I am writing this early on Monday, Dec. 18. Sleeping hasn’t been easy since the first appointment in October, but the storm arrived in New York last night. It’s like 60 degrees and the wind is so loud, it sounds like a train is running through my yard.
This is Part 4. My appointment with Dr. Chaterji.
I called Dr. Chaterji’s office to make an appointment right after I got the core needle biopsy results from Dr. Hertz. I had googled her online, and along with all the recommendations, I felt that she was the right choice. This from webmd:
Ranjana Chaterji, DO is a board-certified general surgeon specializing in the comprehensive, minimally invasive and compassionate treatment of benign and malignant breast disease. With a passion for women’s health and healing, Dr. Chaterji completed a fellowship in breast surgery at Northern Westchester Hospital’s Institute of Aesthetic Surgery and the Breast Institute, which included training in reconstructive and plastic surgery.
Here’s a short interview with her on YouTube.
Reviews all good.
Office staff at the Breast Care Center were great from the start. My appointment was first set for later in November, but on Monday, Oct. 31, I got a call that there was a cancellation the next day, so I saw Dr. Chaterji on Nov. 1 at 3 p.m.
As I have said, her bedside manner is excellent. She’s professional and matter of fact, yet seems genuinely caring, and there’s no doubt to her experience and expertise.
We chatted a bit, there seemed no hurry, discussed my medical history (evidently, I’m high risk, more on that perhaps another time) and she did a breast exam. We discussed the test results, and she said surgery was the course recommended. She asked if I had any questions.
My big question was this:
Why, if both findings were benign, do I need surgery?
She explained that the risk of surgery was worth it because surgery reveals a percentage of these findings will also show cancer, even when testing does not. But she did say, while not suggested by her, I could take a “wait and see” approach with more frequent ultrasounds, etc.
I felt her honesty and patience with me was worth something. (I later talked to a friend, D., who said she experienced this same situation. She had the surgery, and they did actually find cancer. She is fine now.)
In any case, the doctor said she wanted me to get a breast MRI because that would show whether anything else was going on and also give a better look at what had already been found.
She also said: No more than three times a week for meat and alcoholic drinks. (I hardly eat meat now, but drinking? Yikes.) Alcohol and meat are both breast cancer risks.
Part 5. The MRI.
You can see how this kind of thing moves along from one point to the next. High anxiety every step of the way. (It all started in early October.)
From here on in, I was in touch with Dr. Chaterji’s staff. Her nurse, Val, said they would handle making all appointments. That was nice. The MRI was set for Nov. 10.
She also said, please call with any questions, and I think if I called her 10 times, that would be about right. One question was the same:
Why, if both findings were benign, do I need surgery? She could tell it was hard for me to accept, and I think this is as close to an exact quote as I can get (my notes only go so far):
“It’s not the papilloma so much as the radial scar. We say that the radial scar ‘keeps bad company.’ ”
I also was searching for everything I could find online regarding papillomas and radial scars. The upshot was all the same, this from NIH:
The radial scar (RS) or complex sclerosing lesion (CSL) of the breast represents a management dilemma on diagnosis at breast core needle biopsy because of the risk of associated malignancy identified only upon surgical excision. . . .
In conclusion, RS or CSL diagnosed at core needle biopsy still warrants surgical excision because of the significant percentage (9%) of cases with associated malignancy. . . .
At this point, I was almost ready to accept surgery, but first, I asked for a second reading on the biopsy from the Northwell radiology department, just to be sure. Soon enough, the results came back, basically the same as those from Optum.
I then called one of my oldest friends, R., a pathologist, who I have known since I was about 7 years old, and read him the results. His answer was clear: “Debbie, there is NO good reason NOT to do the surgery;” the papilloma could only get larger, and the radial scar could only become more dangerous.
The MRI was scheduled back at Optum, since I had started this journey with them. It was loud, as they all are. But this was different from others I’ve had in two ways: I was face-down and also getting “contrast,” which was injected.
Some info from the American Cancer Society on that. Briefly:
The test is painless, but you have to lie still inside the narrow tube. You may be asked to hold your breath or keep very still during certain parts of the test. The machine may make loud thumping, clicking, and whirring noises, much like the sound of a washing machine, as the magnet switches on and off. Some facilities give you earplugs or headphones to help block noise out during testing. . . .
When breast MRI is done to look for breast cancer, a contrast material called gadolinium is injected into a vein in the arm during the exam, which helps show any abnormal areas of breast tissue.
About gadolinium , from this radiology site in Australia, so I guess it’s in wide use.
Gadolinium contrast medium is used in about 1 in 3 of MRI scans to improve the clarity of the images or pictures of your body’s internal structures. This improves the diagnostic accuracy of the MRI scan. For example, it improves the visibility of inflammation, tumours, blood vessels and, for some organs, blood supply.
The MRI really wasn’t terrible, not long, probably no more than 30 minutes, and the contrast didn’t affect me in any obvious way, although the nurse gave me some juice, and also water, when it was done, and advised I drink as much fluid as I could in the few hours to flush it out. So does the NIH:
Patients who are injected with gadolinium-based, MRI contrast agents are advised to drink additional water for few hours after the procedure, in order to clear the contrast agent from their bodies.
It can be toxic, so I was happy to get it finished. But at this point, my concern was less about toxicity than the results.
Part 6. The Mag Seed.
I can’t be sure when I got the MRI results, but when I got the call that nothing else showed up, I was beyond relieved. Almost excited.
Then I called to schedule the surgery.
The next thing I knew, I needed to get the “mag seed” placement. Wait, what? I couldn’t believe it. I had to do something else? I was nearly flabbergasted. It seemed like enough was enough, but not yet. What is a mag seed, I wanted to know.
Nurse Val patiently continued to explain and answer questions. The mag seed (magnetic seed) had to be inserted next to the marker (clip) already there so they could find the precise, exact point to be working on.
Didn’t they know this location from the marker? No, not really. I still can’t explain. Isn’t that why they put the marker in? Not quite. Val said they need the mag seed so they can find the marker. Okay. My understanding, anyway.
From the American Cancer Society, and taking us back to the same site referenced in previous blog.
In newer methods of localization, a localizing device is put into the suspicious area before the day of your surgery, so you don’t have to have it done the morning of your operation. Radioactive or magnetic seeds (tiny pellets that give off a very small amounts of radiation or that create small magnetic fields) or radiofrequency reflectors (small devices that give off a signal that can be picked by a device held over the breast) can be placed completely inside the breast (unlike the wire used for localization). Your surgeon can then find the suspicious area by using a handheld detector in the operating room.
(Dr. Chaterji was using radiofrequency.)
I guess I’m lucky they are using the mag seed; evidently there was a time, not too long ago, a woman would have to turn up early for surgery and get a wire implanted by the radiologist extending outside the body and continue wearing it till the surgery so they could find the location (see previous blog above).
So it was back to Dr. Hertz on Dec. 5, who promised this time would be easier than the marker placement and quicker, and with the tech, the mag seed was placed. (He was right.)
That brings us full circle. See Dec. 17 blog describing surgery. Both marker and mag seed were removed, along with other tissue. And here we are.
It seems the rain and wind have stopped. All is calm!
Fingers crossed that the next time I hear from the doctor, she says we are all done. Now THAT would be the best Christmas gift I could get.
All the best! And happy Christmas!
I don't think I've ever read about this experience. It's riveting and sounds very thorough. You are in good hands and I also await the good news.