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To Biopsy or Not To Biopsy?

Although I am choosing to get a stereotactic biopsy today on (from?) my left breast due to a constellation of stars on my first mammogram, it was by no means a foregone conclusion. There were things to consider first.

“So, what is this procedure?” I asked the receptionist at the imaging center when I booked the first appointment.

“Oh, it’s nothing!” she assured me. ” I had one during my lunch hour and came back to work in the afternoon!”

I eyed her. She had perhaps 6 inches, 50+ lbs., and two or three or four cup sizes on me. She looked pretty robust. However you measure, it was quite a bit more breast to work with than I have.

“So it’s a needle?” I have a pretty severe needle phobia. I was trying not to let it show by acting all casual and nonchalant and psyching myself up inside to face a needle. “And they, what, suck out a sample?” Needle biopsies, my husband would point out to me later, have become controversial as they may actually cause an encapsulated cancer to spread.

“Oh no,” she assures me. Oh good: no needle. “They’re going to make an incision, insert a vacuum tube and suck the grains out.”

An incision? A tube?

“Um,” My questions were starting already. “How are they going to close the incision afterward and keep out infection? Stitches?”

Nope. Steri Strip Skin Closures. Hypo-allergenic strips of surgical-grade tape that you leave on to keep a wound closed until they roll up and fall off, maybe ten days. Houston, we have a problem: Adhesive bandages, including hypo-allergenic ones. Leave ’em on me for more than a day and I start to hive. So much for the “hypo-allergenic” claim. Two days will be intolerable, not to mention that the inflammation of the hives will create an environment not conducive to healing the wound.

They call in a surgical tech who tells me that perhaps we can do Steri Strips for the first day and then return the next day to have the strips exchanged for paper tape. Well, yeah, I tolerate paper tape slightly better, but not for longer than a day. They won’t discuss stitches. Now I’m looking at follow-up care.

It’s really nothing, they both assure me. Unless, they accidentally nick a vein and cause a hematoma — a massive bruise, in other words. But that’s very rare, they say earnestly. We’ll give you a compression bandage to wrap around your breasts if this happens. It hardly ever happens.

A possible hematoma? You mean, a “side effect?” Yeah, I’m familiar with “unlikely side effects” from medical procedures. Two weeks flat on my back after a withdrawal of spinal fluid that most people “go right back to work after.” Six weeks of agonizing dry sockets after removal of my wisdom teeth. And more, of course. With side effects like these, you develop a healthy fear of being poked and prodded.

Oh, and one more whammy: “You shouldn’t lift anything for about two weeks.”

I tried to digest this. It became quite clear that this procedure best not be scheduled two days before a cross-country flight to an active family vacation at the shore with seven children under seven years old

The breast surgeon filled in the rest of the details. I’ll be lying on a table with my breast hanging through a cutout, smashed with mammogram paddles. They’ll use radiation to make a couple of images in order to locate the spots on several planes. More radiation from medical tests that I’d rather not be exposed to, all things considered.

Will I be sedated, I asked? I have MS and I’m dangerously sensitive to anesthesia and ibuprofen. No general, she said, just a local anesthetic like lidocaine injected directly into the site. A big, long needle, in other words.

And, they’re going to deposit a titanium chip as a marker so that the follow-up surgeon will know where to go, if necessary. I can choose not to get this piece of metal, but then if the biopsy came back malignant the surgeon would end up taking more tissue during a subsequent lumpectomy than she would have had to if the marker were there.

I called on my resources and I’m going into this well prepared, I think. I’ve got my homeopathic arsenal ready: hypericum to help heal the puncture wound quickly, if I’m in a lot of pain an hour later bellis parennis will help heal the tissue trauma, and arnica in case there’s bleeding or bruising.

Oh yes, and a prescription of valium for my nerves. That one’s not homeopathic, of course, but I will be grateful for it nonetheless!

So many of you have written and left comments that I feel surrounded by good energies. I’m honored and so touched to connect with you through my writing and cooking. Thank you for sharing your strength with me today. I’ll let you know how it goes.

Breast Health: Knowledge is Power

In my last post I talked about the spots on my films from my first-ever mammogram. They seriously look like specks of dust on the “contact print” image of the first set of shots. Smaller than grains of sand, even. They look like… like… nothing.

I hadn’t missed them during a manual breast exam because they were far too small to be palpated. There’s not a lump to feel. Before advanced body imaging technologies, we would never have known they were there at all.

A stereotactic biopsy was recommended. I wasn’t sure I wanted to do that. Are biopsies always safe? This was not a poke with a needle they were talking about. What were the options?

I called a pathologist in the family to see what he thought. He sees these kinds of things come through the lab all the time.

“They look like a constellation of stars,” I tried to explain. “Like pinpricks, only they’re clustered. Not clustered like grapes, but clustered like stars.”

I knew I could count on him to give it to me straight. He went right to the point.

About 80% of things that present like this are found to be calcifications. (This is what I’m counting on!)

Of the rest, most are ductal carcinoma in situ, or cancer in a mammary duct. As cancers go, this one is 100% curable when caught early, which this most undoubtably would be.

A very small percentage of the cases that present like this at my age turn out to be invasive ductal carcinoma. This would be, shall we say, um, not so good, as cancers go.

We won’t know without a biopsy, he noted. He also recommended a second opion before getting a biopsy (the first came from the radiologist who read the mammogram films). Wise words which I took to heart and went to see a breast surgeon.

She looked at my films, noted the jagged edges on the magnified shots, and concurred that I absolutely must have a biopsy. She told me about a recent study done in the Netherlands that showed that 18% of cases like mine turned into cancer within 5 years. That means that 82% are not cancerous, of course! Ten years ago they would have told me to watch and wait, but now they biopsy earlier.

So much for the haze of denial I’d been living in for a few weeks, thinking she would say they were likely calcifications and we could wait and watch. Punctured like a helium balloon in a rose bush.

Now that I know it’s there, I feel I need to know for sure what it is before I can work on healing it.

I go in for the biopsy on Thursday.

Breast Health: Mammograms vs. Thermograms

I think about breast health sometimes more than others (for heavens sake, please wear a supportive workout bra during aerobic activity like Jazzercise! Those flimsy regular bras just don’t hold you in enough to prevent that delicate tissue from tearing and eventually (gasp!) sagging), but lately it’s been front and center in my mind.

I turned 40 this year and dragged my feet into the imaging center to get my first mammogram last month.

What I really wanted was to find a thermogram and avoid the radiation from traditional mammography, but my ob/gyn/midwivery practice didn’t know of any thermogram centers, so I bit my tongue and went in for the radiation of a mammogram even though they are finding the radiation from medical screening procedures can contribute to cancer. Damned if you do, damned if you don’t.

What I really wanted was to not do this at all. I waited more than six months, until I was ever-so-gently prodded into going by my fabulous life coach, Rachelle Disbennett-Lee. She was right: it was time to go.

A clinical breast exam performed by highly trained fingers can identify 61% of tumors that turn out to be cancer.  Adding a mammogram, increases the ability to find a cancer to 84%.  Research done in Montreal in the mid-1990s demonstrated that adding a thermogram to breast exam and conventional mammogram increases the ability to find cancer early — and do something about it — to 95%. (Read more about breast exams.)

I figured I’d do the mammogram this time and keep trying to find a thermogram for next year. I guess I’m glad I did it, because they found something.

Some things, I should say. In my left breast.

They look like specks of dust on the original contact print, and more like jagged rice grains when magnified 90 times. But they’re definitely there, and there shouldn’t be anything there.

Crap.

Make Your Recipes Soy-free and Gluten-free

A Glorious One-Pot Meals reader asks: “I have two sensitivities – soy and gluten, so two questions.

1. Is it possible to substitute rice or quinoa pasta for wheat pasta?  Rice pasta doesn’t seem to hold up as well normally, so I wasn’t sure it would turn to mush in the pot.

2. Is there a substitute for soy sauce in a recipe?

Additionally, I have had your book for only a month and I love it for ease of use, successful outcome of the recipe, and healthy ingredients. I am an advocate and I am telling everyone about your book!”

-Joyce C., Denver

Thanks for writing, Joyce! I’m thrilled to hear you’re enjoying this cooking method!

As for your question, let me start by saying that every single Glorious One-Pot Meal recipe contains 100% substitutable ingredients, so you could truly take any recipe in the book and adjust it to fit your dietary requirements.

In place of wheat pasta or wheat couscous in a recipe, you could always substitute rice, quinoa, or another gluten-free grain. I love amaranth these days! Just consult the common measurements chart in the book and swap out the ratios of dry goods-to-liquid from the recipe with the ones for your selected grain.

I’ve had great results with Tinkyada Brown Rice Fusillion the stove top, but I’m still working on the perfect ratio for al dente rice pasta in a GOPM.

We also like quinoa pasta. Sometimes I load the pot up with meat and veggies and make pasta separately on the stove top — yes, I know that makes 2 pots, but sometimes even I reach for another pot!

The best substitute for soy sauce is Bragg Liquid Aminos – All Purpose Seasoning. I recently bought a bottle at King Soopers, but you can for sure find it at Whole Foods or Vitamin Cottage. It’s good stuff and will still give you that salty flavor like soy sauce.

Nature’s Anti-inflammatory Spice: Turmeric

When I feel there is something “off” in my body, that’s when I reach for the turmeric. As our friends in India have known for an eternity, turmeric does wonders to reduce all kinds of swelling, from swollen ankles or knees to swollen nerves or joints.

So many of our disorders are due to inflammation of various sorts. Anything that ends in “-itis,” just for starters: bursitis, tendonitis, dermatitis, arthritis, etc.

And of course, auto-immune diseases like lupus, rheumatoid arthritis, and MS that activate an inflammatory response. In MS, for example, the swelling that accompanies the damage to the myelin sheaths surrounding the nerves can cause as much damage as the resulting scar tissue. Often, a corticosteroid such as oral prednisone or I.V. solu-medrol is prescribed to keep the swelling down.

Can you guess how I feel about putting corticosteroids into my body, particularly the long-term, maintenance-level doses that are often prescribed? The last time I took corticosteroids for a problem was in 1999. The prednisone gave me heartburn and packed on 30 lbs. in 3 weeks. The solu-medrol blew out my veins and gave me track marks. But these are just a few of the possible side effects of corticosteroid use noted by the Mayo Clinic. I honestly couldn’t tell if they helped reduce or lessen the optic neuritis (ooohhh… another “-itis!”), or if it just ran its course regardless.

Turmeric Milk
Turmeric Milk

Although I haven’t had a major Multiple Sclerosis exacerbation since 2002, I try to be hyper-aware of my body so that I can address anything that feels “off” before it swells (pardon the pun) into a larger issue.

Hot weather can make these things worse. One evening recently I noticed some new blurring of my eyesight. While it might have been from simple fatigue, ever since my  bout with optic neuritis, incidents like this are enough to send me running for the turmeric.

Now that I drink my turmeric in hot milk it’s a much more pleasant treatment. This last time I enjoyed one cup at bedtime and another the next day and that’s all it took to clear up whatever was going on with my eyes.

My version of Turmeric Milk:

1 cup coconut, almond or other safe milk, warmed
1 Tbsp. ground turmeric
3-4 whole black peppercorns
Honey, pure maple syrup, or other safe natural (not artificial) sweetener to taste

Heat the milk and add the turmeric and peppercorns. Let steep for at least 5 minutes before drinking. You may strain out the powder and peppercorns if you wish, or just leave them in the bottom of the mug.

* The circumin in the peppercorns intensifies the power of the turmeric. I saw this posted from a reader of Arun Shunbhag’s blog and tried it. Now I’m a believer.