“Physician, Heal Thyself.” – From the Bible, Luke 4:23 (King James Version)
“You will need to have additional screening done.” This is what I was told by the radiologist after he reviewed my mammogram. Every year around Christmas time, I get this much anticipated exam done – it’s almost as fun as getting a PAP smear. Even us, doctors don’t always like undergoing these annual visits. Due to my insurance necessitating at least 365 days transpire before my next mammogram, I needed to schedule my mammogram with 3-D Tomosynthesis in early January. On Tuesday afternoon, January 2, after seeing my patients earlier in the day, I walked into the Radiology Department to have my breasts compressed and evaluated.
The 3-D Tomosynthesis test is a new screening introduced about 3 years ago to better detect abnormalities in women with dense breasts. Breasts are composed of different types of tissue : 1) non-dense or fatty tissue and 2) dense tissue comprised of milk glands, milk ducts and supportive tissue. The more fibrous tissue and less fatty tissue, the denser the breast.
Here’s a link to learn more about 3-D Tomosynthesis:
I was led into the mammography room by a very friendly technician, whom I’ve met over the years. She instructed me to take off my shirt and bra and don a pink vest with lots of strings attached to it. I’ve never really understood why they have all those straps on both sides. Is it to cover one breast and reveal the other while keeping one strap tied? We will leave that for another day….
She proceeded to take each breast, compress it under the mammogram handles, careful to get each angle and accurate depth of compression. We completed the needed images and I left. “Done for another year!” I thought.
But that’s not what happened. I received a call from the radiologist later that night, who said that I needed additional screening. His tone sounded firm and yet reassuring – just some additional follow-up was required. This sounded far too familiar to me. How many times had I told patients that they needed more views, an ultrasound or another form of additional screening? Now it was me getting this directive. Per the radiologist’s review, there was a concerning asymmetry seen on one of the tomosynthesis scans. I, being a stubborn doctor, asked to see the images and compare. Yes, there was an asymmetry – seen the previous year, but now bigger and with a dense, white contour. I had to accept this fact and schedule the additional testing.
I thought, ‘Ok, I can do this. I’ll just have a left breast ultrasound and all will go fine”.
So I was scheduled on following Thursday, when a cheerful ultrasound technician applied copious amounts of ultrasonic gel to the surface of my left breast. Alas, after surveying every millimeter of my mammary gland, no abnormality was seen. This was both good news and bad news. Because nothing was seen on ultrasound, this also meant that no biopsy could be done by ultrasound. Therefore, it was recommended that I have a stereotactic biopsy. Now what does that mean?
Let me give you a little perspective about the different types of biopsies. An ultrasound guided biopsy is easier to do and less complicated than a stereotactic biopsy. A stereotactic biopsy uses mammographic x-rays to locate and target the area of concern and help guide the biopsy needle to the precise locations. This technique helps ensure that the area that is biopsied is where the abnormality was seen on the mammogram. It’s referred to as stereotactic because it uses two images taken from slightly different angles of the same location.
Now, they had my attention. What? I needed a deep-guided biopsy of my left breast for an asymmetry that looked very close to my chest wall?
After gathering my thoughts, I scheduled the stereotactic biopsy during my lunch hour on Monday, Jan. 11, so I wouldn’t need to reschedule patients. The same amicable technician that helped with my initial mammogram was there. I breathed a sigh of relief knowing there was a familiar face in the room. She led me into the operating room where a large, oblong table stood with mammogram equipment surrounding it.
She explained what needed to be done, the risks and benefits, as well as the potential for some pain during the procedure. I signed the consent form and looked at the daunting table. Literally, it was a table with a hole big enough for a breast to hang down and be compressed to locate the exact position of the lesion (asymmetrical part of tomosynthesis). I removed my GIA Wellness pendant from my neck and placed it into the palm of my right hand. This healing charm had helped through challenges in the past and I thought the extra positive energy would help me through this one too.
The technician first cleaned the breast area with very cold Hibiclens solution. “Yikes! “I thought. That cleansing solution felt like ice on my warm mammary tissue. Then the positioning and compression started. Two large paddles slowly squeezed until the precise angle was achieved to target the biopsy site.
“Ok, I’m doing really well. Not so bad so far.” I stated to myself.
Then radiologist instructed me what needed to be done next. He calmly said, “You might hear a loud POPPING sound”. And then I felt it – the needle was burrowing into my left breast heading toward to well-calibrated site. “Ouch!” I screamed, but then I turned feverishly silent clenching my pendant for dear life. They reassured me that local anesthesia was being delivered to the site. For some reason, it didn’t seem to be doing its full job. In fact, it felt like a hot searing knife was being thrust into my chest. I clenched my pendant and just kept breathing. I knew it had to be over within 15-20 seconds. Those were long seconds – but finally it was over. I must admit, I do not have the highest pain threshold and I apologized for my outburst. Although I have delivered many babies over the years, I myself, never had to endure the pain of childbirth. (If I had, I assure you that I would have asked for an epidural at the first wave of contractions!!)
After a few minutes, the breast was released from its tight vice, allowed to recover before the tech placed paper strips and a band-aid over the biopsy site. She then crafted a tidy ice pack for me which I tucked underneath my bra to help with the swelling and then I hurried back to the office to see my afternoon patients.
So now the waiting began – the wait for the pathology results. I asked how long did it usually take and the radiologist assured me approximately within 48 hours. Ok – So biopsy on Monday, results on Wednesday. Right? Again, not how things turned out.
By Thursday, I was getting really worried. “Why is the biopsy taking so long to come back?”, I thought. I checked some of my patients’ charts to see the usual turnaround time, and it was about 48 hours. I spoke with my primary doctor and the radiologist. Apparently, the biopsy had to go through “staff review” which is “standard of care.” I didn’t like the sounds of “staff review” – imagining a group of squinting pathologists hovering over a microscope attempting to decipher a diagnosis from a small sample of my left breast. Of course, by this time, I was fearing the worst – infiltrating ductal or lobular breast cancer. So many times In the past, I had to deliver such news to my patients – and believe me, it was never easy. But now, I needed to face the harsh reality that I needed to deal with the results regardless of the severity.
By late Thursday afternoon, still no results. By Friday morning, I was a wreck. “Please just tell me what I have. I will deal with whatever it is, but this waiting is killing me.” I fretted with myself. Finally, Friday morning, my primary doctor called me with the results. It was both good news and bad news. The good news – it wasn’t invasive cancer. The bad news, there was a focus (little area) of atypical ductal hyperplasia (ADH). I had seen other biopsies over the years come back with this so I knew it was a precursor and risk factor for breast cancer. My heart rate slowed down from an aerobic 160 beats per minute to a slow, and steady 72 beats per minute. Now, I could take a deep breath and take it all in.
Yes, I had an abnormality which needed further evaluation. The radiologist recommended an excisional biopsy to remove the entire area surrounding the lesion. This would need to be performed by a breast surgeon. Of course, I wasn’t immediately going down that road and fought back at this recommendation. After much discussion, we agreed that I would have a consultation with the breast surgeon to determine the risks, benefits and options available.
This is scheduled for later today, Tuesday, January 30. I am prepared to listen to what she has to say and evaluate the best treatment option available. To say the least, this has been a harrowing experience for me and I have deep empathy for all of my patients who have undergone this or other challenging health procedures.
So what has this experience taught me?
First, I realized that as a physician, I am not immune towards disease, whatever state that means. I am also not a wonder woman who can take on the world. In my opinion, this result was a “wake-up call” for me to take charge of my health and listen to my body. How many times have I proclaimed this to my patients? If they didn’t take care of themselves, who would? Angie, my medical assistant, and Cynthia, my receptionist, both stated that I was working too hard and needed to start looking at ways to reduce my stress level.
I took a step back and reflected on the past 6-12 months. These months were fraught with fear about my mother’s declining health and worsening dementia, as well as the financial stress of paying for her in-home 24/7 dementia care. I had been living my life on auto-pilot, waking up and taking care of my patients 5 days a week and visiting my mother every 4 weeks. She lives in Mammoth Lakes, Ca. which is beautiful – but also a 6-7 hour drive depending on traffic.
In addition, I had put out a lot of time and effort to raise funds for my Amazing over 40 website which failed to reach its goal. This is still a mission and vision that I hold for my patients and women all over the world. Yet, I know realize that it will happen when the time is right.
A few times, my mind considers this whole process as highly “inconvenient” – but then I see how this is really a blessing. Often, we do not heed to the subtle signals given to us, instead waiting for louder and more ominous summons to get our attention.
You all will be happy to know that I’m going to take better care of myself. I’ve decided to take one Friday off a month, go to the gym for more regular work-outs/ therapeutic steam sessions, book myself a massage every 2 weeks as well as extend the time interval between visits to my mom. I love her dearly but also need to balance these trips with my own needs.
I am fortunate and ever grateful to have such a thriving practice with truly incredible patients. I am humbled that I too need to take care of myself and heed my spoken patient advice. Life is unpredictable – it can throw us all some curveball which turn us upside-down and feeling without direction. Yet, in the end, if we set our eyes on the target and catch those balls (and not bury our heads in the sand), we will survive whatever is thrown our way.
In next week’s blog, I will let you know how it went with the breast surgeon.
In the meantime, please share your own experiences with your own wake-up calls – from one that made a slight shift in your life to one that was life-transforming. Through sharing, we will empower ourselves and others through life’s challenges!
In health and happiness,