Daily Archives: December 14, 2012

The biopsy went down well

The surgeon/radiologist was Dr. Gilman, the Associate Director of Thoracic Imaging and Intervention at MGH and someone already familiar with my lungs, having performed at least one (and possibly two) of my previous biopsies. He is kind, calm and possesses the sort of delicate and fine boned hands that seem entirely apt for the precise operations he performs.

Prior to the procedure, a needle core biopsy, Dr. Gilman explained that there were two feasible locations within my lung from which to extract a sample. One of them, which could be accessed through the side of my chest, posed a greater risk as it was uncomfortably near to my heart. The better choice was a region of consolidation that hugged my pleural lining. In order to maximize the area from which the sample(s) would be taken, it was necessary to approach vertically rather than horizontally. And that meant that the needle would have to first pass through my left breast.

An IV with twilight or a lightly sedating dose of anesthesia was started, with a bit of Xanax thrown in to stave off any possible nausea. My left side was propped up until I was lying at a vertiginous tilt, and I was securely strapped in place.

As they prepped the skin around my breast, I began to feel the effects of the sedation. Usually, I’m easy when it comes to anesthesia, however, I managed to hover on the edge of awareness for much of the procedure. I knew I was moving in and out of the CT scanner and also recall seeing the CT image displayed on a screen; the outline of my breast pierced by a long needle reaching into my lung. Surprisingly, I was also occasionally cognizant of pain, and even flinched once–not something you want to do when undergoing a needle biopsy. After that, I focused on holding still, and, perhaps because I was rather emotionally detached, found it easy to do.

At some point the nurse asked if I’d like additional Xanax–I believe I mumbled yes and then immediately nodded off. I stayed asleep until it was time to take me for the first post procedure x-ray. The next couple of hours were less comfortable, as I was now wide awake and needed to lie on my stomach without speaking. The orderly who brought me back from radiology had forgotten to hook up my call button and I really, really had to pee. David popped his head in and I whispered my urgent need. A bed pan was brought; a less than optimal solution under any circumstances. This one proved to be of inadequate volume, and a change of bedding was required. Oh, the indignity.

After one more chest x-ray around 3pm (checking for pneumo-thorax) I was given the all clear. Dr. Shaw had come around earlier to say the procedure had gone well, but as I couldn’t ask questions, I didn’t get a lot of information. However, Dr. Gilman stopped by before I checked out and explained that he had in fact been able to get numerous core samples–each a sliver of tissue but hopefully laden with cancer cells. He also said it hadn’t been easy as my breast tissue was exceptionally dense, something that I am well familiar with and that has posed a challenge at my yearly mammograms.

So home I went, groggy and sore of boob. Dr. Shaw called that evening and said that it appeared there would be enough tissue for gene sequencing and a mouse model as well—actual cells from my cancer would be implanted in live mice. Ethically, this causes me some pause. However, if a successful mouse model is established, potential therapies could be tested for efficacy before actually being administered to me, and that is hard to quarrel with.

Now, we await the results.