Thursday, May 30, 2013

New Doctors - Intimidating Facility

It was the day after the official diagnosis of invasive ductal carcinoma, and I was already being whisked into the chief of oncology’s office at the University of Arkansas for Medical Sciences – by choice.  Thanks to Don’s medical connections, I have the privilege of consulting with some of the country’s best medical professionals.  Rest assured that I haven’t and won’t take this opportunity for granted.

At 10:30 a.m. on May 9, my life was no longer my own.  I officially turned it over to a minimum of five doctors and an army of nurses at my new home away from home – UAMS. The day started in the Winthrop P. Rockefeller Cancer Institute’s Breast Center.  The paperwork was comprehensive, as expected.  The orders say to arrive at least 30 minutes early, and it’s always about the paperwork. 
Finally, Don and I were escorted to a cubicle to await the arrival of the oncology chief, Dr. Westbrook.  His silver hair with a tinge of red dominated his jolly face.  “Well, young lady, I’m here to confirm that you have Grade 3-Stage 3 breast cancer,” he said. “You will need a mastectomy, rather than a lumpectomy, because of the mere size of the tumor.”  Ok, I thought, that’s out there pretty quickly.  I’m only one day into digesting the confirmation that I even have breast cancer and it’s already time to cut off the little ta-ta.  Whee!  My cancer-surviving friends said that things would really start moving fast, and they weren’t kidding.

While Dr. W. was still discussing the seriousness of my disease, a tall, female doctor with short, dark hair and a slight slump in her shoulders came into the room with hand extended and introduced herself as Dr. Suzanne Klimberg.  Wow! It was THE Suzanne Klimberg, elected recently as the President of the American Society of Breast Surgeons. I have been blessed with the best. 

She immediately started checking for lymph swelling in my neck, shoulders and under my arms.  She manually felt the mass and said it was  “good-sized” (hmmmm, don’t know if I would have used the adjective “good,” but ok) one that would definitely require surgery.  But first, she said, we would do chemotherapy to reduce the size of the mass. This process will help save more tissue and skin for reconstructive surgery. 

breast cancer, invasive ductal carcinoma, UAMS, Little Rock, Arkansas, Marla Crider
She momentarily excused herself and returned with a medical book that she quickly and proudly introduced as her publication in which she and Dr. Yuen, my yet-to-meet plastic surgeon, wrote together.  She showed me numerous “before and after” photos of previous breast reconstruction surgeries.  I’m convinced.  She even told me I could pick any sized ta-tas I wanted. J  More about that later.

Dr. Klimberg wanted to do a lymph node ultrasound to see where we stood with that possible issue.  I asked when I needed to return for that test.  She said, “You’re here; let’s do it now.”  Really?  Really!  So off I go to a dark little procedure room, disrobe and plop the girls on the gurney for another ultrasound – this time, with my right arm over my head.  She talked me through what she was seeing.  And, then came the “hmmmm.” 

She said she wanted to do a needle biopsy…right then and there.  My how fast things move at UAMS. 

Dr. Klimberg prepped me and personally administered the local anesthetics.  Not too bad.  Once again, I heard the clicking sound indicating when she was cutting the tissue for microscope review. When she completed the process, she stood for more than 10 minutes holding pressure on the wound to make sure I wouldn’t bleed.  We conversed the entire time.  She’s such a soothing and knowledgeable surgeon.  Love this woman!! 

My mind was finally accepting the inevitable and ready to make a plan for a cure.  I’m going to be cancer’s worst enemy! Oh, by the way, the lymph node biopsy from under the right arm came back negative.  Finally!  Some good news.

Over the next 2 ½ weeks, my visits to UAMS went something like this:

May 10 – Breast MRIGuess what I have invasive ductal carcinoma in the right breast and it’s large. Nice to have an expensive confirmation. (Sorry, sometimes the sarcasm just rolls across my tongue!)

May 17 – Dr. Issam Makhoul – OncologistThis blessing of a doctor spent nearly three hours with Don and me talking us through the entire process of chemo, what to expect when, etc. One of the most important (and interesting) things Dr. Makhoul told me was that the second day after each treatment, I would come back to UAMS for a Neulasta injection to stimulate extra white blood cells to help fight infections.  He said that in many cases it’s the chemo related infections that cause people to die, not the cancer itself.  None of what Dr. Makhoul said scared me.  In fact, it got me in my fighting mode. Bring on the chemo.  Let’s get this insidious disease out of me.

May 20 – Dr. Hardee – Radiation OncologistWhen the doctor entered the room, I could have sworn he was 12 years-old.  Young or not, the dude knew his stuff. He answered every question I had with authority and knowledge and explained that I might not have to have radiation after the chemo.  Only the surgery would tell the tale along with the lymph node harvesting. Dr. Hardee is also on the Westbrook, Klimberg, Makhoul breast cancer team – MY team.

May 22 – Port Placement and MUGA ScanUAMS can be a difficult campus to navigate.  Patients must allow time to move around the WPR Cancer Institute, the Outpatient Clinic, and the Nuclear Medicine area.  After a brief workout walking from one end of WPR Cancer Center and the place for the port placement, I was ready for a shower.  After more paperwork, my name was called by Dr. McDreamy – no, really – this young resident was scrumptious, and my inner cougar made an unexpected appearance..  I told Don the procedure might not be so bad, after all.  He just rolled his eyes. Dr. McDreamy accompanied me to the procedure room, where a male RN that could have been a Vin Diesel double, big biceps and all, assisted me on the gurney.  Again, the tag-team told me every move they were making.  I didn’t really care; I was too busy looking at my medical team.  They hooked me up to the ultrasound to find the correct vein under the left collarbone (the placement is almost always on the opposite side of the cancer).  Then I hear them chattering about how they can’t see it - the vein.  NOTE:  If you have small, rolling veins, like me, just get ready.  They pull tricks out of their scrubs to assist in this, sometimes, impossible task of finding veins. And I did say TRICKS.  Nurse Diesel tilted the gurney, head down, to increase the blood flow to the neck.  It worked.  Dr. McDreamy administered the first of the locals.  Not unbearable.  He fished the line down through the vein.  Then came the port hook-up.  More local anesthesia to deaden a broader area where Dr. McDreamy and Nurse Diesel would make the incision and create a flap to hold the port.  Ummmm….this time I took my eye off the prize (Dr. M) and the local really got my attention. Once finished with that, he tugged and pulled skin to cover the round port, then stitched me up internally and used glue for the exterior.  I’m not going to lie. When that little ¾” port area “woke up,” I wanted to slap one young, beautiful resident.  It took about two days for the achy feeling to subside then my inner cougar was raring to go, again. 

MUGA Scan (same day as port placement)  This is a heart scan with contrast dye to confirm the heart can withstand the burden that can come with chemo treatment.  First, I’m pleased to tell all those who have called me a heartless bee-atch over the years, I do have a heart.  I even have a scan of it for proof.  And, it’s ticking along just fine.

May 24 – PET ScanSince I am an insulin dependent diabetic (thank you, Crider genes), this test is a little different.  Because the technicians basically inject the patient with pure, radioactive sugar, I wasn’t allowed to take my daily injection or any of the oral meds.  Needless to say, I couldn’t eat or drink anything for six hours leading to the appointment -  it was scheduled at 1 p.m. -  and my evening meal the night before was a piece of fish with broccoli – yum!!  When another cutie medical professional escorted me into the steel-doored cubicle, he immediately began looking for a vein. 

To make the job easier on the poor lab techs that cross my path these days, I automatically say:  butterfly needle and vein finder.  I learned quickly that lab techs hate to use the vein finders because they think it signifies technique inefficiency. Heck, just don’t stick me two or three times trying to find one of my little blue veins, that’s all that matters to me.  The tech was almost relieved when I suggested the vein finder.  Finally, he discovered a good vein and quickly collected a blood sample into a vial, then injected me with the radioactive sugar.  He handed me a large Styrofoam cup with a concoction in it (uh, Styrofoam isn’t “green” is it?  Shame on UAMS!).  He said it was for the PET scan contrast.  It was orange flavored.  Frankly, I was so hungry and thirsty, that I could have consumed pure lemon juice and thought it was champagne! The tech gathered all the remnants of his vein-finding debacle and hit the steel door button on the side of the wall and said he would see me in two hours.  Then, the steel door slammed shut and made the sound like you hear on cheap, public service announcements about not drinking and driving. 

Exactly two hours later, the tech opened the steel door and came for me and into the round tube I went.  The scan took about 30 minutes.  In all honesty the hardest part was going to be waiting for the results.  You see, this is the granddaddy of all the scans.  It tells where any and all cancer is located in your body.  The plan was for Dr. Makhoul to divulge the results to me immediately before the first chemo treatment on May 28.  I’m in for a long, long weekend. Hurry up chemo treatment.  Let’s get this show on the road!

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Wednesday, May 29, 2013

The Diagnosis is in the Details

Five restless days passed between the initial diagnosis of breast cancer and the prescribed needle biopsy that would determine my fate.  My mind whirled with questions and lots of uncertainties. And, as one might expect, fear would rear its ugly head when I wasn’t paying attention.  More interestingly, I mostly felt anger leading up to the biopsy appointment on May 6.  Anger can be a dangerous emotion unless you use it as a weapon of “mass” destruction, which I had every intention of doing. 

It was finally Monday morning - biopsy day.  I arrived at St. Vincent’s Breast Center promptly at 8:00 a.m. An unfamiliar technician retrieved me from the waiting area and directed me to the procedure room.  She was a little too perky considering what I was about to endure, and she talked way too much.  Did she not realize that the rest of my life would be impacted by what happens in this dark, sterile chamber?  I thought to myself, maybe she did understand and her cheery disposition and chatty behavior was just her way of putting me at ease.  Well, it wasn’t working.

For the second time in two weeks, I took my top off, laid on a gurney and exposed my right breast to two strangers – Perky Patty and a tall, silver-haired radiologist, who talked in a monotone.  He explained that he would locate the mass via an ultrasound then deaden the targeted area with local anesthesia.  I could feel the sting of the needle as he injected a Novocain-like solution into the side of my right breast. It wasn’t uncomfortable.  In fact, I have experienced worse sitting in a dentist’s chair.  Then he went deeper with the needle to deaden the area directly adjacent to the tumors.  At that moment, I would much rather have been in the dentist’s chair.

When Dr. Monotone was convinced that I couldn’t feel him maneuvering within the breast, he extracted a section of the smaller lump, since it was the hardest to reach.  I could hear the loud click of the instrument used to remove the tissue. Then he moved to the larger mass, where I heard the biopsy instrument click three times, meaning he took three pieces of tissue to review under the microscope.  He talked me through each step of the procedure and was able to put my type A, high-strung personality at ease.  I would give him two thumbs up for experience but his delivery needed a little work. 

When Dr. Monotone completed the procedure, he told me the results would be available in 24-48 hours.  Seriously?  Two more days of waiting to learn if I have breast cancer? With so much progress being made in cancer research and other forms of medicine, surely the medical brainiacs could discover how to process pathology results faster. 

I returned to work after the biopsy, which took about an hour.  My office support team anxiously awaited my arrival and pelted me with questions about the procedure. They wanted to know when I would get the results; would I be a candidate for a lumpectomy or mastectomy; and, did I know which surgeon I would use. As they were asking me questions, I could see it in there faces; they were scared for me.  But in many ways their reactions were comforting.  Gal Pal Gloria (Glo) was especially concerned about me, considering her ongoing battle as a sufferer of fibrocystic disease. She told me numerous times during the days leading up to the biopsy that it could easily have been her awaiting results, instead of me.  Glo is my dear friend and confidant and I have no doubts that she will provide whatever support I might need as the treatment plan begins.

During the first 24 hours of the waiting period, every time my cell phone rang at the office, Linda, another member of my support team, was standing at my door seeking some sort of indication that it was the doctor. At one point, I had a short meeting in a neighboring office. Linda retrieved my cell phone from my desk and kept it with her until I came out of the meeting, just in case the breast clinic called.  I’m blessed to have such caring colleagues.  

It was day two when the call finally came.  Within seconds of hearing my cell phone ring, Glo was standing at my side.  The cancer diagnosis was confirmed; however, it wasn’t lobular cancer as Dr. Mustache first thought.  I had invasive ductal carcinoma, which is the most common type of breast cancer.  The pathology report rated the mass as Grade 3 – Stage 3. (So much for lucky number 3!)

Dr. Monotone explained that the high grade resulted from the mass being fast-growing and the stage 3 rating was because of the large size. The tears flowed freely as I tried intently to listen to everything the doctor was telling me. The last thing he said was, “I’m sorry.” I wonder how many times a day/a week he says those words, "I'm sorry."  Must be the toughest part of his job.

Gloria stayed with me until I composed myself then left me alone to call Don. When I heard his voice, I couldn’t say a word, but he knew. Then he made a statement that I will remember always. He said, “Wéll get through this together and I’ll be with you every step of the way.”  Now, that is love
I was totally unaware that several days earlier, Don retreated into his doctor mode and called a former UAMS medical school classmate, the current chief of the oncology department at the med school.  He agreed to see me on May 9 – the day after my biopsy results were revealed, which meant tomorrow was the day.

And so it begins…the journey to wellness.

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Monday, May 27, 2013

Diagnostic Mammogram Versus Dense Breast Tissue

It was Wednesday, May 1, the morning of my scheduled mammogram. I did all the things I would usually do when getting dressed for work, except one; I didn’t coat my underarms with deodorant, which made me feel slightly rebellious.  After dozens of mammograms over the years, I knew that I would be asked to remove my roll-on deodorant before the technician pulled and positioned my breasts between the compression arms of the mammogram machine. Not to worry, the breast center always has an off-brand of spray deodorant available for those, like me, who can’t bear a whole day without underarm protection.    

I arrived for my appointment at 7:30 a.m.  Fifteen minutes later, the “mammo” tech predictably pulled and positioned my breasts in the vice. She took several images of both breasts to compare with the mammogram from ten months earlier.  The tech then escorted me to a dark ultrasound room, where I laid horizontally on a gurney next to the ultrasound machine. She squeezed cold gel on my right breast and proceeded to slide the magic wand over it for a different view of the tissue. She did the same on the left breast. The process took about 15 minutes. She then told me that one of the radiologists would come and review the ultrasound she just completed. 

Marla Crider, breast cancer, blog, patient's story, advice for women, help for women
This example image from a mammogram (not Crider's)
shows an abnormality similar to what was discovered
in her breast. Doctors call it a "markedly hypoechoic
mass" that tends to "spread vertically" and has "fine
irregularities" around the edges of the lump.
A few minutes later, a dark complexioned doctor with a bushy mustache arrived with the tech. He squeezed more cold gel on my breasts and pulled out the magic wand again. As he moved the wand strategically over the right breast, Dr. Mustache directed the tech to freeze the images at certain magnifications. This went on for almost ten minutes.  He finally rubbed the cold gel off my breasts with a towel and asked me to sit up.  That’s when he said it.  “Ms. Crider, you have two suspicious lumps in your right breast that will require a needle biopsy to rule out cancer.” 

There it was… the “C” word, but it sure as hell didn’t stand for cyst. I didn’t hear much of what he said after the word cancer left his lips. My mind was whirling with a million thoughts, almost to the point of dizziness.  Over and over in my head, I kept saying to myself, “Who, me? Cancer?” 

Only 30 seconds or so had passed since he uttered the “C” word, but it seemed like hours.  I knew that I had to refocus and take control of the situation.  I asked Dr. Mustache to not pussy-foot around and show me what he was seeing on the ultrasound.  He pulled the images up on a large screen in his office.  As I sat next to him with the tech at my side, he showed me a large area that “echoed” and a smaller one adjoining it. The left breast showed no signs of anything abnormal.  Finally, some good news. (The “girl” on the left always was perkier.) I asked Dr. M to give me his professional opinion.  He said it might be invasive lobular cancer, which is the second most common type with invasive ductal carcinoma being first.  I kept my composure when he said it appeared to be a fast-growing tumor.  And, then he said he was sorry. Me, too, I said to myself.

The tech told me I could get dressed but first asked if I had any additional questions.  Really, I thought?  Only about a thousand of them! Instead, the tears started flowing.  The tech embraced me - not because it was her job but instinctively because she was a woman who understood.  

After dressing, the tech walked me to the front desk and told the scheduler that a needle biopsy was necessary. After checking my records again, the tech determined that since I take Vitamin E and Omega 3 each day, I would have to wait three days to ensure the supplements were out of my system. She explained that these particular supplements increase the possibility of bleeding.

The needle biopsy was scheduled for Monday, May 6, at 8:00 a.m.

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Sunday, May 26, 2013

The Find: The Day I Discovered the Lump

marla crider, breast cancer, blog, St. Vincent Breast Center, Little Rock, Arkansas
This sample image (not Crider's) shows the four levels of
breast density. From left to right: Level 1 (very fatty
breast), level 2 (fatty tissue makes up more than 50% of
breast), level 3 (dense tissue makes up more 50% of
breast), and level 4 (dense breast with very little fat).
It was Wednesday, March 12 - exactly one week after the 2013 Arkansas Governor’s Conference on  Tourism, the annual event I produce as the Deputy Tourism Director for the Arkansas Department of Parks and Tourism. I slept restlessly and it wasn't unusual for me to wake up at 3:00 a.m. and not be able to return to Snoozeville. Usually, the fatigue subsides in a day or two after executing a large event, but this time was different.

Maybe, I thought, age really does have something to do with endurance.  Either that or my subconscious was up to no good and preventing me from falling into a deep sleep. 

That day, Don, my significant other of nearly seven years, drove to Little Rock from Hot Springs for “date night.” When I made the move from the Spa City one year earlier to accept the position at Parks and Tourism, Don and I vowed that we would not let distance destroy our relationship.  We agreed to alternate weekends – his house on Lake Hamilton one weekend and my quaint condo in Midtown Little Rock on the other – and every Wednesday night would be reserved just for us in the Capitol City. And this was date night.

After a nice dinner and a little wine, the fatigue set in and I was ready for bed. I changed into my gown and, for whatever reason, I decided to do a quick breast exam, something I usually did in or after my morning shower.  When I moved my left hand over my right breast near the outside edge, I thought I felt some dense tissue.  For years, after each mammogram, the radiologists at St. Vincent’s Breast Center categorized me as having very dense breasts.  That’s what I thought I was feeling.  Just to be sure, I asked Don, who is a retired orthopedic surgeon, to put on his physician’s hat and tell me what he thought. The expression on his face changed.  “I feel it,” he said.  “It’s definitely a lump.  Have it checked…sooner than later.”

When I reported to work the next morning, I made a beeline to my gal pal Gloria’s office and explained the find from the night before.  I wanted her to tell me that the lump I felt was similar to the ones she frequently experiences as a sufferer of fibrocystic disease and she complied.  I exhaled and told myself that’s exactly what it was – a fluid-filled cyst - and didn’t think much more about it. 

Later that day, I received a text from Don.  “Have you called the doctor yet?” Dang it, I thought, he’s not going to stop asking until I call my OB/GYN, a laid-back Harley rider, who once greeted me in an exam room wearing greens and black motorcycle boots.   He was not your typical woman’s health professional and that’s why I liked him.  Since it was also time for my annual pap smear, I decided to schedule both and save a trip and a co-pay. 

When I called the clinic to make an appointment, the scheduler told me it would be five weeks before the doctor could see me. Geez, I thought birth rates in Arkansas had declined the past few years.  Apparently not. The OB part of Dr. “Harley’s” specialty seemed to be flourishing. I decided to tell the ever-so-business-like person on the other end of the line that I had felt a breast lump the night before and wondered if the 5-week rule still applied.  “He can see you next Monday to check out the breast, but it will still be five weeks before he can do the Pap smear and exam,” she told me.  “Let’s do it,” I told her.  And the breast appointment was made.

When I arrived for my appointment a few days later, I wasn’t the least bit apprehensive and had basically self-diagnosed myself as having a cyst, not a lump.  Dr. Harley, as I now refer to him, came into the exam room, took my story and examined both breasts. He spent extra time on the right breast, since that’s where I felt the “cyst.”  After the exam, he said he reviewed my mammogram report from ten months earlier and concluded that I didn’t have a cyst or lump, just dense breast tissue.  If I preferred, he said he would be happy to schedule a diagnostic mammogram and ultrasound just to be sure and to also give me piece of mind.  I decided to monitor the “dense tissue” for a week or so then call him.  I didn’t call. And, Don didn’t buy the explanation from Dr. Harley.

After several weeks of being pre-occupied with out-of-town business trips, as well as my day-to-day tasks as the “fix-it” person in the tourism division, I finally did another self-exam and determined that what used to be a dime-sized lump was now the size of a quarter.  No longer did I think it was a cyst or dense breast tissue.  Something was definitely not right. 

By this time, it was late April.  I immediately called Dr. Harley’s nurse and asked her to make arrangements for a diagnostic mammogram.  She scheduled it for two days later. This time around, I was down-right scared.