Wednesday, July 28, 2010

Incidentaloma - Part 2

I'm back in this room again in the hospital: the waiting room for mammograms and related breast things. I was here the day I found out I likely had breast cancer, and I was here 6 months ago for my first mammogram since my surgery. Today, I'm here for a breast ultrasound.

The women still sit in their incongruous blue pajama-like gowns. The TV blares. The women read, fill out forms attached to clipboards, stare off into space. There are still no keys to lock the clothes cubbies. The magazines are still out of date.

Someone calls my name. Surprise! I'm getting a mammogram, too. The tech is kind, but it hurts. At least she doesn't pretend that it doesn't hurt like some of the techs; I appreciate her honesty.

After more waiting, a different woman calls me in for the ultrasound. The ultrasound tech tells me that she loves her job. She uses warmed gel on my breast; she covers me with a blanket. She points out muscle, fat, and milk ducts in my breast. Fascinating. My breasts are dense, she says. What do non-dense breasts look like? I ask. "They are clear, like a clear day; yours are cloudy," she replies. I always wonder if I should apologize for having dense breasts.

The radiologist is young, Asian, very friendly, and handsome. He explains things well. Nothing untoward found today. Come back in 6 months for more. Any questions?

Now I have an hour to wait until my liver ultrasound. They don't do livers here in the breast clinic, so I have to go someplace else. I'm hungry because I'm not supposed to eat before the liver ultrasound. The coffee at Starbucks smells amazing...Everyone is eating lunch.

I walk over to the other Radiology department. They are able to take me a bit early. This technician is younger, chewing gum. I don't have to take anything off or put anything on. She just rolls up my shirt, and squirts more warm gel on my belly. She says "take a deep breath, hold it" and then "okay, you can breathe." She says this about 30 times. She takes a lot of pictures. She tells me about the liver. It is quite large, and has a lot of lobes. "What are you looking for?" I ask, trying to engage her. "The two lesions they found on the MRI," she says bluntly. Oh, yeah.

When she is done, she goes off to talk to the radiologist. I wipe the goo off my belly. Soon, she returns. Everything is benign, she says. The two lesions are hemangiomas, and there was another one she found that is just a cyst.

Well, okay.

I call A to tell him that everything is fine, and go off to find myself some lunch. I'm tired, hungry, frustrated to have to go through all this, but relieved that the news is good. Now, onto the rest of the day.

Today's agenda

Let's see, what's on for today:
  • drop of J at basketball camp
  • take recyclables to the dump
  • do laundry
  • wash floors
  • go to hospital for ultrasound of left breast and liver
  • go grocery shopping
  • pick up J from basketball camp
  • make dinner
Sounds like a fun day, doesn't it?

Saturday, July 17, 2010

Sometimes Judaism drives me crazy

This morning, I was driving to our Conservative Egalitarian shul. I was giving the d'var torah (congregants give the d'var in the summer when the rabbi is away), and also helping to set up the kiddush (the Sisterhood sets up the kiddush in the summer as well). From the sublime to the mundane, I know.

So on the way, I passed a group of about ten young Chassidic-looking men, walking along the road, looking very hot and tired. Hmm, I thought, why is a group of ten Chassidic men walking through our town? It's just not a common occurrence.

I thought about it a bit, and realized that they were probably walking to the Chabad House in our town for Shabbat services.

Then I thought about it a little more, and realized that they walked right past our shul on their way. Did they even notice it? And if they had, would they have even considered praying there? I think not. You see, our Conservative Egalitarian shul would not meet their standards. We don't have a mechitza. We allow women to participate fully in services, to have aliyot, to read Torah. So no, they would not have felt comfortable at our services.

And that makes me very uncomfortable.

So then I get to shul, and I go into the kitchen, and of course the lights aren't on, so I have to turn on the lights in the kitchen, and in the social hall, which I'm sure you aren't supposed to do on Shabbat, but did I have a choice? And then K and I started pulling things out of the freezer and putting table clothes on tables, and pouring wine and juice, and cutting things up and putting things out...And the question is, we aren't supposed to be working on Shabbat, but how come it's okay for us to be doing all this work to set up the kiddush?

It just drives me crazy. The hypocrisy. The contradictions.

But in the end, the d'var went well, the service was fine, the kiddush was tasty, and a good time was had by all. Even the Chassidic men probably made it to the Chabad house and were happy. Just another Shabbat in our little town.

Wednesday, July 14, 2010

Incidentaloma

There is a new terminology out there -- incidentalomas -- for things that are discovered accidentally during a test for something else. I've actually read two articles recently about them: here is one by Kevin MD, and here is one from the NYTimes.

The problem with incidentalomas is that sometimes you find something important, say a malignant tumor, and save someone's life, but often -- very often -- you find something that you would never had found and which would never have impacted that person's life. But now that you know about it... you have to find out more, and make sure it's nothing. So you test more. You scan. You biopsy. You may even do surgery.

And to what end?

So...guess what? My breast MRI found an incidentaloma. Actually, two. There are some "lesions" on my liver (which -- I had to check an anatomy chart -- is located just below my breast, so I guess that's why the liver was even in the picture). Also, there is an "area of non-mass-like enhancement " in my left breast. They want to do ultrasounds of my liver and my left breast "just to be sure" or, in medical speak, "for further characterization."

Great.

I spoke to several people yesterday, and everyone agreed that MRIs are very sensitive, and often pick up things that aren't anything important. Everyone said "don't worry." So I'm trying not to worry.

But the larger problem, as these two articles point out, is that finding and characterizing incidentalomas can cause well people to become, well, sick people. The NYTime article's author, Dr. Peter Libby, had this to say about it:
"Yet all invasive procedures entail some risk. If only a small fraction of the procedures occasioned by incidental findings lead to a complication, the overall burden of disease unwittingly induced by investigation may be substantial. In many cases, the “incidentaloma” proves benign, or is better left untreated. Thus, the unintended consequences of screening by imaging can make a well person ill."
I am hoping that I am not one of those people.

P.S. 1-17-13 Incidentalomas are still causing trouble, and are still in the news. http://well.blogs.nytimes.com/2013/01/17/the-fallout-of-a-chance-medical-finding/

Friday, July 09, 2010

Don't chew on your mama's tefillin

I've always loved this poem by Merle Feld, We All Stood Together, and how it describes what the experience of standing at Sinai may have felt to the women there. Especially compared to the men's experience.

We All Stood Together

-by Merle Feld

My brother and I were at Sinai
He kept a journal
of what he saw
of what he heard
of what it all meant to him

I wish I had such a record
of what happened to me there

It seems like every time I want to write
I can’t
I’m always holding a baby
one of my own
or one for a friend
always holding a baby
so my hands are never free
to write things down

And then
As time passes
the particulars
the hard data
the who what when where why
slip away from me
and all I'm left with is
the feeling

But feelings are just sounds
The vowel barking of a mute
my brother is so sure of what he heard
after all he's got a record of it
consonant after consonant after consonant

If we remembered it together
we could recreate holy time
sparks flying


Times have changed...but they haven't. Judaism -- or some strands of Judaism -- are more inclusive of women, but there are still those pesky verses of the bible or of prayers that, even with interpretation, are hard to swallow. That's why I was thrilled that Rachel Barenblat -- the Velveteen Rabbi - wrote a poem that is what I consider to be a corrective to Feld's piece. Read, and enjoy.


Another mother psalm: bringing the baby to morning prayer

MOTHER PSALM 7
-by Rachel Barenblat

Don't chew on your mama's tefillin
I say, dislodging the leather
from your damp and eager grasp.
We play peekaboo beneath my tallit,
hiding your face and revealing it
the way God is sometimes present
sometimes not. You like the drums,
the fiddle and clarinet.
You bang your rattle on the floor.
As we sing "Praise God,
all you elders and young children"
you bellow and and we laugh.
During silent prayer your yearning
opens my floodgates.
When the Torah is carried around
I waltz you in my arms, my own scroll.
All my prayers are written
in your open face.

(click here to link back to Barenblat's blog)

Wednesday, July 07, 2010

Breast MRI fun at the hospital


You are confronted with a large tube-shaped machine and a flat cot-like table. On the table are two pillows, and a few other strange contraptions.

"There is no graceful way to do this," admits the technician. She indicates that you should climb onto the table.

"Your breasts go here, and your face goes here."

Say what?

You are lying face down on the table, with your face in one opening, and your breasts hanging into another. The tech puts a pillow under your knees and tries to make you comfortable.

"What do I do with my arms?" you ask.

"They go over your head." Great. My favorite position.

"Here are some earplugs," says the tech. "The machine can be noisy."

Uh...okay.

Noisy doesn't begin to describe it. But I'm getting ahead of myself here.

You feel your body moving (on the table) and you feel wind rushing around you. You are afraid to look up. You sense that you are inside the tube.

"Okay, the first session will be 2 minutes," says the tech.

The machine starts to make clicking noises. Then noises like machine gun fire. It is LOUD. You start to recite prayers to get your mind off the noise.

Deep breaths. Uh, oh...didn't she say no deep breaths? Shallow breaths....

Time passes. Every few minutes the tech announces another interval. "This one will take 6 minutes. This one, 3 minutes." You start to lose track of time. You lose the feeling in your arms. You can't feel your hands. Shallow breaths...

Finally, it's over. How much time has passed? Will I ever feel my arms again? And what will the results show? She says I'll hear from my doctor in 24-48 hours. Great! Can't wait.

P.S. This will help you understand what the MRI sounds like.