Tag Archive | ultrasound

Back to the Sonogramist

Is sonogramist even a word? What do you call the technician who does the sonograms, if not sonogramist? Something to add to our list of random questions posted on the fridge I guess.

The gynecologist wanted me to go back and get another sonogram, just to see what the cyst was doing on my left ovary. Since we hadn’t looked at it in about a year, we needed some current data. I trekked on back into Erie to the fancy OB/GYN practice. It’s a bit big for me – I’m not sure I like getting a pager when I check in. They do have a lovely view, though, and get you in and out pretty quickly. At least for a sonogram.

Overall, it was a quick process. The practice is set up mainly for pregnant women to get a look at their baby, so there’s a monitor mounted on the wall that I could easily see from the table. I find it fascinating to be able to see all my body parts, and the technician was more than happy to explain what she saw and what she was doing. She found the cyst again (darn – I was hoping it would disappear) and did comment it looked a little smaller. At least it wasn’t bigger. Now I can wait until the doctor decides what to do about. I’m leaning towards a big fat “nothing”, but we’ll see what she has to say.

 

Gynecology visit

Vacation is over, which means it’s back to doctor’s appointments. I think next week I have no doctor’s appointments (either for myself or for the kids), which is the first time this year I’ve gone a week without waiting in a doctor’s office somewhere. I don’t consider vacation week to count, but even so, that’s not a good record.

This week, I was off to the gynecologist. If you remember, way back at the beginning of this process, my PET scan had turned up a couple of anomalies. One was a cyst on my kidney and one was a cyst on my ovary. The last time I visited Dr. Li, he asked that I get the ovarian cyst rechecked, just to see what it was doing. I finally got around to calling the doctor. My primary care doctor couldn’t do it. I actually had to go to a gynecologist. Sure, what’s another doctor to add to the fleet of doctor’s I’ve been seeing!

The gynecologist the nurse recommended is part of OBGYN Associates, in the same office building as my plastic surgeon. It’s a huge office – both times I was there this week, there were at least 15 people in the waiting room. They give you pagers to know about when your number will be called to go back in the office. The doctor was very nice – took a quick history and then did a gynecology exam, since I was there and it had been about a year since my last exam anyways. Besides, I wanted to make the visit worthwhile, since they weren’t going to do the sonogram that I really came for that day. I needed to make another appointment for that visit.

Latest gown pattern, with a white sheet on the bottom half

Latest gown pattern, with a white sheet on the bottom half

At least I didn’t have to wait too long for the sonogram – I was back in two days for that. It was a quick wait and then in to meet the tech. You take off the bottom half of your clothes, wrap yourself in a sheet and lay on the bed with your feet in the stirrups. There was a cyst on my left ovary, but no blood flow to the mass, which implies fluid filled and not a tumor. The doctor will look at the scans and double-check, but the tech didn’t seem too nervous. Good. Even though I didn’t think it would be anything serious, any kind of doctor’s visit and test now implies a bit of nervousness.

Tests to clear up the previous tests

One more round of tests before the chemo starts. I needed an abdominal CT scan with contrast and a vaginal ultrasound to check on the abnormalities the PET scan found. I would also need a baseline MUGA test.

ba56The CT scan required a 6-hour fast, so I got up at 5:45 for a quick breakfast, and went back to bed. There was no way I’d make it to noon without some food in my stomach, and I really didn’t want to start my day that early. Turns out the fasting was to allow the barium contrast in my gastrointestinal tract to show up most strongly. I had to drink 900 mL of barium sulfate in about a half an hour. I got berry flavor, which wasn’t actually too bad. The worst was the slightly thick texture of the drink which made me gag occasionally, but I managed to get it all down. Once I finished the barium, it was time to get into the CT scanner – just another table that slides through a tube. I also needed IV iodine to add contrast to the blood vessels. Since I have a PowerPort, they actually got to use my port for the first time – yeah! Nurse said I had good blood return, so the port was working well. 153The iodine injection caused the weirdest sensations. It made the inside of my ears feel hot, and made me feel like I was peeing, although I wasn’t. It only lasted a minute or two, but it was quite odd. The CT scan was quiet, but I did have to hold my breath a couple of times. The nice thing was there was a counter on the machine that told me how many seconds longer I would have to hold my breath, so I wasn’t wondering how much longer every time.

Elements added: Barium and Iodine

The ultrasound to look at my ovaries was the easiest test yet, since there were no injections needed. I just had to drink a lot of water before getting there so I had a full bladder for the first half of the test. I did get to empty the bladder before the tech did the intravaginal part of the test. Once again, I got talking to the tech, and she showed me the ovaries and where the developing eggs were on the ovaries.

The final test of the week was a MUGA scan (or Multi-Gated Acquisition scan). Because my tumor is HER2 positive, Dr. Li is adding Herceptin to my drug regimen. One of the less common (2-4% chance) side effects in heart failure, which would definitely count as a bad thing. So, as a precaution, everyone on Herceptin has periodic tests of their heart to make sure it’s fine. There’s a lot of natural variation in heart efficiency, though, so you need a baseline test to compare with future tests.

A MUGA scan uses radionucleotides, specifically tc43technetium, attached to your red blood cells to get a picture of how efficiently your ventricles contract. Technetium will attach to different cells in your body, depending on what loading medication they give you. I got the loading medication (a sn50tin-based solution), and then sat in a waiting room while it moved throughout my bloodstream. After about 20 minutes, I got the technetium injection, and then moved to the machine to measure my heart function. There, I laid under a set of white plates for eight minutes and was done. Since I had been talking quite a bit with the tech (are you sensing a theme here?), he called me over and showed me the pictures the machine took. It was pretty awesome seeing the blood move through the heart, and the walls of the heart moving. The scan is set up to compare the ratio of the left ventricle at minimum and maximum contraction. Once again, I was radioactive for the day, and a bit longer than the PET scan since the technetium has a half-life of six hours.

Elements added: Technetium and Tin

CT results showed the mass on my kidney was a cyst (yeah – not renal cancer!) and there’s a cyst on the ovaries. Ultrasound was inconclusive – there’s a mass on an ovary, but it wasn’t clear with it is exactly (probably the cyst seen on the CT). MUGA showed good heart functions to start with. All set to start chemo now!

Biopsy

So, we picked the kids up from camp on Saturday, and the biopsy was scheduled for Monday morning. My mother-in-law came down to watch the kids since Miss Adventure had to go to theater camp at 9:30 in the morning, and my husband wanted to come with me for the biopsy. Sunday night I got a call from the nurse, which I thought was odd. Turns out the radiologist who would be performing the biopsy was very sick and would be unable to come in to the office on Monday. I had the option of tentatively scheduling for Tuesday or driving two hours to do the biopsy at a different facility. I wasn’t that desperate to have a needle stuck in me, so I opted for the reschedule. That did mean my mother-in-law wouldn’t be around to watch kids, so we had to call around and find somewhere Mr. Curiosity would be willing to go and play for a few hours while Miss Adventure was at her theater camp, and then pray the radiologist was better.

Tuesday morning came with a call confirming (NOT cancelling) the biopsy, so we sent the kids off to their respective locations and headed in to Erie. Dr. Chan was my radiologist, and he was excellent. Very soft-spoken, and he talked his way through the entire procedure so I knew what he was doing the whole time. First they numb the location up with lidocaine, starting at the skin’s surface, and then injecting deeper into the tissue. That was the most uncomfortable part of the procedure for me, since I hate feeling the pressure of something being injected. It did a great job, though, since I never felt a thing when they put in the needle for the actual biopsy. It was very loud when they took the tissue sample, but Dr. Chan snapped the needle once before he put it in me so I didn’t startle.

I had an ultrasound-guided biopsy, which meant that I was able to watch the biopsy in real-time. I didn’t watch the breast biopsy, but I did watch the lymph node biopsy. You could easily see the needle moving in and out as they numbed the skin, which made me a little woozy. I don’t have a problem with needles, as long as I don’t see them in me. I had no problem with watching the biopsy needle zip in and out to take the samples.

Once they were done, I had to get a mammogram to check the location of the biopsy clip they had inserted in my breast. The squeezing made the biopsy location bleed again, so the nurse had to redo the paper strips they put over the site. Then, they wrap you up tight with an Ace bandage around your breasts that you have to keep on overnight. It’s not at all comfortable, but it’s done to keep the biopsy site squished together and not producing fluid. Any time you have a new cavity in your body, your body tends to fill it with fluid. So, they wrap you up tight to prevent fluid production.

Once I was all cleaned up, my husband and I went back and talked to Dr. Chan. He went over the mammogram and biopsy information and discussed why he was certain the tumor was cancer and not just a cyst or anything else. Again, it was quite comforting to talk to Dr. Chan. Not because what he was saying wasn’t scary, but because his certainty moved it from the realm of “what if” to “what now”. Dr. Chan said he’d talk to the pathologist and see if he could rush the results, which I should expect in 2-4 days.

I was supposed to keep the paper strips on until the fell off days later, but I had an allergic reaction under some of them (it looked like poison ivy). I called the nurse about the itchiness, and she said I could just use a regular band-aid. I was a little sore for a few days under my arm since the lymph node Dr. Chan biopsy was close to some muscles. There was also some bruising the developed over the next few days that still hasn’t completely resided, three weeks later.

Mammogram and breast ultrasound

The first indication that there was something wrong came when I got a mammogram. My primary physician had confirmed with me there was some kind of mass in my right breast, but he assured me it was probably nothing since it had arisen so quickly. However, just to be safe, he ordered a mammogram and an ultrasound for the following week.

For anyone who is going to get a mammogram because of a suspicious lump in your breast, I HIGHLY recommend you bring some moral support with you. Turns out, in these days of digital mammograms, the radiologist can read the mammogram and have a pretty good idea of whether it is cancerous or just a cyst in about five minutes. I went by myself – it was just a test, and why should my husband sit in the waiting room for who knows how long while I’m in a room getting my breast squeezed, right?

The mammogram itself wasn’t too bad. You stand there and move your arm around, and the technician makes sure your breast is in the ideal spot. She asked me to point out where on my breast I felt the lump, so I did (thinking to myself – it’s this whole side, can’t you tell?). After the mammogram, I went right back to the ultrasound technician, another woman. She took a bunch of pictures, but it’s not like it was difficult to lay quietly on the table.

The radiologist came back with the technician after I got dressed, which is never a good sign. He stated that, while they couldn’t be 100% sure until they did a biopsy, all signs pointed to cancer, and would my schedule allow a biopsy in two days? I actually pushed back the biopsy, since my husband and I had planned a two-day bike trip around the Niagara Peninsula while the kids were at camp for the week and I didn’t figure waiting until after the weekend would make a significant difference in my treatment. I think I made it to the car before the shock wore off, the reality hit, and I cried. I cried again when I got home and my husband and I tried to process the fact that I had breast cancer. At least the kids weren’t home to see us so upset.

Next up, the biopsy.