The 2011 story, part 2

For those of you tuning in now, I had two core needle biopsies of the right breast (for calcifications) yesterday at Virginia Mason’s breast clinic downtown.

There is no need to read this or reply. I need to write about it … and I know that some of you have had this procedure and some of you may at some time have it. So I’m sharing the writing.

I wrote this in a thread on how technology augments the brain, a five-week online class/discussion on mind amplifiers that I am taking with Howard Rheingold.

Flash forward to yesterday: I had two core needle biopsies in my right breast. This augmentation — external tech not internal — was an incredible thing to watch — I want to write publicly about this later but here are some quick observations that I think relate to the topic:

  • – Digital mammography is more plastic than film, making it easier for radiologists to identify potential cancer cells really really early. (I haven’t checked to see if false positives, ie, ratio of screening tests conducted to identified cancer, have increased.)
  • – The core needle biopsy used at my hospital facilitates precise placement of the needle in three dimensions, with the selection based on the mammogram and a series of digital images (x-rays) taken while the patient is lying face down on a table. Computerized technology drives the needle that is obtaining the sample.
  • – Computerized technology allows the doctor, staff and patient to immediately see (it’s a pretty large greyscale monitor) if the sample contains sufficient questionable cells. If I lived in Phoenix, I could have gone to a clinic that also reads those samples before you leave. Here, I have to wait until next week.
    Assuming the sample is a good one, the doctor then inserts a titanium marker (different shapes to denote different things) so that (a) the area can be watched on subsequent mammagrams and (b) if surgery is needed the surgeon has a signpost.

The “nurses” (there were two, one was an RN the other a radiology tech) talked to me before and after. No aspirin for a week. No baths for three days. What to do if the breast started bleeding (compression). What to do if there are signs of infection after three days (immediately go to ER or call doc if biz hours). No lifting or reaching overhead with right arm.

The compression to hold the breast in place during the biopsy is not painful – it is less “tight” than a mammogram. On the other hand, the table, with its center “hole” through which the breast is placed, is bloody uncomfortable. Why the designers did not learn anything from massage tables is beyond me. You have to turn your head to the left or right and it is there, flat on a lightly padded table, for a really long time. You can’t move, because the techs/docs are trying to figure out where your calcifications are so that they can get the coordinates (3D) to prime the needle. My neck/back (right side) is still really sore/painful today. I can take tylenol, and I do have percocet left over from Jan surgery.

My first biopsy was relatively straightforward. It took a little longer than the tech thought it might to get the breast positioned, but there was nothing painful about the procedure except the initial shot of numbing meds. It was successful – ie, sufficient calcifications extracted to send to the lab.

My second, not so straightforward. It took more than an hour to locate; they called it a “marathon.” The equipment in the biopsy room is not as sophisticated (resolution) as that in mammography room. Eventually, I had to have extremely painful (compression) mammography until they located the “faint” calcifications. Then they drew on my breast (the shape of the small paddle) to help find the calcifications when I was back “on the table” in the other room. This time, numbing didn’t “take” … in the sense that I had to have continuous injections and we had to stop the extraction process at least four times — you’re not supposed to feel anything, so when I felt the “bee sting” I yelped as I had been instructed to do.

The three “docs” kept saying “you’re doing great” and stuff like that. I finally said, “thanks but I’m not doing anything!” That’s when they let me know that listening to their instructions, staying still, etc is enough of an exception that they felt the need to remark — or else this is just part of a “make the patient feel as good as possible” conversation. Who knows?

I went home with two small ice packs tucked in my bra (both biopsies are medial, one near the “top” and one near the “bottom”). No pain until later last night when the right breast ached a lot… at what felt like a point in between. I changed out of the underwire into a sports bra to sleep (I’m supposed to wear a bra to sleep for three nights).

Today, still sore but the much greater soreness is neck. And knowing I can’t get in the hot tub to ease it!

TAFN. More later.

Featured image: Mayo Clinic

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