Chapter 8 meeting the Plastic Surgeon

When my co-workers first find out about my impending surgery some of the old timers told me to talk to Frances. Not only did I work with Frances, but she and her husband were long time members of my church (small town remember?). Frances didn't work at the circulation desk like most of us so I didn't get a chance to talk to her often. She was in charge of the technical services department, which is where the books are cataloged before they are shelved. Since I didn't see her that much during my normal work hours, I decided to come in to work a little early so we could chat.
I asked her about her cancer scare and why she had a double mastectomy and reconstruction, even though her biopsy was negative. Frances told me that her family had a long history of breast cancer. In fact, cancer was so prevalent in her family that many of the female members were in a long-term medical study. She told that she had many questionable mammograms and had gone through more biopsies than she could count so in 1990 after another iffy mammogram and biopsy she decided 'NO MORE'.
Frances was among the early group of women who had preventive bilateral mastectomy. Many people, including members of her own family, told her that she was crazy, but she was tired of living with the fear. At the time, she had two small children and staying alive for them seemed more important than having breasts.
It is important to understand that having a double mastectomy is not a guarantee that a woman will never get breast cancer, because it is impossible to cut away all of the breast tissue. But by having the surgery, that woman's chances drop about 90% of getting the disease. The ultimate irony of the story is that a few months after having the surgery, one of Frances's sisters was diagnosed with breast cancer. Luckily it was caught early and the sister is alive and well today.
Frances discuss the different kinds of reconstruction I told her that Dr. Sullivan recommended that I stay away from implants and go with something called a trans-flap.
"That's what I had." Frances said, and then she told me her story. The procedure was still quite new in the early nineties. Frances was sitting in the waiting room of her surgeon when she picked up a copy of the magazine Red Book and read an article about trans-flap surgery. She showed the article to her doctor. He told her that he didn't know much about the surgery, but would investigate it for her. A few phone calls later he found that there was only one doctor in the area that did that surgery.
She had the trans-flap and was very satisfied with the results. Frances confirmed what Dr. Sullivan told me, a trans-flap operation is the taking of skin, mussel and fat tissue from the stomach of the patient (basically a tummy tuck), then transplanting it in to the hollowed out breast and Voila! A new breast. Sounds easy.
"Don't believe them when they tell you that you that you will never get a tummy bulge again" She says pointing to her stomach. "SEE, THEY LIE!" I thought that her stomach looked pretty flat.
"Who do you have your appointment with?" She asked me.
"Some doctor with a strange Arabic name.
"Asgari?" She asked.
"Yea, that's the guy. Do you know him?" I asked her.
"He was my surgeon! He is the best of the best." That made me feel better. It is always nice to hear a high praise about a doctor from a former patient. Frances told me a little about his background.
"Dr. Asgari is from Iran. He came the United States abound the time that the Shaw fell from power. The doctor is very sophisticated, very European, sooooo continental. Great! Now I am intimidated by a person that I haven't met yet.
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We were now in the last week of school for the girls. The last week of school was all half-days and I felt that it was important for the girls have a good last day. Which is usually a day long party. I really want Sam to have a good send-off because this will be her last day in Elementary School. In Beaville Middle School starts in fifth grade, like, I don't have enough to worry about. In less than three months my ten-year-old will be entering Jr. High….oh, I mean Middle School.
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On June twenty-first and Mark met Dr. Asgari. His office in was located in one of the very ugly building that stands across the street from the hospital. The street used to be called 'Millionaires Row' because of all of the grand houses that were located there. Slowly, one by one the beautiful houses were torn down and ugly modern buildings were erected in their place. Dr. Asgari's office was in the ugly building that almost never had parking. We are forced to park in a residential area about a 1/4 mile away.
The medical buildings were constructed on the same hill as the hospital. Like the hospital, what is the main floor in the front of the building is two floors down if you use the back entrance. So finding a doctor's office for the first time was confusing. I found the halls narrow as I walk down them looking at door after door until I find the right office.
The waiting room was small then again it was a one-person office.
The first thing that I notice was the fresh cut flower arrangement that was located on a table just inside the entrance. As I looked around the waiting room I noticed that Mark and I were alone, there were no other patients waiting. I had never seen an empty doctor's waiting room before. The room was done in yellows and beige's, with a few very nice matching leather couches and some straight backed chairs that had a floral design. There were also matching end tables. There was a clear plastic rack on the wall that held magazines and brochures. All the magazines were current. The room was conformable and practical. My mother (who only decorated in white and beige) would have loved it. I love it. And, because it did not have a television or music I give it and A+. But Mark didn't like it, he thought it looked cold.
We went to the reception window wondering if we are in the wrong office. We were not. The receptionist was somewhere is her twenties. She was beautiful, with blond hair and a great figure. Then again, what else would the receptionist in a plastic surgeon's office look like? I filled out all of the forms and had a nice chat with the receptionist. Her name was Lacy. It didn't take me long to realize that Lacy was actually hired for her brains. I like her instantly, which is a good thing because in the future we would be spending a lot of time together dealing with the insurance company.
Lacy explains that Dr. Asgari does not belong to any HMO. He gave up on them a long time ago. He sets his price and whatever the insurance company won't pay I will be responsible for. She told me that insurance companies are unpredictable so she had no ideal what my insurance will cover. The cost of the operation is-ready for this- $10,000. Yikes.
Understand that I am 1/4 Scottish and playing to stereo types, Scott's are notorious for being cheap. I will spend money on my kids in a heartbeat, yet not a penny on myself. Trying to get a dollar out of me is harder than getting a dollar from Jack Benny. I didn't need the surgery and my husband did not care if I got the reconstruction or not.
Some women have to have the reconstructive surgery. Their marriage wouldn't last with out it. Not mine, my husband loves me and the reconstruction surgery was for me, not him. I didn’t want to spend the money but Mark insists that we at least talk to the doctor.
A woman came from the exam-room while I was talking to Lacy. She waved to Lacy as she walked past us, through the waiting room and out the door. Moments later Dr. Asgari came out of his office and asked us to follow him. He was in his early to mid fifties. His hair was dark with just a touch of gray; his coloring was not light or dark. He could easily be mistaken for Italian or Hispanic, only his distinctive nose indicated his Arabic blood. He was dressed in suit pants, a white shirt, a tie and white doctor's coat.
Dr. Asgari had and average size office which was decorated just like waiting room, but there with a few small sculptures (which I later learn he made, it’s nice to have a plastic surgeon whose hobby is sculpting). On a bookshelf I notice a professional family portrait: beautiful wife, two sons.
Mark and I sat across from the doctor. I'm was feeling very uncomfortable. Unlike Dr. Sullivan who had a reassuring smile, Dr. Asgari was all business to the point of appearing cold. I noticed that he really did have that continental look that Frances told me about, and I found myself being intimidated. The doctor asked Mark and me few questions that told him that we were already interested in the reconstruction surgery. He did not have to try to sell the idea to us. Later when I talked to other women who had seen a plastic surgeon (including Dr. Asgari) and they told me that the doctors had shown them 'before and after' pictures of the results of an reconstructed mastectomy.
Once it was established that I was interested in the surgery, we all went to the examination room. The room was big for an examination room. It was painted the normal exam-room white and it had the standard sink and counters lining the walls. What it did not have was a traditional exam table. Instead it had a kind of exam chair, where the patient kind-of sat and kind of-stood at the same time. I have never seen anything like it before.
Dr. Asgari opened a cabinet and took out a hospital dressing gown for me. He told me to take everything off from the waist up, and then he left the room. I looked at the hospital gown. It was not like any gown that I had ever seen before. Hospital gowns are usually blue or white and made of cheep cotton, or they are green and made of paper. Not this one. It was a yellow gown was a gauze like fabric, it was kind-of see through. I thought why bother wearing it at all? I shrugged and changed in the yellow gown.
Now remember, I am a minister's wife and a assistant librarian, which makes me very modest. So there I was, half-naked sitting/standing wearing a gauze slightly see-thought hospital gown. And I thought I was uncomfortable before! Dr. Asgari came back in to the room; he sat on a stool in front of me and started to examine my breast. It was weird having a doctor that I have just met touching me, but it was even weirder to have this happen with my husband in the room.
I was getting more and more uncomfortable as the exam continued. Dr. Asgari talked more to Mark than he did to me. I think that was because I stopped talking. I tried to crack a few jokes, but the doctor had no sense of humor, so I stayed quiet.
Dr. Asgari explained that the reconstruction surgery would be done at the same time as the mastectomy. First he and Dr. Sullivan would work together with Dr. Sullivan performing the mastectomy, removing the breast tissue, but leaving the skin of the breast. Then Dr. Asgari will take muscle, skin and fat tissue that were removed from my stomach and use it to build a new breast. Then after I heal and complete my chemotherapy will the second surgery be performed. The second surgery involves Dr. Asgari reconstructing a new nipple on my right breast and reducing the left breast to match the right one.
"Could I go smaller?" I asked. I have always been at war with my breast. I have felt that I was a D cup body in a size A cup mind. Dr. Asgari looked at me and said:
"How small do you want to go?" Suddenly I have a choice! I have always wanted a breast reduction and this was my chance. The doctor explained that he would have to go a little smaller. The largest that he could manage was a C cup, and even that depended on how much fat/muscle tissue he could get from my stomach. He told me that he could only use 2/3's of my stomach muscle, apparently this has something to do with blood flow, and in most cases 1/3 of the stomach muscle was useless.
I found myself speechless. Here was a chance of life-time and I was too frightened to think. I looked down at my body, the body that betrayed me, and I realized that this was the only body I've know and I was going through enough changes that I didn't want anymore! I told the doctor that I wanted my breast to be to be as close to the same as possible. A decision that I later regretted. There would be many times between this doctor's visit and the operation that I wanted to call Dr. Asgari's office and say "A set of small C's please", but I was too shy.
Trying to lighten the mood, I told him that he would have no problem finding enough fat in my stomach to fill my breast. He looked at me with a very serious expression on his face and said that he thought that there might not be enough fat for the surgery. I was starting to like this guy.
As the exam was about finished he told me that he needed a few 'before' pictures. I knew this was coming because long ago back in the excessive eighties, I had a roommate who worked for a New York City photographer. This guy's job was to take the 'before' and 'after' pictures for many big named plastic surgeons. Through my roommate I always knew which New York celebrities were going under the knife.
This is the digital age, and I am in New Jersey, so my doctor took his own pictures. He told me to stand against a wall, then he poised my arms, opened my almost hospital gown, than sat back down on the stool and started snapping away. Now remember standing right behind him was Mark. It was just too weird.
There I was, standing half-naked in front of a man that I met thirty minutes ago and he was taking pictures of my naked torso with my husband standing behind him. The whole thing struck me as funny, and I wanted to laugh, but laughing didn't seem appropriate. So, while trying to suppress a laugh, my face looked as if I was scowling. Dr. Asgari took a few more pictures and quickly exited the room. Mark told me that my expressing looked like it is saying:
"You can take the pictures, but now I am going to have to kill you!!!" I guess intimidation works both ways.

Chapt 7 Cont..

June 12th Mark and I drove the girls to school. Ronni was still in a great mood from a field trip to the Bronx Zoo she took the day before. The happy chatter was good because I was able to focus on her and not me. First we drop-off the girls at their respective schools, then it was off to the hospital. Mark drove while I give him directions. I don't like to drive. I do it all the time, but I don't like it. As a driver you have to watch the road. As a passenger you can look around, take in the sights and relax. So, given a choice I will be the passenger every time.
We sat in the waiting room briefly, and then entered Dr. Sullivan's office. After the introductions are made we discussed my biopsy results. The test showed that I had two tumors, one at six o'clock and the other at eight o'clock. Because of the locations Dr. Sullivan felt that a lumpectomy would not work. I would need a full mastectomy.
I was disappointed but not surprised. In my research, some books said that if a surgeon won't do a lumpectomy-run. On the other hand other books said that in certain circumstances mastectomies were the only option.
While I was thinking…second opinion, Dr. Sullivan went on discussing how he would approach the surgery. He drew pictures, showing his approach, explaining every detail of the process. Then he started talking about the sentinel node.
"The sentinel node?" I asked.
"Yes, the sentinel node test is my standard procedure." He said. Mark and I looked at each other and smiled, Dr. Sullivan continued explaining the procedure. "What about reconstruction?" I ask. That’s stopped him.
"Do you think you might want reconstruction surgery?" He asks.
"I might." I reply. I would love to say that I did lots or research on reconstruction or that I spent hours and hours reading about the pros and cons of the surgery, but that would be a lie. I became aware of reconstruction surgery in the early eighties when I was at the peak of my soap opera watching.
I started watching 'soaps' when I was a teenager, like many people my age I was a huge fan of Dark Shadows which was on at 4:00 pm. I just loved that show and I couldn't wait for it to be on. First I turned on the TV at 3:55 pm, then 3:50 and so on before I knew it I was hooked on General Hospital. Then One Life to Live and so on. Before I realized it, I was schudeling my life around my shows.
Why did I stop? Because of a comment I over heard at work one day. By this time I was in my early twenties and I working full time as a reservationists for Eastern airlines. On a normal day I would wake up somewhere around 9:00 am, then I schudeled my errands so that I would be home by noon and watch my soaps. I watched them from 12:00 to 3:45 pm, then hop in my car and rush to be at work by 4:00 pm (by this time Dark Shadows was cancled). Sometime I would be late to work because I just couldn't pull myself away from the TV.
Then one day when I was on my break and I over heard two women who were sitting near me talking. One of the women was very excited about a place that she had gone too recently and invited the other woman to join the next time that she went, but the second woman said something like:
"What time? I HAVE to be home by noon so I can watch my soaps." The first woman explained that the place didn't open until 1:00 pm so the second woman declined. I thought how stupid! Then I realized that I was living my life the same way. So I decided to quit.
It wasn't easy. The problem was I really wanted to know how the story lines that I had invested so much time in would resolve themselves. But if I watched to see how storyline 'A' ends-I got sucked in to storyline 'B'. I didn't think that I was ever going to get over my addiction, then techonolgy came to the rescue in the form of a VCR. I was able to tape the soaps and watch story line 'A'. Then I would fast forward through story line 'B'. With in a few months I was cured. This maybe part of the reason that I hate TV's in waiting rooms, it makes me feel like an alcoholic who is forced to sit in a bar.
Anyway, there was a character on one of my soaps that had breast cancer and was refusing treatment because loosing a breast would take away her womanhood. The TV doctor explained the wonders of reconstruction surgery, she had the surgery, lived and was still the town vixen. I didn't know much about the surgery, only that the surgery existed and that I might want it.
It wasn't that I looked at a mastectomy and as horrible disfiguring surgery. If I could find a plastic surgeon who can give me a fake breast, great. If not, that was okay too. This attitude can also be traced to the eighties.
When I was in my early twenties and working at the airline, I met a guy that I will call Paul. We started out as friends, then the relationship slowly changed. Paul had a secret, which he didn't tell me until it was obvious the relationship was becoming romantic. Paul's secret was that a few years earlier he was in an accident, an explosion really. A furnace at his job blew up, killing one and injuring others. Paul's injuries were the worst of the survivors. He had been burned on over seventy per cent of his body. Actually at the time he was given only a five per cent chance to live.
He had a body full of scars that I hadn't noticed. He had a few scars on his face but since he wore his hair long and had a full beard I didn't see them. I should have been suspicious about a person who wore long sleeved shirts in July. At the time of the accident Paul had a serious girlfriend, who stood by him through out his recovery. When he was well, they got married, but the marriage didn't last long. After the divorce he didn't date again until he met me. As our relationship became more physical, he started to panic.
I was going to be the first woman he met after the accident to see his scars, all of his scars. I will always remember the first time that we made love, watching him slowly, timidly taking off his shirt. Neither of us knew how I would react. Up until that point, the only burned people that I had ever seen were on TV. We were both nervous. There was nothing romantic or sexy about that day, just fear. As he took off his shirt he looked down at the floor and said in a quit voice:
"It's ok if you want to run out of the room, or throw-up. I'll understand." His chest and arms were full of scars, his back was the worst. I didn't run or throw-up. I walked over to him and held him, my fingers tracing the outlines of his scars. It was an important moment for both of us because he realized that his scars would not interfere with his love life, and I could confirm that even though I had always stated that I wasn't superficial, I now knew I really wasn't
In the long run our relationship didn't work out. We were two people who should have never been lovers. Our personalities were more suited to being friends. Years later when I was in a bar with some friends I ran into Paul. He was flirting with women at the bar, and they were flirting back. He wore a short sleeve shirt that was half unbuttoned, proudly displaying many burn scars, which were not slowing him down one bit-lets not talk about the gold chains. We talked for a few minutes; he even bought me a drink. I remember thinking that I had created a monster.
All of these thoughts ran through my head when I head the word mastectomy. I wasn't afraid of scars or losing a breast, I didn't think that having a mastectomy would change my quality of life. But if reconstruction was a possibility-why not? At the end of the meeting, Dr. Sullivan gave me the names of two doctors. The first one was an oncologist named Dr. O'Hara. Dr. Sullivan suggested that she look at my charts and x-rays, then give me her thoughts about having the surgery. All of the books said to get a second opinion from a second doctor NOT associated with the first one. But because of all the time I took finding Dr. Sullivan I trusted him.
I decided to follow his advise about the second opinion and set up an appointment with Dr. O'Hara. I wanted to meet my possible oncologist as soon as possible. My mother had a good surgeon, but a lousy oncologist. I wanted to meet this Dr. O'Hara and decide whether I wanted her to be my doctor or not.
The second doctor was Dr. Asgari who is a plastic surgeon, a type of doctor that I never thought that I would ever be going to. I was scheduled to meet with Dr. Asgari on June 22 and Dr. O'Hara on June 23rd. The problem was that June 21 was the last day of school. I wanted Mark with me when I meet these doctors but I didn't want to drag the girls to the doctor's appointments, we needed babysitting coverage. Another one of the women from the church came to our rescue offering to watch the girls both days.
Diane and her husband were both active members of our church. They were in their early thirties and both work as systems analysts (what ever that is). They have a son who is six and a daughter who is three. They were the first couple to invite Mark and I over for dinner when we first came to this church. Diane is a pretty woman who stands only an inch or two shorted then me, she is thin, and has shoulder length straight brown hair. When I first met Diane I thought that she was very shy. Later I would learn that although she was quiet, she could be a force to be reckoned with. When she gets involved in a project, she runs it with the precision of a Swiss watch. Lucky for me because Diane will become the coordinator of everyone who wanted to cook for me. She will set up a schedule that would make the next few months much easier.

A Brief History of Breast Cancer. Chapter 7

In this chapter I will give a brief history of cancer. I used many sources to put this history together including web sites: http://www3.cancer.org; http://.harvard.edu/html/sch00028.html ;
http://www.freevas.demon.co.uk/students/Halstead.htm ; www.rainbowofhope.org ; http://undelete.org ; http://www.bcsc.ca/bsca_html/about/about_historybc.html . And I used books: he Breast Cancer Wars: Hope, fear and the pursuit of a cure in Twentieth-Century America by Barron Lerner. Dr. Susan Love’s Breast Book by Dr. Susan Love. Take Charge of Your Breast Cancer by John Link M.D. And The Great Influenza, by John Barry.


I waited for a week for Dr. Sullivan's office to call. They never did,
I had called them about the results of my biopsy. The woman who answered the phone had no idea what I was talking about. She said that she would look in to it and call me back. This was the first clue, or maybe the second (remember the missing x-rays?) that this doctors office was staffed by idiots.
The next day I went to work hoping that sometime during the day I would hear from Dr. Sullivan. At work I was helping a woman who was looking for information on 17th century France when I notice a friend of mine named Erin walk in to the library. We waved to each other as I rushed past her. A few minutes later I saw Mark walk into the library, which was a rare because he usually only comes to the library when he was dropping off or picking up our daughters. Since both girls were in school I wondered what he was doing there. He looked sad. I found the books on France that the woman needed then I walked over to Mark. He took my hand and led me to an empty section of the library. He held both of my hands, there were tears in his eyes. He told me that the doctor's office finally called with the test results…the tumors were malignant…I had breast cancer.
I paused for a few seconds then thanked his for coming to the library to tell me. He wanted me to go home with him. I told him that I was staying and that I that I would see him after work, and then I sent him home. Erin walked over to chat, I was hanging on by a thread and I didn't want her to see me burst into tears so I told her that I was very busy and that I would talk to her at another time. I walked back to the circulation desk, hoping that work would distract me. There was a pile of books that needed to be checked-in so I starting checking them in when my supervisor Caroline walked over to me. She stood next to me for a minute not saying a word. I turned to her and said:
"The tumors are malignant." Then I continued to check-in books as if nothing was wrong. She asked me if I wanted to go home. I said no. I kept checking-in books. Then I started to shake, me knees became weak, my eyes filled with tears and I whispered to her that maybe…I should leave.
I walked home and fell into Mark's arms. We didn't say anything; we just held each other and cried.
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I was thirteen the first time that I heard the term breast cancer, it was the summer of 1969 and I was spending a week at my girlfriend Mandy Scott's house. Earlier that year my family had moved from Michigan to New Jersey. In July we drove back to Michigan for a family event. Instead of driving back with my family, I was allowed to stay with Mandy's family for a week then fly back to New Jersey. It was a trip of firsts for me. I had never been away from family that long, and I had never been on a plane before, I felt very grown up.
Mandy's mother was having a great time playing hostess; she took us to her in-laws summer home on Lake Michigan and on other adventures. She treated Mandy and I as if we were grown-ups, I was having a blast.
One afternoon the three of us were sitting around the livingroom, Mrs. Scott was entertaining us with another one of her funny stories.
"…so, I was sitting on the couch next to my sister talking, when her two-year-old crawled in to my lap and pinched my nipple. Seeing this, my sister whispered for me to yell 'ouch' I asked why, then she pointed to her son holding my fake breast and said 'if you don't yell it will confused him.' So I started yelling:
"OUCH, OUCH!!! Mandy and Mrs. Scott started laughing. Then Mrs. Scott noticed the look of confusion on my face then said:
"Ten years ago I had a mastectomy." She went on with her story thinking that her explanation was sufficient. I had no idea what she was talking about, so I made a mental note to ask my mother about it when I got home.
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Modern day magazine articles sometimes give their readers the false impression that in the old days nothing was done to try to help women with this disease, yet there was Mrs. Scott, a woman who had her surgery in the late fifties. I got curious and wanted to know more about breast cancer, so I asked myself two questions. One: What is Breast Cancer? And Two: How long have people known about the disease?
I can give a very basic description of breast cancer, keep in mind that I got straight C's in science in High School and College. The first thing I needed to understand was why if two different people have cancer that spreads through out their bodies, why one person is said to have-say breast cancer and the other person-liver cancer. Isn't cancer just cancer? No, I found out, it isn't. What I learned is that cancers are named after the body part where the cancer originated, breast cancer starts in the breast, liver cancer starts in the liver, and so on. So, no mater what parts of the body the cancer spreads to, it will always be referred to by its first location.
Next I learned that breast cancer, like most cancers, are caused by cells that grow out of control. Breast cancer starts in breast tissue. About 86% of breast cancer starts in the ducts, another 12% start in the lobules with the remainder starting in the surrounding tissue. Theses rebellious cells then form a tumor. Cells from the tumor can break away and go to other parts of the body where they keep growing. If the cancer spreads, it is said to have metasidzed. Whether the cancer spreads to the other organs or not, can determine who lives and who dies. There are proximally 175,000 new cases of breast each year, with about 40,000 deaths. There are many factors that determined what kind of breast cancer a woman has, and what her chances for survival are. Doctors break breast cancer in to 4 or 5 stages (depending which book I read) 0-4 with each stage being deadlier than the one before it. I was in stage 1, but my oncologist said that I was just on the border of stage 2. This means that with surgery I had between a 75-95% chance of living for five years depending on whose numbers I looked at. But with each added treatment such as chemotherapy or tamoxifen my odds improved.
Describing breast cancer is a complicated, first there are the different stages, then there is the size of the tumor to take in to account, plus whether the nodes are positive or negative, and also if the estrogen receptors are positive or negative and so on. I get a headache just thinking about it.
Okay, now I had a vague idea what breast cancer was, the next thing I wanted to know how long doctors have been trying to treat it. This gets really interesting. There are documented cases I kid you not, dating back to the early Egyptians. The popular treatment back then was to cautery the disease tissue. Which means that the tissue was burned with some kind of branding iron which destroyed any dead or unwanted tissue. Considering they didn't have any kind of anesthesia back then, that must have hurt. Ouch!!!
Next there was Galen (130-200AD) a Greek physician who had served the emperor Marcus Aurelius in Rome and whose books on physiology and anatomy remained popular into the Middle Ages. The strange thing about these books was how inaccurate they were. In Galen's time it was against Roman law to dissect humans, so his books were based from the dissections of animals. Galen believed that a special diet should be the treatment for breast cancer, still some of the people of that time period preferred exorcism or topical applications.
It was during the Renaissance that a Flemish anatomist named Andreas Vesalius (1514-1564) dared to question the thinking Galen. Vesalius did dissect humans, his studies lead him to believed that a mastectomy was the logical treatment. He also used sutures instead of cautery to control the bleeding. Then a physician named Le Dran (1685-1770) was created with being the first doctor to realize that breast cancer spreads through the lymph nodes.
Did any of these treatments work? No one really knows because it wasn't until the middle of the 1800's that doctors started keeping detailed records. By this time many doctors understood that if left untreated the disease would spread, so for many surgeons treatment was the removal of the effected breast and the surrounding glands.
By the late 1800's most surgeons were doing mastectomies. Unfortunately because the doctors didn't have the ability to detect the disease in it early stages, only woman who were in advance stages of the disease were being treated. This meant by the time women sought help their tumors that were very big, some as large as half the size of the breast it self. It was considered a success if a woman lived for three years after her surgery, only 12% of those treated survived for ten years.
It is impossible to write about the history of breast cancer without talking about Dr. William Halstead (1852-1922), a man known as the 'Father of the radical mastectomy'. History portrays Dr. Halstead as either a hero, whose medical discovers were great for woman and saved many lives. Or as a man whose medical discoveries destroyed the lives of the women he saved. It depends on whose point of view I read.
First lets acknowledge his important contributions and influence in medicine. He pioneered treatments not only in breast cancer, but also in thyroid and parathyroid, GI track and bile ducts, blood vessels and treatment for hernias. He was involved in the development of local anesthetics, he introduced surgical gloves in the operating room, and he was the founder of the system of residency that brought structure to surgical training programs in the United States.
I was shocked when I learned that in the 1870's while European medical schools required rigorous scientific training, medical schools in America required its students to attend two, four month terms of lectures (the students didn't even need to pass all of them). Which meant that a person could graduate from an American medical school with out ever looking through a microscope, performing an autopsy or seeing a patient.
Halsted got his undergraduate degree from Yale and received his MD from Columbia University, then he quickly went to Europe so he could actually learn something about medicine. Dr. Halsted developed the radical mastectomy, which entailed the removal of the cancerous breast, the nearby lymph nodes and the two chest wall muscles on the effected side of the chest. 'The Halstead mastectomy' was more than how much tissue was removed, it was also how he removed it. Dr. Halstead believed that all the tissue had to be removed in one piece. He did this because he felt that cutting through cancerous tissue might lead to the spread of any remaining cancer cells. He then taught this method to all of the surgeons in his training programs. Before long these trainees were performing the 'Halsted radical mastectomy' around the world.
Next we move to the 1920's. Some surgeons were 'improving' 'the Halstead mastectomy' by cutting deeper and removing more tissue, while others (mostly Europeans) were questioning the procedure. After all the operation was very disfiguring, painful, and sometime lead to arm swelling known as lymphedema.
Remember this was about the time doctors first started using X-rays to look for tumors, so the cancer was being found earlier which improved the survival rate. Doctors now spoke of a woman living for 'five-years' instead of 'three-years' after her surgery. Also the ten-year survival rate had jumped to 50% (getting better).
It was also in the late twenties that doctors' starting debating about the use of radiation. Some thought that used by itself or in conjunction with a less invasive mastectomy, the new treatment was as or more effective as a radical mastectomy.
Treatment slowly improved as medical knowledge improved. Early radiation was kind-of a guessing game, with doctors still refining the equipment and learning what voltage to use. The thirties saw a gradual improvement with the equipment, which could now direct a higher voltage of radiation into the cancer yet do less damage to healthy tissue. It was also in the thirties that women's clubs and magazines started to encourage woman to look for early signs of cancer and seek treatment as soon as possible.
Even though European doctors were promoting breast self-exam (BSE) to their female patients as early as the nineteen twenties, it wasn't until the fifties that American doctors started promoting BSE to their female patients. Making up for lost time the fifties also saw American doctors declare their own war on cancer. For many, the objective was to get every last cancer cell in the patient. For women this lead to the super-radical mastectomy, which encompassed the splitting of a patients clavicle, ribs and sternum.
The fifties was an interesting time, while some surgeons were hacking off body parts, other surgeons were experimenting with the less invasive modified radical mastectomy (removing the breast only). Meanwhile improved statistical analyses was questioning claims that the radical and/or super radical mastectomies were really increasing longevity of women with breast cancer.
It was in the fifties that other ideas for treatment started also, one those ideas was chemotherapy. During World War II it was discovered that nitrogen mustered gas inhibited cell growth. It was this discovery that lead to chemotherapy, I'll talk more about that later. At first chemotherapy was only used on patients with move advanced cancer, but in 1958 the National Cancer Institute started researching using chemotherapy on a wider range of cancer patients. Another change was a small group of medical people who wanted to do statically studies comparing the radical mastectomy vs. a modified radical mastectomy vs. lumpectomies (removing only the tumor). But American doctors refused to participate in these studies
Each decade or so doctors' were able to detect breast cancer earlier and earlier. In Hastead's era by the time a woman came into a doctor's office the tumor was usually around egg size. As women became more aware of what to look for they went to their doctors with smaller and smaller tumors. BSE really help, by the fifties the tumors were usually no bigger than two centimeters in diameter when the average woman sought treatment. In the sixties with the improved mammogram doctors were able to detect tumors at about one centimeter, which as too small to be felt.
Researchers at the University of California made the next big discovery, they found that certain genes in normal body cells somehow become abnormal (what?). I don't understand why, but this discovery helped unlock the mystery of cancer. Something about being able to identify some genes that can spur cancerous growth.
By the late sixties surgeons in other countries had gradually abandoned radical mastectomies, replacing it with surgery that was less invasive, yet in America 70% women were still being treated using the radical mastectomy.
The seventies changed everything. America was going through some major changes. One of which was talking out loud about subjects that people use to whisper about, like cancer. Prominent women such as First Lady Betty Ford and Actress Shirley Temple went public their breast cancer, which gave American women permission to talk about their own bouts with the disease.
It was also the height of the American woman's movement female writers started to fill the media with questions about the necessity of a radical mastectomy and the lack of quality of life that the surgery gave it survivors. The most famous of these writers was a woman named Rose Kushner (1929-1990).
Ms. Kushner was a journalist from Baltimore who was diagnosed with breast cancer in 1974 and was horrified with how she was treated by the medical profession. First she wrote an article about everything she went through during her treatment for the Washington Post, and the story was reprinted in hundreds of newspapers across the country.
Then in 1975 she published a book titled Why me? What Every Woman Should Know About Breast Cancer to Save her Life. In those days the biopsy and mastectomy were done in the same surgery. I can't imagine what it must have been like to go into surgery with a small lump on your breast and waking up with a huge scar where the breast once was. Ms. Kushner had to call eighteen different surgeons before she found one who would do the procedure in two steps. Rose Kushner and other female writers helped women learn how to stand up the doctors and become involved in their treatment.
It was in 1977 that the drug tamoxifen was first approved. Its antiestiestrongenic actions (whatever that is) were shown to help reduce the chanced of the cancer coming back.
The eighties to the present have seen many improvements in cancer treatment. Earlier diagnose, better mammogram machines, improved chemotherapy, more lumpectomies, better reconstruction surgery, sentinel node biopsies, better communication between doctors and their patients, more female doctors, bone marrow transplants, stem cell research, a wider use of tamoxifen for cancer patients, and I am sure other stuff that I never heard of.

The Biopsy Cont...

-
Back at the waiting room a little time had passed and some of the people had been called, and there are now some empty seats available. We didn't leave our post. The woman gagging on the barium finishes drinking the stuff and was quiet. The TV droned on…
“Traci,” I heard a voice say.
“Here” I answer. She told me to follow her and I did. Mark was planning to stay in the waiting room, but I ask him to come in to the ultra-sound room with me.
“Am I allowed to come in there?” he asked. I didn’t know, but I was so frightened that I didn't care about the rules.
“Please stay, until they kick you out.” I whispered to him. So we both follow the technician in to the next room.
We entered the ultra-sound room and were greeted by a beautiful young woman. I think that she was somewhere in her early thirties but I am not sure. She has long brown curly hair, twinkling brown eyes and a welcoming smile;
“Hi, I’m Angela…bla bla bla.” Angela started explaining to us what the procedure for a stereotactic biopsy will be. I had a vague idea because I read up on this type of biopsy, but I was glad that she explained the procedure to me again.
The doctor would use a long (very long) needle which he would insert into my right breast. Using the ultra-sound machine Angela would guide the doctor to each tumor where he would take a sample of the tumor for testing. The doctor would use four needles in all, two for each tumor because he liked to take two samples from different parts of each tumor. Then a team of experts would examine the tissue samples. I liked the fact that more than one person would be looking at the tissue samples. I was not real convertible with the idea of one person (who maybe was having an off day) deciding if I had cancer or not.
Angela then told me to take off every bit of clothing from the waist up, and put on a hospital gown with the opening in the front. She left the room. First I changed in to the hospital gown, then I sat on the examination table Mark sat in a chair next to me, Angela did not ask Mark to leave.
A few minutes later Angela came bouncing back into the room, she asked me if I brought back the x-rays (mammogram-rays?) that I had checked out of the hospital? I tell her no. I checked the x-rays out in May and bought them to Dr. Sullivan’s office. I told her that I left them with the doctor at his request because he wanted to study them. He told me that he would return them to the hospital. As we were discussing the x-rays, Dr. Martin, the doctor who was doing the biopsy walked in. When I went to Dr. Sullivan I thought that he would be doing the biopsy, but he told me that he was sending me to a doctor who was an expert in biopsies. If I need surgery after that, then Dr. Sullivan would take over my case.
Like Angela, Dr. Martin looked like he was from central casting. He was tall and handsome, somewhere in his late thirties, and he had a very charming bedside manor. I was starting to feel like I walked into a soap-opera hospital scene, in more ways than one.
The doctor introduced himself to Mark and I then turned to talk to Angela. The smile was no longer on her face. I felt an immediate chill between the two of them. The tension in the room grew so thick that the sharpest scalpel in Memorial Hospital would have been useless. Mark and I look at each other our eyes are saying ‘Are these the people who will determine my future?’ Angela tells him that the x-rays are missing, he tells her to check again, because if they were not found that I will have to have x-rays taken again, and that would throw off their schedule. She leaves the room.
Once Angela was gone Dr. Martin turned on the charm, he explained the whole procedure (again). He would use a local anesthetic on my chest, so I would be awake for the procedure. Then he left the room.
“Can I stay, or should I wait outside?” My husband whispered to me.
"You're not going anywhere." I tell him. "These people are scary." He stays, and we wait. It felt like as a patient I spent most of my time just waiting around.
Soon Angela came bouncing back in to the room, all smiles holding the x-rays. Mark and I speculated that someone from the hospital placed a call to Dr. Sullivan’s office and had the x-rays sent over. All I cared about was not having to have a new mammogram done. Moments later Dr. Martin came in, and the frosty atmosphere returned to the room.
I lied down on the table face up, my hospital gown off. They cover my body with what seemed to be some kind of cloth, only a small part of my right breast exposed. That was nice because I didn't feel embarrassed. Dr. Martin gave me a local anesthetic. My torso went numb, but I was alert. The doctor walked to the counter and took a needle out of its packaging. It looked like a foot long stick with tweezers on the end.
The needle looked scary,
“Don’t be frighten by the length." The doctor said. "It’s designed for many different kinds of biopsies.” The doctor tested the needle by opening and closing the tweezers part. He rejected any needle that did not meet his standard. He then made a small incision in my breast and slowly pushed the needle in. Angela worked the ultra-sound guiding Dr. Martin. Mark and I found ourselves becoming fascinated by the process, watching the needle move through my body on the screen. I have to say the doctor and technician became all business. They worked well as a team. Barley a word was spoken, yet, they were able to anticipate each other’s moves. But I still felt coldness between them.
After a while my mind started wandering and I found myself making up scenarios about Dr. Martin and Angela. When Mark and I started dating we both only had part-time jobs so there wasn't much money. One of the cheep ways we found to entertain ourselves involved watching a TV show that was not in English. We would watch the action and make up our own story lines and dialog. We thought that this was very funny.
As the biopsy continued my mental stories about the doctor and the technician became stranger and stranger. They were twins separated at birth, one was raised rich, the other poor. That’s why they hate each other… No, lets see. Angela always wanted to be a doctor, and resented all doctors…No, that’s not right either.
On, and on, my imagination goes, until I decided that this was a love story gone bad. Very, very, bad. This game kept my mind occupied while the biopsy continued. Dr. Martin would open a new package test the new needle, finds one that he likes, and started the process all over again. The biopsy seemed to take forever and for some reason that I don’t understand I started to feel sleepy. I found myself drifting in and out of consciousness. Mark watched the procedure spell bound by the technology.
Dr. Martin tells me that I have very dense breast tissue which made the process more complicated. Trust me, it is very strange to be lying on an examination table, looking up at a man that I had never seen before, pushing a needle into my breast. Not only that, he was using his hip to help push the needle farther in to my body. I watched sweat beading up on his forehead, weird. Dr. Martin gave a running commentary of each aspect of the biopsy. He warned me right before he took a tissue sample. The mechanisms made a clamping sound and I felt a jolt in my body, I don’t know how to describe it, but it was strange.
I was starting to think that the biopsy was never going to end when Dr. Martin told me that he was done. Then he leaves. Angela stayed for a few minutes cheerfully chatting as she told me not to call the hospital for the results, but that someone from Dr. Sullivan's office will call me in a few days, then she leaves. I got dressed and we were about to leave the room when Dr. Martin stopped by again and wished me luck.
It was so strange, whenever one of them was in the room, that person was charming and cheerful. But, when both of them were in the room, neither of them smiled, and all the chit-chat stopped. It's funny, when you think about it. Mark and I had stood outside the waiting room so we would not be subjected to the Soap Opera blaring in the TV only to become part of a real life hospital drama that was every bit as bazaar.
Mark and I left the room and headed out to the parking lot, I was feeling physically sore and mentally drained. I started thinking that maybe my perception of Angela and Dr. Martin is just my imagination gone wild when Mark said to me.
“What was their problem? I looked at him surprised.
“You noticed it too?” I asked. “I thought it was my imagination.”
“ There was something going on between those two, during the whole procedure she kept looking at him and he would never make eye contacted with her.” Well, I know my husband is more observant than most men, but if he noticed also, then there was some bad history between the doctor and the technician. Like I said, the whole event was so strange that between their good looks and their behavior I felt like I was in a soap-opera.

The Biopsy Cont...

-
Back at the waiting room a little time had passed and some of the people had been called, and there are now some empty seats available. We didn't leave our post. The woman gagging on the barium finishes drinking the stuff and was quiet. The TV droned on…
“Traci,” I heard a voice say.
“Here” I answer. She told me to follow her and I did. Mark was planning to stay in the waiting room, but I ask him to come in to the ultra-sound room with me.
“Am I allowed to come in there?” he asked. I didn’t know, but I was so frightened that I didn't care about the rules.
“Please stay, until they kick you out.” I whispered to him. So we both follow the technician in to the next room.
We entered the ultra-sound room and were greeted by a beautiful young woman. I think that she was somewhere in her early thirties but I am not sure. She has long brown curly hair, twinkling brown eyes and a welcoming smile;
“Hi, I’m Angela…bla bla bla.” Angela started explaining to us what the procedure for a stereotactic biopsy will be. I had a vague idea because I read up on this type of biopsy, but I was glad that she explained the procedure to me again.
The doctor would use a long (very long) needle which he would insert into my right breast. Using the ultra-sound machine Angela would guide the doctor to each tumor where he would take a sample of the tumor for testing. The doctor would use four needles in all, two for each tumor because he liked to take two samples from different parts of each tumor. Then a team of experts would examine the tissue samples. I liked the fact that more than one person would be looking at the tissue samples. I was not real convertible with the idea of one person (who maybe was having an off day) deciding if I had cancer or not.
Angela then told me to take off every bit of clothing from the waist up, and put on a hospital gown with the opening in the front. She left the room. First I changed in to the hospital gown, then I sat on the examination table Mark sat in a chair next to me, Angela did not ask Mark to leave.
A few minutes later Angela came bouncing back into the room, she asked me if I brought back the x-rays (mammogram-rays?) that I had checked out of the hospital? I tell her no. I checked the x-rays out in May and bought them to Dr. Sullivan’s office. I told her that I left them with the doctor at his request because he wanted to study them. He told me that he would return them to the hospital. As we were discussing the x-rays, Dr. Martin, the doctor who was doing the biopsy walked in. When I went to Dr. Sullivan I thought that he would be doing the biopsy, but he told me that he was sending me to a doctor who was an expert in biopsies. If I need surgery after that, then Dr. Sullivan would take over my case.
Like Angela, Dr. Martin looked like he was from central casting. He was tall and handsome, somewhere in his late thirties, and he had a very charming bedside manor. I was starting to feel like I walked into a soap-opera hospital scene, in more ways than one.
The doctor introduced himself to Mark and I then turned to talk to Angela. The smile was no longer on her face. I felt an immediate chill between the two of them. The tension in the room grew so thick that the sharpest scalpel in Memorial Hospital would have been useless. Mark and I look at each other our eyes are saying ‘Are these the people who will determine my future?’ Angela tells him that the x-rays are missing, he tells her to check again, because if they were not found that I will have to have x-rays taken again, and that would throw off their schedule. She leaves the room.
Once Angela was gone Dr. Martin turned on the charm, he explained the whole procedure (again). He would use a local anesthetic on my chest, so I would be awake for the procedure. Then he left the room.
“Can I stay, or should I wait outside?” My husband whispered to me.
"You're not going anywhere." I tell him. "These people are scary." He stays, and we wait. It felt like as a patient I spent most of my time just waiting around.
Soon Angela came bouncing back in to the room, all smiles holding the x-rays. Mark and I speculated that someone from the hospital placed a call to Dr. Sullivan’s office and had the x-rays sent over. All I cared about was not having to have a new mammogram done. Moments later Dr. Martin came in, and the frosty atmosphere returned to the room.
I lied down on the table face up, my hospital gown off. They cover my body with what seemed to be some kind of cloth, only a small part of my right breast exposed. That was nice because I didn't feel embarrassed. Dr. Martin gave me a local anesthetic. My torso went numb, but I was alert. The doctor walked to the counter and took a needle out of its packaging. It looked like a foot long stick with tweezers on the end.
The needle looked scary,
“Don’t be frighten by the length." The doctor said. "It’s designed for many different kinds of biopsies.” The doctor tested the needle by opening and closing the tweezers part. He rejected any needle that did not meet his standard. He then made a small incision in my breast and slowly pushed the needle in. Angela worked the ultra-sound guiding Dr. Martin. Mark and I found ourselves becoming fascinated by the process, watching the needle move through my body on the screen. I have to say the doctor and technician became all business. They worked well as a team. Barley a word was spoken, yet, they were able to anticipate each other’s moves. But I still felt coldness between them.
After a while my mind started wandering and I found myself making up scenarios about Dr. Martin and Angela. When Mark and I started dating we both only had part-time jobs so there wasn't much money. One of the cheep ways we found to entertain ourselves involved watching a TV show that was not in English. We would watch the action and make up our own story lines and dialog. We thought that this was very funny.
As the biopsy continued my mental stories about the doctor and the technician became stranger and stranger. They were twins separated at birth, one was raised rich, the other poor. That’s why they hate each other… No, lets see. Angela always wanted to be a doctor, and resented all doctors…No, that’s not right either.
On, and on, my imagination goes, until I decided that this was a love story gone bad. Very, very, bad. This game kept my mind occupied while the biopsy continued. Dr. Martin would open a new package test the new needle, finds one that he likes, and started the process all over again. The biopsy seemed to take forever and for some reason that I don’t understand I started to feel sleepy. I found myself drifting in and out of consciousness. Mark watched the procedure spell bound by the technology.
Dr. Martin tells me that I have very dense breast tissue which made the process more complicated. Trust me, it is very strange to be lying on an examination table, looking up at a man that I had never seen before, pushing a needle into my breast. Not only that, he was using his hip to help push the needle farther in to my body. I watched sweat beading up on his forehead, weird. Dr. Martin gave a running commentary of each aspect of the biopsy. He warned me right before he took a tissue sample. The mechanisms made a clamping sound and I felt a jolt in my body, I don’t know how to describe it, but it was strange.
I was starting to think that the biopsy was never going to end when Dr. Martin told me that he was done. Then he leaves. Angela stayed for a few minutes cheerfully chatting as she told me not to call the hospital for the results, but that someone from Dr. Sullivan's office will call me in a few days, then she leaves. I got dressed and we were about to leave the room when Dr. Martin stopped by again and wished me luck.
It was so strange, whenever one of them was in the room, that person was charming and cheerful. But, when both of them were in the room, neither of them smiled, and all the chit-chat stopped. It's funny, when you think about it. Mark and I had stood outside the waiting room so we would not be subjected to the Soap Opera blaring in the TV only to become part of a real life hospital drama that was every bit as bazaar.
Mark and I left the room and headed out to the parking lot, I was feeling physically sore and mentally drained. I started thinking that maybe my perception of Angela and Dr. Martin is just my imagination gone wild when Mark said to me.
“What was their problem? I looked at him surprised.
“You noticed it too?” I asked. “I thought it was my imagination.”
“ There was something going on between those two, during the whole procedure she kept looking at him and he would never make eye contacted with her.” Well, I know my husband is more observant than most men, but if he noticed also, then there was some bad history between the doctor and the technician. Like I said, the whole event was so strange that between their good looks and their behavior I felt like I was in a soap-opera.