LUMPECTOMY - THE SEQUEL . . . Stories old and new

If I've told part of this before, please forgive me.  The "dancing doctor's" brave video has opened Pandora's box of medical memories and things to be thankful for.

In the 70s, in a then-small California city, my doctor got the idea that there might or might not be a lump in my right breast.   The next thing I remember is sitting in a hard chair in the middle of a large, chilly room, naked from the waist up.  The surgeon was in the room with me; so were a number of male medical students or interns or whoever. If there was a female nurse around, I don't remember her at all.

 I was fairly miserable during the long time it took for almost everyone to palpate my breast and discuss my plight, if there even was a plight.  All that poking and puzzling; no findings.

Although I don't know the standard of care for breast diagnosis in the 70s, the surgeon decided on a combination surgical biopsy and possible mammography method that I now understand had been developed at the beginning of the century at Mayo Clinic.

In this approach, the patient was put under sedation.  The suspicious area was excised and sent to pathology for frozen section -i.e. slicing it up paper thin.  If the pathologists found malignancy, the breast and possibly near-by lymph nodes were removed.  Finally the patient would wake to find out if she still had her breast.

I must have put myself into a sort of pre-surgery denial fog.  My husband, who later became my ex-husband, made a brief, awkward attempt to talk about outcomes.  I was not at all clear on how much to tell my little, grade-school age daughters, and still don't remember what I did tell them.

Finally, I put on my red blouse and was driven off to the hospital.  I should probably inject here that I didn't really like the surgeon.  In those days, women made remarks like "He's not much for bedside manner, but he's good."  Later, he became a client of mine, and we still did not become friends.

When I finally woke, I believe for some reason one of my in-laws was in the room--is that possible?   (We were not huggy in-laws.)  A nurse stuck her head in, said "benign," and vanished.  Someone asked me what I wanted to eat.  There was no sign of the surgeon.   By the time my green beans arrived, I was still too groggy eat them, and went back to sleep instead of enjoying the fact that my husband was in the room.

After so many hours under the anesthesia of the day, I was a little dopey for a while.  Even weeks later I would suddenly get tired when we went for a walk.  Were there pain pills?  How long did I stay in the hospital?  There must have been pain, since the nipple had been removed for the exploration.   The good news is that the scar has been almost unnoticeable.

Just a very few years ago, one of my daughters told me she and her sister had been sure I would die in the hospital.  I wonder if anyone tried to comfort them when I wasn't around.

***

Through the multi-step DCIS diagnosis, the old scar on that nipple wore a cute little sticker like a wreath, to keep it from looking like a problem on film.

The good news:  I have a surgeon I like, who is as kind and caring as the best family doctor, and who also did a great job removing the affected area for analysis. I am different now than in the 70s; I would not have let him do the procedure if I hadn't trusted and liked him.  

And lumpectomy let me avoid, as many women can now, the long and dangerous surgery to remove a whole breast.

LUMPECTOMY - THE SEQUEL . . . Famous decisions--the other side of the story

I've read plenty about a surgeon and a film superstar and their double mastectomies. I know the surgeon had been diagnosed with breast cancer; we've all heard the superstar's reason.    I don't mean to downplay what they've gone through, but I also knew they could expect world-class care.  Now I read that their stories have started a clamor for voluntary double mastectomies.

I was thinking tonite (Thursday) about the dangers of what they have gone through, as well as the benefits.

And I have often thought before about why lumpectomy is simply called "breast preservation" or similar names.  To me, lumpectomy, when it's the standard of care, is the way to avoid an incredible amount of danger of infection, not to mention pain, dangers of major surgery, and lengthy, difficult convalescence.   I've shuddered at the stories:  frantic daughters of mastectomy patients tracking down nurses, and insisting, "Give Mom her shot.  Now!"   I'm glad I've been spared for now from being that suffering mom.

I had nothing to say with any authority about this question, so took a break, went to KevinMD, and lucked into an article by

Miranda Fielding is a radiation oncologist who blogs at The Crab Diaries.  

I clicked The Crab Diaries, and found her cautions on that very subject - possible reasons not to choose a double mastectomy and when or why not.  She is a wonderful storyteller and you may want to read.that January 2 post, Primum non Nocere..

My suspicions are confirmed, and there are even more reasons to think very, very carefully about voluntary double mastectomy for yourself or someone you love.

LUMPECTOMY FOR BEGINNERS - The other F word

My friend was right.  It is a shock to hear the word cancer on the phone or in the doctor's office. My supportive neighbor says I'm handling it well.  I don't talk about fear -- but now I'm thinking about it

Learning about the steriotactic biopsy was Fear and resistance - the procedure sounded barbaric to me. And yet it went well and I had a good time at the hospital.

And I was able to compartmentalize about the lumpectomy.  I trusted the surgeon, and after all, I've had plenty of successful experience with surgery.  I didn't even feel fear beforehand.  Maybe the doctor's telling me he had said a prayer was a help.

Then the post-op two-week appointment!.  (The surgeon had told me when we met that he would recommend I see a radiation oncologist and a medical oncologist.)  I read the pathology report again, more thoroughly.  Nothing on the report, as I've mentioned, gave me any hope of avoiding radiation.  So after we talked a little about the incision and the size of the specimen, he gave me the paper with the oncologists' contact information, and his reasons for choosing them.  

 I went home and put the contact information sheet in a red file.  I talked with my neighbor, I blogged about when to call the radiation doctor's number.  I reminded myself that she couldn't make me do anything I don't want to do.

I focused my research, still a lot of it from Mayo Clinic, on radiation.  I read other women's stories, and I felt Fear.  I made a list of my radiation concerns and felt FEAR.  I quoted some things, and felt FEAR.   I included a list of medical conditions I already have, and the one thing I've shared with friends:  how many x-rays I've had.  

I copied statistics from Sloan Kettering on how much longer I would be free of cancer if I had radiation and certain long-term meds.  They were compelling.  But . . .

There is a pattern here:

 In spite of having lost a best friend to cancer, I'm obviously more afraid of the treatment than I am of getting more cancer.  Or is the Fear of cancer buried so deep that I don't feel it, and so huge, that I don't dare feel it?