Palliative Care

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Dr. Tom Caprio, a geriatrician, talks about Palliative Care.  Find out what Palliative Care is and what Palliative care isn’t.  Questions and comments are encouraged, so don’t be shy.  If there is something about Palliative Care you’d like to know about, leave a comment for Dr. Caprio.

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The Value of the Geriatrician

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Tom Caprio, MD is a practicing geriatrician.  In this video, Dr. Caprio defines the role of the geriatrician and gives examples of how the geriatrician plays an important role in the health of a senior.  You can find out more about Dr. Caprio by reading his bio on About Us. 

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Mammogram Morning

Mammogram Morning

BLOGGER:  ARIN GOLDMAN

Though October may be the official breast cancer awareness month, January is the month I have my annual mammogram.  As the daughter of a breast cancer survivor I am always nervous before my “mammo” but I have managed to control my apprehension level by following an annual routine.  On mammo morning I go for a run, shower,  resist the urge to put on deodorant, get to the radiologist’s office early and, once told  that my scans are clean, breathe a huge sigh of relief, schedule next year’s appointment and go out for something chocolate.  I had no reason to believe that last year’s routine would be any different but it was:  I flunked.

After taking the normal set of pictures, the technician came back to take another one of my left breast.  Since it is not that unusual to need a do-over or two, I was not  initially alarmed but that changed when she kept coming back for still more shots.  On the fourth take I started to hyperventilate and called for the as yet unseen radiologist who appeared to calmly explain  (just to be clear - she was calm, I was not) that the scans had located a cluster of micro-calcifications within my left breast, something that wasn’t there last year.  She explained that a micro-calcification cluster could be an early stage of breast cancer.  While she reassured me it was likely to be nothing, she said that it was important for me to have a biopsy and offered up an appointment for a stereotactic needle biopsy. Though I had little idea what that was I took the next available appointment for the following Friday, thankful that she did not think it was an emergency, but still very spooked.  When nothing else showed up on my accompanying sonogram,  I left the office clutching a piece of paper with the instructions for how to prepare for day of the biopsy, thoroughly confused by what a cluster of calcifications was and what I really should do next.

Ten years ago when my mother had needed a breast biopsy it was performed by a surgeon.   Was a radiologist the right specialist for this procedure?  I thought that I was medically savvy, but I had no idea what a stereotactic biopsy was, nor what it entailed.  I always scheduled my mammogram to take place mid-week because early on I had decided that if a problem was ever detected I would want to use one of my life lines and “call an expert” right away without any weekend interruption.  I was relieved that this year was no different and immediately called a high school friend,  a surgeon who headed up the breast cancer unit of a major medical center.   She confirmed  that times had changed with the less invasive stereotactic needle biopsy procedure replacing the scalpel for evaluation of calcifications like mine.  She also verified that this was a procedure best performed by a skilled radiologist.  Familiar with my radiologist and comfortable with her capabilities, she recommended that I go ahead with the procedure making sure to copy her on the results in case further action was required. 

Having contacted the expert, my next step was a Google search.  The ability to research medical conditions firsthand is a bit of a mixed blessing, there is a great deal of information available on the Internet but  alot of it is alarming.  Still  despite my jitters I needed to know more so I started surfing.  It did not take long to locate the information I was seeking. Individual calcifications generally do not raise much concern and frequently are just monitored closely.   However, micro-calcification clusters could be nothing at all or a stage zero or stage one form of breast cancer called ductal carcinoma in situ (DCIS).   While the term stage zero might sound pretty innocent, treatment involves both a lumpectomy and a program of radiation, not the news I wanted to hear but what I needed to know.  In terms of percentages, what the doctors had described as a highly unlikely chance of cancer was referred to on the web as a 15 to 20% probability. Thought not as much of a slamdunk as I hoped for, the odds were in my favor  that  this would  turn out to be nothing and if it was cancer my mammogram would have served its purpose by catching it at a very early, treatable stage.

On the day of the biopsy I arrived at the radiologist’s office still unsure of all the procedure entailed but anxious to get it over with.   First I was asked to lie down on a table with my breast positioned over a large hole.  A position as awkward as it sounds. A number of scans were taken to insure that I was positioned so that the targeted calcifications were accessible to the doctor. Given the location of my cluster and the modest size of my breast I had to be pan-caked into the table before the desired view was achieved and then, with the help of a few clips, I had to remain still for the next 45 minutes or so while the biopsy was completed.  The doctor had explained that this was the hardest part of the biopsy.  Awkwardly clamped to the table I found myself hoping that she had been telling the truth.  Fortunately it turned out that she was right, although very uncomfortable, there was nothing painful about the procedure itself.  After injecting my breast with a local anesthetic, a shot less painful than one at the dentist’s office, the radiologist employed a mechanically guided needle to individually remove each of the calcifications.  Once removed, a tiny tag was inserted into my breast to assist in the identification of the site in case any additional procedures were necessary.  No stitches were required; the radiologist merely covered the needle hole with a water proof bandage and  made me promise to wear a jog bra at all times for a few days for compression, to restrict my activities and to keep the wound site dry through the weekend so that there would be no bleeding or scar.  I went home, took it easy overnight, and then spent the weekend walking my dog with one arm,  replacing my usual run with time on the elliptical machine and trying hard to banish any alarming thoughts from my overactive brain.

On Monday, earlier than expected while I was in the shower examining the tiny red scar on my left breast, the doctor called with the best of all results. Everything was fine, my cluster was benign; no additional actions were required.  After the call, I dried off and got dressed, made an appointment for next year’s mammogram and went out for that much deserved chocolate anything.  One year later I am happy to report that this year’s mammogram morning went off with out a hitch.

To find out about Arin, click here to read her bio.

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