Thursday, July 28, 2011

Sad Membership...

The so-called "27 Club" gained a new member last week when the talented and troubled Amy Winehouse was found dead in her apartment. Cause of death is as yet undetermined, but given the singer's recent history, a safe bet would be drug overdose. If that theory bears out, we'll still probably never know whether it was accidental or intentional. And really, it's none of our business. Either way, it's another heartbreaking chapter in music history, and will only add to the sad mystique of the "27 Club".

Brian Jones.
Jimi Hendrix.
Janis Joplin.
Jim Morrison.
Kurt Cobain.

Those are the "major" stars in the 27 Club. There are lots of others, with varying degrees of reknown, but these five are the most well known. Despite having only released two studio albums, Amy Winehouse will likely be thought of along with those top five who died at age 27, arguably at the height of their respective careers. Her addictions and public antics aside, she had an amazing voice and a fresh way of phrasing things.

That's really the saddest part of it... all that talent lost. Can you imagine what new musical ground Jimi Hendrix would have broken if he had lived even another 20 years? Or what further impact Kurt Cobain and Nirvana might have had on rock/alternative music had he not opted to check out early? It boggles the mind! Such a waste.

So is it the 27th year that's a curse? It think it's just a coincidence. A lot of people who are insanely creative and talented in some way seem to be, well, a little insane. It seems as though very gifted people battle a lot of demons. History is littered with examples. (Hello... Van Gogh, anyone?)

Do great artists HAVE to suffer for their art, and abuse themselves and/or die tragically? I think not. There are also plenty of examples of immensely talented people coping with their lives (and demons) successfully. (Picasso, hell... even Keith Richards is still around!)

Granted, with success often comes excess, and that almost certainly contributes to some of these untimely deaths. But I have to wonder if better coping skills play a part in avoiding them, and whether a troubled soul like Ms. Winehouse would have come to a tragic end at some point anyway without those coping skills. I don't know what the answer is. I just know it's damn shame to needlessly lose a talent like that. Amy, I hope you're finally at peace.

Thursday, July 21, 2011

Adventures in Breast Health Part 3: Results and Risk Management

Well, Campers... are ya ready for the big reveal? Wanna know what the biopsy results were? The breast specialist's office called me when they got them the day before my follow-up appointment to let me know...  Just as expected, the tests came back negative. Normal. Nothing to worry about... at least for now. Here's what the report said:
Breast (Left, 10 o'clock, 5 cm from nipple), core needle biopsy:
- nonprolferative fibrocystic changes.
- no atypia or malignancy detected.

COMMENT: The fibrocystic changes include stromal fibrosis, adenosis, and slight duct epithelial hyperplasia.
What does all that mean? Basically, that I have lumpy boobs (which we already knew), but nothing cancerous. At least for now.

So on to the follow-up with the fabulous ARNP (Advanced Registered Nurse Practitioner) that is my breast specialist from the breast surgery medical group I was referred to last year. She is awesome. She checked the biopsy site and said it looked like it was healing fine, no edema (swelling), no bruising. She did a breast exam, and pointed out a lumpy cyst or two for me to feel... they were familiar (I've felt them there before), but I'll keep an eye on 'em. Then we talked about my future adventures in breast health. Let me tell ya... sounds like it's gonna keep on being interesting. I'll explain...

I am now officially in the "high risk" group. Last year, I was rated at 18.7%. This year, based on a whole bunch of factors, I am now rated at 21.4%. Or maybe it was 18.4% last year and 21.7% this year... can't remember. Regardless, 20% is the magic number. If you cross that line, you are considered at high risk for developing breast cancer at some point in your lifetime. Well heck... I was damn close to 20% last year, so it's not that big of a difference. BUT... now that I am officially high risk, it makes me a candidate for breast MRI.

Oh boy. Yep. Back on THAT rollercoaster after all! But at least now it is actually warranted. And here's why, as my breast specialist so eloquently put it: "At this point, mammograms are pretty much useless for you. You're too dense." Well, it ain't the first time someone has called me dense! I CAN be a little slow on the uptake at times. But what she meant was that my breast tissue is so dense that a cancerous tumor could easily be hidden on a mammogram. A mammo is still good for showing calcifications, but all those lumpy, dense fibroids hanging out in my funbags would help hide any pesky tumors that might decide to camp out there. An MRI will smoke 'em out. And that's a good thing.

Unfortunately, it's also possible that the MRIs could lead to more biopsies because more suspicious (but benign) areas may show up on the images. But that's okay... I feel the same way as the 2-year survivor PA who performed my biopsy does: If you see ANYTHING remotely suspicious, stick a needle in it and let's find out for sure! I'd much rather sit through a few needle sticks every year than miss a cancer in the early stages and have to endure THAT kind of treatment. (Seriously... I cannot stress enough how painless the biopsy was.) Not sure yet how often they'll want to do the MRIs. Could be every six months, or once a year, or every other year. Depends on what they find after the one I'm supposed to get six months from now.

So I'll be scheduling a breast MRI in December if I've met my deductible by then, or January if I haven't so that the out of pocket cost can go toward next year's. Yeah... chalk up another penalty courtesy of my boobs: I get to pay for an expensive MRI or two every year. Even with my insurance plan's discounted rate, it's gonna be pricey. I'll have to squeeze our tight budget just a little more. And just like with the small band/big cup syndrome, I'm left wondering what women who have the same breast issues as mine but smaller budgets do. What do they have to give up to get the screening they need? How will I afford regular MRIs myself if I ever lose my insurance or they opt not to cover them? Would I have to risk developing an undetected cancer because I can't pay for an MRI that would catch it? Probably. Fingers crossed I'll never have to make that choice. My heart goes out to the women who do.

I am also now required to have a manual breast exam twice a year. (By a professional. Sorry... I'm not looking for volunteers!) I already get one at my annual "well-woman" visit. I can't remember if my GP does one at my annual physical, which coincidentally and conveniently usually falls about 6 moths after my well-woman exam. If not, I'll just call for an appointment with the specialist. What the heck... it will get me closer to meeting my deductible, right?

So all is well for now, and my current adventures in breast health are complete for the moment. Who knows what kind of circus will crop up when I get the MRI at the end of this year. But I'll definitely share the fun with y'all! Hopefully, it will help put you at ease if you find yourself in a similar situation.

This has been a public service post. And now, back to our (ir)regular programming.

Tuesday, July 19, 2011

Adventures in Breast Health Part 2: The Left Jab

The preparation info sheet for my scheduled breast biopsy recommended that I "wear a snug fitting bra, preferably a sports bra" the day of the procedure. As I mentioned in Part 1, it's difficult to find a bra in my size at all, let alone a sports bra. A friend recently clued me in to Nordstrom's lingerie department... I was gobsmacked! They actually carry (and keep in stock!) lots of small band/large cup sizes! It was almost like Nirvana for a petite but overly-endowed girl like me. So off to Nordstrom I went, in search of a 34DDD sports bra to wear to my biopsy appointment. I was pretty sure I'd find one there, though I held out no hope of finding one without an underwire. (Do they even make them without one at that cup size?)

A very helpful sales associate assisted me in locating the sports bras in my size, and also pointed me in the direction of a sales rack with other bras in my size. Woot woot! Then I went to try some on (I've learned to NEVER buy a bra without trying it on). Now, my boobs really don't seem any bigger to me, so maybe companies are just making their bra sizes run small these days, because my helpful sales associate took one look at one of the 34DDD bras I tried and suggested that I was probably a 34G (that's 4 Ds). WTF???? Seriously??? As if it isn't freakin' hard enough already to find a dang bra!!! Oh joy. Anyway, thankfully Nordstrom has even my new voluminous size IN STOCK!! Not a lot of variety, but enough, and some pretty ones too! I left with a new sports bra (yes, with underwires) and two other bras, just cuz they were pretty and on sale. But here's the deal... even on sale, they weren't cheap by any means. My heart goes out to all ladies who suffer from the small band/big cup size syndrome. If your budget is tight, how the heck can you afford a 34G bra, on the rare occasions that you can find one in stock at a place like Norsdstom? It was a stretch for me to squeeze it into the budget. And really, is it that small of a niche market that more companies wouldn't make and/or carry them? Really?

So, on to the biopsy. I arrived at the hospital's breast center at 8:00 am for my 8:30 vacuum assisted needle biopsy appointment as requested. I was sent down to the biopsy scheduler's office to sign some papers, then back to the breast center waiting room. The ultrasound tech called for me at about 8:40 or so, and led me over to the procedure room. She had me swap my bra and shirt for a hospital gown, and explained everything they were going to do. I was told to lie face-up on the gurney (with a nice comfy pillow), and she confirmed via sonogram the location of the area they wanted to biopsy. It was just about center, above the nipple of my left breast, exactly where it was on the previous sonogram. (She also took a quick look at my lymph nodes and said they looked normal, though she's not really supposed to say anything about what she sees.) She marked the area with a pen. So far, so good.

Then the physician's assistant (PA) who would be performing the biopsy came in. She explained everything to me again, and answered any questions I had. Then we got started. First, she confirmed which breast (left) and wrote "yes" on it, in case any of the three of us in the room forgot at some point. (It's funny, but they have to do that just to be safe.) Then she cleaned the area with some cold stuff. At this point, the tech zeroed in with the sonogram to guide the PA to the area in question. The PA started with several injections of a local anesthetic (xylocaine, I think). She said to let her know if I felt anything after the first couple tiny pinpricks. I did not. I'm guessing she made the small incision next (I didn't feel anything), and then inserted the bigger biopsy needle. I was watching the needle come in on the sonogram screen, but seriously did not feel a thing! When the needle tip was in the area they wanted to sample, the PA said "you'll hear a click in a second..." And then I heard a loud click, kind of like a spring release or something. I didn't feel anything except maybe the very slightest tiniest bit of pressure... barely noticeable at all. The PA confirmed that the click was a tissue sample being taken. They took several samples, maybe five or six or seven, all guided by the sonogram. Finally, a tiny surgical clip was placed in the area they tested, as a marker for future reference. It's the size of a sesame seed and made of titanium. With the marker in place, the PA removed the needle and held gauze on the incision to stop the very little bleeding there, while the tech labeled the sample container for the lab. Then they put some special surgical tapes over the incision, and then taped a small piece of gauze over that. I was only in the procedure room for a total of about 20 minutes, beginning to end! Quick and virtually pain-free!

(Not to tell other people's stories, but the tech had been through a fine needle aspiration like the one I had done last year, and the PA had the same procedure she just performed on me a couple years ago... she's now a two-year breast cancer survivor! It's comforting to know that they've been through it and know what it's like to be the patient. They also know first-hand how important it is to have the tests done correctly!)

One final step left, and that was to have a mammogram of my left breast to make sure the surgical clip was in the right spot and showing up as it should. And no, they don't squash your boob as tightly for that as with a normal mammo. They just need to make sure the marker shows up. After a few minutes of waiting in the "inner" waiting room of the breast imaging center, the mammography tech said everything was in place and I was free to go. Less than two hours for the entire visit, beginning to end, and absolutely no pain.

Well, the procedure itself was painless. I DID have just a little bit of discomfort yesterday evening, but very minimal. I wouldn't even call it pain, really. A couple Tylenol knocked it right out. I HAVE felt a very few twinges of minor pain for a second or two every now and then, but not many. I also have a couple cool little round gel ice packs that I can insert into my bra if I start feeling any discomfort. So yeah, I'd still stay the whole thing has been almost completely pain-free.

I gotta say, that breast center is amazing. Every person I've come in contact with there has been so pleasant and helpful. I even got a call from the "nurse navigator" this morning, who was just checking in to see if everything was okay. LOVE them!!  I'm glad I have access to such a great breast center. They seem to be up-to-date with current medical advances and guidelines. The needle biopsy I underwent was SO much less invasive than an open biopsy. Ask your doctor if it's an option for you if you ever need a biopsy. In most cases, it should be the preferred method.

I should get the result when I see my wonderful breast specialist later this week. I'm expecting the results to be negative... 80% of biopsies are. Stay tuned!

Thursday, July 14, 2011

Adventures in Breast Health Part 1: The Smash n' Grab

When I started this blog, I didn't intend to ever post any really personal information. I'm making an exception for a topic that's very important and close to my heart: breast health and breast cancer.

I'm making this exception in part because maybe it will encourage women to get their breasts examined regularly by a healthcare professional. (Sorry... your husband, boyfriend/girlfriend or that random dude you picked up at happy hour doesn't count, ladies!) And also because relating my experiences might make it less scary for someone else who may end up traveling the same path someday. So I decided to post about my latest adventures in the world of mammograms, sonograms, and other testing. Bear with me, because this first installment will be a little long, but there's some good info here

Let me start with a little background history.... I've never had a great relationship with my "girls". Most of the women on my mom's side of the family were/are short with with big boobs, and I inherited that trait. I blossomed fairly early in that department, but not unusually so. Then in the 8th grade, there were accusations from a snotty cheerleader that I "stuffed". I quickly put an end to the rumor by flashing that bitch in the hall one day. (Boy did THAT shut her up for good!) I still didn't think I was really all that overly endowed until the 9th grade, when a male pal signed my yearbook "To the girl with big tits... love, B-- (I'll withhold the guy's name in case he ever stumbles across this blog). What?? Big tits? Who, ME??? Jeez! They were just a C-cup at that point, but I guess a C-cup on a 5'2" skinny little frame look pretty big. I was never self-conscious about 'em until then.

Enter high school, and I filled out even more, ending up sporting a D-cup by graduation. Yep... STACKED at a tender young age, surrounded by wolves. At least back then they were perky! In the years since, I've added just a few extra pounds and my cup size has increased. I'm currently spilling out of a 34DDD, and gravity is doing me no favors... I require bras and bathing suits with STRUCTURE... like steel girders and winches and iron bars. It's extremely difficult it is to find 34DDD bras in stock in most stores. (Victoria's Secret... HA! Their secret is that they don't make bras for real curves.) And who wants to mail order a bra that they can't try on first? I'll give you one guess how fun bathing suit shopping is for me. It's not the few extra pounds and the touch of cellulite that make it so miserable... it's searching (usually unsuccessfully) for a suit that covers AND supports my boobs without hanging off the rest of me like a set of old curtains. Same goes for shirts and dresses to a lesser degree. They're usually either too tight across the bust or too loose everywhere else. So my "funbags" are something I have a grudging tolerance of, and not much more.

Now, add fibrocystic lumps to the mix and hilarity ensues. I had never heard of fibrocystic breasts until I found my first lump at age 25 or 26. My gyno (love her!) ordered a mammogram to confirm that it was just fibroids (it was), and I've had regular screenings since then. All results were normal until about four or five years ago. In addition to changes in my breast tissue, my mom was diagnosed with breast cancer in 2006. Never had a family history until then. Mom was the first. (Way to blaze a trail, Ma!) Suddenly, the imaging centers were wanting to investigate mammogram findings with sonograms, and then a couple years ago, they wanted to follow the sonogram with an MRI.

Honey... you just haven't LIVED until you're lying face down on an MRI table with your boobs hanging down through the specially designed cutouts, IV drip in your arm, MRI machine banging around ya. But all results came back clean, and it was back to just the regular mammo/sono combo, but every three to six months. After about a year and a half, they cleared me to go back to just once a year. Until a year later (last year), when they wanted to do another MRI. At that point I questioned it, only because it seemed like it was turning into a big ol' merry-go-round. So I called my gyno (who has been in charge of my breast health since that first mammogram) and asked if she thought that an MRI was really the way go. That's when she decided to send me to a breast specialist.

Ooooh! Breast Specialist! Never knew there WAS such a thing! So I went to see one of the breast specialists my gyno recommended. The good news... she agreed that an MRI wouldn't really tell them what they needed to know. The not-so-good news... she said a fine needle aspiration biopsy was what needed to be done. Yikes!! The word biopsy was pretty scary to me! Made me a little nervous. But actually, the procedure is pretty quick and simple, and really not terribly painful. They just use a needle, guided by sonogram to the cysts to be investigated, and they suck out the fluid and test it. It was actually kinda cool to watch the cysts collapse on the sonogram screen. (By the way, they were investigating "complicated cysts" as opposed to "simple cysts". Complicated cysts have debris floating around in 'em. Also kinda cool to watch on the sonogram screen... like little tiny snow globes.) All tests came back normal... "See ya next year for your mammogram. We'll do a sonogram if needed".

Cut to this year. I had my annual mammogram last week. Of course they also did a sonogram (knew THAT was coming). The physician's assistant then came in and told me that the radiologist was recommending a vacuum assisted biopsy. A few days later, my breast specialist concurred. This is different than the fine needle aspiration biopsy... a bit more invasive and intensive, but still a pretty simple outpatient procedure. I found some videos that show how the procedure is done, and I'll link them. (Click the pretty colored text areas to view them.)

Am I worried? Not at all, surprisingly. My gyno just did a manual breast exam at my well-woman visit last month, and remarked that my boobs felt less lumpy. And the area they want to check out only showed up on the sonogram, not the mammogram. So it's likely that it's just a clump of fibroids (damn things). I don't expect the procedure to be very painful, though I'm sure it won't be very comfortable or fun and there will certainly be some soreness afterward. And if they DO find anything, they'll be catching it early when it's most easily treatable. Seriously... if they're gonna find something, hell yeah I want them find it as early as possible!

Even if I get the unlikey diagnosis of cancer, I'm not afraid. I personally know 3 or 4 women who have successfully fought breast cancer, including my mom. She's now a 5-year survivor! (Yay Mom!) Plus, I would probably finally get the breast reduction surgery I always wanted but never wanted to actually go through. (Now THAT'S a gruesome surgery!) Might was well do it if they're gonna be cutting bits away anyway, right? But I seriously doubt the results of my upcoming biopsy will be positive for cancer. I just don't think it's in the cards. Not yet, anyway.

So, ladies, do yourselves a favor and be sure to get your regularly scheduled "Smash n' Grab". Depsite what anyone might tell you, mammograms really aren't all that painful and they can save your life. Also, if you have chronic breast issues like fibrocystic tissue, ask if your doctor can refer you to a breast specialist. I feel SO much more at ease with a specialist checking everything out. If that's not an option, just be sure that you have a good rapport and clear communication with your doctor, AND GET REGULAR SCREENINGS!

Stay tuned... I'll post about the biopsy in Part 2 at a later date. The fun is just gettin' started!

Thursday, July 7, 2011

Horrible Bosses was not horrible...

Movie poster from Warner Bros.
I had an opportunity to attend a preview screening of the movie Horrible Bosses last night. Not bad for a comedic summer flick. I mean, sure... it's one of those mostly guy-centric movies, but there was plenty in it that I found funny as well.

The three main characters, each enjoyably well-played by Jason Bateman, Charlie Day and Jason Sudekis, have distinct personalities and issues caused by their respective employers. As for the bosses, no surprise that Kevin Spacey turns in another scathing performance as a raging asshole... he's done it so well before and doesn't disappoint in this role. Colin Farrell is convincing as an overindulged, degenerate cokehead son who inherits his father's business. But the real surprise is Jennifer Aniston as a debauched sexual harasser.

Jennifer Aniston has always had a somewhat wholesome image, so I could hardly believe the shockingly raunchy phrases she was uttering as her character... and that's what made it so funny! I'm not even sure it was TRULY funny, but her porn-star-worthy vulgarity was so comical and unexpected given that it was coming from her. I'm guessing there will be a lot of young men with completely new fantasies about her after viewing this film. (Or maybe not so new... I don't know what goes on in the minds of young men these days, and I'm not sure I really want to!)

I don't think any other actress could have pulled off that role successfully. Ms. Aniston, who has always exuded a bit of a "girl next door" charm, has also generally given the impression that she doesn't take herself too seriously. She always seemed to have an underlying current that hinted at a wicked sense of humor. I think that's what really gives her the edge in this role, and in it she is wicked, indeed! Kudos to her for taking on such a portentous role and working it with aplomb! 

Horrible Bosses is unlikely to be in Oscar contention, but it's worth at least a matinee ticket if you enjoy movies of this genre. It opens tomorrow (Friday, July 8th). Just don't bring the kiddies!

Wednesday, July 6, 2011


Hanging out in our backyard is almost like being in Hawaii.

Well, not really. But the plumeria is blooming, and it smells so good! And our pineapples are growing bigger. Can't wait to eat 'em!