Surgery Update

. . . and how I got here.. in three parts

Surgery is Part 1. So this is a longish blog.

Surgery was on Thursday, Dec. 14, and went well. I’m writing this Saturday, with a couple of days behind me, and I feel perfectly fine, so I’ll get back to the story. This is not graphic, but I hope informative. Before that, though, I thank all of you who texted, wrote or called with your good wishes, and Julian for the ride!

Surgery was scheduled for 10 a.m. at Northern Westchester Hospital, and I arrived two hours early as instructed. I was surprised and heartened to see an old friend, a nurse, J., working that day. (We met when our kids were young, and the girls remain good friends to this day.) A good sign.

Dr. Ranjana Chaterji was my surgeon, and she is outstanding. A good bedside manner, as people say, and the expertise you want when someone is working on you. Before surgery she came in to review the procedure and answer any questions. I thank her for her patience because I feel like I had 101 questions, but that’s what journalists do. 

The anesthesiologist (I can’t recall her name, but under the circumstances, that’s not surprising.), the first woman I have had do that, was with her, and we discussed the anesthesia. I said I typically don’t do well with it, vomiting as soon as I’m in recovery, and not just a little bit. (I’m no stranger to surgery, and some of them big ones.) 

I was hoping for light sedation to avoid this, but they explained I would need general anesthesia due to the location of the tissue being manipulated. However, they would be using a protocol called LMA, where I wouldn’t be intubated, which was more appropriate for me and had fewer side effects. I had never heard of this. From the University of Vermont Health Network:

Laryngeal Mask Airway (LMA) – When possible, the anesthesiologist will use a Laryngeal Mask Airway device instead of intubation because it is quicker and causes less discomfort for the patient. An LMA is a tube with an inflatable cuff that is inserted into the pharynx (the upper part of the windpipe).

Soon I was feeling the effects of going under, and the next thing I knew, I was in recovery, and feeling pretty good. No vomiting. No pain.

One of the nurses (and they all were wonderful) asked me whether I wanted to have my friend help me prepare for discharge once I was back in my room. Of course, this was a yes; I was glad she would be there. We caught up on our kids’ lives as she got things in order and reviewed the instructions I was to follow. I think some memory goes out the window with surgery, but I recall she said that everything she was telling me was covered on the printed instructions I was given. She was my angel that day.

By 1:30 p.m. or so, I was back home wearing a surgical bra with an extra for changing it out each day. That’s it. I had little to no pain, just a touch of soreness, so I did some icing as instructed and took a couple of Tylenol to “keep ahead of the pain” as we hear, but it never came. I have some redness, but no bleeding, no swelling that I can see, no bruising yet, though that may still happen. Don’t ask me how this is possible, I have no idea. 

The stitches are all inside, and I don’t know how many it actually took. (One thing I didn’t ask!) There is some glue on the incision, and a small bandage that was to be removed Friday, which is when I could also take a shower. 

Dr. Chaterji called Friday afternoon to check how I was doing, answered a few more questions, and said she would call with pathology results as soon as she heard. This could take up to a week. My followup to see her is Friday, Dec. 22. 

Part 2. Going back to the beginning. Friday, Oct. 6. The annual screening.

My mammogram and ultrasound were scheduled for 10 a.m. at Optum in Yorktown. Of course, probably like every woman who gets these annual screenings, I was praying silently for a good outcome. Up till today, it’s always been a thumbs up. Today, the tide turned.

First, I had the mammogram, then, because I have “dense breasts,” I had the ultrasound, which is a precautionary extra screening for the condition. (More later.)

Before the tech starting the ultrasound, she told me that protocols had changed so that the doctor only calls you in when he needs to speak to you. In the past, everyone got to speak to the radiologist. So I knew it couldn’t be good when she was finished and the doctor wanted see me.

Dr. Papell, who was familiar to me because I met him during appointments in the past, very gently delivered the news. He said while the mammogram showed nothing, the ultrasound showed something tiny (5mm) and suspicious, on my left breast, that might be nothing, but really should be looked at with an ultrasound-guided core biopsy to check. This is an inexact quote because I was grappling with the information, but I think he said something like: “Please try not to worry too much; whatever it is, it is very small.”

I requested if he or Dr. Hertz, another radiologist I knew from earlier appointments, could do the biopsy. The scheduling worked out with Dr. Hertz and was set for Tuesday, Oct. 24, in Mt. Kisco.

The fact that the ultrasound revealed what the mammogram did not is why they do it. Dense breast tissue makes it harder to spot an abnormality on a mammo.

Here’s info from Yale Medicine.

“With conventional mammography, while we can be as accurate as 98% in a fatty breast, our sensitivity can drop to as low as 30% in women with extremely dense breasts, which is why supplementary screening with ultrasound or MRI—depending on the patient’s personal risk factors—can be such an important aid in finding breast cancer,” says Melissa Durand, MD, an Associate Professor of Radiology & Biomedical Imaging at Yale Cancer Center.

A couple interesting points, same source:

Dense breast tissue can make it harder for doctors to detect small tumors in mammograms. Like dense breast tissue, tumors look white in mammogram images. This makes it more difficult for doctors to distinguish tumors from dense breast tissue. Because of this, for women who have dense breast tissue, mammograms may overlook tumors.

Also, it’s quite common.

If your report told you that you have dense breasts, you’re far from alone, because about 50% of women in the U.S. who have screening mammograms are diagnosed with dense breasts. You can’t tell if you have dense breasts based on how your breasts look or their firmness—or your body type, weight, or the size and feel of your breasts.

Part 3. Oct. 24. The core biopsy. 

The appointment for the core biopsy, also called core-needle biopsy, was at 9 a.m. When I made the appointment, I was given several sheets of information about what to expect, so between that and what I found online, I was comfortable with having the procedure. Basically, from the given paperwork, it is this: “The radiologist will use imaging guidance to advance a needle to the area to obtain tissue samples.” 

The area was locally numbed, and I found the procedure wasn’t very painful, but I did feel pressure as Dr. Hertz inserted the needle several times, extracting tissue samples each time. He was assisted by the ultrasound tech, and he was very clear about what he was doing and when. 

I had also been informed that he would be inserting a tiny metal marker (clip). Why? From the paperwork:

“The breast biopsy marker serves to mark the biopsy site. If surgery is necessary, the marker will assist the surgeon in identifying the exact area to remove. If surgery is not needed, the marker safely remains in your breast, so we know the area that was biopsied on future imaging. . . .. It will not set off airport alarms or metal detectors.”

Details and more info from the American Cancer Society found here.

The procedure was followed by a quick and gentle mammogram to make sure the marker was in place. Dr. Hertz said he would call me as soon as he had results.

I found a video on YouTube, from Erika with a K, breaking down the procedure step-by-step in a short 11-minute video, in a way I never could detail in this blog. It’s well worth the look if you are curious. For the most part, she does a great job on preparing anyone for this. (Two things if you watch: I did not have any bleeding afterward, just a little bruising, and they only insert one marker.) Find it here.

He called on Friday, Oct. 27, to tell me the results showed two benign findings, a papilloma (safe) and a radial scar (not safe). Although both were benign, he said the radial scar (also called complex sclerosing lesion) is something that doctors usually feel should come out. He and, subsequently, my primary and gynecologist, all recommended I see Dr. Chaterji.

The rest for next time. (Tomorrow, I hope.)