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 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

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.

doug

on hearing that my pathology was benign, when perhaps more exactly my breasts may be known as "knock-outs", doug wrote today:

I think they just wanted to cause a scene to get more attention  :)

bruises

there is some pain underneath both of the incisions. just a little bit, coming with the occasional throb, sometimes enough to say "ouch". the bruises are now mostly a light amber color and cover a large area, but they themselves don't seem to hurt. there's a really large, meatty red area of bruising under the lateral area of incision, where my breast flops over. i haven't taken darvocet since monday. i think i'll take a tylenol and be on my merry way to the dentist and then to work today...

fortune

today i soaked up some negative ions from the ocean at tennessee valley. under my favorite puffy white clouds against a blue sky, i walked just far enough to smell the waves crashing against the cove. on my way back i saw three deer cross my path to a field of yellow daffodils, and just afterwards i passed what looked like a great egret -- a snowy white S balancing on spindly legs ending in wide claws which barely made an impression in the long grasses -- standing right by the trail, perhaps overwintering in the valley. when i got home after seeing dr kaymen and dr mulder, i had several emails from friends who were happy about my breast. i am so lucky...

typical hyperplasia

as leanne said, nima grissom called tonight with an early and good report. there are extra cells in my ducts, but they are not a problem. as susan love suggests to do in her breast book, i asked if the pathologists were sure to actually see the calcifications on the slides, since we know they were actually removed, and she said yes. not all the calcifications were removed -- she said i actually have them scattered throughout my breast, which we didn't realize. we understand that the more scattered they are, the more typically benign they may be. originally we thought they were localized into those two places. also, there was no difference in the pathology of the two separate locations, which reinforces the idea that it's a benign process all over my breast.

i don't even need to schedule a follow-up appointment with dr grissom, and i don't need to get another mammogram for another year! since not all calcifications are removed, they will probably show up on subsequent mammograms, and she says they'll know what to do with them then. i'm not sure what would make me need to repeat a similar kind of biopsy. not sure i'd like to, but so far this hasn't been as painful as we feared. the cuts seem to be fixing to heal nicely ... eventually. no real pain yet -- lots of capacity for sleeping, though...

susan love describes different stages of extra cells in the ducts on p.260/breast book:

You'll recall that I've described the breast as a milk 
factory, with two parts-- lobules that make the milk, and 
ducts, like hollow branches, that carry it to the nipples...
Over the years, you can get a few extra cells lining in the
branch--sort of like a fungus.  This is called intraductal
hyperplasia, which simply translates to "too many 
cells in the duct."  In itself, this is not a problem. 
Sometimes the cells can begin to get a bit strange looking,
and this condition is called intraductal hyperplasia with 
atypia ..."

so i have extra cells lining the duct, but they are "normal" and not "atypical."

just to be clear, i asked dr grissom was there any "atypical hyperplasia", and she said no, and confirmed that what is there is not an indication of subsequent risk of breast cancer.

i hope to carry this feeling of being well-taken-care of for a long while. as unpleasant as a biopsy is, i've had good soups, chocolates, pendants of amber, fine company, family, felines (and even a canine or two) and friends, which might not make me healthy, but it doesn't hurt! thanks for that to all who are reading this.

in deference to the awesome work and life of Gerry Rogers, i'm renaming my weblog from the original "my left breast", respecting the namespace of her important film, at www.myleftbreast.com. check it out...

fine and benign!

pathology results back a day earlier than expected and moya's calcifications from both piece of tissue are declared benign normal hyperplasia. whee! yay! relief! more later ...

pictures

thanks to leanne for that great write-up of friday's activities...

abbe and eve just stopped by with what looks like delicous vegetable soup. everything's been going pretty smoothly, and i've been feeling pretty well (though sleeping in large chunks). today, there was a momentary set-back when i showered for the first time and got to remove the outer gauze, thus exposing the actual wounds. kind of brought it all home. they aren't terribly bad cuts, and the bruising is not all that bad either, and eve showed us how her breast is totally perfect now - you couldn't even tell there was any scar anywhere - so it's all in pretty good shape. nevertheless... i guess i got to be in denial that anything happened till i saw the cuts.

we've posted some pictures of the whole thing -- mostly of the needle localization process. please don't look if you are at all squeamish! if you aren't, and want to know about the process, check it out.