Wednesday, January 21, 2009

Questions and... more questions.

I'm one of those people who likes solving problems. Especially difficult ones. It feels good to wrestle with an issue, then finally have that "aha!" moment of triumph at the end. Unanswerable questions are fun riddles, but I don't like them in my life.

And life, of course, doesn't really care what I like. C'est la vie, of course. Har har har...

Last September, I went in for a routine mammogram (an early routine due to my mom's experience with breast cancer). The results indicated something out of the ordinary on my right side: a tiny, round blip on the x-ray film. They scheduled a follow-up ultrasound to try to figure out what it was (although they guessed it was probably a cyst). The next week, I went for the ultrasound and spent about 15-20 minutes while the technician looked for her target. Results: inconclusive. She couldn't find it. The technician recommended that I come back in 6 months for a follow-up mammogram and we'd start over then. The open-endedness of it all nagged at me, but I went home, planning to make another appointment for March.

Fast forward to Christmas, explaining the above story to my mom over a pot of chocolate fondue (mmm... fondue...). I was strongly encouraged to schedule it for three months instead, given that her cancer had progressed nearly to the lymph nodes before it could have been detected through a self-exam. The nagging part of my brain got quite a bit louder after that, and I finally called my doctor's office in January to ask his opinion of the whole situation. A week later, I received a phone call back from his office, referring me to a specialist. This wasn't exactly the response I was expecting (I figured I'd get sent back for another image to be taken). I was happy they were actively discussing the issue, but it also made me a bit nervous to think it's gotten this far.

Today was my appointment with the specialist, who also, oddly enough, happened to be the same doctor who removed my gall bladder in '97. I know this guy. Yay! He performed a follow-up ultrasound in his office and explained exactly what he was looking for, where it should be, etc.

The good news: He found it.
The bad news: It's not a cyst.
The questionable news: He's not sure what it is.

Other good news: Whatever this something is, it hasn't grown or changed shape since the initial mammogram in September. It's pretty small (1/4 inch in diameter), it's virtually indistinguishable from the rest of the tissue around it (which probably made it so hard to spot during the first ultrasound), and it doesn't look like anything problematic.

Other bad news: Whatever this something is, its size and position (pretty far back along the wall of the chest) make it very difficult to target. He doesn't want to biopsy it based on the ultrasound, because he's afraid he won't hit it.

The options:
  1. Wait 6 months and follow up with his office directly.
  2. "Tag" the spot where he thinks the something is by injecting a small metal tag (like a tiny wire) into the site, and comparing with a mammogram to see if he got the right location. The upside of this: we'd know (eventually) where this thing is. The downsides: it could take a while to get it, and the wire could potentially get in the way of a biopsy. It also seemed like a bone he was throwing me if I absolutely positively wanted him to do something now.

I voted for option 1. Option 2 seemed more like the "make the patient feel better" option, rather than doing anything really productive. Since this thing hadn't changed in three months, I was less worried about any immediate danger, and decided not to play hide-and-seek with a biopsy needle.

So I'm waiting... in July I get the next series of mammograms, and in August I get seen by the doctor again. The idea is to see if it's changed any, and to make any determinations from there. He's trying to solve this problem, himself, so he doesn't want to let this go. I can relate to that, in more ways than one right now.

So... I'm not really sure what I'm trying to get out of posting this. I think I just needed to say it, put it behind me and move on for the next 6 months. I've got a life to live, a great family, kids to play with, friends to laugh with, races to run and Spinning classes to teach. I don't have time to worry about something I can't do anything about right now.

Thanks for bearing with me, though. :-)


Leap Year Dad said...

I am thinking positively for you and in the knowledge that you are a genetic freak and are producing gallstones in new and unique locations. Love you dear and I'll see you next week.

Don Dwoske said...

Call up Dr. Gregory House... he'll figure it out. Until then, if you need to have a drink or two with some old friends, count me in. I'm sure we can come up with some wonderful suggestions for what's inside you after a few beers get into our systems.

Jen said...

And you'll probably make me laugh so hard, it'll pop right out. :-)

I'll have to check my calendar... sounds like a good plan.

Philangelus said...

I'll keep you in my prayers. This kind of thing is nerve-wracking no matter WHAT it turns out to be. **hugs**

Philangelus said...

Jen, have thought about this some more and talked with my husband (who went through cancer himself about 15 years ago.)

The doctor you went to is a surgeon, right? Not an *oncologist*? There's a huge difference. The fact that he doesn't think he could hit it during a biopsy doesn't mean another surgeon wouldn't, particularly one that does ten of those procedures (and only those procedures) a week.

If you were to get a second opinion at a hospital that specializes in cancer (like Dana Farber) with doctors who deal with only cancer, they might have better equipment and better techniques and simply more experience and practice in getting to it.

It sounds crazy, but this was exactly our experience when my husband went through it all. The smaller, generalized hospital was okay but a bit confused. Sloan Kettering Cancer Center in Manhattan knew exactly what, when, and how to do it. When his father went through his cancer, he again was dealing with smaller local hospitals that consistently failed to visualize the cancer on scans and yet the only thing they knew to do was to repeat the scans.

It might be worth a second opinion from a specialist, is what I'm saying. Six months is a long time to wait on something like that.