Have You Heard?: ABUS

The "Have You Heard?" series from BLAT is meant to summarize developments in the breast cancer world. As always, be sure to consult a physician with any questions or concerns you have about your cancer care.

Have You Heard?: Automated Breast Ultrasound Screening (ABUS)

It's well established that even the most advanced mammography available fails to render effective diagnoses in women with dense breast tissue. Nearly 1/3 of cancers go undetected in patients with dense breast tissue. Young and middle-aged women most often have dense breast tissue which appears cloudy on mammography imaging, and can often obscure the view of tumors in the breast tissue. Ultrasound has long been used to supplement mammography in an effort to improve detection of breast cancer. Yet, even when used in combination, many women still don't get the correct diagnosis. My case is a perfect, and all too common, example. I had a mammogram and ultrasound. According to the radiologist's report, I had "micro-calcifications, likely benign" and should "return in 6 months for follow-up." 6 months would've LITERALLY meant the difference between life and death for me. Luckily, my PA was smart and thorough. She sent me to a breast surgeon (Dr. Elizabeth Weinberg, who just happens to be the BEST breast surgeon in South Eastern North Carolina!) where my lump was immediately biopsied, and found to be malignant. My dense breast tissue likely obstructed the view of what we later found out was a 5.5cm Invasive Ductal Carcinoma (the size of a lime). Cancer had already started to spread to my lymph nodes. If we had waited 6 more months for follow-up, I would've been stage IV, metastatic instead of stage IIIa. As of now, there is no cure for metastatic breast cancer, and sadly, very little research is done to cure cancer at this stage.

While it is maddening that little is done to develop a cure, or even to track the medical experiences of women and men with stage IV breast cancer, it's good to know that some R&D teams are still making breakthroughs that have the potential to help millions of women, particularly those with dense breast tissue. Enter GE:

GE Healthcare has developed the ABUS: Automated Breast Ultrasound Screening, an ultrasound device that is the only FDA approved ultrasound for screening dense breast tissue. Check out the image captions for details.

Courtesy of GE Healthcare: On the left, an ultrasound image
 obtained with GE’s ABUS reveals an invasive malignancy
 (where the crosshairs meet). On the right, a standard
mammographic image of the same breast
shows dense tissue with non-specific calcifications.

So, why isn't ABUS a standard part of the diagnostic protocol? The fight to include any ultrasound as an automatic part of diagnostic imaging for breast cancer has been a long one. Objections include cost and manpower. Many reports express fear that radiologists would be inundated with ultrasound patients because of the sheer number of women with dense breast tissue that are referred for diagnostic imaging each year. It should take a technician around 15 minutes per patient to obtain the ultrasound images, and then more time for the radiologist to read them. Given the amount of time that goes into the diagnostic process, the backlog at any given practice could become outrageous. Also, given the financial climate of our healthcare system, physicians are not in a position to afford the new equipment, or are forced to choose between a 3-D mammography (which is also being raved about for the quality of its imaging), and an ABUS when deciding on new imaging equipment for their practice.

Ultimately, advanced screening methods save lives. Early diagnosis leads to MUCH better outcomes for those facing a breast cancer diagnosis. In my opinion, young and middle-aged women with any indication that something is wrong should automatically have ultrasound included in their diagnostics, and it should be with a machine, like ABUS, that can improve detection of breast cancer in dense breast tissue.

Want to read more about ABUS? Check out: Elaine Schattner's article in Forbes, or go to GE Healthcare's website.
**all images on this post are property of GE Healthcare**

It's FAT

Phew! It IS just fat. Fat necrosis to be more specific. I'm feeling so incredibly relieved.

Yesterday seemed to drag on. No matter how I tried to distract myself, my thoughts kept drifting back to the what-ifs. I took Charlotte and a friend of hers to the park. I sat on the bench, watching the girls play. I looked over at a mom on the swings. The back of her shirt read "Keep Calm and Trust God." I got the message. But the day continued to drag. Why hadn't she called? Was she waiting for more info, delaying giving me the bad news until she had finished with patients for the day and had more time to talk and answer questions?  And then the phone rang. Dr. Weinberg's voice was cheerful, bubbling through the phone line with GOOD news. "Relax and enjoy your vacation," she said. "It's just fat, just like we thought." Phew. We hung up and I cried some more. Actually I fell to my knees and cried and thanked God.

Phew.

Another lump

As I write this, it's 11:05 on Friday, March 13th. I'm not much for superstition, but I can't help but notice some similarities between today and a fateful day about 16 months ago. It was Nov 12th when Dr. Weinberg first biopsied that nasty lump, and the 13th when she called to tell me it was cancer. Once again, on the 12th of a month (March, in this case) I sat in her office for a biopsy. And once again, on the 13th, I sit here anxiously awaiting her voice on the phone. Is it cancer?

Just days ago, I found another lump. It's different than last time, higher up, much smaller. Immediately, I thought "it's just fat lumps." The timing is right, about 3 months out from my reconstruction, for the fat grafting on my left side to start settling in. Fat is unpredictable, and it is likely that some of the fat has clumped together leaving a lump I can feel just beneath skin. Nevertheless, finding a lump after the treatment I've been through for the last year is scary. Those odds are always lurking just beyond my consciousness, nagging at me. It's something I'm trying to move beyond.

I left a message for the doctor the next morning, and within 15 minutes, the receptionist was on the phone setting up an appointment for Thursday, the 12th. I didn't notice the similarity in the date until I was already at the appointment. Superstitious or not, why tempt fate?! Oh well, that's neither here nor there. [the cliche queen in me must come out when I am most stressed, lol!]

Doug came with me to the appointment yesterday. Right away, Dr. Weinberg put us at ease. It was likely fat from the grafting, it felt smooth like fat lumps do. Just to be safe, she wanted an ultrasound. Fat shows up bright white on an ultrasound. It would be easy to see if there was reason to worry. We were all for it. We're preparing for a vacation, ready to leave the stress behind. The ultrasound tech, Dana, was great, showing me all the white spots showing up on the screen and talking me through the spot where I felt tender. She took measurements, and called Dr. Weinberg in to examine the screen. Most of what they saw was definitely fat, connected, bright white and deep. But there was an area that wasn't quite as white as the rest, right near the skin, where I'd felt the lump. Dr. Weinberg suggested I come back in a few weeks as a follow up, but then she hesitated. "We could always just biopsy it right now so we'll know." Given my history, my odds, and how sneaky that last lump was, I opted for the biopsy.

This biopsy was different, guided by the ultrasound, I could see the needle for the lidocaine. I could see the corer (is that even what it's called?) removing samples as it was happening. Doug looked on, ever my rock. This time, the clicks weren't quite as loud, and there was some suction involved. I tried not to watch.  Dr. Weinberg said the samples looked like fat. Last time, she didn't say anything at all. I'm taking that as a good sign. I can't have cancer again already!

And now, I'm sitting here, pacing, trying to keep busy, and waiting to hear her voice on the phone. Waiting to hear it's just fat. I wasn't going to share this until I knew the results, but then I did promise myself I would use this blog to be brutally honest about what this cancer experience is like. It seems these scares are part of that journey. An ongoing tension and source of worry.  I don't think I've ever prayed so hard for fat in all my life.

Whatever the results, I will share with all of you soon. Good or bad, I need some time to process these emotions, so please don't worry too much. Lift this up in prayer, please, and know I am always so grateful for your support through every curve in the road.

Right Now Counts

I don't know about you, but I often (before, during and after cancer) get wrapped up in what the future holds. I am a very driven person. I set goals and I work hard, heck - I push hard, to achieve them. As much as accountability is part of my core personality, so is this drive to achieve my goals. I'm a dreamer, yes, but I am a dreamer that will see her dreams realized.

Being driven is good in many ways. I tend to get a lot done. I don't give up easily. I'm great at visualizing the big picture and the details; seeing how things are interconnected in life. I pay attention to (most) details, and learn from mistakes. 

This drive is also damaging, because I can easily miss one simple fact; Right Now Counts. It is so easy to put on the blinders and miss the moments. You know, the really great moments of everyday. They happen all the time. So often, that I take them for granted sometimes, or just miss them entirely because I'm too focused on everything that needs to get done, everything that needs to change, everything that CAN be better. 

The things I do may seem excessive to most. Right now, I'm working hard to balance (and excel at) being a great wife and mother, daughter, sister, and friend,4 jobs (online teaching for 2 colleges, tutoring in a writing center, and substitute teaching grades K-12), to keep up with our active lifestyles, and make major dietary lifestyle changes to improve my health, and find time for exercise (because despite constantly being on the move, I RARELY hit 10,000 steps a day; what gives?!). If you know me well, you know that I am pretty good at balancing on this trapeze, that what doesn't break me becomes a learning experience, making me stronger or better in some way. But there are days the safety net beneath me calls me from the chaos. We all fall from time to time. I'm beginning to see that in the falling is a moment of quiet where I remember that right now counts, and I want to hang out in the safety net beneath the "get 'er done" mentality for just a bit longer. There, the moments of right now fill my cup. There is where each embrace, each kiss, each laugh, each tear, each smile, each cheer holds us tightly together and reminds us how important each moment is. Right there, in that quiet space beneath the clanging of everyday life, is where our memories lead us to this moment, and these moments, together, create the memories of our future, reminding us that right now counts.

I'm going to try hard to remember this, to pay more attention to now, to let the "busy" noise of everyday life fade out so I can remain more mindful of the moments that really matter in the end. I hope you will too.

Fruits of the Spirit

I've been mentally writing this post for days. Wondering how or if "you" will judge me for what I write here. I promised you, and more importantly, myself, early on, that this blog would be an honest account of what this breast cancer, and now post-cancer life is like. So I'm going for total transparency here.

In some ways, I am doing really well. Recovery from the exchange surgery wasn't too bad. Mostly it was inconvenient and uncomfortable to wear all of the compression garments. I hadn't known that was coming and I don't care much for surprises. My results aren't what I was hoping for. The new "breasts" if you can call them that, are uneven, one is definitely larger than the other and still tends to slide toward my armpit. The incision on my radiated side became hard suddenly, but otherwise seems to be healing well. I have more scars, but the old ones are starting to fade a bit, and I should be cleared for tattooing in a few months. Please don't read this as a failure of my surgeon. He did a great job surgically. Much of my disappointment stems from one of two issues; I don't feel like I was well prepared for what the outcome was likely to look like and some part of me was secretly hoping the new "breasts" would be more like the old ones. I seem to be mourning them now, post reconstruction, more than I did after the mastectomy. I didn't know that animation deformity was a normal outcome of this kind of reconstruction. The implants are placed under the pectoral muscle. When the muscle engages, it pushes down on the implants and pushes them in a down and out motion. This is really noticeable in female bodybuilders that have implants. When they pose onstage during competition, animation deformity is what makes their implants push down flat and out into their armpits. I wasn't prepared for how different it would feel to do something simple, like open a medicine bottle or close a car door. I really wish someone had told me or I would have known this is what it was going to be like before I made the decision to go with implant reconstruction. I'm sure I'll just get used to it, like everything else.

This week was a tough one. I've been out and about a lot more lately and lots of people have noticed that I don't have the long hair I wrote about in my last post. Let me catch you up... I got the weave on Sunday morning. By Wednesday, my head still hurt and my hair line was welting and bleeding in some spots. Obviously, though the cornrows were beautifully and expertly executed, they were too tight for my wussy scalp and the hair HAD to come out, and I mean right then!  It was late on Wednesday night when I asked Doug to help me get the hair out. We had no idea it would take as long to get it out as it did to put it in. More than 3 1/2 hours later, I had a fro a la Thing 1 or Thing 2 from Dr. Seuss, and I finally had some relief. Add a bit of guilt for the wasted time, money, and energy, but at least my head didn't hurt anymore.  Anyway, the hair is gone and people are noticing. While I know full well they are not noticing in a bad way, or even thinking anything about my appearance, I am. I don't think I've ever felt this self conscious. I don't say that to solicit a bunch of compliments. So many of you have told me you like my hair short, or that I look beautiful, and I realize I should be (and AM) very grateful to be alive, regardless of what I look like, but this physical part is SO FREAKING HARD. I wasn't prepared for how my appearance would make me feel weak. I worked hard to develop as a person regardless of beauty. I felt beautiful because I was smart and vibrant and a good person. Now, I just feel ugly and out of control and scared A LOT. I wonder if other cancer survivors feel this way too, or is it just a weakness in me?

I've been reading and researching a lot during this journey. I feel like I ought to just go to medical school at this point because I'm so well versed in this ugly thing called Breast Cancer, and even still, compared to what there is left to know, I know nothing. It's overwhelming really, the amount of information available without really offering any cut and dry answers. It's frustrating. Anyway, getting back to that tough week I was telling you about...   I'm very sensitive to the challenges my friends and family face. This week, a friend got difficult news about her daughter, another gave birth nearly a month early, my daughter has been sick with the flu and then WHAM! 3 local YOUNG women from the breast cancer community died. 3. Young. Women. In. One. Week. I didn't know 2 of them, and only knew one from a couple of encounters for the Pink Fashion Walk last year, but their stories and their spirits are unforgettable. You didn't have to know them to feel their loss. I never did well with death. Some people can shake the sadness, move on easily. Some can stay focused on the relief that going home to our Lord brings. I always just felt really stuck and strange and sad. And now, knowing how much their stories are like mine, I struggle with their loss. I want to pound my fists and yell out "It's Not Fair!!" like a child. I know our stories are our own. I'm not them and they're not me. I'm blessed to be here, surrounded by love and able to live. The loss of three young women, all moms to young children, is devastating, but in a way it makes me want to burn a little brighter to honor them.

A good friend of mine called me Saturday morning. She had just heard that our mutual friend (one of the women I mentioned above) was in hospice and likely to pass soon. I hadn't known we both knew her, and she hadn't known that her friend was dying (it wasn't public knowledge). The news took us both by surprise. I had known she was back in treatment, but not that the prognosis was so grim. My sweet friend called me, not because we both knew the woman, but because the news lit a fire in her and she was going to light a fire in me. Little did she know, the embers were already in place.
My sweet friend told me she was ready to change her lifestyle. To get rid of all the junk food she'd been feeding herself and her family, and she wanted me to join her because (I'm guessing) she wasn't going to lose another friend to this awful disease. I went for the most aggressive course of treatment offered by the oncologists on my team because I wasn't about to let cancer kill me. But I have been failing miserably when it comes to diet. We all know that junk foods and sugar feed cancer. If there is even one cell of that crap left in me, I'm going to starve it. I've done the research (as I mentioned before) and I know what needs to be done. So why am I still shoveling Girl Scout cookies in my face every chance I get? Why am I doing this to myself?!

It's pretty clear how strong the connection is between emotions and food. Unless you've recently rolled off the back of the turnip truck (southern for dumb), you know that we all eat for any number of reasons other than actual hunger. I've been using food to mask fear and weakness. It has to stop. I am 4 sizes larger than I was when I was diagnosed, and I keep getting bigger and bigger because I haven't made the changes I know I need to make. So this is it. Utter accountability.

If you see me out and about and I'm feeding myself something that isn't good for my body, call me out on it. Please!  You'll be helping save my life. If you have good, healthy recipes, or ideas that will help me make this transition, share them with me. Please! I'm done with cancer, for now and for good. It's time to face the fears and the weakness. It's time to stop making excuses.

Now, I've got to run and catch up with that turnip truck. Turnips are WAY healthier than cookies....

P.S. I love you sweet friend! Thank you for loving me.  

Thank you all for loving me!

Let There Be Hair!

Happy New Year, friends! Hope everyone finds 2015 treats them better than 2014 (even if '14 was a good year for you). I, for one, am determined to have a much better year. Let each day be better than the last!

I have a surprise! Ok, for some it's not a surprise because I've been obsessing about this for months. I finally went ahead with it. I GOT A WEAVE!  The super short, super curly hair was not for me. Each look in the mirror made me want to take down all the mirrors in my home. I just don't want to see my reflection and have CANCER looking back at me. So, I changed it up. 

Doing this felt a bit awkward and a lot empowering. I did a lot of research, and it seems that weaves aren't all that much different than extensions, and better suited for my needs and budget. I did cheap out a bit on the hair (they're called wefts) because I was unsure of the outcome or how long it would last. If I do this again (which is likely) I'd probably get better quality hair and lighten up a bit more.  I went with hair that is 2 shades lighter than my natural growth and it still looks very stark, very dark for me. I'm sure going from next-to-no hair to lots of long hair, along with the dark color which I am not used to, will just take some getting used to. Also, my stylist (Ommo, a beautiful, young woman from Senegal) told me I had to have some "leave out" where I would naturally part my hair. Those short curls aren't blending so well with the long curls of the weave, so we tried a lot of gels and sprays which just made the hair look slick and flat. I came home and messed with it a bit. I think it will end up looking great, but there is a learning curve and I've got some learning to do. 

In Exchange

It's the morning of my exchange! I'm a mixed up mess of excitement and anxiety. This is already such a busy time of year filled with holiday celebrations, the final grading push for the semester, planning for the next semester, etc., and I've gone and added another surgery to the mix.

Here's the plan: I'll arrive early, but maybe not so bright (and they want me to go out in public with no makeup on and nothing in my hair). Today's surgery is happening at a surgical center that allows my surgeon more leeway with the types and storage of implants he can use. I'll check in, get set up for anesthesia, and likely be shipped off by 7:30am. My surgeon will remove the expanders that have been the bane of my existence for the last year (ok - to be fair and accurate, they have only been one of the banes of my existence this year, assuming a person can claim more than one bane at a time...), and place implants. As far as I know the implants are Naturel High Profile Teardrop Silicon. I may or may not have the fat grafting after all. If I wake up with bruising from liposuction, then I'll know he decided to do it. I'm also pretty sure he'll be going in from under the foobs instead of through the original scars. This will leave me with 2 more significant scars, but they should be hidden under the foob, and hopefully give me a better chance of healing well on the radiated side. I'll be home by lunch, and have to wear another one of those terribly sexy surgical bras for the next two weeks. They'll be giving me an injection of a muscle relaxer called Exparil, which lasts 72 hours and should be all the pain management I'll need for recovery (fingers crossed!).

I've been told again and again how easy this surgery and recovery are. I hope that holds true. I can use easy right now. I'll post a follow-up soon and let you know if that's true! Til then...