Merry Christmas biopsy #3

Today is Boxing Day and I decided to bypass all the sales and continue to recover from the past week. On Monday I had an appointment with a family doctor. Up to now I have not had a local family doctor. Unless you are over 55 they are very difficult to come by in Victoria. Aside from crazy Christmas vacation traffic on my way into town it was very unexciting and I will probably keep her as my doc if I can't find anyone in the near future that is closer to me. After the appointment I ran some errands to prepare for Christmas Eve dinner with my in-laws.

Tuesday on the other hand was quite the gong show. First I met Sarah for coffee and a bite to eat. More semi-crazy traffic but otherwise we had fun as always. Then I had to head over to the Jubilee hospital for the repeat biopsy on my enlarged lymph node. When my oncologist gave me the time for the appointment she said that she didn't know where the biopsy would be done so I should ask at the information desk.
I made it to the information desk with about 10 minutes to spare for my appointment. The clerk looked my up in the system and found a lab requestion for a fine needle biopsy. There was no other information. That seemed a little weird to me as the previous biopsy had been done in medical imaging but the clerk sent me to the outpatient lab that was off in a different wing of the building I was in.

When I got to the lab it was pretty quiet with only 1 staff member around. Lucky for me as soon as the staff member saw me she wandered off somewhere. I suspect that she was hoping I would just go away. After about 5 minutes she came back. I told her that I was scheduled to get a fine needle biopsy done and I wasn't sure if I was in the right place. She looked at me with a slightly scared look on her face and told me that they didn't do those things here. Here being the outpatient lab.
I told her that all that was in the computer was a lab requestion for the fine needle biopsy but the previous biopsy had been ultrasound directed. She very happily told me to go to medical imaging, which is in yet another wing of the building, so off I went.

When I got to medical imaging it was just a minute or so before my appointment time. I had to wait a couple minutes then I was called up to be checked in. The clerk looked me up in the computer and all she found was the lab requisition. She handed me off to another person that I think was the temporary scheduler while the regular scheduler was on vacation. The scheduler looked a few things up and couldn't find any information. Eventually she decided that she should call my oncologist's office since she couldn't find any paperwork for me.
So, she talked to the nurse that normally knows everything at my oncologist's office and nothing was figured out. The scheduler requested a requisition get faxed over to medical imaging and she could book me in for the following Tuesday. Ah crap.

I emailed my oncologist to let her know about the problem and then I decided I would grab another coffee before I headed home. I was standing in line to get coffee when I noticed that I had a voicemail on my phone. I checked the message and it was someone from the lab calling me to see if I would be coming in for my appointment as I was now half an hour late. The message didn't tell me where I should actually be so as I was calling her back I went back to the outpatient lab.
I got voicemail but I was back at the lab by the time I hung up the phone. This time there were 2 people at the lab outpatient check in window. When I told them I was supposed to be getting a fine needle biopsy done they immediately told me "those aren't done here you have to got up to the 5th floor to the fine needle aspirate lab". Ohhhhhhhhhhhhhhhhh..........that makes so much sense. They gave me directions, I had to take a special elevator that was right beside medical imaging (of course, where else did you think the elevator would be?).
While I made the trek up to the FNA lab the clerk was going to phone up to left them know I was on the way.

Once I finally made it to the right place I only had to wait a couple minutes until the pathology tech came to get me. I was taken to a small exam room that had a bed and a cart that held all of the tech's supplies. For once I was appropriately dressed, I had on a button down shirt with a tank top on underneath so I didn't need a hospital gown with its special hospital laundry smell, I just had to take off the button down.
I chatted with the tech while we waited for the pathologist to come in. Back in the day, when I was a student tech, my very first rotation was in the anatomic pathology department at the Jubilee. Truly felt like my life had come full circle yet again.

After a few minutes the pathologist came in. Turns out he is good friends with my oncologist and he had done part of residency training in oncology at the Cancer Agency in Vancouver.
For the biopsy, the first part was a 25 gauge needle into the node and the fluid collected was put on a slide. The pathologist immediately took the slide out of the room to look at it under a microscope to confirm that he was in the right area and getting a good sample. He came back really quick and all things were a go.
The rest of the sample collection was 7 more needles, 1 was 25 gauge the rest 23 gauge, into the lymph node. The end result was enough sample to be able to confirm the ER and Her2 status of the cells. The pathologist said he would look at everything the following day, Christmas Eve, and I would be notified right away if there still was not enough sample and I would have to come back for a third attempt. The actual testing had to be sent to Vancouver so results will not come back until next week at the absolute soonest.
A bandaid was slapped over the poor, abused area of my armpit and I was told to expect some bruising, swelling, and pain. Then I got to go home. Yup. Got all 3. I have really only been able to start using my arm comfortably again today. My poor armpit sure looked and felt like it had been run over by a bus on Christmas Eve.

Then.......on Christmas Eve I went for a lymphatic drainage massage. For the last few weeks my lymphadema has been pretty bad and my left hand has been really sore to the point that there are times I really can't use it. I am left handed just in case you didn't know 😉
So, between the lymphadema on one side and the biopsies on the other side lifting and carrying has not really been a possible activity for a few days. I have gotten really good at sitting on the couch.

The massage itself isn't really as relaxing feeling as a muscle massage for me. With my hand swollen it hurt every time something touched the back of it and about a quarter of the massage is just my hand. By the end the swelling does go down so it does hurt less and now, 2 days later, it is a little better.
Not long after I got home from my massage Ian got home from work and he brought most of his family. It was so great to see everyone!
We had traditional tourtiere for dinner, always a treat on Christmas Eve. And we drank lots and ate lots of Christmas treats and generally had a great time. A really fantastic way to celebrate Christmas!

Everyone headed back to Vancouver that evening so Ian and I had a quiet Christmas day with the pets. Just what I needed after all the appointments I had been through.

I hope everyone had a wonderful Christmas! I may not post again until after the New Year unless I hear something about my biopsy results. Have a safe and happy New Year's and I will be back in 2015 🎉

Christmas Biopsy #2

Let's see.....the last week has been a little action packed.

Last Tuesday I was called by a nurse at my new breast surgeon's office. My surgeon was scheduled for surgery on Friday at the Royal Jubilee Hospital so I was booked at a clinic for 07:45 to get the little bump biopsied. Uhhhhhhh.........07:45? I haven't been out of bed before 10 am in about 2 months. It is one of those suck it up, buttercup, and get it done moments. At least I am getting the biopsy done really quickly.

Later on Tuesday my wonderful bestie, Keetah, arrived for a visit with her mum, a couple of super cute pooches, and her long lost brother. It was a couple days filled with lots of food and drink and laughs. Orchid was awfully glad when they left. Miss Satori, the puggle, really wanted to practice her cat chasing skills much to the amusement of the humans.........our entire house is hardwood. There was a lot of running with no forward movement from the puggle.

Thursday afternoon I got a call from my oncologist. She had received the results of my biopsy (!!!!!). That was unexpected. The biopsy showed that the enlarged node was due to breast cancer. Yay! I haven't suddenly got lymphoma or melanoma. But, there was not enough sample to confirm the estrogen receptor and Her2 status. It is possible that the cancer has mutated and one or both of those markers has been lost. Fingers crossed that isn't the case.
If the cancer becomes ER negative then the letrozole will be ineffective and if it becomes Her2 negative the herceptin becomes ineffective. If the cancer loses both there will be a lot of chemo in my future.
So, because there was not enough sample to complete the testing, I am booked for a repeat biopsy on Tuesday afternoon. Joy.
My onc also told me that she has been in touch with my radiation oncologist and most likely I will be going for radiation on the lymph node at the beginning of January. The question now is how many treatments will I need?

Friday morning, dark and early, and rainy of course, I trundled off to the Jubilee. I got to the clinic where the biopsy was to be done and it was all closed up. The clinic was actually not supposed to open until after my scheduled appointment time. I waited a couple minutes and my surgeon showed up. She told me to just take a seat and she would be back to get me in a few minutes after she had set up.
A clerk showed up then and called me up to confirm my name and birth date then I waited a few more minutes.

My surgeon came back and showed me to the procedure room. Normally there is a nurse in the room to assist but the appointment was so early there were no nurses yet so we were on our own trying to figure out how to turn on the big light needed for my doc to see what she was doing. I had to change into a gown and my doc came back with a resident. He got to be the assistant.
The area around the bump got frozen with lots of freezing but I barely even felt the needle for the freezing go in. Goes to show just how numb I still am from my mastectomy.
Then I got sliced open and the bump was cut out. My surgeon was nice enough to show me the piece of tissue she removed. There was a clip attached from when my mastectomy was done. Possibly the bump was just due to me reacting to the clip. Sure hope that is the case.
I got sewed back up, the end result was a 2 cm incision in my chest. I got a few dissolving stitches, a few steri-strips, and a bandage on top just in case there was any residual bleeding. Results should be back in a week or so.
I felt alright when I left but I suspect that I was just slightly in shock. I had a little bit of lightheadedness and felt just a little icky. On the whole scale I was ok though.

I went home and went back to bed for a couple hours. After I got up for the second time that day I stocked up on fluids and got myself ready to back to the Jubilee, to the Cancer Agency to be precise, for my herceptin. Ahhhh, such a good day.
Only 1 poke was needed to get the IV and I was in and out pretty quick. Needless to say I was in bed before 8:30 that night.

I spent the weekend relaxing and socialising and enjoying the Christmas season. Next week the medical fun continues.

A Christmas biopsy

Last Friday I received a phone call from the medical imaging department at Victoria General. Would I be able to come in Monday morning for a mammogram, ultrasound and biopsy. Ummmm.........yea......of course. Such a silly question.

While I was waiting for that phone call I did manage to put up my Christmas tree. And I even fit in a Costco adventure with my mom and Aunt Gwen and the three of us got our Christmas baking done. The baking is a little late this year but it sure is tasty.
And Jasper is super lucky, I seem to have lost, or I may have thrown out while packing, his Christmas antlers so no Jasper wearing antlers picture this year.

The weekend was pretty uneventful and then it was Monday morning. The medical imaging scheduling person had told me to expect some delays once I was in the department. They are trying to fit as many people in as possible before Christmas. The mammogram should be on time but there could be a wait for the ultrasound and biopsy so I should expect to be in the department for a while.
With that advice in mind I arrived at the hospital and had to decide how many hours of parking to buy. I figured 3 hours would be enough. Turns out I can only buy parking in 2 hour increments. Glad to know hospitals like ripping sick people off.

In the medical imaging department I had to follow the pink line to get to the breast imaging area. Once there I was the youngest person by about 10 years although I could hear a child somewhere in the department who was definitely in the depths of despair. Poor little tyke.
With the warning that I could be sitting around for a while I came fully prepared with ebook and phone for entertainment. I only made it a few pages before I was called in for my mammogram.

It was a little strange, the radiology tech asked me some questions about my medical history, any history of breast cancer in the family, when was my last mammogram, what treatment I currently on, did I have chemo and radiation, were any lymph nodes positive when I had my surgery? Except for the current treatment question I really had to think about everything else. I don't think about the past stuff any more. It is just that, in the past. Can't do anything about it or change it so there isn't much point in thinking about it.
So the mammogram was quick and easy. A little squashing and body contortions and it was done. Certainly one of the easiest things I have to deal with so far.

Then, it was back to the waiting room. I only made it another 10 or so pages in my book before I was called in for the ultrasound. Not bad, I had barely been in the hospital for an hour at this point. The ultrasound tech repeated most of the questions the mammogram tech had asked. Much easier the second time through.
The tech also asked if I had any other concerns other than the enlarged lymph node. I mentioned the little lump above my surgery scar so the tech decided to ultrasound that first. Ultrasounds are another wonderfully uneventful test. I lie about and stare at the ceiling. Easy.
Part way through the ultrasound another tech popped into the room to see if we were ready for the radiologist to do the biopsy. We weren't. That meant the radiologist would do another case first so there might be a delay before my biopsy was done.
The ultrasound was finished up and the tech reminded me that there might be a wait for the radiologist. Turns out the tech doing my ultrasound was the supervisor of the department. She was the one that had ensured I got in really fast because my oncologist had supplied enough information in the ultrasound request to demonstrate the need for rapid testing without needing further information. I have to remember to tell my oncologist to keep doing what she is doing. It truly is a service to her patients.

After a short wait the tech and the radiologist came into the room. The biopsy was just going to be fine needle aspirates and not core biopsies. Yay! For those in the know, we are talking 25 gauge needles. Barely feel those going in. I did feel the next bit where the radiologist uses a combination of mushing the ultrasound wand into the lymph node and jiggling the tip of the needle around in the node to collect as many cells as possible. Then it was done 3 more times.
On the upside, the tech commented at one point that this radiologist was the best one in the department at fine needle aspirates. The radiologist always got bigger samples than everyone else. That is always a great thing to hear while you have a needle stuck into your armpit.

Altogether, the sample collection only took about 10 minutes and once it was done all I got on the site was a couple band aids. Getting this biopsy done does make me think of that day in July of 2012 when I had my original biopsies done. That time it was fine needle aspirates on a couple nodes plus 2 or 3 core biopsies of the lump in my breast. I remember the radiologist was called in from some other task to do my biopsies so she was wearing opened toed shoes, they may have even been heels, in the procedure room.
The other memorable thing about those original biopsies that were done late on a Friday afternoon was that the following Sunday morning I thought I would pass out while standing in the immigration line at the Vancouver airport. I was on my way to Rochester, NY for training for the job I had just started. I suspect that I was still in shock at the time and that trip was an adventure involving transfers in Denver and Chicago.

I'm getting so bad about tests that I totally forgot to ask when my oncologist will receive the results. Kinda makes the waiting easier. I'll expect the results some time in January.

CT scan #.......um.......I don't know

After much digging on my part I was finally able to feel the enlarged lymph node that I knew had to be in my right armpit. When I saw my oncologist last Thursday I was able to show her where it was. Turns out it is really deep which is why it has been so difficult to to feel during a physical exam.

Friday was CT scan day. It was the full meal deal, abdominal CT followed by head CT. 2 for 1 is nice since it saves me an iv and yet another dose of the contrast dye. Although, I am hoping that I end up having so many CT scans I eventually start turning purple from the inside out.
With scans done I was told I'd wait about a week for the results.

Bright and early Monday morning, or at least at 9:30, which I think is early for a Monday, a message was left on my phone from my oncologist. She already had my CT results. That was really fast so I couldn't decide if that was a good thing or a bad thing.
When I returned the call I found out it was a good thing.

As expected, there was an enlarged lymph node in my right armpit. No surprise there. The splotch on my skull is shrinking. Yay! There is nothing in my liver. Yay! And everything else remains stable. Yay!

With all these results it was decided that I would continue the current drug regimen of zoladex, letrozole, and herceptin. I am also going to be booked for an ultrasound and biopsy of the lymph node to confirm if it is breast cancer and to see if there has been any change in the estrogen receptor and her-2 status.  I am also waiting for a consult with my radiation oncologist as the plan is to use radiation to treat the lymph node.

On Tuesday I met with a breast surgeon. My greatest dream is to have a mastectomy on the right side and a double reconstruction. By doing a double reconstruction I don't have to worry about the problem of one perky boob and one floppy boob as I age. Unfortunately, I doubt I am a candidate for reconstruction since I am currently not stable. Even if reconstruction is off the table I would still like the right side mastectomy done. I have to say that I find the imbalance right now annoying and rather inconvenient.
If I get the second mastectomy and no reconstruction I am going to get a mastectomy bra tattoo. If you haven't seen one before, here is the general idea
http://www.dailymail.co.uk/femail/article-2281345/Photo-breast-cancer-survivors-tattooed-chest-shared-thousands-Facebooks-attempts-ban-it.html.

Hmmmmm.......I have digressed slightly. On Tuesday I saw a breast surgeon.  She is very concerned about 2 things. First, the lymph node. She finds it odd that the original tumour was on the left side and now the right lymph nodes are affected and there is currently no sign of any tumour in the right breast. Because of this she really wants the ultrasound and biopsy done as quickly as possible.

Second, I have had a small bump just above my scar at my mastectomy site. The bump is about 1 cm but after it initially showed up, in February???, it shrank a little and doesn't seem to have changed since. There is a slight red tinge to it which is apparently not good. Of course, I have no idea if it has always looked like that. I sometimes think I should reread all my blog entries occasionally, all the details start running together after a while.
Anyway, the surgeon thinks the bump should be biopsied as well so now I am waiting for that appointment as well.

And that is my life right now, endless appointments. At some point I need to find the time to put up my Christmas tree.