Yesterday it was reported that a doctor’s appointment was had with Doctora Elena Velderrain. Also visited yesterday was the curious but very pleasant Doctor Pedro Velderrain, Elena’s brother. He is an ultrasound specialist and as such works closely with his sister who is an obstetrician and gynecologist. They share patients naturally. She reviews the progress of pregnancies and he takes the developing babies’ photographs. She also does manual breast examinations and he uses ultrasound to determine the nature of any abnormalities she encounters.
The visit to Dr. Pedro was recommended by his sister at an appointment over a year ago. She reported that ultrasound was just as effective at finding lumps in the breast and much more accessible and economic than a mammogram. She did not mention a more important detail, which is that it is also a lot less tortuous, breasts are not squished pancake fashion in a vice-like machine.
The doctor first took the family history and there was an opportunity to look around his office. There were pictures under the glass of his desk, just like in his sister’s office. Ultrasounds of perfect little faces of sleeping babies (fetuses) waiting until it was time to join the rest of us. The faces appeared serene, as though sleeping, or maybe meditating.
The main reason for appearing, it was reported to the doctor, was that a sister had been diagnosed with breast cancer [and is fortunately cancer free now after a lumpectomy followed by a series of chemo- and then radiation therapy]. My father’s mother died of breast cancer. Therefore there is a higher risk of developing breast cancer.
The hospital gown was put on, open to the front, but this time only shirt and bra had to be removed, significantly less uncomfortable. And onto the table.
The doctor is experienced, 20 years, looking for cancer in the breasts of women, checking the well-being of fetuses. And he is personable much like his sister. Very pleasant. Which puts the patient at ease while he runs his gel-covered wand over the breasts, or in Spanish, pechos.
Also like his sister the good doctor has a television monitor above the table where you see what he sees. Expressing an interest in the details of what we are looking at results in a full explanation.
“The white lines are called Cooper’s ligaments, connective tissue of the breast. That is a fat deposit, these are ducts and this….this is a cyst. Well defined…tiny…less than half a centimeter.” Sensing the tension of the patient “and nothing to worry about.” Of course an explanation of what a cyst is was required. “A duct has collapsed and the body encapsulates the resulting discharge. This is a tiny one. Nothing to worry about. I can show you video of a cyst being aspirated if you like. ”
The video magically appears on the screen. It is explained that the large black oval delineated by white lines at the top of the screen is the cyst. An arched line below some fuzzy tissue is a breast implant. Then, from the right side of the screen a fine line enters the field of vision goes into the oval, the cyst, and before our eyes the cyst shrinks and collapses as the fluid is removed. Almost like magic.
Then the doctor produces an image of an ultrasound of advanced breast cancer. “This was a friend of our family. She knew that there was something wrong with her breasts, but she refused to come in because she was afraid to hear the diagnosis. By the time she came in several years after noticing the lump, this is what I found. Two large masses. She died six months after this image was taken.”
A potent reminder of the importance of regular examinations and that fear is a poor motivator. The same fear resulted in a long delay between the previous mammogram and this current ultrasound. Unacceptable. Of course now that the experience is had there is no more fear. The process is simple and painless.
There is nothing to fear but fear itself.
“Come back if the cyst bothers you and I can aspirate it. And be sure to come back again in six months regardless. Unlike a mammogram, you can have ultrasound regularly because there is no exposure to radiation. Your history means you should do this. And keep eating healthy!”
A file folder was offered and inside were photos, this time of breast tissue, specifically the cyst, and a full description of the findings of his examination (in Spanish). Total cost 900 pesos ($65).
A little research and it was found that “fibrocystic breast changes” (cysts in the breasts) are very common. Between 30 and 60 percent of women have them. This means that up to 60 percent of women have reason to have their breasts examined thoroughly by ultrasound to ensure that they are indeed cysts and not a malignancy. It is not necessary to have them aspirated and many will disappear on their own. Nevertheless, women finding lumps in their breasts should have them examined by ultrasound and may be relieved to discover that it is only a benign cyst. Either way, it is important to conduct regular self examinations and to have regular check ups, particularly if you have a family history of breast cancer. Don’t let fear get in your way.