5/31/19: Insurance Letter Confirming Approval for MRI

I can't remember when I received this letter, so I'm just guessing the end of May... I guess it doesn't matter.

The MRI required pre-authorization, and the letter stated that my request had been approved. It was back-dated to May 19, and the MRI had to fall within a month's window of time.

5/23/19: Phone Calls

Taking my PCP's advice, I called the Breast Center to inquire about my MRI appointment.

After choosing the automated menu selection for scheduling, the person who answered the phone said my timing was perfect; my insurance company had just approved the pre-authorization.

My NP had told me that the MRI should be done at a particular time during my menstrual cycle, so my MRI had to be scheduled during a specific window of dates. I made my appointment, which would be in 1 1/2 weeks.

I also took my PCP's advice and decided to schedule an OB/GYN appointment to discuss birth control options.

I loved my OB/GYN who saw me through the births of both my children. I also regularly saw an NP in the same office, and I loved her, too. A few years after having my second child, I figured my PCP could take care of my Pap tests and the prescription for my birth control pills, so I stopped going to my OB/GYN. That was about 8 years ago.

I started by looking up my old providers. Unfortunately, neither were still practicing in my area. Now that I had to find a new OB/GYN, I decided to look within the same hospital network as my PCP and the Breast Center.

I went online to cross-reference doctors in the hospital network at locations near me with the list of in-network providers listed by my insurance company.

I called up the local OB/GYN practice affiliated with the hospital. As a new patient, they randomly assigned me to a doctor, and luckily it was the one I preferred based on the online profiles. I made an appointment for the earliest available date, which was 5 months from now, in October.

Just for good measure, I also called my insurance company. I confirmed that I do not need a referral for an OB/GYN appointment. I also learned that I had met my personal deductible, so the cost of the MRI should be fully covered; I would only need to pay a co-pay of $100.

5/22/19: PCP Appointment (Annual Physical)

Amidst all this, I just happened to have my annual check-up with my PCP.

She had received all the reports from my various tests and appointments. I told her I hadn't received a call yet about scheduling my MRI. She advised me to call them, and said that scheduling can sometimes fall through the cracks, so I shouldn't be afraid to be pushy.

We also discussed the fact that I currently take a birth control pill. In some cases, birth control pills may increase a woman's risk of breast cancer. All my current breast-related appointments basically mean I now have a higher risk of having breast cancer, and my PCP recommended I speak with my OB/GYN about switching to a different type of birth control.

5/17/19: Letter with Mammogram & Ultrasound Results

I received a letter in the mail informing me that my diagnostic mammogram and ultrasound "showed no evidence of cancer."

However, the letter went on to say (with bold emphasis as included in the letter):

"[T]he area of concern in your breast that prompted this exam should be further evaluated by your physician/healthcare provider. He/She will determine the necessary follow-up at that time... The area of concern should not be ignored despite a normal mammogram."

Of course, I had already followed up with the NP at the Breast Center.

5/16/19: NP Appointment

If you remember, I am actually writing these posts in retrospect. I am writing this post on June 15, and by now I have been to the Breast Center a number of times. I have to say, everyone I have interacted with at the Breast Center has been amazingly kind, professional, and helpful. You figure it probably takes a certain kind of person to work at a place where they mostly deal with patients who have or might have cancer. These are women who are all really good at their jobs, and I appreciate them so much.

So anyway. The Breast Center NP confirmed my two lumps are easily palpable. 

Regarding my first lump, she reassured me that sebaceous cysts can occur anywhere on the body, and I just happened to get one on my breast. 

She said the second lump felt similar to the first lump, but since we can't assume anything, we need to take the next step to figure out what the second lump is. After a mammogram and ultrasound, the next step is to get an MRI. 

The NP explained that MRIs require pre-authorization from my health insurance. The Breast Center would take care of obtaining that pre-authorization, which usually takes a few days. Then they would call me to set up the appointment.

She advised me to not bother with a dermatologist just yet. We would see what the MRI showed, and then go from there. 

5/13/19: Mammogram and Ultrasound - Inconclusive

At the Breast Imaging location, even though I had been told on the phone that a mammogram wouldn't be necessary (because one had already been performed on that breast within the last 3 months), while sitting in the waiting room, I was told that the radiologist wanted a diagnostic mammogram after all. This time, I definitely remember little stickers being placed on both the lumps.

Since my appointment had been scheduled as an ultrasound only, I guess having the mammogram first disrupted their schedule, because I had to wait a bit longer than usual for my ultrasound. 

The ultrasound technician (not the same person I saw at my first visit) looked at the first lump first, then looked around for the second lump. Curiously, she couldn't see the second lump on the ultrasound machine. She asked me to show her exactly where it was, and she spent quite a bit of timing looking for it, but she just couldn't see it on the machine. Eventually she gave up and left the room to confer with the radiologist. 

The technician and the radiologist (also not the same person I saw at my first visit) returned together. The radiologist, too, spent quite a bit of time looking for the second lump on the ultrasound, but couldn't see it. I really don't know how ultrasound technology works, but it seemed weird - and a little alarming - that the machine couldn't detect a mass that obviously existed and was easily palpable.

Anyway. The radiologist confirmed that the first lump was a sebaceous cyst, and she recommended I see a dermatologist, who might advise me on whether to leave it alone or get it removed. 

Regarding the second lump, the radiologist simply said that she was unable to see it. She said maybe the dermatologist could advise me on both lumps. I have to admit, this lack of information was troubling, and internally I was glad to know I had an NP appointment at the Breast Center coming up.

5/7/19 - 5/8/19: Phone Calls

This time I didn't hesitate to call my PCP. I told them about my second lump, and asked how I would go about making use of that Breast Center referral. They gave me a phone number for the Breast Center, a department of the affiliated hospital network. Once I had an appointment, I would have to call the hospital's referral line to get a referral for the particular provider I would be seeing.

I called the Breast Center. They said I could make an appointment with one of their nurse practitioners (NP), but because I could feel a new lump, they would want a diagnostic mammogram and ultrasound for the new lump first. Since those test results are available immediately, once I had that appointment set up, I could make the NP appointment for any time afterwards, even on the same day if possible. Helpfully, this person also informed me that there was a satellite Breast Center location closer to my hometown, so I wouldn't have to drive into the city. 

I called my PCP to ask them to submit orders to my Breast Imaging location for another diagnostic mammogram and ultrasound. They said they would call me when the orders are in, which they did later that afternoon. 

The next morning, I called the Breast Imaging location. My 3-month follow-up ultrasound for my 1st lump was just a couple weeks away, so we decided to move that appointment earlier, and combine it with the procedures for my 2nd lump. I was told that I actually would not need a diagnostic mammogram, because a mammogram had already been performed on that breast within the last 3 months.

Then, I called the Breast Center located near me and made an appointment with an NP. I made sure to ask for the NP's "NPI number", which I would need for the referral.

Finally, I called the affiliated hospital's referral line to set up the referral for my NP appointment. 

5/6/19: I Found a 2nd Lump

Over the weekend, my right nipple was itchy. My nipples have felt itchy from time to time, but nothing prolonged or particularly concerning, just something that comes and goes infrequently enough that it's not something I worry about.

But on Monday evening after this itchy weekend, as I was scratching around, I felt a second lump, right next to my nipple. I carefully felt the area and determined, "Yes, it's clear, this bump is my nipple, and this small bump about the same size is separate and not my nipple."

Now I was worried. Maybe it was another sebaceous cyst... but maybe not.