I posted about the beginning of my breast cancer screening journey two weeks ago at this link. I posted about the second leg of my breast cancer screening journey--my consultation at Mayo Clinic's Breast Clinic last week--at this link. As a brief recap: I'm 30 years old. Due to family history of breast and ovarian cancer, my gynecologist recommended I undergo breast cancer screening 10 years before my mom's first diagnosis at age 40. My preventative baseline mammogram on July 29th and follow-up diagnostic screening on August 12th showed that, due to the clustering and "abnormal" branching formation some microcalcifications on my left side are making, it could be a sign of early stage breast cancer. The only way to tell for sure is to conduct a stereotactic biopsy. The biopsy would tell the doctors one of three things: 1) It's cancer 2) It's not cancer but it's something to keep an eye on 3) It's an atypical cell formation and nothing to worry about.
I was nervous to get a stereotactic biopsy because my mother had one 20 years ago and it was a terrible experience for her. She did not go to Mayo Clinic, but instead got her biopsy done at a breast clinic in the city. She was bruised and bleeding as a result of it and I wasn't very much looking forward to going through the same thing--nor was she happy that I might have to go through a similar amount of pain as she'd experienced 20 years ago. However, we both knew I was going to Mayo Clinic which was recently ranked the #1 Hospital in America by U.S. News and World Report. It's also the #3 Top Hospital for Cancer Treatments. My grandparents went there all the time for their annual checkups and surgeries and swore it was the best hospital in the world. After my first visit to Mayo last week and going through my stereotactic core needle biopsy there on Friday, I completely agree that Mayo Clinic is the best of the best and that even though it's kind of far away in Rochester, Minnesota, everyone should have the opportunity to meet with a doctor there at least once in their lifetime.
For my stereotactic core needle biopsy, I hit the road early Friday morning with my parents, my sister, my husband, and my husband's parents. My husband and his dad made sure to sport their Chicago Cubs apparel. We decided we should make it a ritual to take a photo with the Mayo Brothers outside of the Gonda Building and Damon Parking Ramp, so we did that and then checked in at Mayo's Gonda Building at 9:45am. I only had to wait 5 minutes until I was called back to change into the robed waiting room at 9:50am. I changed into a robe and waited another 5 minutes before I was called into a consultation room.
I talked with the intake nurse for 5 minutes, confirmed my name and birth date, was given a consent form that I was instructed not to sign until I spoke with the radiologist, and was instructed to watch a 4-minute orientation video about what a stereotactic core needle biopsy is and what aftercare is like. The part of the video that stuck out the most to me was the encouragement to keep ice on the incision to prevent bruising but to make sure to keep cloth between the ice pack and my skin to prevent frostbite from the ice pack. I laughed out loud because it seemed kind of hilarious to think that I could end up with frostbite as a result of this whole procedure--that wasn't a factor I'd considered! So I thought about that for a little while and sat until 10:30am, when one of the radiologists came in.
The radiologist was nice and apologized for the 30 minute wait. I said that was totally fine because he was probably very busy. (I was shaking with nerves for a while after the nurse left so by the time the radiologist came in I'd managed to calm down a bit.) He asked if I'd watched the video. I said I did. I also said my mom had a stereotactic biopsy 20 years ago and it was a terrible experience because she bruised and had a lot of bleeding. He said that was good to know and that they’d make sure to not let that happen. I asked where he went to school and he said he went to the University of Wisconsin-Madison Medical School, the University of Minnesota Medical School for residency, and was now a fellow at Mayo Clinic. He asked if I had any more questions. I asked if he’d be the one doing the procedure and he said yes, he would be, with one other radiologist. Two doctors, yay!, I thought. I asked him what the next steps after this procedure would be. He said the tissue sample will either show that my cells are 1) cancer 2) not cancer but something benign to keep an eye on or 3) something benign that needs to come out. I said that made sense and that I would sign the consent form now. While I was signing he asked what I do and I said I’m a Ph.D. student studying journalism. He said “Interesting!” I said, “There’s never a dull moment!” And he said “Really?” And I said, “Well, yeah, someone has to solve the fake news problem!” He laughed. Then I handed him the consent form which he needed to sign as the practicing physician and I noticed he was left handed like me. "A fellow leftie!" I said. "I noticed that too!" he said.
The radiologist left and said someone else would come get me. I wasn't sure how much time would pass before the next person came in to get me so I started reading through an issue of Rochester magazine. Fun fact: In the August 2019 issue, I learned Rochester has a chess club. Do you know what the timers on chess boards are for? To keep track of time for each player: each player gets 90 minutes total to complete their moves throughout the whole game!
Then a nurse came to get me at 10:45am and asked if I had to use the restroom. I did. Then we headed into stereotactic biopsy room 1.
I was surprised first of all that there was an entire room dedicated to stereotactic biopsies. It was large. I was also surprised to see another nurse in the biopsy room. I was introduced to her, and realized there would be two nurses and two doctors for the procedure. One of the nurses had worked at Mayo for 44 years! Behind the nurses there were huge computer monitors with my previous mammogram results on them and a ladder for me to step up onto a flat bed with sheets and a hole in the middle. They had me lay on my stomach with my chest in a hole pressed between a mammogram machine that was placed beneath the table. I laid with my head to the side of the table with my left arm by my side and my right arm over a rolled towel to make it more comfortable. They also gave me a warm blanket to lay under which was nice.
Two radiologists arrived after I was situated on the table and introduced themselves as I was laying on my side and staring at the wall. The one doctor I’d met in the consultation room previously. The other doctor took her time to introduce herself and let me know she’d be walking us through the procedure step by step and announcing each step as it comes. I said that sounded good.
So the room was filled with two nurses and two doctors. The lead doctor started with:
“Before we begin, I need you to describe the procedure we’ll be doing today just to make sure we’re all on the same page!” she said.
“We’re doing a stereotactic core needle biopsy to identify the suspicious microcalcifications at middle depth on my left side.” I said.
There was a pause but then a friendly chuckle as the doctor said, “Very good! You memorized the whole report!” Which I basically did.
Then one of the nurses came over to the side of the bed I was standing by and talked to me through the entire procedure. We talked about everything from our tattoos to siblings to parents to school to my Ph.D. program to dogs to significant others and children while the doctors announced every step of the procedure as it came:
- Local anesthetic. “We’re going to inject a local anesthetic at the site of the biopsy now. You’ll feel a pinch. I’ll count down. 3, 2, 1.” There was a pinch but it hardly hurt at all. I told the nurse and doctors it probably didn’t hurt that badly because I got a tattoo on my foot and that was way more painful. My nurse then told me she also had two foot tattoos one on the right and one on the left and she agreed they are very painful. She has mountains on her right foot and flowers with an elephant on her left. She asked what my tattoo was based on. I told her about how my right foot tattoo, "Abide," is based on my favorite chapter of the Bible, John 15. (I forgot to tell her that my tattoo is by the best tattoo artist in Chicago, Allie Sider. Check him out on his website and Instagram at Logan Square Tattoo.) We also agreed black and white tattoos are superior to colored tattoos.
- Insertion of the core needle. “The local anesthetic is setting in now. Let us know at any time if you feel any discomfort and we can add more to the site of the incision.” As soon as the local anesthetic was set, the doctor said they were going to insert the core needle and that it would be a bit loud.
- Insertion of the core needle continued. BOOM! There was a loud popping noise, almost like an Airsoft or Paintball gun, that went off under the table. This noise was accompanied by what felt like a bullet that entered in the left side of my chest and out the other side. Obviously that didn’t actually happen but the amount of pressure I felt made it feel that way. It wasn’t so much painful as it was a bunch of pressure. “Did you feel that?” The nurse asked. I totally did. “I’ve been shot!” I said. So the doctor said, “Hold the needle!” And I got more anesthetic before they proceeded with placing the core needle in the exact position they needed to attain the biopsy samples.
- Extraction of tissue samples. “The core needle is in the correct position, so we’re going to go ahead and take a couple of samples, okay?” the lead doctor said. So the doctors proceeded with taking samples of my tissue through the core needle they’d placed on my left side. There was beeping and some pressure while the nurse and I kept talking. One of the doctors kept checking in with me to make sure there wasn’t any pain (there wasn’t :)).
- Verification of tissue samples. A few minutes after extraction of the tissue samples, the doctor told me they'd attained a good tissue sample and wanted to X-ray the samples to make sure they’d attained the correct microcalcifications before removing the core needle and concluding the procedure. I laid there, very still, while they checked the samples. The sample check was complete in two minutes or less and the doctors let me know they’d found the correct microcalcifications and could send the sample off to pathology! "You did an excellent job," the doctors told me. "We got a good sample on the first try!" I knew this wasn't always the case so I was very, very thankful that the biopsy went so well.
- Placement of the "tag." To close out the procedure, the doctors explained they would be inserting a metal “tag” into my biopsy site that would help a surgeon find the area of concern should surgery be needed down the road and also so the area of concern could be identified in mammograms later. I didn’t feel much as they placed the tag. I found out later, on my radiology report, that my tag is in the shape of a top hat, like a Monopoly game piece. :)
- Extraction of the core needle. They let me know they'd be pulling the core needle out which was much less eventful than the insertion of the needle. It was basically silent and I felt nothing.
- Stopping the bleeding. The nurses applied 10 minutes of pressure to the biopsy site to stop excessive bleeding.
- Bandages. I pushed myself up from the biopsy table and was a bit dizzy but was able to walk down the stairs down from the elevated table with the help of the nurses. The nurses then placed bandages on the biopsy site--SteriStrips--which will fall off on their own in 7 days.
- More mammograms. I had to go get two more rounds of mammograms--one regular and one magnified--after the biopsy to make sure the metal tag was in the right place / to mark the place of the metal tag. I've now had approximately 15 to 20 mammograms in a month's time--more than some women might get in their lifetime!--and consider myself a veteran mammogram patient. I'm also ready to be done being radiated.
- Results. The doctors let me know that my results will be delivered to me by my primary care doctor in approximately 3 business days. The nurse said my doctor would call me by Thursday and if I don't hear anything by then to call the breast clinic. The nurse also told me that my results might be uploaded to my Mayo Clinic app before the doctor calls but encouraged me to not read the results before I talk to my doctor. "Google doesn’t always provide the best or most accurate answers to patients’ questions," she said.
All in all, the stereotactic core needle biopsy procedure itself took approximately 45 minutes. The doctors and nurses I met during my appointment were amazing. The procedure was not pleasant but not terrible either. Thanks to continual icing and Tylenol intake (I can't take Advil because it possibly increases bleeding), recovery is going exceptionally well. I'm sore and have a bit of bruising but that was all to be expected. The nurses said I can lift things starting 24 hours after the procedure but I asked the nurse if I could be a wimp and not lift anything for a few days. She said "Of course!" So I haven't lifted much of anything for two days now and don’t think I’m going to be lifting much of anything for the good part of a week.
Now I get to wait. Waiting is not my favorite thing to do. I’ve heard the hardest part of this whole cancer screening process is waiting. At this point I’d have to agree. While I'm waiting, I've prayed, cried, laid awake at night, and have been really sick (I had food poisoning for three days last week at Disney World of all places which was horrible). At church this morning, the whole church prayed for me during the 11am service. They prayed that the results of my biopsy would be benign and that I'd be completely healed. They encouraged me with Psalm 90 and Psalm 91. I know I'll be healed no matter what, but I'm not sure what the results of my biopsy will be. By Thursday, I'll know if I have breast cancer or not. Either way, God is in control and I trust Him! One of the hymns we sang at church this morning was "He Will Hold Me Fast." My favorite version right now is by Shane & Shane. My favorite verse: "When I fear my faith will fail, Christ will hold me fast."
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