All is well

I had a follow-up ultrasound this morning.  While the tumor still exhibits some questionable characteristics, it has decreased in size, which indicates that it is not likely cancer.

They believe that it is a Lactacting Adenoma--a benign tumor affected by the hormones of pregnancy and lactation. The ductal tissue sampled in the last core biopsy are congruent with this diagnosis.

Whew.  Thank goodness.

Of course there is more follow-up in the near future, just to be sure, but for all intents and purposes the not knowing is over.

Hooray!

Whatever happened with that last biopsy?

I've been asked the question a lot lately.

After faithfully documenting my breast lump experience, I puttered out after I was told that I would need to repeat the core biopsy because the radiologist missed sampling the tumor and had instead sampled cores of healthy breast tissue.

My lack of enthusiasm developed during a conversation that I had requested with my physician in order to prepare for the second core biopsy, which was scheduled for later that week. Our discussion provided yet another twisty-turn that I couldn't decipher as either good or bad, but that certainly did make me feel very, very tired of the entire experience.

To bring you up to date:

When we finally connected over the phone, I pressed for more information about how and why the radiologist had managed not to sample my tumor at all, and also inquired whether the same one would be performing the re-do. Before we got too far, my doctor said that she had again spoken to the radiologist (who remains confident that she did in fact sample the tumor), and also requested that the pathologist re-review the samples to confirm that there was not a single a sign of a fibroadenoma. There was none.

Based on my doctors advice and her confidence in the radiologist's skill and judgement, I decided not to undergo a second core biopsy in favor of another ultrasound in early October. My doctor said that although the results are not what they expected to find, that does not mean that the results are wrong.

So, it could be great news, or maybe not.

I've noticed that the lump is much, much smaller, so I hope that is a good sign too. Next week, we'll find out what the lump has been up to over the last 6 weeks and then decide if another biopsy is really necessary.

worth repeating

On Monday I got a call from my doctor with good news that couldn't be elaborated on over the phone.

On Tuesday I went for a follow-up appointment and learned that the official diagnosis was a ruptured milk duct. After all that. However, I questioned why there was no mention in the report of fibroadenoma, as the first biopsy had indicated. My doctor thought it was a little strange as well, and left to discuss with the Pathologist his findings in more detail. He hadn't come in to work yet so my doctor said she'd investigate and give me a call back.

This morning I learned that the cores of tissue that the pathologist reviewed were in fact all ductal and breast tissue, which means that the tumor was missed entirely. The radiologist biopsied healthy breast tissue, and nothing else. I was told that sampling error is rare, but I'm a little suspicious as to how it is possible that the lump, which is not small, was not sampled at all.

All of this to say that I will need to have the procedure repeated.

I'm annoyed. I don't want to miss another week at the gym. I don't want to orchestrate another herculean feat of scheduling in order to be sure that Roscoe is cared for at home, and that I have a helper to accompany me with Merritt to my appointment. I don't really want to go through the procedure again and I definitely do not want to get a milk fistula--I felt lucky to have had the procedure once with no complications and I don't want to push it. Finally though, I don't want to be in limbo anymore. Not knowing affects me and it's hard not to think about it every day, especially when I spend every day with my boys.

Hopefully, I can schedule a repeat biopsy sooner rather than later.

Core Biopsy

Well timed, I read an article yesterday (You can still be a great mother, even if you can't breastfeed) that describes one woman's experience with breast cancer. The author shared a sentiment that helped me to make sense of my own feelings and find a place for my fixation to preserve my and Merritt's nursing relationship. She wrote: "When you're diagnosed with something really devastating, there's only so much you can hear. For me, it was that I couldn't breastfeed anymore. All I could think of was, 'what will I feed my baby?'"

Thank you to everyone who researched information for me, offered your contacts or your breast milk, and empathized with my torment over the last few months. If you want to catch up on the whole story you can read more sequentially here, here, here, and here.

All along I had hoped to know some thing that might illuminate what is the right thing to do in this situation. An impossibility, I found. In the end, there was no single piece of evidence that made the decision clear or easy. And I loosely debated right through dinner last night, as Andy and I devised a game plan for today.

Despite not finding the answer to whether or not I should proceed with a core biopsy, what I did find was my own confidence to persevere whatever side effects might come from the procedure. I've read accounts of women who nursed through milk fistula, for days, weeks, even longer, until they healed completely. I've read stories of moms who weaned as a result of a fistula, but who managed to nurse their baby effectively from just one breast. I've also read lots of happy endings where a core biopsy resulted in neither a milk fistula nor a cancer diagnosis.

When I spoke to my boss last week, who is both a physician and a public health expert, she encouraged me to trust my doctors--if the folks at the Betty Lou Ourisman Breast Center think that a biopsy is necessary, it is ok for me to put myself first and take care of what needs to be taken care of. She was confident that whatever might come after would be something that I could weather. I finally felt it too.

So, today when the ultrasound showed that the tumor continues to grow and that the cells inside are just as heterogeneous as they were a month ago, I consented to a core biopsy.

There were several things done to minimize the risk of a milk fistula, and to remain sensitive to my intentions to feed Merritt. I can share details in a later post for any of you who may be going through something similar and who might find it helpful.

Otherwise, the procedure was smooth sailing. Post op instructions dictate no heavy lifting for at least 48 hours--that includes the kids, I was told, but not much I can do about them!--and ice and compression for the first 24 hours. I nursed Merritt on the affected side five hours after the biopsy without issue. The wound is dressed with Tegaderm, so I really can't tell what's going on under there but, so far, there is no indication of any milk leaking or moisture. Fingers and toes crossed.

I have follow-up next Wednesday, which will hopefully mark the end and not a beginning.

Revisiting the scary place

After the good news from my doctor last month, I was able to more or less put out of my mind anything related to cancer. Within a few weeks though, I noticed that the lump was bigger--that I could feel it just by running my finger over the top of my skin, and that I could actually see it most of the time. I gave the breast center another call last week and they asked me to come in as soon as possible.

Another ultrasound confirmed that the lump has grown--at a rate that exceeds even the most aggressive cancers (so I think this bit of information was filed under the "we think this is benign" category). More importantly, and alarming, the cells inside the mass have completely changed. A month ago they were uniform and unassuming, this week they are jagged and lined up in odd patterns.

My doctors do not know what they are looking at. They have little experience with these issues in lactating women, they said so themselves. The only way to know for sure is to do a core biopsy.

I have resisted the core biopsy procedure in an effort to avoid the very real risk of a milk fistula. I've been told that the risk is relatively low, but because my tumor is located centrally in an area where all the ducts come together the odds are increased.

If it does occur the ultimate solution is to wean from nursing, which would be devastating.

I'm disappointed and becoming increasingly angry that more information isn't available to nursing mothers when it comes to making decisions like these. Even websites like the American Cancer Society and Susan G Komen, do not address cancer or diagnostic options in the context of lactation.

Hopeful that some unpublished information might be available, I spoke to an oncology nurse at the American Cancer Society. I was dismayed that she wasn’t able to answer any of my questions or provide any concrete guidance. It’s difficult to make educated decisions without data. I expressed frustration that there isn’t more to base my decision on, and she responded in agreement that “most women don’t like to breastfeed”, speaking to the fact that low prevalence of breastfeeding renders research on the topic of cancer and nursing a low priority.

Her comment was irritating because prevalence of breastfeeding isn’t low because women “don’t like” to breastfeed. On the whole, our society doesn't value breastfeeding. That right there is the problem.

Yes, there are overarching recommendations from the Centers for Disease Control, the World Health Organization, and the Academy of Pediatrics whose guidelines differ in some respects but ultimately agree that breastfeeding should be exclusive for the first 6 months and continue through the first year, and beyond for as long as the mom and baby desire.

The problem is that there is little societal support for women and their babies to establish and foster a nursing relationship. Modern birthing practices, standard protocol in NICUs and nurseries, stingy maternity benefits, and additional challenges for women once they return to work all add up. Not to mention the emphasis our culture places on early independence for babies, and the pressure that many new moms feel as they are bombarded with messages big and small that minimize breastfeeding and encourage the weaning process.

It's no coincidence that while 75% of new moms initiate breastfeeding at birth, only 13% of moms are still breastfeeding exclusively at 6 months, as recommended. Initially, it was suggested that I return to consider my options for addressing the tumor once Merritt is weaned (I think they figured it be at most a couple of months), but when I said that it wouldn't likely be for another 14 or so, they had to change their game plan. I have doctors who are truly well intentioned and who want to support me in the ways that I need to be supported as I move through this process, but I'm beginning to feel as if my effort to preserve this aspect of my relationship with my son (especially for his nutrition) is considered to be rhetorical in the face of something that is potentially cancer. I get it, and at the same time I think it's crazy.

Anyway, I felt overwhelmed by the fact that we were revisiting the biopsy topic, and for several reasons I decided to wait another month in order to do more research and to further weigh the potential benefits against the potential risks.

Does anyone have any stories of core biopsy (with or without milk fistula) while nursing?

Good News.

My doctor called us at home late Wednesday night to tell me that the biopsy results were indicative of a fibroadenoma--a benign growth. I am relieved and feeling a lot but haven't yet had time to really process my thoughts.

While she mentioned that biopsies carry a 5% sampling error, she also said that the radiologist and pathologist were each confident that they biopsied an adequate amount of tissue from all areas of the tumor.

It is their practice to order a follow-up ultrasound, just to be on the safe side. Mine is scheduled for September. In the meantime I will take extra care to watch for any changes.

Thanks so much for your kind words and encouragement.

Knowing more: Friday's appointment

Friday morning finally came after what felt like a very, very, long week of waiting. My anxiety had ramped up over the later part of the week and, despite my better judgement, my mind had been wandering to some pretty dark and scary places.

Andy stayed home from work so that we could tackle the appointment and wrangle the boys together, and we drove uneventfully to the hospital in the city for what we thought would be a quick second opinion.

Roscoe was too full of curiosity, energy, and emotion to sit in one place for long so we split up shortly after we arrived. Roscoe and Andy left for the waiting room, while Merritt (hungry, as always) and I stayed to wait for the doctor. She arrived lovely and poised, her tone was warm and she spoke slowly and deliberately. I liked her right away. I felt relieved to be at Georgetown and confident that I was in the right place. She reviewed my family's cancer history (there's really not much to document), and other risk and protective factors. Then we moved on to discuss my lump.

She showed me an image from one of the ultrasound films, and pointed to a clearly delineated oval. She explained that the borders of the mass are smooth (a good sign), and that it grows in the plane of the breast tissue (also a good sign). She noted that one area of the mass has more shadows than the rest, and that the biopsy had probably been ordered based on that area alone. She did an exam one-handed, clutching Merritt in the crook of one arm since I needed both of mine to strike the familiar breast exam poses.

Then she asked if I wouldn't mind another ultrasound. Of course I didn't. We spent some time discussing the information that I had received about the potential risks involved with a biopsy during lactation. I learned more about milk fistula, and met with the other doctors to further discuss ways to minimize the risks while still moving forward with the procedure.

Three months of "watchful waiting" was identified as an alternate option, and when I shared that a catastrophic thinker like myself would have a hard time surviving that long, she mused that we wonder why the cost of health care is out of control, only exacerbated by unnecessary tests. "It's because people can't bear to live with the uncertainty." I shook my head, knowingly.

I asked if they would advise a biopsy given a different circumstance--say the same diagnosis but a woman not currently nursing her child. They said yes, they would, and right then I knew that it was what I wanted too. I wanted the same standard of care.

She left the room to order the ultrasound and to see if a biopsy could be performed later that afternoon.

What might have been one hour, turned into almost six as I was ushered into and out of the maze of hallways, doors, and patient rooms that make up the Breast Center. Andy and the kids had been given a consult room to camp out in so in between meetings I sought shelter there too, filling Andy in on the latest, nursing Merritt, and chatting with Roscoe who has had a lot to say lately.

In the end, the doctors decided it was best to take a conservative approach and instead of using the smallest gauge needles as necessary for a true core biopsy, they started with the largest gauge needle used for a fine needle aspiration and worked their way down until they had enough tissue to comprise an adequate sample. For me, that meant two different sized needles and five separate attempts.

I watched the whole thing on the ultrasound and felt some of it, too, since the doctor opted not to give me a full dose of lidocaine.

I nursed Merritt right before the procedure to empty as much milk as I could, and I nursed him on the affected side just a few hours later once back at home. The site has been a little tender but I can hardly complain.

I'm grateful for physicians who listen, and who care about families. Physicians who are unafraid and willing to find creative solutions in order to meet their patients where they are and who provide the best quality health care to ensure the highest quality of life.

The results will be in later this week.

Oh, how I've missed you so

I went to my boxing gym tonight for the first time in 8 weeks. Maybe you can relate but after the first two weeks had passed, I was feeling too out of shape to show my face in that place. Ah, such a vicious cycle.

Spotting at week 7 also made me a little cautious to be punching and kicking a heavy weight bag, and the high intensity intervals and drills were enough to convince me that perhaps I was out of my element as a newly pregnant lady.

Two months passed, and I really missed my workouts. Two months' dues were withdrawn from my account, and I hated the idea of wasting any more money or mental energy thinking about all the fun I "used to have" at LA Boxing.

Then the clouds parted and the first trimester passed, and I started to feel like my old self. I eased back into an exercise routine that has me feeling confident and strong. And then, over the weekend, after prompting from one of my gym buddies, I worked up my nerve to at least give my gloves and my wraps one more spin before declaring boxing a pregnancy no-no for good.

I drove the 30 minute drive (with my music up so loud that even Little Sears was boogieing) and when I arrived I was greeted by a room full of familiar faces. I have to admit that it felt good to make an appearance, and share the news that I'm expecting. And then, since I'm kind of a show off, I got to impress them with my prenatal exercise abilities!

I was quite out of breath after the first 5 minutes of jumping rope, but so was everyone else, so that made me feel just fine. I did modify a lot of the exercises. I said "no thanks" to the crab walk and "no way" to burpies. I did The Plank instead of a crazy, bend-in-half ab exercise, and enjoyed every squat, crunch, and push-up I was ordered to deliver. Although, my belly does bump the floor now if I try to go all the way down....

I hit the bag a tad softer than I normally would to limit the jarring motion, but by the end of class I was energized, sweaty, and feeling quite happy.

I no longer plan to freeze my membership, an idea that I've entertained more than a few times over the past months. Instead, I'm going to embrace my new state and continue to do the activities that I love, and modify as necessary.

Nursing Bras

Nursing bras can be confusing. Especially when you have no idea what to expect from pregnant and new momma boobs.

What size(s) should I buy? Which brands will I like?

I bought all my nursing bras from Bravado. They have a helpful "how will my boobs grow?" guide. The Original Nursing Bra was perfect for its comfort, and utility. I bought one in black, and one in white. I quickly learned that nipple creams stain! White is great because you can bleach them in the wash, but I liked black better because it hides stains well and, when nursing in public, I felt less exposed.

The only thing I don't love about the Original is that the material is not particularly soft, especially after many washes; and once the first few months had passed (and milk supply was established), it didn't offer a very supportive silhouette.

Four or five months into nursing I was ready to graduate to a more "shapely" bra and I tried Bravado's Body Silk Seamless but I found that it was too bulky for nursing--the amount of material I had to pull down and underneath Roscoe's little head was just too much, it always flipped up and hit him in the face!

I've been on the search for the "perfect" nursing bra ever since I found out I was pregnant with Little Sears, which is a tall order because the needs of a nursing momma change over time. I should probably call this my search for the perfect nursing bra(s).

I recently tried the Bamboo Sleep Bra by Belabumbum and I think I may have found my perfect bra for late pregnancy and those first few newborn months.

So soft and stretchy, it has a racer back and comes up the front like a halter top which flatters every body type. Accessibility is super important for nursing, and this bra features an easy pull aside mechanism versus a snap down flap. It's comfy and kinda sporty, which I really like. I'll definitely be buying at least two more of these! They come in a range of nice colors too!

What's your favorite nursing bra?

I guess you're just what I needed

My passion for cooking has taken a back burner to Life, and with very little free time for anything at all, I've not kept up with my wifely duty of preparing and presenting hot meals on a nightly basis. When hunger strikes, Andy and I subsist on whatever we can forage for and assemble quickly, and with minimal effort. I muster enough energy to replenish Roscoe's freezer stash, and Andy is left to fend for himself. Every now and then I manage to cook some form of protein early in the week, and to boil a pot of rice. Otherwise, it's catch as catch can.

With the exception of a few days a year, if I'm not cooking it, we're not eating it.

So you'll understand then, what a treat it was when I opened my front door this morning to find a girlfriend of mine bearing all the components needed to assemble (just for me!!!) a full on breakfast of blueberry pancakes, sausage, eggs with cheese, bananas and pineapple, and fresh pressed OJ...no one has cooked much of anything for me in months, and her effort was as nourishing to my belly as it was to my soul. Sometimes a new mom (can I still call myself that!?) just needs to feel pampered. Mission accomplished.

& diet derailed. But if I was going to blow it, I'm glad I went out with a bang.

If there's one way to my heart, it's through something tasty. I'll be sure to pass on the love to someone else in need of a pick-me-up.

2 ounces of sanity

Last week I received the breastshields I ordered from Hawaii--they arrived 4 days early in a crumpled box tossed on the back stoop. A brief bolt of fear struck through me as I envisioned my shields cracked, or worse. To my relief, they were in perfect condition.

That night after nursing Roscoe to sleep, I hooked myself up to the pump and immediately realized the difference in having a breastsheild that fits: suction.

Just a few minutes into the expression phase and the milk was flowing. The first let-down! Unfortunately, it was the only let-down. My 20 minute pumping session produced one let-down and a little less than an ounce of milk. One single ounce.

I was panicked. How can I workout if I can't leave the baby? I re-channeled my anxiety and committed to pumping once every night with the hope that my body would begin to make more milk in order to cover the "feeding". I've pumped every night since, and slowly but surely, I've been able to produce more milk--last night, 2 ounces which = 1 feeding.

What's even better is that I've been to the gym 5 times since I joined, and on the night that Andy braved it alone, he fed Roscoe a bottle and lulled him back to sleep. I arrived home to a quiet house, a long hot shower, and another pumping session.

It's hard to describe how it feels when everything works. Roscoe seems to be mellowing out and I'm back at the gym. I think I'm getting the hang of being Roscoe's mom, and I'm finally starting to feel like myself again. My life: different but improved.

Here's another note of thanks--I'm grateful for technology that allows me to mother the old fashioned way, and still keep up with the modern day.

Mini Reunion

Roscoe and I caught up with two of our Bradley classmates yesterday afternoon!


Roscoe met Lilian (4 weeks old) and Sammy (2 weeks old) for the first time, while the new moms exchanged birth stories, advice, and adventures to date. It was sanity saving to catch up with other women who can directly relate to what I'm experiencing right now. For one, exclusive breastfeeding is harder work than I anticipated!

This is yet another way in which our birthing class has proven it's value: Andy and I now have a network (in our immediate area), of at least three other new moms and dads, that we can tap for emotional and social support.

The "big" Bradley reunion is set for mid July, and we're all eagerly awaiting the births of the last two babies (due in mid June, and early July)!

Relax!!

This afternoon, Heidi made a house call in order to treat a new mom to a full body massage.

I'll admit, it was DIVINE!!

Orchestrating a sleeping Roscoe with Heidi's arrival required quite the planning on our end, but as she knocked at the door, I was just handing over to Andy a drowsy baby. Lucky for all of us, Roscoe slept for almost two hours, which gave me the uninterrupted time I needed to truly enjoy a little pampering, and also left time for an infant massage lesson at the end.

Baby Roscoe seemed to like his mini massage and I enjoyed the opportunity to learn from a professional; Roscoe can definitely look forward to more!