pathology report

Pathology reports are terrifying. I can think of no other grouping of 8 1/2 x 11 inch paper with the potential to inflict such rack & ruin. Four measly pages, what might otherwise be considered a rudimentary book report, but with the power to turn your insides to ice water at one glance.

Reading a pathology report is a combination of a race to the finish to see if there’s anything terrible contained therein, with a good helping of “WTH does that mean??” rounded out by the distinct feeling of utter confusion. It’s also a little weird to read about your own body in such clinical, anatomical, far-removed-from-me-as-a-person way. Oh, how I would love to sit down and have a beer with Gustavo de la Rosa, MD, aka the pathologist who wrote my latest report. Since he would likely think I was stalking him, I decided to leave him alone and do my own research.

Unlike previous pathology reports, this one, from the Big Dig, seems pretty positive and full of good news, and more importantly, free of any bad news. Important distinction, that. On the first page alone, it says “No evidence of malignancy” 6 times. Holla! I also learned a new word in reading that report:¬†papule. Any ideas what that means? Click on it to find out. My education continues; shouldn’t yours?

It’s interesting how the pathologist describes the different chunks of my body that were offered up as samples: “Received in formalin, labeled ‘left breast capsule’ is a piece of fibrous tissue measuring 12.5 x 7 x 0.3 cm. One surface is tan-pink, smooth and glistening, and the other is tan-brown and roughened with some unremarkable yellow, lobulated adipose tissue but no gross lesions are identified.’ ” I think Dr de la Rosa could have a career as a copywriter. The descriptions of the colors alone are noteworthy: who knew my innards were tan-pink, tan-brown, yellow, white-tan, and yellow-brown? There are also references to pectoralis muscle, striated muscle, intercostal muscle, cartilage, soft tissue, fragmented tissue, fibrofatty tissue and fibrous tissue, not fatty.

foreign body giant cell reaction

Long story short in the 7 categories of chunks of me that were tested is no evidence of¬†malignancy, but evidence abounds of “foreign body giant cell reaction consistent with implant capsule” on the left, which means the left side of my body didn’t like the tissue expander placed there during the mastectomy. The right side disliked it even more, with “florid foreign body giant cell reaction.” Florid means it really didn’t like the expander. I always associate florid with rosiness or abundance, so perhaps that applies to florid foreign body giant cell reaction, as in abundant or highly developed bacteria growth. Not such a rosy picture after all. The pretty pink photo above is deceiving. When I first saw it I thought, ooooh, pretty. Then I realized that it’s some seriously ticked-off cells having a gigantic inflammatory reaction to an unwelcome visitor. Yikes.

The methodical and organized way in which the information is laid out appeals to me, with the Anatomic Pathology Diagnosis broken down into 8 sections, A through H. Each section is a different chunk of flesh that was tested and range from the tissue expander itself to left pectoralis muscle to soft tissue and lymph nodes.

The gross description of the tissue expander is pretty darn detailed: “left breast tissue expander is a flattened, spherical mesh structure with a circular plastic disc on one aspect measuring 4 cm in diameter. On one side it is inscribed with ‘Mentor’ and ‘MH 550 cc.’ This specimen is submitted for gross identification only.”

“Gross identification” doesn’t mean it was nasty, but done with the naked eye instead of under a microscope. Putting a tissue expander under a microscope doesn’t make any sense, but then again, neither does the phrase “naked eye” because when exactly do eyes wear clothing? These are the thoughts that plague me while reading about my smooth and glistening, white-tan fibrous skin.

Dear Santa,

I’ve been a pretty good girl this year. I’ve smiled at fussy babies in checkout lines at HEB. I did my time at the grade-school class parties (not my scene, to say the least). I called the collection agency back — yes, I really did — when they left me a message saying I owed money on a past-due hospital bill that my insurance company says has been paid. I donated nearly-new clothes & home goods to charities multiple times. I helped out with the school fundraiser, even though I really, really, didn’t want to. I’ve said please and thank you and bring my own bags. I was a big girl and good sport about all the trips and baseball games I missed this past summer.

And while we’re on the topic of this past summer, dear Santa, do ya remember all the hell I went through? It all started on April 27, 2010, when I was diagnosed with breast cancer. Talk about an “aha” moment. The timeline quickly unfolded like this: the rest of April and first part of May were consumed with tests, tests, and more tests: BRAC analysis, CT scans, x-rays, PET scan, bone scans and MRI. In case that’s not enough acronyms for ya, there was also the L-Dex and then the genomic typing of ER/PR positive and HER2 negative. More injections and blood draws than my poor left arm’s veins could keep up with (literally; there’s a permanent knot in the big vein). Countless appointments with the breast surgeon (Dr Dempsey, who is on the “nice” list) and plastic surgeon (Dr S, who may be on the naughty list), and 3 different oncologists.

Meanwhile, there was research to be done and crushing decisions to be made as I prepared for surgery. The phrase “life and death” took on a whole new meaning, sweet Santa. There’s a strange juxtaposition between packing school lunches and signing field trip permission slips while also filling out my medical directive and living will. I learned pretty fast how to act normal when everything around me had been turned upside down. I think, dear Santa, I also did a pretty good job of adjusting and adapting to the new normal. I think, fat man, I’m still doing a damn fine job of that. One quick look at my profile tells you that there most definitely is a new normal around here.

Santa baby, I was a good girl after the double mastectomy and the lymph node removal that left me battle-scarred and weary. I was an especially good girl in the face of the plethora of prescription drugs I could have used & abused. I was a diligent girl when it came to choosing green drink over Diet Coke, all-natural hormone-free yogurt over Blue Bell.

Santa, I was a brave and good girl when the nasty infection set up shop in my still-raw chest wall. I endured the 103-degree fevers, 22 days in the hospital, multiple tissue excisions and untold poking & prodding without much complaint. I missed the comforts of home, my dogs & my kids more than words can say, but I only cried twice. And even then, it was when no one else was around to see.

We don’t even need to recount the 18 days during which I was attached to the wound vac 24-7. I would really like, dear Santa, to permanently erase that memory from my grey matter, por favor. But I would like to remind you that I was a trouper during the home health days, and all those hours that were consumed with wound care and the administration of IV antibiotics. And while I’m at it, can I get a little shout-out for not killing Dr S, even though he probably deserved it?

Oh Santa, I do crave some credit for all the antibiotics I’ve endured — and continue to endure. From the Vancomycin to Cefapim, from the Cipro to the Zyvox, from the Biaxin to the Bactrim and Minocycline. Those last two will be part of my daily routine for a few months yet, but I’m already looking forward to the day in which I don’t have them on my kitchen counter anymore.

So Santa, how about we make a deal? I’ll set out all the milk & cookies you want in exchange for one little thing. All I want for Christmas is to have it easy for awhile.