waiting room to wait for Moya to come back from the O.R.

2:35pm: Dr Nima Grissom (Moya's surgeon) called to report that everything went fine, the tissue removed was x-rayed to confirm it was calcifications and ... "just in case Moya doesn't remember, I told her that pathology's running a bit late so I'll call on Tuesday to let her know if the results are or aren't available" -- what a fabulous doctor!

moya's rockstar recovery (and amnesia)
By 2:45pm Moya was sailing by the waiting area with her thumbs-up in the air looking as though she'd just had a facial and a massage instead of a biopsy. We followed her into her room where she teased the guy who was pushing the bed and asked for a back massage. She was very chatty but she's already forgotten being pushed in the bed and getting out and into the chair. She started dictating to me as follows ... she wanted to remember everything:

• after being wheeled through the double-doors to surgery, she was rolled into a sort of holding-area room. a pretty plain room.
• someone named Pilar in a red, white and blue cap came in
• she was given a little blue 'shower-cap'-like hat to wear
• the anesthesiologist, Dr Michael McGehee, arrived and met with her on any potential health issues ("do you smoke? anything?")
• dr grissom was there briefly as well
• she was wheeled into surgery, where she was a little surprised that she had to get up and get onto the surgical table all on her own (once they wheel you around, you can actually get up and move?)
• the surgical table was narrow and otherwise not unlike a massage table - she might have asked if she was getting a massage again
• two huge silver circles hung over her - the lights
• dr grissom was there and asked if she got her phone message. moya thinks she tried to say something entertaining.
• moya gave her the cellphone number to call with pathology results.
• dr mcgeehee had no trouble inserting the IV -- pop, and it was in
• a clip went onto her right index finger, to monitor her oxygen
• dr mcgeehee explained all about the automated blood pressure thing as he put it on
• he also put an oxygen thing at her nose -- a plastic tube that wrapped under her nose, with two little pipes into the nostrils. pleasant air came through it.
• two other people were fussing around on the edges and moya tried to meet them and get their names, but they seemed busy
• her left arm was spread-eagled onto the left-arm-platform
• moya looked at the clock - 1:45
• having successfully established the IV, dr mcgeehee dripped something into it, then told her there was "a little versed going in" and she felt coldness going up her arm
• she remembers dr mcgeehee saying something like 'it's actually not cold - it's room temperature. it just feels cold because your body temperature is warmer' -- or maybe she made that up. that's the last she remembers.
• dr mcgeehee said 'moya you can wake up' - and apparently he had shaken her to wake her up.
• she looked at the clock; it was 2:30
• they wheeled outside the surgery room, and dr mcgeehee talked to her for a little bit. all she remembers is that he said "you might not remember this conversation."
• she didn't realize there was an elevator ride and doesn't remember it (surgery on 1, recovery on 3)
• she was very pleased to see juice and water and crackers in her room but she really wants to eat sushi.
• she said she had the best sleep ever and felt refreshed when she woke up!

instructions instructions instructions
The nurse (Blossom) says she'll get Moya a prescription for Darvocet -- that it probably won't hurt like the dickens but it will be sore and then she gave me some instructions for Moya since "Moya probably won't remember this later if I tell her" (the M.A.C. has an amnesiac side effect):

• no pushups or sit-ups or strenuous exercise for 2 weeks
• the steristrips on the incisions (under the dressing) need to stay on for 10 days.
• no showers or baths for 2 days after surgery
• on Sunday (after 2 days), take off dressing and leave the steri-strip tape across the incision. Soap up hands and clean/rinse over the steri-strips but don't shower directly on the incisions (it'll hurt). Pat dry and leave steristrips as they are -- exposed to air -- to help scab and heal.
• after 10 days, peel off the steri-strips in the shower -- get them really really wet and then peel off. Don't peel off dry because skin/scab will peel off (ew!)
• if it feels uncomfortable (now) take Darvocet -- don't wait until it's really painful because the Darvocet will take 1/2 hour to kick in
• call Dr Grissom next week to make followup appointment for 10 days after surgery
• wear bra for support -- it's better not to let breast move around -- keep it supported

Around 3:45pm we all left to bring Moya home -- she went with her parents and I went to Walgreens to pick up her pain medication.

back home!
Moya's an excellent patient and she's healing super well. She's also taking the pain meds every 4 hours so she doesn't feel any pain (preventative medicine!) and she's very disciplined with icing the incisions every 1/2 hour. I've been cooking up roasted squash and garlic, sauteed mushrooms in wine and butter, and smoky eggplant ‘bharta' (indian dish).

She's sleeping okay though it's hard to find the right position to lie in to avoid putting pressure on the incisions. I woke up every few hours to look at her and make sure she was okay. Given all of the prep talks we had with doctors and friends about possible pain and discomfort, she's doing extremely well.

good friends and shopping and food
We have a stack of rented movies and kitchen full of food and an amazing amount of support and help offered from friends. Wow!

We went out for brunch this morning with Moya's parents and then to Dema and Home Remedies in the Mission for browsing before Moya got tired and we went home for a nap.

Sylvia and Karin brought vegetarian borscht (which I ate and liked even though I don't generally like beets!) and we shared it with David and Kathy who dropped by for the evening.

And tomorrow maybe a little walk around the neighborhood or Crissy Field and plenty of lounging about and napping.

more later ...
We'll have pathology results sometime during the week and will send out an update. Thanks for all the good wishes!

boob job is done!

it went great. more later. moya's at home being as charming and witty as ever.

biopsy day

someone left a book on caltrain #81 yesterday. it was women who think too much.

so much of what i do and live around involves food. i'm not even hungry yet i'm lost without the ritual of food. what do i do for the next hour and a half before we leave for surgery? and if we arrive early, what do we do instead of going for coffee at peets?

leanne bought $130 of groceries, and wrote a menu for me for my recovery, which includes that onion soup with the buckwheat crepes i like so much. there is also a list of no less than nine rented movies.

it's a clear, sunny day; wanda's sitting in the sun and through the windows it looks like spring.

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.

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.

two days

i am wondering what it will be like in the women's bath with scars. then again, i chopped off the tip of my thumb slicing okra for dan's indian food extravaganza last night, and i'm not too concerned about that ...

tea

leanne sends us to provence for my biopsy, and caterina sends tea!

leanne's dream log

mountainous ski lodge with biopsies instead of skiing

last night i dreamt that moya and i were driving up a mountain to get to the place where she'd have her breast biopsy. the road was narrow with tight curves, for some reason i thought it was a mysterious road, and a cliff went straight up on the right and straight down on the left (much like driving north on hwy 1, i suppose). it was a bright and sunny day with white puffy marshmellow clouds. the road ended in a trailhead and we got out of the car and hiked up the trail. there was a large victorian building at the end of the trail that i instantly recognized as a ski lodge (i love the parts in dreams where i just k-n-o-w). but there was no skiing at the "ski lodge" and no snow. instead, there was big view and a receptionist who took moya's health insurance and doctor and surgeon information for her biopsy and sent us off to the lounge. the waiting room had big comfy soft chairs and a bar -- which was tended by christy shepard. i procured martinis for me and moya and we sat in the big comfy chairs and looked out at the view across mountains and valleys and waited. i was confused about where i was (what country, where on the map, that sort of confusion) and the view from the puffy chair made me wonder if we were in provence.

then spike was scratching at the window and opening the curtain -- letting in 8am sunlight -- and i woke up.

a bit o' background for help in interpreting (!)
. . . christy shepard provided fantastic couples therapy services for me and moya in the late 1990's
. . . we were talking about france at the anti-war march on sunday
. . . we've been talking about going on a hike thursday evening before moya's friday event
. . . dr susan love's breast book talks about outpatient surgery as being a bit like going to a spa
. . . i love puffy fluffy clouds -- ricky lee jones and the orb sing a song about little fluffy clouds that moya put on a mixed tape for me in the late 1990's

whew!

word of the day

i am happy with merriam webster's word of the day:

hale \HAIL\ (adjective) 



: free from defect, disease, or infirmity : sound; 
also : retaining exceptional health and vigor 



Did you know?
When you need a word to describe someone or something in good 
health, you might pick "hale" or a synonym such as "healthy," "sound," 
or "robust." Of those terms, "healthy" is the most general, implying full 
strength and vigor or simply freedom from signs of disease. "Sound" 
generally emphasizes the complete absence of defects of mind or body. 
"Robust" implies the opposite of all that is delicate or sickly and usually 
suggests muscular strength as well as the ability to work or play long 
and hard. "Hale" applies especially to robustness in later life. The phrase 
"hale and hearty" is often used to describe an older person who retains 
the physical qualities of youth.

white amber and bras

janice wrote more about the white amber piece i get to carry in my pocket to surgery:

it is believed to have more medicinal powers than the clear types and 
also to have more magical properties.  I tell people that the reason I am 
so healthy is that I am around so much amber so much of the time!  
Anyway, it is believed in "amberland" to have great healing powers 
and the people of the Baltic use it in various ways (I even have some 
lotion), mix it with tea to drink, burn it as incense, etc.  Have heard 
some even more far-fetched uses.  (remind me to tell you sometime).

pretty interesting. yesterday, leanne and i got me fixed up with some sports bras from the sports basement, which should be less painful on the cuts in my breast after surgery. now... the reason i haven't been fixed up already with sports bras is not so much that i don't jog, although i don't, but because i've never found one to contain me. we found a couple xl's (maddeningly scarce), and they seem to work ok, didn't need to choke me while wrestling over my head and shoulders, and don't feel like rubber bands around my body. the lovely glitter-adorned package on friday night contained a special lacy bra from the lovely alla prima... just to make me feel better! now that one is a good fit, of course. it would seem like my biopsy is single-handedly saving the local economy.

in my dreams last night, it was a very hot day and i was fixing to climb up a mountain. i was trying to figure out what shoes and shirt to wear. i was having trouble tieing my shoelaces. it was so hot, i hoped i had enough water. but i remember the feeling of how good it was going to be to hike up that mountain.

it's a bright sunny day in the city today after hard rain on the chinese new year's parade last night. it looks like a good day for marching.