MRI – H i n d s i g h t

The Gift That Keeps On Giving

March 3, 2023March 4, 2023 Susan Greco

Aren’t we done here? I’m one thousand one hundred ninety-eight days post lumpectomy (believe me, you’d count too), and by the looks of things I’m breezing along—religiously scheduling and attending annual mammograms and scans, daily popping my treatment pill, going to New York and whining, wining and dining with my breast friends (aka breasties), and even raising money on a cancer walk. By all accounts, I am evolving into an unremarkable cancer patient. Scratch that. Survivor. I’ve done the rose smelling, looking forward to things, looking back trying to flatten the bumpy reality of this ride, and done my damnedest to remove the cancer distraction, survive, and get back to the work of evolving.

I’m doing all the things. Taking the daily ten-year pill (Anastrazole) to block estrogen from feeding any mf-ers who dare sidle back up to the table for a meal. The twice a year insanely expensive (thank God for insurance) Prolia injections, which for half the year halt my bone sloughing activities so I can climb out of osteoporosis, which I can thank aforementioned ten-year pill for. So far my spine has graduated into osteopenia and hopefully the hips will study hard and make the grade too. And then there are those mammograms we women all loathe, but the highly uncomfortable smush we must enlist.

A friend who also didn’t sign up for this sistership remarked about the surprising fear you get when there is something new. You spiral all over again hyperventilating over endless frantic Google searches. Some fear is healthy and helpful because it enables you to react quickly if you need to (fight or flight) but being an expert anxious overthinker who can slide into panic mode on a moment’s notice is not.

Take Tuesday, for example. I’d been noticing some swelling on my left side where all the hell had broken loose in late 2019, and it seemed the asymmetry was subtly increasing. I don’t need symmetry, but I do need consistency. Once cancer enters the scene, change, the only constant, is above all not welcome. Since my annual MRI was the next day, I slipped into an exceptionally nasty rabbit hole, you know the one where you start bawling those sad guttural notes and realize you won’t have the chance to finish several important projects you finally had the guts to start, but which you’ve only just begun. You’ve drifted back to that island alone, back on the torn raft, and once again you can’t bring yourself to glance back at the shore where you’ve left everyone going about their enviable ordinary lives which, from your vantage point, look sparkly, exceptional even.

You replay all your decisions. Why didn’t I just get a double mastectomy and be rid of this troublesome attention-seeking tissue, which per my doctor wasn’t a better option since lumpectomy+radiation = mastectomy when it comes to outcomes. You lament all the things you never stepped up to do because you let self-doubt win out. You won’t get to see that beautiful blue paint you picked out for the house you’re renovating, whose renovation has been at a standstill for three months, or live to see the day the new upstairs toilet is plumbed down the hall from your bedroom so you can stop sleepwalking the 22 stairs down to the bathroom in the far corner of the house. Your empathetic cat jumps on your lap and looks into your teary eyes trying his best to calm you, stretching his 16-lb body over your chest, his sweet, adoring attempt at a hug. Bo, my lovebug. You appreciate it, but it’s still your problem and yours alone. That’s the lone journey that is cancer.

I broke down to my breast friends in a sad teary video unlike any I’ve left. Historically I’ve been the optimistic one, you could say annoyingly cheerful even, and letting this other woman run amok and star in her own video was a risk I was willing to take. Someone needed to join me on this ride back out to sea. The response came in sweet videos from these ladies who get it.

The MRI was as they always are. Expensive, a lesson in patience and stillness, and as always, I can’t understand why those socks they give you with your gown aren’t donated to people who could use a pair of socks, any pair especially these which are warm and have treads. I’ve asked and they’re thrown away. Maybe I will live long enough to spearhead a hospital sock campaign to gather them all up and distribute them to the sockless? Each time I request classical music to accompany the MRI’s knocking/phone off the hook/discotheque soundtrack, and because so far it’s worked, why switch music and tempt fate? Afterward the technician said they usually read them quickly, so I figured maybe end of day I’d hear something.

The nurse practitioner I’d called at my breast surgeon’s office returned my call and they could see me in a few hours at 1pm. I wanted them to feel firsthand this swollen asymmetry and maybe an ultrasound would show something an MRI couldn’t? I stopped to pick up coffee and ran into a friend, the same one who’s walked to radiation with me a few times and who’s mostly up to speed on things. Her simple, “How are you?” brought forth from me an abbreviated non-teary-eyed version of my plight, that I was sandwiching an errand between scan appointments. It all felt rather healthy, despite the great unknown I still faced, and thankfully the conversation moved on to lots of other areas like kids, work, house renovation.

“Your tissue is folding around your scars and pulling up causing the puffiness. See where this is?” the nurse practitioner asked. I don’t see anything unusual here.” The tears, thousands of which were still collected behind my eyes from the day before, broke free and this poor woman had unwittingly found herself in a scene. I started hugging her and it was clear she was not a big hugger, but with no choice, did it anyway. I must have hugged her two more times groveling with my, “You don’t understand how crazy this makes me” excuse for carrying on. She added that radiation is the gift that keeps on giving, resulting in dramatic tissue changes that don’t necessarily settle over time. A few more hopeful nods from her and she got the hell out of dodge, and I got dressed, but not before leaving my breasties a video.

With mask pulled off my face to reveal the full red puffiness of my tear-stained checks, I left an update to the tune of “The nurse practitioner thinks it’s okay and the ultrasound looks normal; it’s just my tissue is pulled and puffed up.” Released from prison, I moved quickly through the elevators and parking deck, reaching my husband with my get out of jail card news and then left my sister a voicemail, which was barely audible through the endless supply of tears I’m now able to produce on command. The breast friends fired back multiple videos of relief which gave me a place to land. It’s much more fun to skip out of jail if you’ve got folks cheering on your escape since they too have been incarcerated.

In her video, one of my friends mentioned how fear of recurrence for her is almost worse than the actual initial diagnosis, which I wholeheartedly agree with. We now know too much and with this new knowledge, our mind is an even far more dangerous place to be. She shared the analogy she’d read about (https://at.tumblr.com/somehedgehog/cancer-the-mountain-lion-in-your-fridge/1d3nsa19vdc0) of having had cancer being compared to having a mountain lion in your fridge. It’s there. You can hide it. You can live with it because it’s in the fringe, but sometimes you open it and are reminded that it’s always going to be there.

Home to find an email with MyChart MRI breast w/ and w/o contrast results somewhat inconclusive:

Finding 1: Area in the left breast appears benign.
Finding 2: Area in the left breast requires additional evaluation. Additional mammographic images are recommended. A possible ultrasound may be warranted following the mammographic views. Recommend diagnostic evaluation with mammogram and possible ultrasound for left breast swelling.

More calls to doctor to see what they make of MRI and ultrasound findings when seen together, and the surgeon suggested a diagnostic mammogram. When pressed, the PA admitted additional evaluation can result when the patient is voicing a new complaint, aka me, and they take it seriously. I’m glad I can’t seem to keep my mouth shut because I want that comfy place with more eyes on me. I want my file to be stamped “free to go” until the next crisis, ahem scan, happens.

On March 8, I’ll be back at the cancer center for a diagnostic mammogram and ultrasound, and I’ll get same-day results, which my PA expects will be fine. After that, I will begin weekly breast lymphatic massage therapy, a healthy drive up to Roswell where whomever is assigned my high maintenance breast will manually redistribute the tissue and I’ll be more comfortable. Whatever it takes, sign me up.

breast cancer, Covid-19, Health, hope, uncertainty

Eighteen days to Brenda

September 10, 2020September 11, 2020 Susan Greco

I went in August 24 for a diagnostic mammogram. My radiologist suggested I go ahead and get one instead of waiting until October as my gynecologist planned. The mammogram at this hospital presented stark differences. The robes you change into aren’t a screaming, Pepto-Bismol pink, but a white soft cottony waffle weave accented with subtle thin pink piping. They’re stacked neatly waiting on you in a warming box. Divine. Here I found few deep Southern accents, but more Brooklyn, and simple pastel beach scenes or botanical wall art; you’re not coddled as much either, which surprisingly I liked. Besides, the last place brought bad news, and I am so over bad news, so I needed a new place.

When you’ve had what I’ve had (yes, I now get to check the “history of breast cancer” box), for future mammograms, instead of going home to wait on your letter in the mail, your results are on-the-spot. It was a long wait, and after looking each other up and down for a few minutes, a woman across from me and I eventually broke our masked silence with a “What are you in for?” dialogue. Me: “I’m Stage II, 100% ER positive, post lumpectomy, chemo and radiation.” You? “I’m triple negative.” Even though no one in our predicament can determine exactly how we ended up here, we each tried our best to reveal what might have contributed, with a Forgive me for I have sinned confessional to each other. She: “I used to eat ice cream every single night.” Me: “I’ve stopped red meat and now only occasionally enjoy a glass of wine.”

A nurse calls her, and she gets up to go hear her results. Next a man, I presume the radiologist, got me for mine. Immediately I assumed since I got the doctor, the news seemed more complicated, and complicated could spell trouble. We went to a room that was far too nice for doling out good results. He made small talk before he dove in, admitting if he didn’t know better, that I’d had a lumpectomy, my scans might have raised a red flag. Lots of them as it’s a mess in there. Not his words exactly, but with all the pins, scar tissue and density obscuring things, he seemed exhausted from wading through the scans, as if he’d just returned from war.

I knew my left breast was a mess when back in 2000 I began breast feeding my first baby. I knew there was milk in there but, damn, quite the struggle to get it out! Always a poor producer and the plumbing seemed faulty every time I pumped or breast fed my babies. But you have to get it out of there or you’ve got a painful situation on your hands! After his initial comments about such chaotic density, the radiologist said everything looks fine. Gosh, did we really need to sit in that private room for all this? I got up and left, happy to dodge this scare. The woman who’d led me to the dressing room asked a man at the checkout desk to schedule an MRI. I asked why an MRI, since my mammogram was fine, and she mumbled something about high risk. Wait, me? I ignored my confusion and instead requested the first available appointment and to get on the cancellation list. I snagged the only one they had, four days later at 6:45am.

I had an MRI before back when all this breast drama started up in November of 2019, but experiencing how particularly thorough this new place was gave me a reassuring level of comfort, that this hospital is sparing no detail, turning over every stone so I’ll continue to turn up “normal.” Friday came and I was up at 5 to leave by 6. It was quiet in the lobby except for a few patients waiting for their own scans. Wonder what they’re in for? Since MRIs are loud, you get headphones and your choice of music. I went for my old standby, classical. No sooner did they slide the headphones on than Pachelbel’s Canon in D began. Always floods me back to my twilight wedding, walking down that beautiful outdoor aisle passing smiling friends and luminaries along my way. The technicians worked efficiently, and I was heading home in 45 minutes.

Busy in my kitchen later that afternoon, I got a call from my radiation oncologist. She asked, had the radiologist already called me? Uh oh, I’ve heard this kind of call before. Cut to the chase please, I thought impatiently. “Ms. Greco, the radiologist saw some areas of concern on your MRI and wants to schedule a biopsy.” First off, my brain is screaming, area(s) PLURAL? You have got to be &#$@-ing kidding me?! And then it moves on to the OF CONCERN part, concerning it its own right. I had noticed a little pea sized nodule during my daily breast massage but assumed it was just knots left behind from surgery and radiation. After radiation ended in April, the radiologist had suggested I daily massage the tissue to keep it from forming too much scar tissue, which I’ve done.

Alas, this was no dream and I was told they’d be calling soon to schedule my return for another MRI + biopsy + mammogram. Great way to start the long weekend. Ugh. I got scheduled for that following Friday, a 7am appointment, with arrival at 6:30. Another early morning, but nothing like getting it out of the way.

Thankfully between our house renovation and chats and visits with my boys and my own endless internet research on breast nodules four months post radiation, fat necrosis, and any other topic which resembled my situation, the week ticked along fairly quickly.

Up early again for the MRI and arrived to find another handful of people socially distanced in the waiting room. I got registered, my hospital bracelet, etc. and was escorted to the dressing room. As with the previous MRI, I had an IV inserted in my arm so they could inject a contrast dye, which improves image quality. I got my choice of music again and this time I thought, let’s change it up. I asked for something calming but not classical, and the nurse suggested nature sounds, so nature sounds it was.

My nature music started with water sounds and soon my brain went to our recent plumbing situation with camellia roots wrapped around our pipes and toilet and adjacent tub filling with water. After the plumbing fiasco (which we resolved) I moved on to stiller waters and imagined my sister and me canoeing on Lake Lanier, like we did as teenagers. Our oars cut the glassy water as we maneuvered into coves, the mature adventurers we were, now out of view from our parents we’d left behind on our sailboat docked in its slip. As I lay masked on my stomach, the doctors slid me in and out of this machine, instructing me over and over to stay completely still. I’m guessing they felt they must repeat the instruction given how much I talked at the outset, thinking surely this motor mouth wouldn’t put a lid on it and stop moving in order for them to get their work done. But as the kind nurse told me afterwards, I was a real trooper. It must have been nearly an hour that I was on that table and somehow, I didn’t move at all.

After my water music segued into crickets and other summer night insects, I noticed a little half moon shaped light below near the floor or maybe on the table I was on. It looked like the Morton salt girl’s umbrella, complete with curved J shape below for its handle. As I was wheeled in and out of this machine never knowing when they’d move it out or back in, I was reminded of one of my favorite Six Flags rides, Mo Mo the monster, when the guy working the ride spun me around extra times since I was the birthday girl. I decided getting zoomed in and out of this machine was instead a fun ride, plus I had the benefit of summer bugs and the Morton salt girl for company.

Once the biopsy began, the nice nurse – the one who gave me the warm robe and told me I was a trooper — began holding my hand. I remember when a nurse at an earlier biopsy last year began lovingly stroking my calves. This nurse held on to my hands and I realized how good that felt, especially these days when we don’t get to hug anyone except those we live with. I needed that touch so badly and while my left hand was holding on to the emergency ball they give you to squeeze in case you need them to stop, I found a few fingers on my left hand joining her hand with my right to communicate an extra, this is so nice and I feel loved, message. Because I had been numbed, I didn’t feel them jostling and twisting to get this suspicious mass during this core needle biopsy, yet I could tell it wasn’t simply a pulling on a syringe but a turning motion as if wrangling a cork out with a corkscrew. Weeee! I got wheeled back in again and more loud MRI knocking noises harmonized with the summer bug sounds, and I was back out. A final jostling to insert a pin, another marker to light the way for the next person doing my scan, and in and out several more times, and it was done.

Next on the menu was a mammogram. Freshly bandaged, I was promised this mammogram was of the gentle variety. Having not had one since my initial diagnosis in November (and since subsequent surgery and radiation), I didn’t realize how much it was going to hurt since the former surgical site was terribly tender. Picture your ear lobe after you pierce it, forever left with a knot. My knot hurt getting flattened onto the machine, especially fresh from the biopsy. As I was pressed into a pancake again, the blood started coming, smearing the glass. My wandering mind went to a hilarious sketch years ago with Dan Aykroyd channeling Julia Child boning a chicken, blood spurting up and down onto the bird. Instead of high-pitched Julia gasps, this technician was calm and simply wiped it away. But my poor breast, how much more was it going to endure? A few more images from a few more angles and I was left to wait while she met with the doctor down the hall. She returned with news he was pleased with the images, and off I went to check out.

The nice nurse who’d held my hand handed me off to a gentleman at the exit desk, telling him I’d had a biopsy. He couldn’t hear her, so he whispered, as if trying to simply mouthe it, “She had a b i o p s y ?” lest the folks in the waiting area learn my situation. I felt this strange cloud of shame and sadness waft over me. He told me in a quiet sympathetic voice to enjoy the holiday weekend. I uttered a “You, too,” and got the hell out of there. Once home I had to take it easy which for most people means lie in bed and rest. I had to realize that paperwork, dishes, laundry and dog walks could wait and that I could actually lie in bed and rest, which is exactly what I did, icing the area 15 minutes every hour on the hour until bedtime. The biopsy site stung so that kept me still and thankfully my 13-year-old dog was content to stay put on the kitchen floor, slinking in and out of sleep.

The doctors told me I’d hear results by Tuesday or Wednesday, and it was an interminable five days. Wednesday came and went and nothing. I had decided it’s ludicrous that I would be the one with that unfortunate case of a recurrence a mere four months post radiation. No matter the new diet, ridiculously slight alcohol intake, stepped up exercise, mine was an aggressive little bugger that could withstand chemo and radiation and emerge with a renewed, Please ma’am may I have another? annoying verve. My sister tried to convince me I’m not special that way. I felt a bit like a criminal, like I was being punished yet couldn’t understand my crime. I figured I had a 50/50 chance and felt like over the weekend they’d rustle up a public defender – a la My Cousin Vinny – and the next week hopefully I’d have some semblance of a case ready.

Now it’s today, Thursday, and I couldn’t stand the silent house any longer, so I left for the hardware store, where I tinker from time to time, just like my dad used to. I love it there because it’s small, there’s plenty of interesting merchandise, and people are ready to help you find what you need, answer any questions you might have (except the What do you think will come of my biopsy? variety). Found some flowers on clearance to replace my tired zinnias and was loading them in the car when the phone rang. An unknown exchange, certainly not my doctor’s office, but I answered it anyway. On the other end of the phone was a smiling Brenda’s voice, which exclaimed: “Hi Mrs. Greco, I have good news for you, as I know you’ve been waiting. We got your results in and it’s only scar tissue. So we won’t need to see you for six months.” I literally said, “God Bless You” and thanked her profusely. If you can hug through the phone, then that is what I did. It was heartfelt and I’m certain Brenda felt it. I love that Brenda.