Wednesday, May 16, 2012

Unfamiliar Boobies

Have I mentioned that May has not exactly been an awesome month? I had my 36th birthday (with no children), Mother's Day (again, not for me), and I had my follow up appointment with my doctor after my fourth failed fresh IVF (fifth failed cycle including the FET, I'm really not sure how to count those's a transfer, so it's in vitro, but it doesn't include stimming or egg retrieval, so it's kind of a bonus round). There are so many things about the follow up that had me feeling not so great and wondering how the hell we got to this particular point in our journey. All of which I will write about later. The topic for today is how my follow up appointment and Bryce's concern about what this process is doing to my body led me to a referral I was really hoping to avoid until I was 40.

Every time we do a cycle and my body is pumped full of various injectible hormone drugs, Bryce worries. He sees what it does to my body (bloating! weight gain! ginormous ovaries! estrogen levels through the roof as evidenced by crying/screaming/turning into a complete wackadoo!) and he doesn't particularly like it. Not just because I am difficult to live with when medicated, but because he worries about the wear and tear on my system. I have also been nervous about the impact these drugs have on my body, namely the increased risks of certain cancers (breast and ovarian). If you read the medical inserts for the drugs, which is good practice for being informed but when you actually read it you immediately think you are going to die in various horrible ways if you take these medications, the risk is mentioned. Anecdotally I have heard all kinds of things about the connections between IVF and breast and/or ovarian cancer. And I freak out. I am as terrified of dying an untimely death due to cancer related to my treatment as I was of ectopic pregnancy--both are rare but I managed one so I am slightly more nervous about the cancer thing than I used to be. But Bryce is probably more nervous. So, in our follow-up he mentioned that he was uneasy about the effect of the drugs on me, and my doctor gave me a referral for a mammogram. Because apparently when they do the bloodwork they look for weird white blood cell counts, and ovarian cancer would be found presumably on an ultrasound of my ovaries, and my ovaries are very well photographed. So off I went, three days after my 36th birthday, to get my boobies squished.

I was really, really upset about it, to tell the truth. I was worried that they were going to find something, of course, because I have terrible luck and really think that there is some angry spirit residing in my house, avenging itself by keeping the babies away. But I was kind of pissed that it was "Happy birthday to me, please smash my boobies flat!"  What a nice present. And plus, you are supposed to get a mammogram when you're 40. And you're a mommy. And your boobs have already been used for nutritional purposes. I really, really thought that I would experience childbirth before I would be waiting in a room with 50 year old women, wearing a lovely front-tie pink gown, getting ready to have (very nice) strangers totally abuse my poor boobles. So I was scared, but also resentful.

The mammogram itself really wasn't so terribly bad. They manhandle your boobs, one at a time, into this machine that has a plastic tray on a lever that comes down and squashes your breast as flat as it will get. This is where I was actually quite grateful for my huge boobies, because when they are bigger they apparently hurt less to be squashed. You can get them in there no problem. It was painful when they did the top-down squish, because it felt like the tissue was being ripped from my collarbone area. The diagonal squish wasn't bad at all, even though that one is supposed to be the most uncomfortable since it gets your pectoral muscle in there, too. The machine was really kind of cool--the nurse adjusts the height to make it effective and comfortable(ish) and then lowers the tray thingie down. After the pictures are taken, which is about 12 seconds, the tray thingie literally pops back up and your breast reconstitutes to its un-squashed glory.

After the messed-up photo shoot, they tell you that if all is fine and normal you will get a letter in 7-10 business days (but that most people get it in 3). If a repeat scan is needed you will get a call. Then they tell you NOT TO FREAK OUT when they call you, because especially with first-time mammograms it's hard to tell what's what since there's nothing to compare it to. Your boobs are unfamilar territory. So a lot of first-time people get called back. Most of the time it's nothing.

My mammogram was on a Tuesday. Wednesday came and went, and I didn't get a call. YES! Finally, something normal relating to my reproductively-related parts. I was so happy. I really was excited to be getting that "you're totally normal" letter. And then Thursday came and I got a call. What the hell? They couldn't call me Wednesday? I had to be lulled into a false sense of normal-ness before being smacked in the face with "We need some more pictures?" I tried my best, but it was really, really hard not to freak out. So I called my friend, who is married to my best friend, who just happens to be a radiologist. And he just happens to read mammograms all the time. I needed to know if I should be freaking out or if I would be ok. I basically wanted to make sure that the lovely people at the Breast Health place weren't just being nice to me and lying through their teeth that I shouldn't be worried.

The good news is that my radiologist friend told me that that there is no room for "probably benign" anymore due to the litigiousness associated with breast cancer diagnoses. The number one cause for malpractice suits against doctors is apparently delaying a diagnosis of breast cancer, and so radiologists have ridiculously high malpractice insurance (as do OB/GYNs, because when something goes wrong with your baby, apparently you sue like the dickens). So, unless they can say "This is 100% benign," you get a rescan. And maybe an ultrasound. Or even a biopsy. This was really scary to me, because I didn't want a biopsy, but apparently this is incredibly common because mammograms are super detailed now but not any better at telling what's cancer and what's just funky boobieness.  So, since I don't have a family history and I didn't have an obvious lump and this was preventive "hey, you've been pumping your body full of really high levels of lady hormones, four times in two years, and you're 36, so we should really check out your boobs just in case," I tried to not be worried, because it was probably just a case of unfamiliar boobies. Even though that angry spirit and/or some kind of scary neurotoxin lurks in my house, rendering us infertile and killing my cat like a mine canary. I am not paranoid at all.

The next Tuesday (this past Tuesday) was my re-scan. And, an ultrasound--which would have really freaked me out had my radiologist friend not warned me that they might do an ultrasound on the same day (thank you, radiologist friend!). When they take extra pictures of your suspicious boob, they do new and exciting angles that are not comfortable at all. And they use a smaller tray, which seems like it would be more humane but actually squashes localized tissue even more, and so it's definitely not cozy. I had bets with myself that the offending breast would be my right one, since that one is the bigger one. Most women have asymmetrical boobs, but my right one is up to a whole half cup bigger than the left. I really like my left, because it is perky for a DD. I wish my right one was more like my left. Now you know way too much about my boobs, but that's what this whole post is about so I don't feel too bad about it. I was right--it was my stupid floppy right boob, probably because it has more tissue and is harder to see (not that I actually know anything about this, medically).

After the localized right-boob squishing, I got to hang out in the sub-waiting room until they called me in for my ultrasound. I have to say it was really nice to have an ultrasound that didn't involve being pantsless and in stirrups. However, I am used to having the screen tilted my way so I can concentrate on the picture show of my enlarged and follicle-filled ovaries instead of focusing on the giant wand probing my nether regions. They don't do that for a breast ultrasound and so my neck hurt a little from straining to see what a boob on ultrasound looks like. It looks weird, like one of those meditative sand art things you see on people's desks, with the sand and the water squished between two panes of glass and it makes wave patterns when you flip it over. But then there was a dark spot, and I freaked out a little again. The dark spot looked kind of like a follicle. So I told the technician that I was used to looking at ovaries (and she asked if that's what I do, so I told her no, it's what I see as a fertility patient), and this was totally different. But the dark spot looked an awful lot like a follicle and so I said, "Hey, that looks like a follicle! Is it mature? Is it ready to be retrieved?" I'm so glad she had a sense of humor and laughed (even if it was just out of politeness). She even measured it like a follicle. I just hoped it was in the "Definitely Benign" category.

She left to see the radiologist and then came back--it was normal! It was a "complicated cyst" which apparently is just a cyst with weird attributes but they name it something scary just to make you worried again. They come and go and it probably would have been felt on my OB/GYN breast exam (which I have been postponing because I hate going in every year and having to update with more horribleness and no pregnancy), but it will probably be gone on its own shortly. So it just came to visit at an already stressful time to mess with my mind. How nice. But, the upsides are multiple: a) I don't have cancer and so the angry spirit is apparently appeased for the time being, and b) I don't have to have another mammogram until I am 40. And hopefully am finally a mommy. And hopefully am the owner of boobs that have been/are being used for nutritional purposes. And hopefully can just get a nice, "You are normal" letter in the mail and avoid all this worry. (I do have to add that as stressful as this one-week episode was, I was grateful to be checked out--because if I did have breast cancer I would rather worry and then be diagnosed early than not have the stress of worrying and then find out later than is optimal that something nefarious has been hiding out in my boob. So I am totally for mammograms starting at 40!)

Bryce is glad now that I've been checked out and declared normal. He's probably also glad because I've stopped making dark jokes about having breast cancer that aren't really funny but helped me not be a total basketcase. I'm glad that I'm normal and healthy in the boobular area. And we're both glad that now we can move forward, get ready for our frozen cycle sometime this summer, and keep on moving towards that elusive but not impossible pregnancy.

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