6/28/29: The Genetic Counselor Called Me with More Testing Results

I missed her initial call, but she left a message saying she had "more reassuring news".

I think the results for the 83 genes came in already. She said they are "essentially negative". 

She said her team meets to discuss all cases in the second week of July, so I may hear from her again if they have any new thoughts on my results. In the meantime, she will send me the results in the mail.

6/27/19: The Genetic Counselor Called Me with Testing Results

It's good news.

My testing for the 9 most common genes linked to a significant increase in risk for breast cancer showed no known mutations. This means I do not have a known inherited risk for breast cancer.

However, the testing did show that I have "variants of unknown significance" (VUS). The variants were found in my BRCA2 and PALB2 genes. The genetic counselor said they don't see these kinds of variants often enough in the lab to know if they are linked to cancer or not. They might just be benign mutations that occur in the general population.

Since not enough is known about these variants, they won't affect my surgery plans. That is, my genetic testing results do not provide additional justification for a double mastectomy.

Still... It struck me that the genetic counselor specifically used the word "known". I don't have any known mutations. But maybe my two variants are unknown mutations linked to breast cancer... After going through my family history with the genetic counselor, the prevalence of cancer on one side of my family seems concerning enough that it wouldn't be too hard to believe that there may be something genetic, even if it's not yet known...

Anyway, I did opt to do the further testing for the 83 genes associated with various hereditary cancers. The genetic counselor will call again with those results when they come in.

6/27/19: I Joined Facebook Support Groups

We haven't met with the breast surgeon yet. I have a long list of questions for him, but as I wait for that appointment, I find myself leaning towards a double mastectomy with no reconstruction. Without breast reconstruction, I could either "go flat" or wear prosthetics.

To get a better idea of what to expect, I joined these Facebook groups:

Double Mastectomy Discussion And Support Group - This page includes women with and without breast reconstruction, so I can get an idea of what both paths entail. There is also a fair amount of talk about breast cancer, which is also helpful.

Fantastic Flat Fashions - Most women's clothing are designed and cut for breasts, so it can be a challenge to find clothes that fit and are flattering.

Flat & Fabulous - This page includes women who went flat immediately after a double mastectomy and also women who previously had reconstruction and then had them removed.

9/8/19 Update: It took a while, but my request to join another group was finally approved. In my experience so far, these groups have been super informative and supportive. It's important, though, to remember that each person's situation is unique, so I'm careful to filter the information for content relevant to myself, and to not compare my experiences with others'.

Flat & Fabulous Breast Cancer - A sister page to Flat & Fabulous that focuses on breast cancer treatment and support.

9/19/19 Update: Now that I've got my treatment plan that includes chemotherapy and hormone therapy, I've joined additional groups in hopes of getting a better idea of what to expect from the drugs I'll be taking (Tamoxifen, Lupron, Herceptin, Taxol).

Triple Positive Breast Cancer HER2 PR+ ER+ - A page dedicated to the type of cancer that is driving my treatment plan.

triple positive breast cancer survivors - If there's more than one group for something, I usually join the biggest one, figuring more members means more frequent posts and comments and a wider range of experiences to learn from. This group has fewer members than the other one, but not by a lot, so I just joined them both.

Tamoxifen support group - Tamoxifen treats ER-positive and PR-positive breast cancers. About 2/3 of 3 breast cancers are positive for at least one of those hormone receptors.

2/27/20 Update: I left the Tamoxifen support group, since I ended up taking exemestane instead.

6/26/19: The Breast Center Called Me with an Appointment Change

I wasn't home to receive the call, but they left a message.

The breast surgeon needs to re-schedule our appointment from Friday to the following Monday.

It's only 3 days, but it's 3 more days of anxiety and uncertainty while not knowing exactly what kind of cancer I have, when my surgery will be, and what my treatment plan going forward will be.

6/26/19: Insurance Letter Confirming Approval for Genetic Testing

The genetic testing required pre-authorization, and I received a letter stating that my request had been approved. It was back-dated to June 20, and the service had to fall within a month's window of time.

6/26/19: Letter with Mammogram & Ultrasound Results

It feels weird getting these formal results in writing after already moving forward with verbal results and next steps.

This time, the letter informed me that the diagnostic mammogram and ultrasound on my left breast "showed an area of abnormality...[and] a biopsy is recommended."

I already have an appointment for the MRI with biopsy, but I'm leaning towards getting the double mastectomy, which would make the MRI with biopsy moot.

6/20/19 - 6/21/19: Phone Calls (Insurance Referrals)

It suddenly occurred to me to wonder if I need a referral for my breast surgeon appointment next Friday?

I called the Breast Center to ask. I left a message, and someone called me back first thing the next morning. She said from their office's perspective, I am all set. However, she suggested I call my insurance company, since they may require a referral for their own reasons.

I called my insurance company. They confirmed that yes, I do need a referral from my PCP to the breast surgeon. My existing referral (good for 6 visits in 1 year) to see my NP in the Breast Center uses my NP's "NPI number". I will need a separate referral to see the breast surgeon using the breast surgeon's "NPI number".

I called the Breast Center to request the breast surgeon's NPI number.

I called my PCP's referral line to request the referral (also good for 6 appointments in 1 year).

Then I suddenly wondered if I should have had a referral for yesterday's appointment with the genetic counselor.

I called the genetic counselor's office. I felt sheepish when I realized that I had called her direct line, instead of an administrative line. I figured since I had her on the phone, I could ask one question that had occurred to me: If I test positive for genes related to breast cancer, will the results be able to tell me if the gene came from my mother's side or my father's side? The answer is no.

Anyway, she gave me the NPI number for her supervising doctor (a medical oncologist).

Finally, I called my PCP's referral line again. I explained yesterday's unexpected and urgent appointment, and he was able to put in a referral (presumably back-dated) that would cover yesterday's appointment (again, good for 6 visits in 1 year).

What a lot of hassle. I'm not even 100% sure the genetic counseling referral was needed, but I figure better safe than sorry.

6/20/19: The Nurse Called Me with Appointments and Receptor Results

While we were at the genetic counseling appointment, the nurse called and left a message. I called her back and was able to speak with her.

She said she spoke with my NP and had some information for me.

First, I got an appointment with the plastic surgeon. Unfortunately, it conflicted with the appointment with the breast surgeon, so she was trying to see if my breast surgeon appointment could be changed. I told her the NP had said I could always decide about breast reconstruction later, and that I'm not sure yet how I feel about breast reconstruction, so right now I am more concerned about meeting with the breast surgeon as soon as possible. I wouldn't mind delaying the appointment with the plastic surgeon. The nurse agreed to keep my breast surgeon appointment as scheduled, she would cancel the plastic surgeon appointment, and look to re-schedule the plastic surgeon for a later date.

Second, I got an appointment for the MRI with biopsy. The date is about 1 1/2 weeks after my appointment with the breast surgeon, so we won't have the biopsy results in time for the breast surgeon appointment. I am wondering how soon we could schedule the surgery... Having both genetic testing and MRI biopsy results before the surgery would be ideal. But I'm also wondering if, after all this anxiety and stress, would I rather just get the double mastectomy no matter what, and save myself the future trouble of having to worry about cancer in my left breast? I need to think about this. The NP had said we can cancel the MRI with biopsy if I opt for the double mastectomy regardless of test results. 

Third, they got partial receptor testing results. I am positive for both estrogen and progesterone receptors. This is good news. This means hormone therapy drugs could be used in my treatment. (I can't help but think how my many years of taking birth control pills may have affected the breast cancer growth... I took a combination birth control pill that contained estrogen and progestin, a synthetic form of progesterone.) They are still waiting on the HER2 testing results.

The nurse said the first step right now is surgery. Then I would meet with a medical oncologist, who would handle my treatment after surgery. 

6/20/19: Phone Call + Genetic Counselor Appointment

While driving home from my morning appointment, someone called and left a message about the genetic testing. I returned the call as soon as I got home.

The genetic counselor who works at the local site is on vacation. I will need to see a counselor at the main hospital in the city.

At first, the only available appointment was on a day that wouldn't work well for me. I asked if there was anything else available, and here's a bit of luck, they had a cancellation! All I had to do was get into the city by 1:00 the same day.

I Google Mapped the directions, and thankfully my husband was able to come with me, and do the driving. The older I get, the more anxious I get about driving in the city.

So we both met with the genetic counselor. She explained the role of genetic counseling in the context of my diagnosis.

For starters, the counselor told us that 1 in 8 women eventually get breast cancer. Of those, only 10% can be linked to a hereditary cause.

Apparently, age 43 is considered young for being diagnosed with breast cancer. This site lists age 62 as the median age of diagnosis for breast cancer for U.S. women. A younger diagnosis makes it more likely that perhaps the breast cancer is related to a gene.

Genetic testing results are a factor in deciding the course of treatment. I'm already supposed to get a mastectomy. But if my genetic testing reveals that I have a gene that is linked to breast cancer, that means it's more likely that I will eventually get breast cancer in my other breast as well. In that case, the surgeon would be more likely to recommend a double mastectomy.

The counselor also said that the surgeon may use a more aggressive technique during surgery if I have genes linked to breast cancer, as it would be more imperative to try to remove all breast tissue.

Some genes are linked to both breast cancer and ovarian cancer. If I have one of those genes, for example, after I complete my breast cancer treatment, I might be asked to consider removing my ovaries as well.

Beyond my own health, genetic testing results could also affect my children. If I have a gene that could be passed on to them, they, too, would benefit from genetic testing, most likely starting in their 20s or 30s. We became emotional at the thought of our children facing cancer themselves, getting their own genetic counseling, some time in their future.

The first step is to do a blood test screening for the 9 most common genes linked to a significant increase in risk for breast cancer. If that comes back positive for any of the genes, the testing would probably stop there. I would move forward with a "genetic team," including a medical oncologist. They would counsel me on how my genetic testing results might affect my ongoing medical care.

If the screening comes back negative for the 9 most common genes, they would probably recommend I do further testing to screen for 23 additional genes that are linked to breast, ovarian, and uterine cancer. Alternatively, I could opt to screen for 83 genes linked to a whole bunch of different cancers.

Finally, she said that genetic testing requires prior authorization from my insurance company. She would handle obtaining the pre-authorization, and at most I might have to pay $250.

She asked me for a thorough medical history of incidences of cancer in my family, which aids in determining the likelihood of me having a hereditary gene linked to cancer. Then I had my blood drawn. The genetic counselor said she would call me in 1-2 weeks with the results.

6/20/19: Mammogram and Ultrasound - Inconclusive + NP Appointment

Today's appointment was scheduled because the MRI showed "something" in the left breast.

I thought they were going to do an ultrasound of my right breast, too, but they didn't. Maybe there's no need to look any further now that it's clear the right breast will be removed anyway.

In the waiting room, I was asked to fill out the standard mammogram paperwork again. This time, my answers included my recent MRI, biopsy, and breast cancer diagnosis. My NP popped in and said I could ask to speak with her at any time during my visit.

First, I got a diagnostic mammogram of my left breast.

Next, the ultrasound of my left breast. When the ultrasound technician left to show the images to the radiologist, the nurse who was at my biopsy came in. She was so comforting, I couldn't help a few tears from slipping out.

The technician and the radiologist returned. The radiologist was the same doctor who performed my biopsy. She said the technician didn't see anything in the ultrasound. She repeated the ultrasound herself to confirm the same.

So, neither the mammogram nor the ultrasound could explain what the MRI showed. The radiologist recommended an MRI-guided biopsy for my left breast, and also genetic testing. Before leaving, she gave me a kind, sympathetic, "I'm sorry you're going through this" kind of look.

At this point, my appointment was technically over, but I asked if I could speak with my NP.

I held it together until my NP walked into the examining room. She handed me some tissues and reassured me my reaction was normal. 

She said she is still in the process of making the appointment with the plastic surgeon.

She will make my appointment for the MRI with biopsy. That appointment would have to take place in the city. These appointments are typically made about 2 weeks in advance.

She will put in a referral for urgent genetic testing. They will call me to set up an appointment. 

She said genetic testing results typically take about a week. Even if the results aren't available in time for next Friday's appointment with the breast surgeon, we should still keep that appointment. 

We will proceed assuming both the biopsy and genetic testing are negative.

If the biopsy comes back as cancer, or if the genetic testing shows I carry genes linked to breast cancer, the surgeon would likely recommend bilateral surgery - a double mastectomy.

The NP said that even if both tests are negative, I should still think about whether or not I want to get both breasts removed. For some women, preserving natural breast tissue is very important. For others, reducing the anxiety of cancer recurrence is more important. If I decide to get a double mastectomy for preventative reasons, she would cancel the MRI biopsy, as the results would be irrelevant if the left breast is going to removed anyway.

I asked if there is any chance of recurrence if both breasts are removed? She said the goal is to remove all the breast tissue, but sometimes it's not possible, so there is a small 1-3% chance of recurrence even after a double mastectomy.

And how would I be screened for cancer, if there are no breasts to image? She said I would have regular clinical visits with her, the NP, and she would perform physical exams to feel for lumps. (I didn't think to ask, but will add to my list: Would breast reconstruction surgery affect the ability to palpably detect new lumps?)

Regarding breast reconstruction surgery, she said I don't need to decide that now. I can always choose to have it done at a later date. It was something of a relief to have one less thing to worry about right now.

To aid her in setting up my appointments, I had previously given her my summer vacation schedule. I told her to disregard them. I don't want to delay treatment.

6/19/19: My NP Called Me

My NP called this morning, as promised.

Every time someone from the Breast Center calls, it's a different number. But now I know to pick up just in case.

I had prepared a list of questions in advance. The NP had me ask my questions first, but in this post, I think it makes more sense to describe important information first.

I have my appointment with the breast surgeon next Friday. I'll have my husband go with me to that appointment.

The NP said the surgeon would likely recommend a mastectomy.

She said she spoke with the surgeon about my case. The cancer being in 2 locations, in 2 quadrants of the breast, is complicating. Usually, when the cancer is in one location, they surgically remove the tumor, then treat the location with radiation to reduce the chances of recurrence. I guess the radiation is targeted to the specific location of the cancer, and it's not an option if there are 2 locations. I wasn't clear on why not, but I found this site that lists radiation as an option if the cancer is "located in one site."

Additionally, the second lump being so close to the nipple is also complicating. She said because of this location, breast-conserving surgery doesn't provide a good option cosmetically. 

She said she would also make an appointment for me with a plastic surgeon to discuss breast reconstruction surgery. We will have to drive to the main hospital in the city for that appointment. At this point, I'm not sure how I feel about breast reconstruction surgery, but I figure it makes sense to meet with the plastic surgeon to learn about the process and what my options are.

Other things we talked about during the phone call:

I asked for clarification regarding the first lump. She said the lump itself is a sebaceous cyst, and the cancer is behind it. The cancer showed up as a "shadow" on the ultrasound, so it looked like maybe the cyst had ruptured, but it turned out to be "not related." I'm still not fully clear on it, but it seems like it's just a coincidence that the cyst happened to appear in front of the cancer.

And the second lump? It's a cancerous tumor. She called my case "multifocal" because there is more than one lump, but when I Googled it, I think maybe she meant "multicentric" because she was clear that my 2 lumps are in different quadrants. I'm not sure if having multicentric cancer is automatically worse than having unifocal cancer, but it can't be better. (In Googling "multicentric breast cancer", it does appear that a mastectomy is the typical course of action.)

The NP said that when there are multiple tumors, they evaluate the cancer based on individual tumor size; they don't add up all the tumors for a total size. She referred to my tumors as "small," and she said having the 2 locations doesn't necessarily mean the cancer is more advanced. I guess that's reassuring. 

I asked if they could tell what type of cancer it is, and what stage? She said they are still waiting on the receptor testing. And they will have a much clearer picture after surgery. During surgery they will look at the lymph nodes (something about a dye, and a biopsy) because apparently if breast cancer spreads, it will spread to the lymph nodes first. She did say that my lymph nodes "looked okay" on the MRI, so that's a "good sign."

Finally, I told my NP that I had read online that it takes about 2-5 years for breast cancer to grow big enough to be palpable. So understanding that my body has already hosted this cancer for a while, is there anything I can or should be doing now that I've been diagnosed? She said the only lifestyle recommendations are regular exercise and a healthy diet.

6/18/19: I Watched a Movie

I've tried to keep my posts mostly factual, but I would be remiss if I didn't mention the emotional toll.

Last night my husband and I watched the movie Always Be My Maybe. I'd already seen it once, so I knew exactly what to expect.

*** Movie Spoiler Alert ***

The part when Marcus's mother dies caught me by surprise. I mean, I knew it would happen. But I didn't expect it to hit me so hard. Mothers die in movies all the time. But now, the idea of it wasn't just abstract. It's a very real possibility that I am very afraid to face.

6/17/19: (Diagnosis) My NP Called Me with Biopsy Results - I Have Breast Cancer

My posts are now caught up to real time. I'll post new information as I receive it.

My NP called me on the 2nd business day after my biopsy. "The two lesions both show breast cancer."

I have to say, I did not expect this.

Both diagnostic mammograms of my right breast showed "no evidence of cancer."

After two ultrasounds on my first lump, two different radiologists identified it as a sebaceous cyst, and were unconcerned. (I am not clear on this, but is the first lump itself still a sebaceous cyst, and the cancer cells are underneath it?)

It was only because of the appearance of the second lump, which did not show up on the second ultrasound, that the MRI was ordered, which led to the biopsy, which led to this diagnosis.

Anyway. The NP called the cancer "grade 2". She said there are 3 grades. According to this site, "grade 2" means the cancer "looks less like normal cells and is growing faster".

She said the testing on the "receptors" takes more time, and we still need more information on those. Depending on the receptor testing results, the cancer may respond to hormone medication. She said a particular protein called "HER2" can help indicate how aggressive the cancer is. None of this made much sense to me on the phone, but later I read up on breast cancer hormone receptors and HER2.

The NP confirmed my upcoming ultrasound appointment, then said she wanted to add a diagnostic mammogram of my left breast to that appointment, so we have all possible testing done for both breasts.

The next step after that is to have an appointment with a breast surgeon. But I guess some things still need to happen behind the scenes, because she said she can't set up that appointment yet. Maybe the receptor testing results will dictate what kind of appointment I need with the breast surgeon.

My NP said she will call me again on Wednesday to check in, to see if I have any questions. Hopefully by then she'll have an appointment with the breast surgeon for me.

After I hung up with the NP, I thought of a question. I called her right back, and luckily she was still available to talk. I asked her if, now that I had been diagnosed with breast cancer, should I stop taking my birth control pill? She said yes, once a person is diagnosed, they do recommend stopping any hormone medication. It's not imperative to stop immediately, but as soon as I'm able to stop, I should stop. (I stopped immediately.)

6/14/19: The Nurse Called Me

The next day, the nurse who accompanied me during the biopsy called me to check in.

This time, I missed the call because I had gone for a walk. I called her back and left a message thanking her for her call and saying I was doing fine.

She had sent me home with two instant cold packs. I had used them both the evening before, as instructed, even though I didn't feel any pain.

I removed the band-aids and realized that the extraction locations were "below" the lumps, not directly adjacent to them, but on the underside of my breast. Over the weekend, the areas would become bruised, but they didn't hurt. I didn't feel much discomfort at all, except for some itchiness around the band-aids and steri-strips.

6/13/19: Biopsy

I arrived early for my appointment, and had a pleasant exchange with another woman entering the Breast Center.

After changing into a hospital gown from the waist up, the first step was the ultrasound. I lay on my back with my right arm positioned over my head. The ultrasound technician looked at both locations without saying much. I asked her if she was able to get a look at the second lump. She said it was difficult to distinguish between the lump and the nipple, but she was able to see it.

We waited for a nurse to arrive. To my surprise, the nurse was the woman I had met walking in. She stayed with me for the rest of my appointment, her supportive bedside manner keeping me calm.

Meanwhile, the ultrasound technician had left, presumably to confer with the radiologist. When they returned, I was relieved to hear the radiologist say she would attempt to biopsy both locations. She said she wasn't sure if she could get samples from the second location, but she would try. (I have to say, this radiologist was so much more personable than the other two I had seen previously.)

As the radiologist came and went to prepare for the biopsy, the nurse explained that after the tissue samples were taken, the radiologist would insert a tiny titanium "clip" into each site, so each location would be easily identifiable for future reference.

The radiologist explained the biopsy procedure. A shot of Novocaine would provide local anesthesia. After that, I should only be able to feel slight pressure, no pain. The ultrasound would help guide the position of a "core needle," which would extract the breast tissue. I didn't dare look at the instrument for fear of getting queasy. Each extraction would be accompanied by a loud "click" sound, which the radiologist demonstrated so I would know what to expect. Finally, she told me that I should expect bruising afterwards.

The ceiling above me was designed and lit to look like a skylight through which I could see blue skies, wisps of white clouds, and colorful tree tops. I kept my eyes on this calming image while the ultrasound technician and the radiologist got to work on the first location, with the nurse standing by. The Novocaine shot pinched a bit, but then I didn't feel a thing when the radiologist extracted 5 samples.

The second location near the nipple was more difficult, and the radiologist had said she would try to get at least 2 samples. With the "click" of the first extraction, I flinched. I could actually feel it. It wasn't painful, but also not painless like the extractions from the first location. The radiologist checked with me to make sure I was okay, and then continued. She was able to get I think 4 or 5 samples from the second location as well.

Just as the radiologist finished with the second location, I felt a flow of blood run from the middle of my right breast down the outside of my torso. Yikes. The radiologist quickly put pressure on the area, then the nurse took over. I lay with the nurse putting pressure on the second location for quite a while before the location was covered with steri-strips and a band-aid.

With the biopsy finished, and the titanium clips inserted, the ultrasound technician took some more ultrasound pictures. As a final step, I would also need to get a "soft" mammogram of my right breast, meaning a mammogram in which the breast is gently positioned, but not squeezed.

Before taking her leave, the radiologist mentioned that I should come back for another ultrasound for my left breast, because the MRI showed "something" in the left breast, too. (To date, all diagnostic mammograms and ultrasounds were only on my right breast, where the two lumps are located.) This was the first time I had heard anything about my left breast, and to be honest, the idea that I had to come back yet again for yet another test was overwhelming.

The nurse had me sit up slowly in stages, first with my feet still on the table, and then with my feet hanging over the side. Just as the nurse asked me if I was ready for the mammogram, I started to feel queasy. Then I felt very warm, and a little foggy. The nurse had the mammogram technician get me some water and Teddy Grahams, then some ginger ale and saltines. After a while, the feeling passed. The nurse said "hot flashes" are a common reaction to Novocaine, and apparently I got a lot of Novocaine.

Once I was feeling better, the nurse gave me written instructions for how to handle the biopsy recovery. She said she would call me the next day to check in, and she would call again in 3-5 days with the biopsy results.

Then I went with the mammogram technician to get the "soft" mammogram.

Lastly, the mammogram technician left me briefly, and then came back with my appointment date and time for another ultrasound. They would look at both breasts, presumably just a follow-up for the right breast. She mentioned the idea of doing the ultrasound the same day, but then said everybody thought I had been through enough, and it would be better to come back another day.

6/7/19: The Scheduler Called Me

Someone from the Breast Center called in the afternoon to set up the ultrasound and biopsy appointment. I was relieved the call came before the weekend.

The only thing concerning about this phone call was that the person said I would be scheduled for a "repeat ultrasound with possible biopsy." I asked why she said "possible" because I was under the impression that I was definitely getting a biopsy of two locations. She said I would "most likely" get a biopsy, but the "possible" just indicates that the decision would be made depending on what the ultrasound shows. I could theoretically get one, both, or neither location biopsied.

While I waited for my appointment date to arrive, my anxiety increased at the idea of not getting both locations biopsied. At this point, I just wanted to know for sure what was going on with each lump.

6/6/19: My NP Called Me with MRI Results - Images are "Suspicious"

I need to start answering unknown callers on my cell phone, at least while there's a possibility of receiving a call from a medical professional.

I missed the NP's phone call. She left a message about discussing my MRI results. I returned the call immediately, but she was already no longer available. I waited 3 anxious hours for her to call me back.

She said the MRI images showed "suspicious enhancements" in both areas.

Regarding the first lump: My understanding is that the MRI confirmed a cyst within the skin. However, the area underneath the cyst was "suspicious."

Regarding the second lump: This area was "enhancing on the MRI with a similar pattern" as the other area. Given the MRI results, this area should have been detectable on the ultrasound; it's surprising it wasn't.

The next step would be a repeat ultrasound with biopsy for both areas.

Up until now, I had gone to a separate Breast Imaging location for my tests, mostly because it was where I had been getting my annual screening mammograms, and because it was slightly easier to drive to than the Breast Center. At this point, though, it seemed wise to consolidate all my appointments at the Breast Center.

The biopsy results would be available about 5 days afterwards.

I don't know what all goes on behind the scenes, but the NP said someone would call me to schedule the ultrasound and biopsy appointment. Maybe it's just not the NP's job to schedule appointments.

Again, I waited for a call.

6/4/19: NP Appointment

After the MRI, I headed over to the Breast Center.

Since "my" NP (the one who saw me initially) was not in the office that day, I was seen by a different NP. She gave me a lot of good information, so I'm glad I had this appointment after all.

Mostly, the NP reassured me that bruises and sebaceous cysts can appear anywhere on the body, and I just happened to get them on my breast. The bruise itself looked like a regular bruise. Why did it appear? Who knows. Maybe I put weight on it in just a certain position while sleeping. The bruise would just have to run its course, which means it might get worse and change lots of colors before getting better. 

She assured me that the area was not infected. Symptoms of an infection would include redness, pain, and a fever. 

She also explained that using a warm compress mostly helps to encourage the cyst to drain, but since neither of my lumps had any kind of opening in the skin from which to drain, there was probably no reason to do it, unless I felt it relieved some discomfort. 

She said if the cyst drained, that would be a good thing. Surgical removal was an option, but the entire "sac" would have to be removed, or else it would likely just return again. If the cyst isn't actually causing any problems, it's usually best to just leave it alone.

I mentioned that the bruise was becoming more painful as the day went on. The NP suggested I wear a supportive bra. (Back at home, I pulled out my most supportive bra and wore it for the next several days, even while sleeping. It really did help relieve the pain quite a bit.)

Finally, the NP took a photo of my bruised lump to show my regular NP. I wish I had thought to take a photo, too, for my own records. But I didn't.

6/4/19: MRI

I had received in the mail an informational letter about my upcoming MRI, plus a couple forms to fill out in advance. With these forms in hand, I reported to the radiology department of the same hospital as the Breast Center.

My NP had let me know that MRI contrast (a dye) would be used to enhance the MRI images. The nurse in the radiology department prepared me with an IV. She explained that during the MRI process, they would inject the MRI contrast via the IV.

The nurse also said that I could choose to listen to music during the MRI, if I wanted. I thought about it, and decided I would prefer silence. Or rather, just the sound of the machine. I'm writing this post on June 17, and I can't remember now whether or not they gave me earplugs. I think they did.

I have to admit, I did not know I would be face-down on a table with my breasts hanging through openings on a padded table. (I got a fetal MRI during my second pregnancy, so I guess I just assumed I would be lying on my back.) I suppose it might have been helpful if I had prepared for my appointment by educating myself in advance, perhaps by reading a web page like this one. Contrary to the illustration on that page, though, I was positioned such that the table I was lying on slid me into the MRI machine head-first.

It's hard to say how long I was in the machine. Maybe 30 minutes? All I can remember now is having to stay still while the machine made all kinds of noises. About 2/3 of the way through, the technician let me know they were going to inject the contrast via the IV. I don't think I felt anything. They took a few more images, meaning the machine made more noises, and then it was finished.

Awkwardly, when I changed back into my clothes, I self-consciously noticed that the face pads on which I had been lying for the MRI had left indentation marks around my eyes. Before heading to my NP appointment, I passed some time in the lobby, waiting for the marks to fade away.

6/4/19: First Lump Bruised

On the morning of my scheduled MRI, I woke up to discover that my first lump was completely bruised. The area was surrounded by black and blue discoloration, as if I had been firmly elbowed, and it hurt.

I was alarmed. Since the day I found my lump, this was the first time it was bruised black and blue, and the first time I felt pain in the area.

I called the Breast Center and described the situation. The nurse on the phone took a message, then called me back. She said my NP was not in the office that day, but she spoke with another NP, who said that bruising around a surface lump was common, and an office visit was not necessary.

However, very kindly and with understanding, the nurse on the phone said that I could certainly come in for a visit if I would find it reassuring, especially since I would be in the hospital building already for my MRI that day.

I made an appointment with a third NP who had an opening that afternoon, after my MRI.