Home from Lefty's Biopsy

Home again, and so happy to be.

Yesterday was the MRI wire guided excisional biopsy on Lefty.

The two-stage procedure was done in the adjacent imaging and ambulatory surgery centers of the huge Christiana Care campus. Starting in the surgery center, an anesthesiologist put in an IV line to provide access for the radioactive "stuff" for the MRI and for the surgical anesthesia.

Next a trip down "Patient Way" to the Imaging Center. On the MRI table on her belly, left arm outstretched ala Superman, boobs hanging through a board with two round holes, Venita was in and out of the MRI machine for about 90 minutes. Really nice tech Sarah, and a really funny radiologist, Dr. B. (Why is it of the specialists, radiologists tend to have a human side?)

Took some films to compare to the MRI films from last month. Didn't have a mammo plate clamped on as Venita had previously been told (whew), but there was some sort of minor "compression" device. Dr. B got a feel for the location of what he called the "lesion," and started giving Venita shots of lidocaine into Lefty. Remember, Venita can't see any of this; she's face down in the superman pose. Dr. B was a hoot; he would place the tip of the syringe against Lefty and say "one, two, three," and push the needle into the tissue while saying "ouch." Each time he pushed the syringe plunger, he would say "ouch." Venita asked what he was doing, he said "Saving you the trouble of letting me know it hurts."

(Venita: "What do you mean by lesion? Dr. B: "The tissue of interest. The tissue that looks different from the surrounding tisse and that we want the breast surgeon to biopsy for pathology.")

After 3 shots and a few minutes for the lidocaine to "work," Dr. B started to place the wire, which was a 20 gauge biopsy needle. He had a hard time penetrating the skin--said Venita was "thick-skinned." As soon as he made it through the skin, Venita gave a big OOOUUUCCCHHH!!, and Dr. pulled back and said that Venita must need more lidocaine. "One, two, three," and pushed in the needle and plunger but didn't say ouch. Venita asked why he didn't and he said because that one didn't hurt. Venita assured him that it did. "Oh," he said, feeling bad that he had failed to supply all the requisite sound effects.

It took unusually long for the needle to get appropriately placed. Between Venita's thick skin and the fact the lesion was at the chest wall, it took maybe 8 separate insertions/adjustments to get the needle where Dr. B wanted it. While Venita waited for films to be printed for Dr. Cutter, Sarah brought Jim back to see Venita and to see the MRI machine.

Back into the wheelchair and a return trip up Patient Way to the Surgery Center. A short wait in the "back" waiting room, and then directly into the OR; no separate "pre-op holding."

Nurses and techs get Venita all strapped, and draped, and hooked up to monitors and IV bags. . . .

Dr. Cutter walks into the the room and says hello to Venita, Venita asks how Dr. Cutter is going to get to this lesion given it's at the chest wall, Dr. Cutter gives Venita that "how dare you question my skills" look as she sarcastically says "with a knife" . . . .

Dr. Cutter looks up at the anesthesiology nurse, and the next thing Venita knows she is being woken and asked to get off the table and into a wheelchair.

Coming out of the sedation was a little harder this time. Venita had teeth-chattering shivering. A nurse brought Jim back to the recovery area. After a blood pressure reading with a "normal" diastolic pressure, Venita was allowed to dress and leave.

No post-procedure visit from Dr. Cutter to either Venita or Jim. (Jim didn't see her pre-procedure either.) Dr. Cutter just disappeared. No pain meds sent home with us. Discharge nurse also seemed surprised by this "cut and run" behavior. Venita's using the Percocet she has on hand.

No big ace bandage this time. Just a gauze dressing and sports bra over the steri-strips. All of the breast tissue in Lefty is sore, from the breastbone over to the armpit. A much deeper, widespread pain than with the biopsy on Righty, where the tumor was right at the nipple. From what we could tell changing the gauze dressing this morning, Venita will have quite a dent in Lefty.

Finger and toes crossed for good news from the pathology report.

Venita plans to spend the day resting as much as possible. The mastectomy/reconstruction on Righty is tomorrow. Sigh.