Thursday was a painful session. Somehow the doctor had neglected to tell me that today's session would be longer and I would not be allowed to move the whole time. It certainly was longer. For someone with arthritis and tendinitis, it was like lying on the sidewalk for a half hour with arms above my shoulders in awkward positions. My left arm and neck were in pain, despite my high threshold.
If I had known I would not be moving for so long, I would have taken two Tylenol at home first, loaded my arms and neck with pain ointment, and insisted on enough time before they started to be sure my arms would be tolerably comfortable.
This first session involved taking x-rays to mark the three angles of radiation aimed at the site of the surgery. Take an x-ray; get it approved by the doctor, do the treatment, and so on. Many new marks on my skin. I do appreciate the extreme attention to accuracy.
When I got back to the changing room, I felt shaky and a bit nauseous. Just sat in the changing room for awhile; then in the waiting room.
Then I had to go to the market. As I was leaving there, one of my favorite radiation therapists called to remind me that tomorrow's appointment is at noon. He listened to a little of my griping (for which I apologized) and assured me that tomorrow would not take quite so long. I hope that's how it will be.
This morning, Sunrise Rounds post was a wonderful story about how natural it is to fear recurrence, and how we must, must work with a doctor on a surveillance plan to stay current of how we're keeping healthy.
Showing posts with label patient care. Show all posts
Showing posts with label patient care. Show all posts
Friday, January 10, 2014
Sunday, January 5, 2014
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.
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.
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.
Friday, January 3, 2014
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
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.
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.
Friday, December 13, 2013
LUMPECTOMY FOR BEGINNERS . . . in the radiation room
If your DCIS is low grade and you are an older patient, you may want to go to http://www.medpagetoday.com and read some of the peer-reviewed article on radiation findings.
Yesterday, after I agreed to radiation, they gave me a gown and took me to the treatment room. I saw a shiny black, low bench, definitely suitable for an upscale bus stop. They settled me on it with a fresh blanket, and positioned my arms above my shoulders; my tendinitis was not happy about this. Overhead was a lighted mural of branches and colored leaves.
As my girlfriend predicted, there was a strange, lumpy pad under my upper torso. This takes a specific mold of where my shoulders, torso, and arms will be for every treatment.
I mentioned my sinus problems, and they smilingly said, If you have to cough, cough upward. They told me if the cough moved me too much, the machine would stop.
Then the tattoos--more road signs for the radiation. Just three tiny needle jabs with some sort of permanent ink. This keeps the marks from coming off in the shower.
At some points, the bench rolled me back with my breast area under a metal arch. Apparently this is where the radiation comes from. It is perhaps less than a foot thick, like half a big, skinny donut, so I was not really enclosed. Note to self: not claustrophobic.
The whole session was comfortable and non-scary, and the staff were kind, happy, pleasant.
After I got home, I found a paper in my folder saying that the first visit Monday would be a half hour, and if I wasn't comfortable in the position, I should take a Tylenol an hour ahead.
Subscribe to:
Posts (Atom)