As you will likely remember but let’s have a link anyway, I don’t want to act like I assume you are hanging on my every word, I was scheduled for a biopsy today to investigate some microcalcifications. I loved the radiologist, who explained excitedly to me that the biopsy involved using TRIGONOMETRY. I have such a crush on women in STEM who love their jobs (I am similarly smitten with our oral surgeon, who wears a headlamp at all times); I hung on her every word, even though I myself would not remember how to use trigonometry even if you dangled me off the side of a cliff and threatened to let go unless I could find a cosine. (I got an A in Trigonometry in high school, but it is because I am very good at test-taking and at figuring out which problems to plug into which formulas, and not because I ever remotely understood what I was doing.)
Where was I? Oh, yes: so today was the day of the biopsy. I was a little nervous. The instructions said I could wear deodorant if I wanted to, which was nice. I was not supposed to take any blood-thinners of any kind (including ibuprofen) for 72 hours beforehand. It was suggested that I have a meal before the appointment, to avoid getting faint/shaky. I did not like the sound of “getting faint/shaky.”
As with a mammogram, I was instructed to undress down to the waist and put on the hospital smock “like a bathrobe” (opening in front). Unlike during a mammogram, I had to climb up onto a high table (as in, I had a two-step stepstool to help me, and I used both steps). The table had a hole in the middle of it. I am always anxious about positioning myself on tables for medical purposes (I feel clumsy, and when I’m nervous it’s harder to understand/follow the instructions), and I would say this particular positioning was one I was glad to have had a chance to gear up for (the radiologist gave me an overview when she was telling me I needed a biopsy). I talked myself through it by telling myself that I am HARDLY the only person who does not have experience in how to correctly lie down on a breast biopsy table, and that I am DEFINITELY NOT the only person who needs to be adjusted after the first attempt.
Anyway. The basic idea is this: one lies down on the table on one’s stomach so that The Breast in Question is down through the hole in the table, but the Breast Not in Question as well as The Ribcage Below the Breast in Question are well-supported by the surrounding table, so you don’t feel as if you will fall through. They give you a couple of thin soft pads to position under your head as you prefer; I found it most comfy to use both pads and also put my hand under the pads for a little extra lift—but this is how I sleep, with a hand under my pillow, so maybe that’s just what felt Right to me, and not what would feel Right to others. In my case, The Breast in Question was the left one, so I was supposed to turn my head to my right, and it was my right arm that was up under my head; I wanted my left arm up like that too, in a sort of Sunbather’s Pose, but they did not let me do that: my left arm had to be down by my side, palm up. It felt okay once I got used to it, but still a little awkward.
The most difficult part is RELAXING. You don’t have to hold yourself up! You are lying down, and well-supported! But it FELT like I had to hold myself up. I kept having to remind myself that I could just lie there and rest and be as comfy as possible, considering the circumstances.
Both the radiologist and the nurse were good about telling me what was going to happen next. It feels pretty weird, because you are lying there on your stomach and someone is messing with your boob FROM BELOW. It is hard to wrap one’s mind around it. And one ear is squashed, which makes it a little hard to hear, or makes it feel like it’s a little hard to hear.
There is a sort of mini mammogram machine underneath the table, so they arrange the breast into that, and then the machine squeezes—not as hard as during a mammogram, just a sort of firm grasp. The machine does imaging to make sure the breast is positioned correctly; they had to ungrasp and regrasp a few times to get things right.
I am hoping I am remembering to mention all the steps. They raised the table at some point, even higher than when I had to use a two-step stepstool to climb up onto it. It’s so the radiologist can sit UNDER the table to do the biopsy. This table-raising might have happened before the grasping/ungrasping/regrasping. (By the way: the radiologist mentioned that for people who CANNOT climb up onto the table or who would PREFER NOT TO, this procedure CAN be done with the patient seated. She said but most patients find it easier not to have to hold still in an upright position, and not to have to see the radiologist RIGHT THERE, and WITH THE NEEDLE, and so forth.)
Then the radiologist warned me she was going to clean the area, and there was a cold wet wiping sensation. Then she said she was going to do the numbing medication, and that there would be a pinch, and that I should NOT “rise up” but should instead “wiggle my feet.” Feet-wiggling was so distracting, I almost don’t remember how much the pinch hurt, but my memory is that it was less than a vaccination, but in that general range of pain: a little stab, but nothing that made me want to jump or gasp. Then she said she was going to do a second dose of numbing medication, but that I would probably feel it less than the first one, and that was correct: I still did feel something, but not much. A mosquito bite, a tiny sting.
Then the procedure itself began, and she warned me that the machine was going to make funny noises, and it did; I suggested it was the sound of trigonometry being done, because I was trying to impress her, but she said “What?” and then I had to repeat it. The noises were like…low-volume vacuuming noises, intermittent machine-running noises, cycling motor noises, that kind of thing. Nothing gross or scary, but I was glad she mentioned them. I could not FEEL much while this was happening. Sometimes I thought I felt Something, but nothing upsetting or painful—just, I could feel something happening in the breast region. At one point I felt a burning sensation inside the breast, but not painful, if that makes sense combined with the word “burning”: you know how if you take a perfectly-too-hot sip of tea/coffee/cocoa, there is a “burning” feeling in your throat but not ACTUALLY burning the way there is when you burn your tongue and you hate it? or if you get in a slightly-too-hot shower when you are chilly, it is a “burning” feeling but you are not actually yelping and turning it down? It was like that kind of burning: definitely I would use the word “burning,” but it did not hurt-hurt, it just caught my notice, like “Oh there is a burning sensation.”
Then it was done, and I don’t think this doctor and nurse had worked together much in the past, because there was a little bit of a dance about getting me out of the machine / up off the table. I am not certain, but I think the issue was that someone needed to apply pressure to the biopsy area the entire time I was (1) being extricated (i.e., as the mammogram machine was releasing its grip) and (2) extricating myself (i.e., as I was moving from lying on my stomach to sitting up), but there were not enough hands to do all the things, or rather not a coordinated/understood allocation of hands; and there was some concern that I would be pinched by part of the machine, but I was not. Anyway, it was managed: I was sitting up on the table, and the nurse was “applying compression”—that is, squeezing my breast hard between her hands, with a wad of gauze over the biopsy site. It’s not an everyday sort of thing to have happen, but she was so normal about it and that helped.
She had to keep squeezing for Quite Some Time. Five minutes? Something like that, possibly longer. Periodically she would peek under the gauze to check the bleeding. I don’t mind blood, so I looked too. There was more blood than I was expecting. When they said “needle biopsy,” I was picturing a needle like a vaccination needle, where sometimes there is a teensy little pinprick dot of blood. In this case I estimate there was half a teaspoon of blood involved total (and that’s only counting the times AFTER I was able to start looking); and the first two times she checked it, there was a sudden welling of blood about the diameter of a pea, maybe a little smaller. The diameter of a petite pea. It made me grateful I did not know beforehand (or afterhand) how big a biopsy needle is.
When the bleeding had mostly stopped, the radiologist applied two pieces of tape, and there was a word for the kind of tape but I have forgotten it. Steri-strips? Steri-tape? Something like that. [Update: I see the paperwork says “steristrips.”] She put them in an X shape over the area. The nurse then took me to have a “gentle” mammogram to make sure the little piece of titanium they put in there was in the right spot. (The radiologist called the titanium “internal breast bling,” and I could not love her more.) It was like a regular mammogram but much less squeezy, and they said the little piece of titanium was where it should be. (If it had NOT been where it should have been, there was no way to adjust it, but they would have noted the situation in my record to avoid confusion later on.)
The breast/skin area around the needle site looked a little deflated to me, but maybe I was imagining it. (I don’t think I’m imagining it. It looks a tiny bit caved in. Puckered.)
The nurse gave me a little (pink, everything breast-related is always pink) ice pack to put in my bra. It felt soothing and nice, but also it was a very hot day so I think it would have felt soothing/nice regardless. I may put ice packs in my bra every summer going forward. (The ice pack had adhesive to hold it in place, and I often get pink/itchy from adhesive, and it didn’t NEED adhesive because it could be tucked into the bra, and I DID get pink/itchy from the adhesive—so if there is a next time, next time I would ask them to skip the adhesive.
She asked me to rate the pain of the procedure on a scale of 1 to 10. I HAAAAATE those scales, and can’t believe how unscientific/subjective they are: dramatic people will say 10, it’s 10, MY SUFFERING IS ALWAYS A 10!! MAYBE A 12!! Careful anxious hand-wringing overthinkers will say “Well, 10 is supposed to be the worst pain I can possibly imagine, and I can imagine some really terrible pain like if I were shot multiple times or if I were being chewed on by an alligator or maybe I mean crocodile or maybe a shark would be worse, so I guess this excruciating, about-to-pass-out pain is probably a 4 or 5 compared to THAT.” Anyway, I told her the pain of the procedure was less than 1, about 1/2, and I feel good and non-hand-wringing about that assessment. Mayyyybe it was 1 at the worst, but I don’t think so. I think it was 1/2. Maybe less.
On the way home from the hospital, the numbing stuff started to wear off. I don’t know if everyone is like this, but when I get novocaine at the dentist office, as it wears off I get a fair amount of pain that seems to be THE PAIN OF THE NOVOCAINE DEPARTING, rather than THE PAIN THE NOVOCAINE WAS CLOAKING, if you see what I mean. That is, once the novocaine has fully worn off, I am not feeling that pain; it’s more like when a limb falls asleep and is waking up again, and you feel pain as it wakes up, but not after it is awakened. It’s one of the reasons I dread novocaine. Anyway it was like that: I felt an ache like novocaine wearing off. It was not VERY painful, but it was enough to make me want to stick my lower lip out and make a small self-pitying whining sound but not a SERIOUS one. I listened to soothing classical music, which I rarely do, but neither NPR nor my usual pop stations seemed right for the situation.
The ice-pack was small, and by the time I arrived home about 40 minutes later it was not cold. They’d mentioned it was reusable—but what to do while it is re-chilling? I am definitely saving it in case I ever have to have this done again, so that I can have one ice-pack in the bra and the other recharging. [Update: I put some frozen corn into a snack-sized ziplock baggie and tucked that into my bra, and swapped it with another snack-sized ziplock baggie of frozen corn each time it got uncold, and it was as good as or better than the ice pack they gave me, so I will just do that instead of indefinitely saving a used breast-care-center ice pack Just In Case.] I put the single ice-pack I had into the freezer, and I would say the sensation at the site of the biopsy could best be described as “stinging/aching.” Again, not terrible, not VERY painful—but stinging/aching. Putting the ice-pack back on awhile later was pleasant. The whole area feels Kind Of Sore—not agonizing, and I’m not flinching much if I accidentally touch/bump it, but I’m aware of it and it’s uncomfortable, and I am enjoying the cold of each fresh ice-pack.
There was a little bit of blood on my bra. They instructed me to wear a bra to the appointment, but I’d add that you should wear one you don’t mind getting a little bit of blood on. OLD bra. Old COMFY bra. They said I might want to wear the bra to bed tonight, to snug the owie part in and keep it from getting unexpectedly jostled. And I might. But I am someone who does not mind my bra, as opposed to someone who can’t wait to take it off each day, so your experience may vary.
I’m allowed to shower/bathe normally, but I am supposed to avoid washing the area of the biopsy, and I’m supposed to gently pat the area dry afterward. I am supposed to leave the special medical tape on until it falls off, or for four days, whichever comes first. (They said it will probably fall off after three days.) I am supposed to let them know if the area of the biopsy becomes hot/pink (infection). There is apparently a small chance of internal bleeding, which would leave a big swollen bruise but would be fine, and it would go away, it would just be icky/uncomfortable for a little while.
The radiologist will call me when she gets the results; she expects that to take two days, but says because today is Wednesday there’s a possibility the results won’t come in until after work Friday, in which case I wouldn’t hear from her until Monday.
Thank you. You always do such a great job of explaining things. I appreciate it.
Also, your radiologist sounds superb.
And now I am waiting with you, sending good thoughts. I hope you are well aware of the cadre of care package senders, Sees candy procurers, and good thought senders you have, should this all go tits up (couldn’t resist, plus I do actually say that in real life). But I am sending many “let this be the end of this particular adventure for Swistle” thoughts for it to not go tits up.
I love how you explain things too, and it often leads to some nice conversations with you in my head. I would often be at the grocery store going, “ Swistle said they were out of this, but we have it here” or something like that. I can imagine doing the same if I ever need a breast biopsy – thinking “Swistle told me about this part” or “This is different than how they do it at Swistle’s office.”
I join your team of readers whose fingers are crossed that this is all just precautionary with no bad outcomes.
First, I wish she had just told you to expect results on Monday! Now we’re all hoping for a Friday update and will be disappointed if she makes you wait three MORE days.
Also: I have regular mammograms and breast MRIs because I’m high risk. The MRI machine works while you’re on a table very like the one you described, but with two holes for your two boobs, and a small bar to support your sternum. You have to lie face down, looking straight down, and they give you a face support pillow like what you might see at a massage parlor. How long did the biopsy take? The MRI takes about 35 minutes and you have to lie perfectly still (sometimes not even breathing, which is fine but not when they don’t count you in and you’re caught off guard mid-breath). By the time they pull me out of the machine my arms are asleep from being straight above my head, and my sternum feels bruised.
Just in case you start needing regular MRIs. Can you even do that with the titanium speck? 🤔
Titanium is not magnetic.
I am not sure how long it took, and time can be weird during procedures, but if I had to estimate I’d say I was lying on my stomach for about 15 minutes. My right arm was starting to fall asleep but hadn’t yet. They told me I didn’t have to hold my breath for the imaging parts, but I found myself holding my breath anyway Just In Case.
They use titanium because it’s okay for MRIs and so forth; they also specified it wouldn’t set off detectors at airport security, which seemed amusing to mention.
I’ve had breast biopsies done on two occasions (at age 33 and 34 and a total of 5 spots if I remember correctly, my boobs are full of titanium markers). Both times were similar to what you described except they had me lay on my back with my arms over my head. Which I think I probably prefer to laying in my stomach? But I could see what they were doing including the massive needle device thing which was fine with me but I understand how some people might find it jarring.
I have the same concerns about the pain scale as you do, but I mentioned this to my PT during our every-fifth-visit evaluation of my progress and she said she is well aware of the discrepancies between people and is more interested in how the numbers move up or down (and also, she says she compensates a bit in her head: like, if a person who’s always AT A NINE!!! says they’re at a ten, she might not be as concerned as if a person who always says 2.5 when they’re visibly sweating and pale suddenly says they’re at a 4).
I don’t know why, but this made me feel better about the pain scale. Does it make choosing a number easier? Hahaha, no. But I am less worried that my probable underestimating is leading healthcare providers astray.
That is really good to know, because I too am one of those “It’s not as bad as having a fox chew out my entrails” people, and yet I am also one of those “I will feel stupid if I die because of my failure to report symptoms accurately” people.
A friend who had to have the procedure where both boobs hang down described it as incredibly painful, so I think our Swistle is probably unusually stoic, but having the description of everything that happened is invaluable. Even if I never need it, someone I know likely will.
How are you feeling about this, and about the wait?
I feel more okay than I would expect, considering how anxious I get about, for example, pretty much everything. I think it’s a combination of (1) This is something that is genuinely worthy of some anxiety, but I’m finding the “Anxiety won’t help in any way” method useful (why does this work for NOTHING ELSE); (2) It feels like we’re ticking through the steps to Find Out; (3) It feels like a relatively low chance of anything being wrong.
That “for example” clause made me LOL in a meeting, so, well done. :)
I am nodding with enthusiastic exasperation about that parenthetical. I have heard, and observed, that we anxious people are better in an emergency because we’ve already thought through the what-ifs and can just follow the plan calmly. At least that’s what I tell myself when lying awake carefully planning how I’d survive if my perfectly healthy, non-risk-taking husband dies suddenly.
Glad you’re doing on-the-okay-spectrum.
Interesting the different ways this is done. I’ve had two ‘needle aspirated biopsies’. Both times I was on my back and it was done using ultrasound as a guide and I did not have any titanium markers placed. My last one was a number years ago so maybe the technology has changed. I’ve had three breast MRIs. Not fun. Breasts hanging down through two holes and like Monica, my arms fell asleep. The last one I had, the technician was a man which surprised me a little and they did not tell me ahead of time. I suggested to the nurse afterwards that they should inform the patients, especially the older/elderly ones about that as it could make some women uncomfortable.
I send you all the good vibes possible for a clean outcome!
I don’t like the pain scale question either. After my C-section, doctors kept asking it. I could only say that lying here in bed with pain medication I feel very little pain, but as soon as I start to get out of bed or laugh or sneeze or whatever, the pain gets excruciating very fast. I mean, what do you expect? They just wanted to know changes in pain I suppose.
After my C-sections they would always start with the pain question; I quickly learned to say “well it’s a 4 now but you plan on touching me, right? Ask me after” and nobody was amused by me. But seriously, you’re going to poke my incision and feel for my uterus FROM OUTSIDE and then not give me pain pills? No, all the pills, please.
The pain scale is ridiculous. I get so flustered every time and worry I am under-rating so that the person will think, “Oh, okay! Not so bad!” and not Deal With It properly… or that I am over-rating so that they will scoff and say, “No way it’s THAT bad. Drama queen much?” and not Deal With It properly.
Internal breast bling is amazing.
Thinking “slow week” thoughts in your lab’s direction so that they read your results quickly.
I am considered high risk and I have mammograms, MRIs and sonograms — one procedure every 4 months through the year. I have have two needle biopsies and two surgical biopsies. They have always turned out to be “something has changed but it isn’t concerning, we’ll make a note”. Hoping the same for you!
I’m also in love with all my woman doctors! Once I’m sedated for a procedure, I’m all “girrrrrl, do you know I love you?”
“Dope Squad” is the SNL skit that says it best, with Poehler and Fey.
Holy cow I was not familiar with that SNL skit, thank you :D
Thank you so much for posting about this – it really helps us nervous folks to read these types of posts. :) As a person living alone with no local friends, I’m curious – were you able to drive yourself home after the appointment? (I really dread the next time I have to do a Medical Thing that requires me to bring a driver with me.)
Here’s to getting the results quickly so you don’t have to wait the weekend!
I know what you mean, I have in the past often not had local friends/family. A suggestion: last year I had Lasik, and I couldn’t get a ride arranged for various reasons, and I used Uber. For some reason I thought the clinic might not like that but they were totally fine with it and it was clear I was not the first to do so. It was a little weird to be in a stranger’s car while semi-blind and Xanaxed, but it all went fine. It was clear that it was also not the driver’s first time in that situation. I live out in the sticks outside a metro area, so it was a little pricey, but worth it.
Yes, I was able to drive myself.
ASK PEOPLE! What is it with women not wanting to be a bother? Or to admit they’re having a medical procedure?
One of my best friends was going to cancel her asscam appointment because her spouse had to go out of town unexpectedly. I only found out because she mentioned the trip and I remembered that she had an appointment and asked. So I drove her and provided a post-procedure meal and someone got proper medical care.
Any chance you’re near DC? I’ll drive you!
I second Uber! My dad (70s) has started taking them to/from Doctor Stuff partly just because he gets anxious about medical things and doesn’t want to deal with driving and traffic on top of everything else, but it’s been working out wonderfully.
Our high today is “only” 99 but I’m going to put an icepack in my bra anyway.
Wishing you much calm and peace, and a quick and harmless answer by Friday.
I am so uncertain of what to say that I nearly didn’t comment. Because I’m sure everything will be fine, but I don’t want to dismiss the whole situation as not worth worrying about, because I would absolutely worry regardless of what anyone told me. But I thought it was cowardly to just duck out, so I’m here to say I love you (in that internet way) and I’m sure everything will be fine, and I love how you explained this all for us. You’re like our intrepid field reporter, experiencing the experiences so we, the Swistle Army, are all well prepared. You’re like our own Katie Couric, but funnier.
Interesting & very thorough description. I had a needle biopsy about 10 years ago. I think I was fortunate that the radiologist in our local hospital developed an “ultrasound guided biopsy” procedure and it was fairly simple, lay on your back- the nurse manoeuvres the ultrasound while the radiologist does the needle part. I believe this is how it’s now done in our area- too bad that hasn’t spread. I also recall that they called me at about 6 pm Friday evening just because they didn’t want me to worry over the weekend. So considerate – I do hope you get your (it’s nothing!) results quickly.
Thank you so much for this post. I really appreciate it.
On the pain scale, I ignore the 1 – 10 scale and tell them if it’s better or worse than X (“this hurts worse than when I broke my toe but not as much as when I broke my nose”, “This is the worst pain I’ve ever felt” (contractions on pitocin),
Your “burning sensation” description is EXACTLY the kind of thing I use. Thanks again. I hope you get the information back quickly. I’m so glad your experience was as good as it could be.
XOXOXO
I do this too! I tell them “I’m saving ten for when I’m shot, and nine was when I had a kidney infection when I was pregnant, so… seven?”
I am someone who does best knowing What To Expect in an unknown situation and I very much appreciate posts like this (I very much appreciate all of your posts actually, but particularly ones like this that I can use as a reference in the future if I’m ever in the same situation.) Everyone’s experience is different and it’s not like ours would be exactly like yours, but just having a general idea of what to expect is so reassuring and I’m thankful for you.
On the pain scale front, I really like pain scale #11 at this link:
https://paindoctor.com/pain-scales/
I have chronic migraine and have to rate my migraine pain every time I see the doctor. I pull this up on my phone each time and say the number and read the words to let the doctor/nurse know exactly what I mean. It keeps me consistent and gives them a lot more information than a number pulled out of the air.
Yes. That pain scale would work for me
Thank you so much for this detailed description. Very interesting! Also basically @Corinne said about my whole comment in hers, above, so — that. But also, for those who don’t already know it, now (mostly) inactive blogger Hyperbole and a Half did a nice revision of the pain scale some years back — http://hyperboleandahalf.blogspot.com/2010/02/boyfriend-doesnt-have-ebola-probably.html .
I love this essay by Eula Biss on the pain scale: https://www.snreview.org/biss.pdf
Thanks for sharing this! She’s funny!
This is an incredible essay!
I so, so appreciate the calm, THOROUGH way that you go over these kinds of experiences. You know what you would be good at? Writing descriptions of shows for visually impaired people to hear.
Also, your paragraph about the pain scale had me rolling. As a fellow “careful anxious hand-wringing overthinker” I salute you. If you’re ok with that, I mean. You don’t have to.
Thank you SO much for the clear, thoughtful rundown of your procedure. Thinking of you with fingers crossed that this will all be a blip and a distant memory soon.
That pretty much describes exactly what happened when I had the same procedure done. Your radiologist sounds amazing. I’m glad to hear that you are employing “The Anxiety Won’t Help in Any Way” method. Fingers crossed you hear something before Monday.
Interesting. This is quite a bit different from my needle biopsy (other than the realization of how much bigger the needle is than I had anticipated – with you on that). I had massive bruising afterwards, and also had a lot of reaction to adhesive – this was more of a problem than the actual procedure. The nurse I had was amazing at explaining exactly how everything was going to work, and I really appreciated it. My results were delayed by the tornado event we had that caused a days-long power outage – hope yours come soon, and are favourable.
I had a biopsy at one point and I’m pretty sure I was on my back and they used an ultrasound. Interestingly, I discovered as I read this that I remember almost nothing else except the radiologist cracking jokes to distract me. She was pretty funny too, so go smart-ass radiologists!
Hoping very much that this will turn out to be nothing for you.
This was interesting to read, and I’m very glad it’s over! I hope you don’t have to do it ever again.