How just saying I was an Ironman kept me out of general surgery

An unexpected upside of completing a full distance triathlon

Completing an iron-distance triathlon has done a lot for me, particularly giving me a confidence boost in other areas of life, but I never thought it would impact my medical care.

You just never know when your radiologist will turn out to be a triathlete, and your diagnostic plan will hinge on his trust in your ability to endure.

Small talk

Early this year at the age of 35, I underwent my first mammogram, at the recommendation of my doctor. The purpose was to establish a baseline for future imaging at age 40 and beyond. I have what we on BT kindly refer to as "aero-boobs" and have never had any lumps or anything irregular.

To my surprise, I received a phone call two days after the procedure asking me to schedule a repeat mammogram, using a magnifying mammogram machine.

My rational mind was unconcerned. I'm young, healthy and have no family history of breast cancer. Besides, if what they saw was so tiny they have to magnify it, it can't be a big deal. The feeling of dread in my belly was simply a normal reaction to this kind of phone call.

I returned for the magnified imaging, which they read and interpreted on the spot. The called me from the waiting room to immediately schedule a needle biopsy to get a piece of these tiny little dots of calcification and check them for cancer cells. This was all happening pretty quickly, but I remained (mostly) calm.

The center had a nurse, Mary Grace, on staff to counsel patients about what to expect in the biopsy. I could tell she was used to talking to women who are scared to death and think they are going to die within a week. I asked my questions (What is calcification exactly? What causes it?) and changed the subject to kids and good books. In the course of discussing how rapid cell growth and/or death leaves behind calcification spots, I mentioned that I work out a lot and I wonder if the rapid cell growth or death could be caused by that. Mary Grace wasn't sure, but asked some follow up questions about my fitness. We talked about triathlons and what they are and the distances of the various races.

A bad option

My next appointment was with a breast surgeon. (They cleverly entitled her a "breast specialist" on her business card so as not to frighten people.) It was while talking with her that the word "general surgery" was first uttered.

The usual plan is to poke a big needle in there, take a little core sample, and test it.

The easiest way to do this is with the patient lying on her back, using an ultrasound wand to pinpoint the correct spot. This was not possible, because the problematic little calcium things were too small to be seen on the ultrasound. We tried.

The next best way is to have the patient lie face down on a table with holes cut in it for the breasts to poke through, squeeze the breast in the mammography machine, take an image, then aim for the spot with the needle and hope for the best. This sounded like a fine plan to me, but the surgeon looked uncomfortable as she was trying to explain why she thought this might not work.

For one thing, the calcifications were at the back of the breast on the pectoral wall, so that made them hard to reach. But there seemed to be some other problem. I kept asking questions until finally I realized that my "aero boobs" were the problem, because they would not stick far enough through the table to be clamped into the mammography machine.

I thought that was kind of funny. Right up until she mentioned the alternative. "If that doesn't work, we'll just schedule you next door for general surgery," she said.

What?

Being anesthetized and cut open was not part of the plan. I asked if perhaps we could take a "wait-and-see" approach. She nixed that idea. So it was with some trepidation that I arrived at the biopsy appointment the next day.

My arm, too

I arrived in the biopsy room to see staff bustling about, including the kind nurse with whom I had first made small talk about triathlon. They were clearly concerned about the plan to try to get at the correct spot, given the constraints of the table. A few minutes after I sat down, the nurse asked if I thought I could put my arm, shoulder AND breast through the round hole in the table. That would enable them to find a better angle and to smoosh my boob harder in the vise-like imaging machine. I said, "Sure. Of course I can."

They did not mention how long I would need to stay like that.

After I was in the correct position, lying with my hips tilted so I was sort of on my side and sort of on my belly, there was a lot of puttering about, stuffing towels and padding here and there. "It really isn't that uncomfortable," I said. "You don't have to worry about it."

"Well, we don't want you to fidget or for your arm to fall asleep or anything," said the nurse. "I don't know if we mentioned this, but you can't move at all once we start. They take an image and then aim for the spot with the needle. If you move even a little, it messes up everything."

Oh.

"In that case, it's pinching a little bit behind my shoulder," I said.

One technician moved some equipment around and asked if it was better.

"Well," I said, "It's pretty good. How long do I have to stay like this?"

She made a face.

"I'm just saying, is it more like five minutes or more like 20 minutes?"

Her eyes grew large. "Oh, it will definitely be at least 20 minutes!" she said.

Okay, well this was a whole other ball game then. But I could handle it.

At this point the radiologist strode into the room, looking over my awkward position with some suspicion. He talked to the nurses and then asked me if was going to be OK like that.

"Sure," I said. "Didn't Mary Grace tell you I'm an Ironman?"

The radiologist, a fit-looking guy in his 40s, shot the nurse a joking glance. "Mary Grace!" he pretended to scold.

"I told you she was a triathlete," insisted Mary Grace.

"Mary Grace, a triathlete and an Ironman are two very different things!" he said, confiding to me that he races sprint and olympic triathlons himself.

I smiled. He visibly relaxed.

He took a last look over the equipment and the images they had already taken, which were visible across the room on a monitor. He drew in his breath.

"OK, gang, this is it. We're going to go for it."

Ouch

Things grew quiet in the room as everyone set to work.

Soon enough, my chest was anesthetized as well as it was going to be, I was asked to brace myself, and a needle the size of a soda straw was buried in my flesh. There were clicking noises, pain, more clicking, more images taken, more moving of the needle, and then they hit a nerve with the needle.

They said I couldn't move, but they didn't say I couldn't use profanity.

The doctor, nurses and technicians stopped to shoot more anesthesia into the area, but apparently the covering over the pectoral muscle doesn't exactly absorb the stuff.

Finally, it was over. More than an hour had passed since they told me not to move a muscle. They rushed my little core samples to another room to be X-rayed, ensuring they had captured at least a couple of the little spots they were after. When they confirmed they had captured everything they were looking for, I was allowed to extract myself from my extreme pose and sit up. As a special bonus, I was taken to another room to have yet another mammogram on my bruised and bleeding breast.

The radiologist was beaming afterward. "We didn't want to scare you beforehand, but we usually joke around a lot more than this. It was pretty tense in here," he said. "This was one of the more difficult ones of these we've ever done."

He credited me with my willingness to endure discomfort and my ability to hold still. I credited him with saving me from being cut open in general surgery.

I was still feeling blustery and full of myself, asking when I could run and swim again. As it turned out, I wouldn't feel like swimming for a while, and running was a painful proposition for a couple weeks. In fact, driving a stick shift home was not fun, and I had to turn the steering wheel with two hands.

But that Friday at 5 p.m., I had a voice mail indicating the sample they had taken was clear. No trace of cancer or pre-cancerous cells.

And thanks to iron-distance triathlon, I only have a tiny scar from the needle instead of a big one from a scalpel, and my medical bill was only a few thousand dollars instead of $10,000 or more.

You never know when you're going to encounter another triathlete, and how it might impact your life!