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Medical Forum / Diseases and Disorders / Breast Cancer / June 2008Pathology Confusion
I'm newly diagnosed with invasive ductal carcinoma and am mystified about the Grade part of my pathology report. SBR says 3 tubules 2 nuclear, 1 mitoses = 6 SBR. I'm guessing this is bad news good news time, gnarly abnormal cells which are hopefully not dividing too fast. SBR is the same on both tumors, sizes 12 mm and 5 mm. Shortly after I was born in Utah in 1952, the first of 814 nuclear tests began in Nevada. The test site always waited till the wind was blowing toward us. Fallout was a common sight, and we were told never to eat snow. There was some debate whether children should be drinking milk, as the cows were eating grass coated with radiation. We were also downwind from Standard Oil and Phillips Petroleum refineries. I just heard that there's a large cancer cluster around the Standard Oil refinery at Richmond, California. This is my second bout; first was cervical cancer in 1985. I've since been the world's biggest health nut, to no avail apparently. Am still waiting on HER-2 results and hormone receptors. Perhaps someone can shed light on my SBR results. Les Wood > I'm newly diagnosed with invasive ductal carcinoma and am mystified > about the Grade part of my pathology report. SBR says 3 tubules 2 [quoted text clipped - 6 lines] > > Les Wood According to this paper www.asco.org/ASCO/Abstracts+&+Virtual+Meeting/Abstracts?&vmview=abst_detail_view &confID=23&abstractID=102006 the initial SBR value alone is not very meaningful in terms of prognosis. Things like tumour size, lymph node status and hormone receptor status are more important. It is however taken into account in determining treatment. Logically it can indicate where a cancer is growing rapidly and treatment is more urgent, for example, or it can tip the balance where a decision is marginal on the other factors. The above paper suggests that what is significant is the change in SBR after neoadjuvant (ie pre-surgery) chemotherapy, where used. It then gives a useful measure of the degree of response to therapy. So I wouldn't worry about grade, it's not extreme and the mitosis rate is low, so it's not going anywhere. Tim Jackson > ... I've since been the world's > biggest health nut, to no avail apparently. I was very sad when I was diagnosed because I've put a huge amount of effort and energy into our health. But sh*t happens :-) Mary > > ... I've since been the world's > > biggest health nut, to no avail apparently. [quoted text clipped - 5 lines] > > Mary I've just received a presumptive diagnosis: I'm in the early stage of the work up--felt a lump, despite negative mammogram 9/07, got a diagnostic mamm on Thursday, and the radiologist bluntly said--this is cancer--had the biopsy yesterday and see the surgeon on Monday. I kept thinking, "this is not in my plans." I completely understand how it's just not something you see coming. I sounds like your pathology report is actually reassuring. Good luck. Judy > > "downwinder" <desertny...@cwo.com> wrote in message > [quoted text clipped - 19 lines] > Good luck. > Judy Thanks Tim, Mary and Judy for your reassurance. It means a lot right now. It is maddening to be surrounded by people with unhealthy habits, and I'm the one who gets cancer--AGAIN. The doctor tells me, it's time to beef up your immune system, and I really can't see what more I can do. Life is unfair, not to mention full of surprises. Sounds like you're a few days behind me, Judy. If the radiologist is right and you're anything like me, first you'll cry, then shock- induced dementia will set in. Suddenly I can't remember anything I'm supposed to do. I'm starting to pull myself together and put things in perspective. Maybe we can go through this together, across the ether. Luck to you too, Les > Thanks Tim, Mary and Judy for your reassurance. It means a lot right now. It is maddening to be surrounded by people with unhealthy habits, and I'm the one who gets cancer--AGAIN. I know! My GP keeps telling me that I've had rough times despite being one of his healthiest patients :-) I dread to think what life would have been like if I hadn't been healthy :-))) > The doctor tells me, it's time to beef up your immune system, and I really can't see what more I can do. Life is unfair, not to mention full of surprises. But good surprises among the less good ones! And at least we have the experience of life, I'd rather have that than not have been born - not that I'd have known if I hadn't if you know what I mean! > Sounds like you're a few days behind me, Judy. If the radiologist is right and you're anything like me, first you'll cry, then shock- induced dementia will set in. Suddenly I can't remember anything I'm supposed to do. I'm starting to pull myself together and put things in perspective. Maybe we can go through this together, across the ether. That's what this group is about. Mary On May 9, 3:14 pm, "Mary Fisher" <mary.fis...@zetnet.co.uk> wrote: > "downwinder" <desertny...@cwo.com> wrote in message > [quoted text clipped - 10 lines] > > Mary I've just received a presumptive diagnosis: I'm in the early stage of the work up--felt a lump, despite negative mammogram 9/07, got a diagnostic mamm on Thursday, and the radiologist bluntly said--this is cancer--had the biopsy yesterday and see the surgeon on Monday. I kept thinking, "this is not in my plans." I completely understand how it's just not something you see coming. I sounds like your pathology report is actually reassuring. Good luck. Judy Judy, Mammograms can't be expected to 'see' everything, the equipment is as imperfect a tool as most things devised by humankind are. In UK technicians aren't allowed to make diagnoses, results are sent to a doctor who takes it from there. But when my consultant told me that I had cancer I was grateful that he wasn't using euphemisms, that he expected me to be intelligent enough to understand that I had a condition which he would be dealing with to the best of his and his team's ability. I was in the hands of experts, it was far better than having cancer and not knowing about it. As for 'not in my plans ' well, what is? We can't plan everything. If it hadn't been cancer it might have been a bus :-) I'm glad you have a positive diagnosis because now you're on the treatment timetable, that's far better than ignoring a problem. Well done for seeking advice when you found a lump. Mine couldn't be palpated even by the specialists, it was too deep. But the mammo found it by comparing one film with the one from three years before. If I hadn't had that routine mammo I wouldn't have known until it was too late. Hugs, Mary > On May 9, 3:14 pm, "Mary Fisher" <mary.fis...@zetnet.co.uk> wrote: > [quoted text clipped - 49 lines] > > Mary Mary and Les, Thank you both: I am in the shock stage. I did make my way to a general info site and learned some information. I'm a doctor, and many of my patients go to the breast surgeon whom I'm seeing, but I'm a family practice doctor, and really didn't know the specifics until I had some energy to look at the site-- written for lay people. I think the radiologist was blunt with me because I'm a doctor. (I hadn't told anyone I'm a doctor, and then when she came in to tell me I needed a biopsy, I told her who I use and asked her to make the appointments, because it was getting late in the day, and the report wasn't even dictated yet While we waited, the ultrasound tech shared that I had done her first pap smear 20 years ago--it was a very surreal moment. So, I got a biopsy appointment the next morning, and the tech the next day--supposedly trying to be friendly, gave me a lecture about how doctors get special treatment, but all patients deserve it. After the biopsy, she kind of kicked me out into the hallway, still reeling, to wait for the mammogram I didn't know I was getting.) My gyn called and was surprised at the radiologist's bluntness, but to be honest, I appreciated the radiologist's concern, where my own gyn was sort of covering herself: "There was no delay here, you came in, I didn't feel anything, but I ordered the mammogram. I have to go, but call me anytime." Delayed diagnosis is a big lawsuit issue, but that's the last thing on my mind, and unfortunately the first thing on hers. I had to call my office and cancel my schedule for Monday. The practice manager tried to get me to come in and do paperwork. Les, I'm in shock and all I can think or not think about is what comes next, and how do I minimize the impact on my daughters and husband. This is life altering, Thank you for your support and I will let you know what she says on Monday--the radiologist had me get all my films to bring to the appointment and that caused a ton of grumbling in the department. It's so hard to deal with all of this and then deal with techs who have to editorialize and "punish you" for some presumed special favor. Judy I didn't ask for special favors. Actually, I'm feeling guilty as hell, because I watched the lump for a few weeks through a cycle before I made the appointment with the gyn, who thought there was nothing there. I feel like I delayed the diagnosis... > ... Actually, I'm feeling guilty as hell, because I watched the lump for a few weeks through a cycle before I made the appointment with the gyn, who thought there was nothing there. I feel like I delayed the diagnosis... As a doctor you'll know that a few weeks won't make any difference. Guilt won't bring back those weeks - or even change anything. Tell yourself what you'd tell a patient ... I'm really surprised that you're in a state of shock though, you must know that bc is very common and that recovery rates are increasing all the time. As a complete lay'man' I'd say please don't worry, it won't do any good and could make you very unhappy which won't aid your well-being. You'll also know that a positive attitude won't influence the progress of your treatment or recovery - what it will do is make that time happier. It's going to be an interesting experience and a learning one too, that can only be good. Stick around here too! I doubt that there's anything you can say which we haven't heard before :-) Hugs, Mary > > ... Actually, I'm feeling guilty as hell, > [quoted text clipped - 22 lines] > > Mary Mary, Thanks for the hugs and comments. The state of shock is that I've been called back every mammogram and had ultrasounds because of dense breasts, and somehow I just through that that's how it would go last week. I know the guilt is useless, and I'm the one who didn't like what I was feeling--my gyn thought I was over-reacting. The shock is that it's happening to me: my plans for the immediate future were all about my daughter's wedding, and not being a patient. I know that breast cancer is common, but it's still a shock when the radiologist sits you down and says, this is cancer. My gyn was humoring me by ordering a diagnostic mammogram, she thought I was just being anxious. There is a part of me that says I've examined a lot of breasts in the last 28 years of practicing medicine, so when I felt it, I could tell it wasn't just the usual fibrocystic lumpiness, so I didn't put any faith in the normal mammogram 6 months ago, I watched it through a cycle and made the gyn appointment. Having something happen to you is a shock. Working on the positive attitude: when I was a resident, another resident's husband was part of the book about spiritual healing, and for a while his laryngeal cancer was in remission, and then it came back, (I think it was Bernie Siegal's book) and the poor guy was beating himself up that he hadn't done enough visualization and positive thinking, that it was his fault--should they edit him out of the book. Judy Hello again Judy, ... > The shock is that it's happening to me: my plans for the immediate future were all about my daughter's wedding, and not being a patient. Well, there's never a convenient time to have treatment for anything. I discovered that when the neurological surgeon rang one lunch time after a dramatic diagnosis of a brain tumour three days before (this in 1993). He offered me two the next day or two weeks from then so I looked at my wall planner. Every day for months was busy and I'd be incapacitated for about ten days. I said that I'd go the next day :-) I also asked what the risk of a craniotomy was, he replied that brain surgery is never without risk. I considered that for a second, thinking that travelling in a car is never without risk and I did it almost daily in those times. So I drove to the hospital, knowing that it would be two years before I could drive again. We in UK don't usually have the option of choosing a date for surgery, the urgency of mine was unusual. When I had breast surgery it was determined by the surgeon's holidays. When my husband had an RRP in 2006 he was given two dates, because I'd been jumping up and down about delay. But if there had been a family event such as a wedding coming up I'm sure all the surgeons would have taken that into consideration. In fact the prostate surgeon did agree that a family visit we'd organised was more important than immediate surgery and that two weeks would make no difference. It was more important for us to see our RAF son before he went to Afghanistan (which he didn't, in the end). If you have surgery you know that you'll be in for a very short time and that most women are back to work soon. Radiation and/or chemotherapy times aren't critical. What I'm saying is that every part of your treatment can be accommodated so that you enjoy your daughter's wedding to the utmost. You're not going to be ill, just temporarily incapacitated. > Working on the positive attitude: when I was a resident, another resident's husband was part of the book about spiritual healing, and for a while his laryngeal cancer was in remission, and then it came back, (I think it was Bernie Siegal's book) and the poor guy was beating himself up that he hadn't done enough visualization and positive thinking, that it was his fault--should they edit him out of the book. I specifically said that a positive attitude won't cure you, it just makes life more enjoyable. I know that some people practise visualisation, I never did, I'm not much good at that sort of thing. I reckon that the doctors are there to do the healing job, I'm just there to make the most of it - and be grateful :-) It really is a most interesting experience, honestly. Not all beer and skittles but, as they say in your part of the world, do-able. More hugs, Mary >>> ... Actually, I'm feeling guilty as hell, >> because I watched the lump for a few weeks through a cycle before I [quoted text clipped - 48 lines] > the book. > Judy Judy, you know you did exactly the proper thing, you did it by the book and if you didn't get a diagnosis earlier that was because it *wasn't diagnosable* earlier. Yes technically it might have been 'detectable', but as a GP you know well that that is only part of the story of making a diagnosis. If you hadn't waited out a cycle your gyn would probably just have told you to go do that anyway instead of booking the mammogram. So forget the "if only", a) because for every "if" there's a "yeah but", b) because we have to live our lives from where we are, not from where we would like to be, and c) because it's already been there about 10 years and another month beyond the threshold of detection really isn't going to alter your risk noticeably. I know well the tyranny of the "positive thinking" brigade, my wife suffered terrible guilt that she couldn't bring herself to think positively enough about her cancer. But this has been researched and it has been shown fairly conclusively that positive thinking or otherwise does not affect cancer outcomes in any real way. Yes this is life changing. We come face to face with our own mortality and we have to suddenly do that bit of growing up we neglected for all those years. It's demanding, it breaks up your sleep and gets into your dreams, it makes you forget things, it makes you react in unpredictable ways. That happens when your life gets changed. It passes. It also means that people you thought were your friends suddenly avoid you: not because they think cancer is catching, but because they aren't ready to do that bit of growing up they need to stay with you. Tim Jackson > >> "judy.n" <judy.nudel...@gmail.com> wrote in message > [quoted text clipped - 85 lines] > > - Show quoted text - Tim, about the people who avoid you, I find myself wishing more people would do that! As a social-avoidant hermit, I'm very sick of all these people fussing over me. Having had cancer 23 years ago, I vaguely remember acquiring coping skills, but this time the treatment's going to be much harder. Judy, make sure you get a copy of your pathology report. I got mine from the doctor who did my biopsy, and was bewildered to find that she knew less about its meaning than I did! I too was unhappy about having to get more mammograms after the biopsy. I've probably had my tumors for a number of years, and they never showed up on mammograms. Having soaked up all those rads from being downwind from the 814 Nevada nuke tests, I'm just now wrapping my head around the idea of post-lumpectomy radiation. Are you having a tough recovery from the biopsy? Blood still oozes from one of mine and they still ache, almost a week later. I also have a five-inch wide purple bruise. Mere trifles compared to what's to come, I know. Contrast your situation with mine, Judy. I have no health insurance, but am getting bare-bones treatment from the federal Breast and Cervical Cancer Treatment Program. I must pay for things like second opinions and implants myself. It's hard to find a doctor who will accept patients without health insurance. I just discovered that one of the two doctors I've been assigned to is a back surgeon. The other is a cancer specialist, but she's an hour's drive away. I have to take matters into my own hands and call around to see what I can find on my own. I don't mean to sound like I feel sorry for myself here--just trying to make you feel better about the advantages you do have. Thanks to you all for being here. Les ... > Yes this is life changing. ... > > It also means that people you thought were your friends suddenly avoid > you: not because they think cancer is catching, but because they aren't > ready to do that bit of growing up they need to stay with you. And that's the very worst part of the process - well it was for me Mary > ... > [quoted text clipped - 7 lines] > > Mary Judy, hope you got your pathology report and can share it with us. I'm three days ahead of you, and right now three days is forever. My attitude hit rock bottom Friday, so you may turn the corner any time now. I got the rest of my pathology, and it sounds okay. Her-2 negative, estrogen and progesterone are plus 3. This latter is confusing; I was expecting a percentage, but was told this is quite high. So the tumors can be starved (?), which I'm already doing. Since I've never taken progesterone, I'm wondering where the tumors got that fix. I have appointments with two surgeons who accept my program, so now just have to choose between them. Am hoping lumpectomy might suffice; may not have to go to India for reconstruction. One doctor is a thoracic and general surgeon, the other I got myself--a cancer specialist but farther away. My only concern is that I don't get an overzealous lymph node remover, as I'm an active hard worker and not ready for that level of disability at the age of 55. Les > I got the rest of my pathology, and it sounds okay. Her-2 negative, > estrogen and progesterone are plus 3. This latter is confusing; I was > expecting a percentage, but was told this is quite high. So the > tumors can be starved (?), which I'm already doing. Since I've never > taken progesterone, I'm wondering where the tumors got that fix. They don't need a 'fix'. The receptor status of the cancer has nothing (or little) to do with hormone levels in the body, and even less to do with external input. The hormones don't directly affect the DNA that codes for their own receptors. They stimulate division of the cells, and lead to random DNA damage, which among other things may include multiplication of of areas that code for hormone receptors - which makes the progeny cells prone to overgrowth, in the presence of that hormone. Not necessarily the one that stimulated it in the first place.) This is just one of the ducks on one of the reels in the cancer slot machine. It also needs for example a mutation that shuts down the mitochondria and the DNA repair mechanism, and one to turn on production of telomerease, before it can really be called a cancer. ER+3 means hormone treatment can be expected to have a strong effect in suppressing further tumour growth. Tim ... My only concern is that I don't get an overzealous lymph node remover, as I'm an active hard worker and not ready for that level of disability at the age of 55. Les Les, I hope I can re-assure you on that matter. ALL the nodes were removed from my axilla, the only result of that has been the occasional ache in my arm. It's no worse than other aches I get in this poor old body :-) Lymph node removal doesn't necessarily cause disability. Mary > ... > [quoted text clipped - 12 lines] > > Mary Mary, That is encouraging, but I'm wondering how hard you've been able to work your arm without getting lymphedema. I do lumberjack work like clearing and burning brush, and carry some heavy loads. My neighbor had all but two of her lymph nodes removed; if she tries to do much of anything, ends up with terrible swelling. It's also my left breast, and I'm left-handed. Thanks for any insight, Les >> ... >> [quoted text clipped - 23 lines] > > Les Where's Ann when we need her? She had lymph nodes removed and does heavy exercise - rowing. It certainly can be done. I believe the incidence of lymphedema in patients who have had this surgery is about 25%, of course the degree can vary considerably within that. It is not clear what the risk factors are, most of the advice around is based on theory, not evidence. Advice used to be to avoid heavy exercise and not to lift more than 10lb, but things are clearly not that simple. My personal belief is that exercise is double-edged. In the short term it causes increase lymph flow, which no doubt increases the risk of edema, but in the longer term it enlarges the lymph ducts, and so reduces the risk. By that reckoning exercise that build up progressively and fairly gently over time should be the best bet for avoiding problems. The usual process for avoiding injury, but with more care taken. It does seem that lymphedema involves some sort of elastic failure of the skin, so one it happens, the change is permanent, so it is important to avoid high-risk events, whatever those are. Infection obviously, probably muscle strains, and anything that constricts lymph flow, eg tight bracelets (remember there are lymph ducts on TOP of your shoulder too, so heavy carry-straps are a bad idea). Tim With sentinel node biospy it is so much lower http://www.ncbi.nlm.nih.gov/pubmed/12678476 http://www.surgeryencyclopedia.com/Pa-St/Sentinel-Lymph-Node-Biopsy.html I would try to have a SNB since it lowers your odds of lymphedema. >>> ... >>> [quoted text clipped - 51 lines] > > Tim >> I believe the incidence of lymphedema in patients who have had this >> surgery is about 25%, of course the degree can vary considerably [quoted text clipped - 7 lines] > > I would try to have a SNB since it lowers your odds of lymphedema. Sorry, I wasn't clear. By "this surgery" I meant axillary clearance. Indeed the Sentinel Node procedure obviates many unnecessary clearances, where the node is found negative, and does not of itself give rise to much (if any) lymphedema. I think a figure around 25% still applies where the node was found positive, although some centres may show lower rates. www.ncbi.nlm.nih.gov/pubmed/15213610 SNB does lower the rate of lymphedema quite a lot, but on the down side it has a small number of false-negatives. In the early days of the procedure this was a significant argument against widespread adoption of the technique. Improvements in technique and training mean it is now less of an issue, especially in the major hospitals, but there still seems to be some debate. Tim SNB is the standard of care in the Boston area, and now the controvesy is where or not the node disection is needed. >>> I believe the incidence of lymphedema in patients who have had this >>> surgery is about 25%, of course the degree can vary considerably within [quoted text clipped - 25 lines] > > Tim >>> ... >>> [quoted text clipped - 28 lines] > Where's Ann when we need her? She had lymph nodes removed and does heavy > exercise - rowing. It certainly can be done. I wish I'd read this before I replied :-) > I believe the incidence of lymphedema in patients who have had this > surgery is about 25%, of course the degree can vary considerably within [quoted text clipped - 16 lines] > bracelets (remember there are lymph ducts on TOP of your shoulder too, so > heavy carry-straps are a bad idea). I forgot to add that we were encouraged to care for our skin by using moisturisers. I haven't done - I'd forgotten about it but I think I should have done. Mary > Tim > ALL the nodes were removed from my axilla, the only result of that has > been [quoted text clipped - 5 lines] > > Mary Mary, That is encouraging, but I'm wondering how hard you've been able to work your arm without getting lymphedema. I do lumberjack work like clearing and burning brush, and carry some heavy loads. My neighbor had all but two of her lymph nodes removed; if she tries to do much of anything, ends up with terrible swelling. It's also my left breast, and I'm left-handed. Thanks for any insight, Les Hello Les, Different people react in different ways to any surgical intervention, I was saying that not everyone develops lymphoedema after lymph node removal or damage. My cancer was in my right breast so my right axilla was affected. I am right-handed. We were encouraged - strongly - while in the ward to do the prescribed exercises, I did them enthusiastically (because of pride, I wasn't going to be shamed by the younger patients!). It was stressed that too much exercise and weight lifting was not advocated. That was then, things might have changed. We were also taught to do manual lymph drainage regularly. I did at first and even now when I remember but only because it feels nice, I don't know if it helped or not. In my city there's a specialised Lympho clinic which advises, provides support sleeves and stockings and any other support anyone needs. I once was given a sleeve but it was so uncomfortable I gave it back. My arms have been measured and compared several times (though not recently) and have never shown much difference. Since my upper arms are fat anyway I'm not sure that was much value. Since then I've been able to do everything I've wanted to do with that arm (I'm right handed), including stretching, lifting, carrying and occasionally using a hand axe. My first task when I got home - apart from helping Spouse to erect a very complicated high specialised tent - was to go up a ladder and cut down all the ancient ivy from our house wall. It involved a lot of stretching and pulling as well as cutting and sawing large diameter branches and the main trunk. I've built walls, dug the garden, carried heavy items to the limit of my strength ... we both lead a very active life. Oh - and that arm has been bitten, grazed, stung and burnt lots of times, there's never been any subsequent infection. I do try to remember to not allow heavy bags to hang from my arm - but I forget :-) I'm sure that keeping my arm moving and well exercised has done it and me good, I don't want to be a victim. Think of the Dragon Racers. There used to be a member here who was an energetic swimmer too. http://www.thecancerblog.com/2006/03/08/dragon-boat-races-breast-cancer-survivor s-paddle-to-prevention/ But as I said that's me and many others, it might be true for you too. I believe that swelling is the exception rather than the rule. Don't take risks though. Hugs, Mary > "downwinder" <desertnymph@cwo.com> wrote in message <snipped Les' section for brevity> > Les > [quoted text clipped - 46 lines] > believe that swelling is the exception rather than the rule. Don't take > risks though. Mary, Thanks so much for such a detailed response. As an IT professional that types all day and a musician, I am particularly obsessive about avoiding injury to my affected arm (left). Living in the humid southern US, I am in constant assault by mosquitoes. Since I normally have a more than average reaction to their bites, I try to avoid them (good luck here). I probably don't have to get so excited when I get bit, scraped, cut (just today I jabbed my left index finger with a pointed knife while preparing Father's Day dinner and I freaked out.) I have a close friend that got lymph edema in her affected arm 20 years after her BC. She suspected a spider bit her when she was bagging raked leaves. We have some pretty nasty spiders in these parts so admittedly the poison and infection caused by them would be more severe than insects. On the bright side, her doctor said she should continue to play her violin as it kept her hand elevated and the fingers moving. So at least (for once) playing the viola would actually help me more than hurt me! Again, thanks for sharing. It made me feel less anxious. Marsha > advice when you found a lump. > [quoted text clipped - 3 lines] > If I hadn't had that routine mammo I wouldn't have known until it was too > late. My gyn called and was surprised at the radiologist's bluntness, but to be honest, I appreciated the radiologist's concern, where my own gyn was sort of covering herself: "There was no delay here, you came in, I didn't feel anything, but I ordered the mammogram. I have to go, but call me anytime." Delayed diagnosis is a big lawsuit issue, but that's the last thing on my mind, and unfortunately the first thing on hers. I had to call my office and cancel my schedule for Monday. The practice manager tried to get me to come in and do paperwork. Les, I'm in shock and all I can think or not think about is what comes next, and how do I minimize the impact on my daughters and husband. This is life altering, Thank you for your support and I will let you know what she says on Monday--the radiologist had me get all my films to bring to the appointment and that caused a ton of grumbling in the department. It's so hard to deal with all of this and then deal with techs who have to editorialize and "punish you" for some presumed special favor. Judy I didn't ask for special favors. Actually, I'm feeling guilty as hell, because I watched the lump for a few weeks through a cycle before I made the appointment with the gyn, who thought there was nothing there. I feel like I delayed the diagnosis... It is a life altering way, I am a RN. When I had my first mammogram there was a very large lump. The tip off to me was the tech ( who I knew many years and was not always kind) was very nice to me. I found it difficult to be a patient where everyone knew me professionally. I had my surgery and treatment in a very large medical center, which know one knew me, it some ways I found this re assuring. Good luck, don't think the worst. Chemo was much easier than I had seen professionally ( chemo use to be done inpatient and the patients were miserable. I worked a reduce schedule. Don't beat yourself. You can't play what if's. Alex, an eleven year survivor > > advice when you found a lump. > [quoted text clipped - 41 lines] > > Alex, an eleven year survivor Thank you all for the helpful comments: Tim, what you wrote is so true. Les, I worked in community health centers and I know how hard it is for people with little or no coverage: it's appalling that you have to fight that battle too. My biopsy site is a bit oozy, sore and bruised, and I'm cleaning it with hibiclens and putting bacitracin on the bandage. It is sore. Alex, I know the desire to be anonymous. I'm sticking with the local breast health center for now, I do know the surgeon and oncologist, but only professionally. I respect both of them. If needed, I'll consider Dana Farber. It's so hard not to think the worst, when we've worked with it and seen it. One of my colleagues just called to wish me luck and to tell me that all my office work is covered, and that kind of concern goes a long way. Thanks. Judy
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