Older Space

I certainly don’t intend to turn this into a blog where I constantly bemoan my physical condition, but I had quite a scare last week and it resulted in a new insight I’d like to share.

I once heard a comedian compare a mammogram to slamming a car door on your breast. It’s quite an accurate approximation. Because I absolutely hate mammograms, I haven’t kept up with them the way I should. Two years ago they found a dark spot in my right breast. That was pretty scary. However, the following ultra-sound showed that it was only fibrous tissue. That was a relief! Although the doctor recommended another mammogram in six months, I put it off until this year.

The Mammogram

Last week the mammogram showed a cluster of dark spots in my left breast. The right one was fine. Who’d have thunk it?

Since the spots were a cluster of cysts, the doctor recommended I have a needle biopsy to be on the safe side. That was really scary! I had visions of a huge scar, chemotherapy, a bald head, and excruciating pain. Thankfully, those visions were 100% wrong.

Because of modern technology, the needle biopsy is an out-patient procedure. Although it’s still a surgery, it’s performed in the same room as the ultra sound. In fact, the ultra sound is used to help the surgeon guide the needle to the proper place, but I’m getting ahead of myself here.

The Needle Biopsy

The needle biopsy is a very easy surgery. As invasive as it is, I didn’t feel invaded for a minute! Here’s the procedure:

1. You don’t need to completely disrobe. You take your shirt off and are given an hospital gown to cover your top except for the affected area.
2. The surgeon gives you an injection to numb your breast. It takes only a very few moments to work.
3. This is sort of funny. In Minnesota, the surgeon has to initial near the surgical area as evidence that they worked in the correct place. They use magic marker. I have still have the initials, although they are fading little by little.
4. The surgeon makes a very small incision in the breast. I believe mine is about a quarter inch long, if that.
5. The ultra sound technician is the only other person in the room. She uses the ultra sound to pinpoint the exact spot that needs to be biopsied. During the surgery, I chatted with her and watched the screen.
6. The surgeon inserts the needle and the biopsy “tool”. That’s what she called it. I didn’t see it at all. She uses the tool to extract two tissue samples.
7. The surgeon inserts a very small titanium chip into the breast. This is so that in future mammograms, medical personnel can easily see that this area was previously biopsied and check for any changes in the area.
8. The biopsy is over! The surgeon removes the needle, applies pressure on the incision to stop any bleeding, and puts a bandage on it. No stitches!
9. After the biopsy, you’ll have another mammogram on the biopsied breast to take a picture of the titanium chip for future reference.
10. You get a small icepack to put on your breast to reduce swelling and help control any pain. Although I have a nice bruise, I had absolutely no pain that an ibuprofen couldn’t handle.
11. You’re done! You can get dressed and go home!

Mammogram Insight

Fortunately the biopsy showed the cysts are benign. However, things could have turned out very differently and I would have been a fool for waiting two years between mammograms. The normal recommendation is one year. In my case, I should have followed up after six months. Not having a mammogram would not have stopped me from having cancer. If the cysts had been malignant, I would have given them plenty of time to grow and metastasize.

Please! If you need a mammogram, get one. If you have no insurance there are programs, such as Minnesota’s SAGE program that can help with payment. Check the American Cancer Society to find programs and treatment options in your area.

I’m Shrinking!

I’m short. For most of my adult life I was 5′ 3 ½” tall. Then two years ago I had a check up and was 5′ 3″ on the dot. This year, I’ve lost another half-inch.

For years, I’ve watched Sally Fields hawking the once-a-month drug for osteoporosis, Boniva^®(2). Yet, my bone density never concerned me … until I started shrinking. After all, I’m not yet old enough to qualify for most of the Senior discounts.

When my doctor recommended a bone-density test, I grudgingly agreed. Over the years, I’ve had my share of mammograms, pap smears, and other invasive women-oriented tests. Medical tests are not something I await with baited breath. They are more often tests I anticipate with gasps of horror. I really didn’t want some stranger prodding and poking at my aging bones.

The DEXA Scan

The bone density test, or DEXA scan, is a refreshing surprise.

1. You don’t need to fast before the test, except if you take calcium supplements, you shouldn’t take them for 48 hours before your test..
2. You don’t need to disrobe if you go to the test wearing clothing that has no buttons, zippers, or metal parts.
3. You walk into a room and lay on a table. The scanner passes over you and you’re done.
4. The test is no touch … well, almost. The technician did turn my leftfoot inward to get a picture of my hip.
5. The scan took about five minutes. My appointment was for 8:30 a.m. I arrived at 8:15 and was back home by 8:45.

Best of all, I am relieved to find that I don’t have osteoporosis. Osteoporosis is a debilitating disease that when left untreated, causes its victims to live out their “Golden Years” in excruciating pain. I have osteopenia. Osteopenia is the precursor to osteoporosis. In my case, it means that I am at high risk for a hip fracture if I don’t start taking care of my bones.

My DEXA scan recommended a bisphosphonate, a calcium supplement, and vitamin D-3. However, according to Consumer Reports, while there’s evidence that bisphosphonates reduce the risk of bone fractures among people with osteoporosis, there’s some concern in the medical community that the value of bisphosphonates is less clear for people with osteopenia (1). If I do need to start taking the drug, a weekly dose of the generic bisphosphonate is much less expensive than Boniva or its relative, the weekly Fosamax^®.

Vitamin D-3

Vitamin D improves the body’s ability to use calcium, the stuff your body needs for strong bones and teeth (3).

I was quite surprised to learn that as our skin ages, it loses its ability to form vitamin D in response to sunlight. In fact, I was surprised to learn that my skin ever formed vitamin D at all. But, apparently that ability came and went without me ever knowing about it (4).

According to the US Government’s National Health and Nutrition Examination Survey (NHANES) data, 70% of people over the age of 50 no longer get enough vitamin D from what they eat. Even multivitamins don’t contain enough vitamin D for folks over 50-years-old.

In addition to vitamin D-3 supplements, omega 3 fish oils are also a source of vitamin D. So if you’re taking fish oil for high cholesterol, you’re getting some vitamin D. Yet, do check with your doctor to get the correct vitamin D dosage. I was shocked at the amount of vitamin D my doctor recommended. Even the high-dose supplements don’t have enough for us older folks.

Resources:

1. Jamie Kopf Hirsh. “Sally Field and Boniva: Great spokeswoman, misleading ad.” Consumer Reports Health.org. 28 Apr 2009. 11 May 2009.
   <http://blogs.consumerreports.org>
2. Of course, it’s only fair to read both sides of the Boniva story. DTC Marketing, the firm that produced the ad has something to say about its Boniva commercials.
3. “vitamin D.” A Dictionary of Chemistry. Oxford University Press, 2008. Answers.com 11 May. 2009. <http://www.answers.com/>
4. Bone Mass Measurement: What the Numbers Mean. Winona Health. N.D. 11 May 2009.