The original intent for this blog was to enlighten anyone who was interested about not just my journey with cancer, but to enable others who have not had this disease, to relate better to those who have had it by describing some of the specifics one experiences. This week was a milestone for which I am very grateful. Another year free of cancer. For the one year (and all subsequent) checkups I fly to Adelaide (1500 kilometres away) to see the surgeon who treated me last year. Without alarming me (much!) she told me the unhappy news that the aromatase inhibitor (hormone treatment) part of the ‘after’ treatment had not had the desired effect on reducing the density of the tissue in my breasts. Normally this drug reduces the oestrogen in the system, which, in turn, reduces the density of the breast tissue, allowing easier diagnosis of future lumps with a mammogram. In my case the tissue has increased in density, making it even more difficult for the doctors to spot any potential problems. This, and several other factors, have put me in a ‘high risk’ category for future cancer. When I first learned this it really spun me around. For a week or so I felt rather stunned.
The surgeon offered to order an MRI for a more accurate assessment of the situation. At first I decided to defer it until next year, as she said that would be fine. But very soon I realised I would be living in the shadow of uncertainty for a whole year if I waited until next June to have the MRI at the same time I had the next mammogram. As we already had a vacation trip planned for Adelaide a month later, I decided to go ahead and have the MRI and see what happened. The problem with MRI’s is they are notorious for ‘false positives’… but of course you don’t know they are false until you have had the needle biopsies and followed up. Needle biopsies may sound like small potatoes, but my own experience last year was worse than the surgery to actually remove the cancer! This is not true for everyone, but for me it was no small decision as I could be opening a Pandora’s Box of ongoing unpleasantness! Nevertheless, knowing seemed preferable to living with the uncertainty. That’s always been my preference in life. Give me the facts, ma’am, just the facts…
A breast MRI is not like a normal MRI, and it may be like some others, I don’t know, I have not had them. All I can tell you is that I had a bone scan with dye injected into me last year and I coped fine with that one. I was lying on my back and breathed quietly while the ‘noisy tube’ did its job. But this time was different. First of all, a person always feels more vulnerable with almost no clothes on, and a paper dressing gown open at the front! The medical technician inserts a cannula into a vein in your arm because they don’t inject the dye before the test, but about two thirds of the way through, and the timing has to be fairly precise. I was led into the imaging room where I was asked to climb onto a ‘frame’ that lay on top of the normal MRI ‘bed’. I was told to position myself so that my breast bone and stomach bore the bulk of my body weight while my breasts hung loosely in the holes of the frame. I rested my head into an oval padded cut out (as for a massage table) and my arms stretched above my head onto a pillow. And then they asked “Are you comfortable?” Compared to what??? The lack of dignity one feels as one’s breasts are dangling in the space of the frame, while the rest of you is unattractively draped over the rest of the frame is hard to describe! But the most challenging part of the process was that I was instructed NOT to take a deep breath, but to breathe as quietly as possible for the entire 20 or so minutes!! And of course, knowing that you are inside a tube and cannot pull yourself out if you feel the need, doesn’t help. And last, but not least, the test itself is very noisy, sounding much like a jackhammer. They gave me a headset that muffled the noise somewhat, but this kind of makes you feel even more ‘detached’ from potential safety. Still, the noise was so loud I cannot imagine having nothing to muffle the sound. I could have opted for a headset playing very loud music but that didn’t sound very attractive either!
I managed to keep it together for the first 12 minutes. (But, of course I had no idea how long it had been because you have no sense of time during the test) And then a panic quickly took over me like nothing I have ever before experienced. I could only say that I was having a panic attack. I squeezed the ‘panic button’ they had shoved into my left hand before I went into the tube, and a voice that sounded very feint asked if I was having a problem? That question sounds laughable now, but at the time I answered quite seriously and with tears in my eyes, “I can’t breathe. I think I’m having a panic attack”. The voice said “okay, stay still and we’ll get you out.” Stay still? Could I actually do that? True to his word they quickly extracted me from the tube and I immediately felt the other technician beside me, her cool hands on my back and my arm. Cool hands. Confirmation of the outside world.
She calmly said to try and stay still and asked me how I was feeling. I told her I felt I couldn’t breathe, that I needed a deep breath but knew I wasn’t supposed to. She encouraged me to breathe deeply several times but to try and stay still, in the same position. As I did I realised I was quickly calming down. I was right, I thought, I needed to breathe deeply!! (And of course, this is our own inbuilt coping mechanism when we are stressed, to breath deeply to calm ourselves) She told me I was 12 minutes into the test and there were about 8 minutes left and that would be the most crucial in terms of stillness. The dye would be injected at this stage and they would not be able to stop the test again without losing the results. No pressure. After half a dozen or so breaths I felt much more calm, amazingly more calm… and while I was not keen to go back into that tube, I also didn’t want my effort thus far to be wasted so I said I thought I could finish. There was a chance, they told me, that when the dye was injected it would cause slight nausea or even a metallic taste in my mouth, or a cold feeling when it went into my arm. Thank God none of those things happened.
At the end of the test when I had to get off the ‘bed’ my whole body was trembling. But I had done it. It was over and I could get dressed and be a normal person again. I walked out into the cool winter air and looked up at the blue, cloud studded sky and wanted to do my happy dance. That’s probably not a pretty sight so I did it inside my heart, and felt the joy one feels on the last day of school!
I have gone over things in my mind many times since the MRI, to try and think if there is anything I could do differently, so that the outcome could be less distressing for me. The biggest difficulty I felt was the weight of my body on my breast bone and stomach, which meant that I could not even take a shallow breath easily. There is nothing I can do to change that, unfortunately. I did have a bad dream and several breathless awakenings at night the following few days. I hasten to add that not everyone finds this process as distressing as did I. I know of one person who says she fell asleep while having an MRI. I can only imagine she was very sleep deprived beforehand! However, I do wonder now that I am very clear about the process, if that may not reduce future anxiety. One can hope!
I have an entire year to think about (dread?) next year’s MRI but the surgeon tells me she can prescribe something to calm me beforehand if I choose to go ahead. She assures me there are many women who struggle with this test, which is why she doesn’t routinely suggest it for her patients, unless there is strong reason. But hey, the test results were clear and once again I’m doing my happy dance inside!
(A very interesting book about the history of cancer and its treatment is “The Emperor of All Maladies” by Siddhartha Mukherjee and is available on Amazon. I highly recommend this to those who have had cancer or who want to know more about it. It is very readable and helps understand the complexities of this disease and the treatments)