Sunday, June 27, 2010

Personal Breast

The Dreaded Mammogram

Valerie says: The annual pap smear - during which a strange man or woman brings your private parts into contact with speculums, gels, swabs, and probing fingers in rubber gloves, all while your legs are up in the air and you can’t see what’s going on – has nothing on the periodic mammogram - during which a strange woman flattens and locks your breast in a vise that conjures up lobster claws and iron maidens, and then leaves the room while you’re half naked, immobile and cross-eyed with discomfort. I sometimes wonder whether any women have ever had the electricity go out during their mammogram. Is there manual override? (Notice the serene body language of the woman in the photo above. That's because the pressure has yet to be applied.)

(Jean says: Remind me NOT to consult Valerie before scheduling my own overdue mammogram. She manages to come up with even more horrifying speculations than my own fevered brain! Somehow, references to lobster claws and iron maidens just don't make me want to rush out and sign up. Methinks there is little chance of her becoming the American Radiological Society's spokesperson any time soon. For me, the term "Iron Maiden" conjures up a concept even scarier than the medieval instrument of torture. Yes, people, I mean none other than the English heavy metal band, Iron Maiden, founded in 1975 in Leyton, East London. What on this earth could possibly be more terrifying than being trapped in a mammogram machine and forced to listen to such headbanger favorites as The Trooper, 2 Minutes to Midnight, Fear of the Dark, Run To the Hills and The Number of the Beast"?)

Valerie continues: I have little fear of doctors, so when I’m told to get a mammogram, I do, and have left numerous films over the past 15 years with the numerous doctors I’ve had to change to and from as my health insurance changed, or as my doctors wearied of my health insurance providers’ policies.

In 2007, I went for an exam, as mandated by my doctor. I had spent several weeks hunting down old mammograms from various sources, and brought them to the facility for comparison purposes. This was the first time I’d ever had a painful test. I was having a particularly severe bout of chronic cystic mastitis (just plain swelling, brought on in my case by a minimal intake of caffeine), and I felt as though someone had sewn bowling balls into my chest the night before while I was asleep.

(See the photo at left for some idea what this is like.) Unfortunately, bowling balls - I mean cysts - make mammograms harder to read. After the mammogram, instead of being reprieved for a year, I was brought to the facility's doctor.

The doctor explained to me that they’d like to do a biopsy on two suspect spots, where he said I had calcifications, which are sometimes associated with cancer. He was very kind and calm, and laid out all the facts for me. I left with an appointment, feeling not happy – no one has ever said biopsies are fun – but confident that the two spots would turn out to be nothing, and I respected the doctor for his professionalism in wanting to confirm this.

When I returned for the biopsies, however, my relaxed confidence quickly changed to irascibility and worse. First, it turned out they were going to do the more invasive needle biopsy, not the less invasive aspiration biopsy I was mentally prepared for. Then, the biopsy was begun by a technician who did not like any of my sensible questions. The room was cold, the gel was cold, and when I asked if I could have an extra blanket, I was treated like a nuisance. (I did not get an extra blanket.) The technician was having trouble getting the needle to the place in question, and called in the kind doctor. The last straw was when the kind doctor morphed into the unkind doctor, who was no better at answering my questions or raising my comfort level than the technician. The doctor was finally able – I think – to draw cells from the first spot, but by this time we were all very tired of one another, to say the least.

Before starting on the second spot, the doctor asked me if I’d like to think about it, and maybe finish the biopsy at another time. I think that was codespeak for “We can complete this - if you’re ready to shut up.” I said yes, let’s finish the biopsy at another time, which was codespeak for “I wouldn’t come back here if this were the last clinic on earth.”

Later I received several reminders to finish the biopsy, and then a bill for some $200 not covered by my insurance. I ignored both the reminders and the bill. I was prepared to pay the bill, but not until I'd had a chance to complain about the service. No one ever asked, so I never paid. I later ignored the letters from the collection agency, and I assume there is a black mark on my credit rating. (I am scrupulous about all my other bills.) My personal feeling is that it was very stupid of me not to get my biopsy completed, and I don’t recommend that anyone do what I did. I was 95% certain that the biopsy was triggered by nothing more dangerous than cystitis, but even a 5% risk of cancer is too high to leave unchecked. On the other hand, doctors and technicians should also be aware that their social treatment of their patients is as important as the medical treatment they give.

(Jean says: Valerie has cracked the code! Medical professionals need to recognize the direct impact their attitude - and their personal interactions -- have on patient compliance. We are more than a name and medical ID number. Like lab rats, we respond most positively to attention and affection - and, of course, treats.)

Fast forward to 2010. When my new doctor asked me in April for the date of my last mammogram, I was shocked to realize it was as long as three years ago, and agreed to be tested. With visions of the 2007 fiasco dancing in my head, I sent out a blast e mail to all my middle aged lady friends asking for recommendations for a good place to get a mammography, and received one that stood out for its lavish praise. My friend told me that given my history I should request both a mammogram and a sonogram, and also assured me that I would love the staff of the facility she uses.

I took the first available appointment – in June – and started calling previous doctors and facilities to find my old films. When all of them told me I had already collected them in 2007, I realized they were at the facility I had left in mid-biopsy. I called, and they confirmed that they had my films. I expected them to remind me that I had an unpaid bill, and that I could have my films when I paid my bill. I was prepared to do that, but to my surprise, they made no mention of the bill. I suggested a date and time when I would pick up the films, and was told they would be ready for me. When I picked them up, I had the feeling all eyes were on me: “This is the lady who didn’t pay her bill, but has the nerve to ask for her films”, they seemed to be saying. I never forget to feel guilty (even when I’m not).

(Jean says: Doesn't Valerie have such a vivid imagination? It's part of her charm.)

Remembering my 2007 experience made me decide to remain caffeine-free for the two months until the mammogram. I didn’t want cloudy results to lead to another biopsy, but I also remembered the sheer agony of having swollen breasts clamped for what seemed like forever in that awful gizmo. This is another of those instances that make you say “Why is it they can get a man to the moon, but they can’t….” etc. Another thing I would have done - if I could have - was work on decalcifying my breasts, but there's no information on that. I've raised my intake of water, in hopes it might flush the calcifications out, and lowered my intake of other fluids, to give my body less filtering work to do, but I have no idea if there's any value to that outside the psychological reward I get for doing something that seems healthy.

I’m delighted to report that my experience at the facility recommended to me was as professional and angst-free as my friend told me it would be. I was seen exactly on time for my mammogram, and was seen thirty minutes later for the sonogram that was scheduled for an hour later. Thinking about my recent foot surgery, the thought of being that person who gets stuck in the mammogram device when the electricity goes off, and having to stand forever on my feet while the staff figured out how to unclamp me, filled me with dread. I pleaded with the technician – wasn’t there a way I could do this sitting down? The woman said no, but with empathy. She promised the whole thing would take less than two minutes, and she was as good as her word. Before I’d even left the facility, I was given a clean bill of health, and my test results were forwarded to my gp and my gynecologist. The receptionist asked if I would like them to keep my films. That seemed like a good idea to me. I’ll probably want to go back there.

(Jean says: Again with the electrical blackout fantasy? I may never make my appointment if I continue to dwell on such images.)

When I left the facility, I celebrated by having a cup of coffee.

(Jean says: Hallelujah! I love caffeine in all its incarnations. When Valerie swore off coffee weeks ago, I felt so guilty indulging in one of the few vices I have left. Mind you, I didn't stop drinking lattes and cappuccinos while in her presence, I just felt guilty!)


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