Stress & (Not) Eating & Ramblings

The days between finding out the results of my mammograms (bilateral BI-RADS category 4 microcalcifications = suspicious for malignancy) and the biopsies done yesterday, I behaved very unlike me. I did not eat to soothe my anxiety. In fact, I had almost no anxiety until the day before when I started feeling what I can only described as “scared”. When pressed by my spouse to talk about it, the feeling came from being out of control of a medical situation, having my body touched, being exposed. All normal things that most people in a patient role experience, but some of us have more issues than others about our bodies. I am one of them.

For years I spent my life with my head cut off from the rest of me – literally. Probably explains why it was so easy to gain 100 pounds during my medical residency as I lost what little contact with my physical self that I had from vigorous sports. To keep the numbness going, I started binge eating after 36 hours of work (ah, the good ol’ days). Then bingeing became a way of dealing with stress in general.

One way I tried to control my life was through knowledge, understanding, problem solving. Free kindergarten did not exist when and where we lived when I was 5, so my Dad started teaching me to read and do math at a very young age. I quickly learned that the world seemed much easier to control if I could wrap my little brain around facts and put them together. Makes for a school-smart kid. Doesn’t necessarily help make one a complete person. He also taught me to play football, baseball/softball and from there I took off on every sport I could participate in. Great stress reduction to move one’s body. My family was extraordinarily loving. Still I split my head from my body.

Fast forward to last week when faced, literally, with my mammograms while talking with the radiologist. All the things that I know, that I researched and taught others to do when faced with medical decisions flew out the window. I didn’t ask enough questions. I stammered around trying to act like a doctor and a patient, trying to keep the detachment in my brain from the obvious physical abnormalities staring at me from the radiology view boxes. After calling Sue and realizing how totally numb that I felt, I went to Starbucks with iPad in hand to research the radiographic findings and get a little soothed from some mocha and caffeine (my one sugar treat). I couldn’t do it. I wrote the last blog post instead. I talked to my Mom (um, she’s dead, so it was a one-sided conversation). Then I steeled myself for the binge urge – it never came. Emotions never came until Sunday night when that feeling of being out of control hit hard.

Segue to yesterday at the radiologists’ office – an amazingly woman-centered environment. With Sue in tow, we arrived early. Suddenly Sue (who had her own breast cancer scare 4 years ago) tells me that the doc doing my biopsies went to the same medical school that we did! Why should that be so comforting? She might still be a jerk – many physicians are. She was wonderful – answered what questions I had and more that I hadn’t thought of; thoroughly explained the procedure; and then spent the entire time (it took 2.5 hours because, well both sides and it takes time to position, repeat pictures, etc.) talking with me as a human and a colleague. We yapped about medicine, Tucson, Texas, public health. I stayed in my head entirely. This time being able to disconnect from the neck down was very adaptive. Only today when I took off my sports bra did I realize how much time my breasts had spent under compression. How stiff one can get from lying like a pretzel wrapped around a machine for a couple of hours. How much pain you can ignore until the stress is gone. Ow, my neck hurts. My shoulders hurt. My boobs – fine as long they stay supported. My emotional state is good also. I don’t feel numb but am eager/anxious to find out the results by Thursday and move on from there.

For anyone who has to have a breast biopsy in the future let me reassure you that the procedure (stereotactic vacuum assisted core biopsy) is relatively painless compared to the old days of sticking a 14-gauge needle in and poking around.

This post has been more stream-of-consciousness than usual. Good for me, not so good for the reader. If you made it to the bottom of the post, I promise not to do this again – until the next time that I do. 🙂

Be Careful What You Wish For

Two days ago after my mammogram, I was lamenting the saggy state of my still rather large breasts and contemplating whether to get them lopped off -OK, OK, surgically reduced and lifted – at the end of my weight loss.

Today I am numb as the results of the mammography reveal very suspicious micocalcifications in both breasts. How suspicious one might ask? The scoring system known as BI-RADS has both areas at 4 on a scale of 0 to 6 where: 0- incomplete, 1- negative, 2-benign findings, 3-probably benign, 4-suspicious abnormality, 5-highly suspicious of malignancy, 6-known biopsy with proven malignancy. To put this in to a better perspective, a BI-RADS of 5 means the chance a woman with that score actually has some type of breast cancer is about 95%. (For those interested, this likelihood is called the positive predictive value or PPV.) The PPV for a score of 4 is only 20-40%, but that is a heck of a lot higher risk than I had 2 days ago. Disturbingly I find there are sub categories, 4a 4b 4c with much greater risk in 4c, as high 79%. My radiologist didn’t breakdown the subcategory – just as well. It is what is.

I am scheduled for bilateral breast biopsies Monday. My wonderful PT and massage for an ailing neck are out the window for the following week then we will deal with the results.

I draw strength from all the physical trials my Mother went through the last 10 years of her life, smiling the entire time. How bad can this be? Cheers!

To Reduce or Not?

Not what you’re thinking. I have reduced: my calorie count and sugar/starch/grain consumption; body weight by 115 pounds; and body fat by an estimated 45%. Now with 50 pounds left, there is one (actually 2) things on mind, rather on my chest.

During a mammogram yesterday, as my boobs in all their pendulous glory lay squished one at a time under the compressor paddle getting irradiated, once again I pondered breast lift & reduction surgery. Why? I don’t consider myself a vain person. (Who does?) Facial plastic surgery and body sculpting are not on the list. But honestly, my chest looks like I’ve had 12 kids. The best under-wire bra money can buy only puts my boobs so close to anatomically correct position. My neck is killing me – so much I was concerned that a 16-year old cervical spine fusion had finally failed. The MRI thankfully only showed arthritis, and my physical terrorist is having a difficult time getting the right side of my neck muscles to unspasm. (“Ah-ha, a paper trail!” said the mammogram technician. “Maybe you can qualify medically for a breast reduction.”) Who wants surgery? Sure boobs above my waist (slight exaggeration) would be delightful. Being able to walk/jog without the slapping of breast tissue on chest, no longer being embarrassed, no more neck pain – all very tempting.

Fifty pounds to think about it. I don’t like surgeons. Hey, I’m a doctor, why should I?

old woman in bikini bottom only