A Door Unopened

A Door Unopened
Knock, knock...

Thursday, October 17, 2013

Blogging my breasts: Who you Calling Dense?

I’ve been threatening to write a breast blog for a few years, now. I mean, let’s face it, when it comes right down to it, who is not interested in breasts? All right. Hold on.  I see you there shaking your heads, Ms. Straight-and-Narrow and Mr. I-Don’t-Let-My-Gonads-Drive. Deny away, but I am quite sure that not so deep down, you know you’re intrigued. As a matter of fact, you’re going to keep reading this blog to find out exactly what I’m talking about. Anyway, as entertaining and pruriently enticing as a treatise on tits might be, I could never quite bring myself to write one—until now.
If I were to write a too-true confessional about my mamms, I might talk about the fact that they made an early and unappreciated appearance. I steadfastly refused to acknowledge them until my mom dragged me (not quite kicking and screaming) to Emporium for my first “bra”. As an active, trampoline-loving 4th grader, I didn’t relish the confinement, but the buds that were tenting my t-shirts were apparently a beacon of looming adolescence crying out to be squelched. My neophyte nipples were ensconced in elastic “cups”, which basically smashed them into submission. The message was clear: Nipples shall not be seen nor imagined through clothing. And there my insistent, not-yet-womanly stash stayed—bound in foam and fabric—for many years to come.
I could mention that my girls never quite met my size expectations. With two well-endowed grandmothers, and a mom who seemed of average dimension bust-wise, I never had reason to doubt that I’d be somewhere on the middle to large end of the curve—if I ever gave it thought at all. This may sound strange, but I never considered them too small until I found out that other people did. It bothered them. I’m sorry to report, this included my mother. Any moms out there, I can advise you with 100% assurance that telling your daughter something to the effect of, “You’d have a really great figure except for those miniscule boobs of yours…” is something less than confidence-building. Don’t do it. Just don’t. There will be plenty of other folks out there all too willing to tell your scant-chested daughter that she doesn’t measure up. She doesn’t need to hear it from her own mother.
(The good news for the mammarily-challenged is that, like our well-endowed sisters, we also have fans. There are large bosom aficionados and small bust groupies <gropies?>. And then there are the equal-opportunity enjoyers who don’t care about size, they’re just happy to be there as long as we let them.)
Possibly, I would run through the various slang terms for breasts that are both hysterical and dreadful: Glandular orbs. Skin pillows.  Flesh cushions. Milk makers. Mastoid mounds. Lady lumps. Rack. Stacked. Jugs. Sex sacks. (Blog readers: please fill in here as you like. I love alternative phrasing. What are your favorite slang/jargon/ terms for mammilla? I would love to read them.)
What finally swayed me to hold forth on the keyboard to discuss my not-so-fleshy-twins in addition to the fact that it’s breast cancer awareness month, was being informed by my doctor after my yearly breast exam: You’re dense. In California it became the law as of April 2013, that if you have so-called “dense” breasts, your health care professionals are legally obligated to report to you your “condition”. 
As an average, heterosexual female I was surprised to find out that my breasts feel different from anyone else’s. I mean, mine are the only women’s breasts I’ve ever felt. I had no reason to believe that different breasts have a different feel. Apparently doctors (and breast connoisseurs like my husband) are able to feel the difference between dense and not-so-dense breasts. Until just about a month ago, I thought everyone had a somewhat firm, discoid feel to their chesticles. Apparently this is not the case.
(My husband concurs with the doctor’s opinion on my breast density which he calls “firmness”. Having amassed a sample size into the 20’s—pairs not singles—I conclude his assessment is at least somewhat well-informed. We mustn’t judge. He spent a good portion of his adult life single and he’s an excellent cook. It logically follows that he earned ample opportunities.)
So why is my doctor suddenly so eager to make this pronouncement about my breasts? Because after 30 years of doing mammography, the health care industry is finally coming clean about the limitations of mammograms for the dense among us.
Depending on the source you cite (and the sources do vary greatly), roughly 40% of women have dense breasts. This number decreases as women age. Approximately one in four post-menopausal women continue to have dense breasts. The density is consists of a preponderance of glandular tissue as opposed to adipose tissue. It’s the glandular tissue that—when the time comes, if it comes—makes milk. What it boils down to is that some of us have breasts that mean business and some of us have breasts that just look pretty and there’s a whole wide range in between.
Examples of low and high density breast tissues:
The problem with high density breasts is that tumors also have a significant density. So basically the radiologist is looking for a dense area (shows as white on the mammogram) within a dense area (again, shows as white on a mammogram). You can liken it to looking for a white, stationary airplane in a thick white cloud—it’s more or less impossible and the denser your breast tissue, the more difficult it gets. Additionally, if you have a higher ratio of glandular tissue, you have a higher chance of developing a tumor.
This all makes perfect sense—right? So my question is this: Why has it taken them 30 years to finally come out and say: Thanks for showing up. We appreciate the opportunity to squeeze and irradiate your boobs. Unfortunately, in your case, we have no way of telling if you have a nascent tumor which is, of course, the reason you’re here allowing us to do these unpleasant things to you.
I do appreciate that they’re informing us of our condition. Ahem! Better late than never, medicos. There is a risk to benefit ratio in submitting to a diagnostic that involves radiation. If you happen to be dense, the ratio is not to your advantage. In addition to the x-ray exposure, you’re wasting time and money and experiencing a concerning amount of pain and inconvenience. And on top of all that, you’re not likely to be diagnosed if you have a tumor.
I had my mammogram this month. Turns out that on the density scale of 1-4, I’m a  4. The person on the phone reporting this to me also informed me I could discuss it more when I come in for next year’s mammogram. My response: “Uhm. Next year? I’m not doing this again next year. Why would I expose myself to more unnecessary pain and radiation when you can’t see what you’re looking for? If they have a different diagnostic by then, I’ll be happy to do that. But I’m done with mammograms.” To her credit, the woman on the end of the phone was respectful and smart enough not to argue.
The good news:
They are working on new diagnostics for the dense among us. Currently, some of us are being pinged with ultrasound; others are getting scrutinized with MRI—both non-irradiating techniques. There are various molecular imaging diagnostics as well. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748346/) However, none of these methods are widely accepted, nor are they insurance-paid.
The bad news:
If you have dense breasts, you are more likely to develop a breast tumor. (How much more likely is debatable. I’ve read from anywhere from 2-10 times—a pretty gaping range.) At this time, there is no fully-certified, medically approved, insurance-covered method of breast tumor detection for dense breasts. However, the medical community is still happy to smoosh and x-ray you regardless of the fact that mammography is basically ineffective for you. So if that sounds good to you, jump on it! If you’re like me—you wait.
Being dense isn’t all bad. For example, when the time came for me to be a nursing mom, I made a prodigious amount of milk. If I let down without a bra on, a stream of milk would shoot across the room. (A nice party trick if you’re at the right party! And no, I never was.) My poor infant son would actually choke while he nursed because of the volume and force of the milk flow. It took a few weeks for him to catch up with my production.  There is also an esthetic advantage to sporting dense breasts: You get very little sag. Admittedly, this may be a function of small size. I mean—gravity is gravity. But I’ve seen small ones that sag and I have to assume, those are not dense. I also maintain the distinction of having the firmest bosom my husband has ever encountered. Although he assures me that this is a good thing, I can’t say whether it’s good or bad. I just accept that it is.
As in all things, we take the good with the bad and try to do what we can to manage the bad as best we can. For my sisters in the high density club, I recommend you find out where you fall on the 1-4 scale and along with me, make some noise about getting some new, useful diagnostics. If you want to know more about this I can recommend this site: http://areyoudenseadvocacy.org/. They also have a page on Face Book page you can like and stay abreast (had to) of any new developments (again, had to).
Five easy factoids stolen directly from the Are You Dense? Advocacy http://areyoudenseadvocacy.org/facts/ :
1.     40% of women have dense breast tissue.
2.     Breast density is one of the strongest predictors of the failure of mammography to detect cancer.
3.     Mammography misses every other cancer in dense breasts.
4.     Breast density is a well-established predictor of breast cancer risk.
5.     Breast density is a greater risk factor than having two first degree relatives with breast cancer.
My recommendation is to be aware. Know what they’re doing to you and why. And if it doesn’t make sense, object, speak up and ask for better diagnostic options.
Ladies, if it’s your lot in life to be dense, at least be smart about it!

Friday, May 10, 2013



Henry Wadsworth Longfellow wrote:
Ships that pass in the night, and speak each other in passing, only a signal shown, and a distant voice in the darkness; So on the ocean of life, we pass and speak one another,  only a look and a voice, then darkness again and a silence.
It wasn’t like that at all.
If Cara were to write in nautical terms about that time in her life, it might be something more like: Two kayaks traveling down the same river heading for the same rapids, would hit the white water at different times. She would hazard the torrents of divorce well before Brad. Out of her marital kayak she’d fly into the cold, clean water of singleness. She would swim alone for a while but not forever. Eventually, she’d be pulled back and into a different canoe built for two.
That would be more like it.
But none of that had happened yet. At this point in time, Cara and Brad were each in their own paddle boats on a stretch of river where the current drew them in close to one another. There was a distinct but unmentioned pull.
Who can explain the magnetic forces of personal attraction? They were both nice-looking, both personable and both married. Perhaps it was the nature of their studies at the reproductive endocrinology research center at the university. The essential goal was to solve the problems of the infertility. In layman’s terms, they researched how to get women knocked up. Sex and the science behind it was their daily job. Maybe it was Cara—she was in deliberate and steadfast denial about her bad marriage, making her susceptible to, and keen for the attention of other men. Maybe it was Brad, but Cara would never be sure since they didn’t talk about it. Many years would pass before she would learn of his divorce. The news would definitely give her pause for thought—one of those “ah-ha” moments.
It seemed, then, that they were each afloat in their own unsustainable matrimonial boats. Whatever the case, there was enough emotional turbulence; chemical eddying and hormonal undercurrent, that it made work life interesting.
Cara’s research associate job, among other things, was to report findings from the assays she performed on the tissues submitted to her scientific oversight. Ovaries, endometrium, testicles and the like, ended up thinly sliced, histochemically stained and preserved between slides and cover glass. She was a mistress of microscopy.
Brad’s principal investigator job, among other things, was to sit across from Cara at the two-headed microscope and listen and watch while she narrated and guided him through experimental results. Together, they viewed magnified samples as she steered the stage, expertly navigating tissue coordinates.  Brad was also Cara’s boss.
The table supporting the microscope was narrow, necessarily so, since the scope itself was not wide. Cara and Brad sat opposite each other, eyes to binoculars. On this occasion—as often happened—their knees knocked, momentarily intercalated and bumped against each others’ in a bid for space. Eventually they settled their limbs, parking their patellas necessarily close, but not touching.  Soon after reaching this articular dentente, Brad reached for the stage controls, asking, “OK if I drive?” Their fingers tangled momentarily as she relinquished control.
“Oh. Sorry.” Cara couldn’t help apologizing. The unavoidable closeness of working at the double-view scope made her edgy, especially when Brad’s knees were close enough to hers that she could feel his warmth. He seemed to be burning some serious calories as he sat across from her. Or maybe it was Cara. Either way, in academia, it was unusual to find yourself in such close proximity to someone else and it felt to her like someone had turned up the heat on a warm, summer day.
Brad seemed unfazed. “No worries. It’s just the nature of the beast. I mean, here we are in the reproductive endocrinology center. Knocking knees, clashing fingers—that’s just part of the preliminaries.” He glanced up, and flashed a rakish smile. Cara wasn’t exactly sure what that meant but Brad was a well-know flirt. Regardless, the comment seemed rather brazen. She laughed—trying to deflect the tension. She wished he didn’t make her so made her damned nervous, but he there was no question that he did—in a good way.
They continued their microscopic exploration. The images were promising. They discussed various theories for the differences they saw and the next assays to run. All the while, their eyes focused down into the binoculars.
Eventually the talk turned to the subject of their families and the recent winter holidays.  Suddenly remembering the gift she’d given him, Cara looked up from the scope and asked, “Hey! How’s that beer I gave you for Christmas? Was it any good? I wasn’t sure...” A case of international beers could go either way.
Brad looked at her and tilted his head.  “It’s really good. Thank you. I meant to say something earlier.”
“Oh, good. I’m relieved to hear. You never know when it’s stuff you haven’t tried.”
He paused, pushed back from the table and crossed his leg over his knee still holding her gaze. “Actually, I think of you whenever I have one. There’s a Joni Mitchell song, ‘A Case of You’. I think of that song, and you, when I’m having a bottle. You know that song? It’s on the Blue album.”
Cara’s eyes shifted from his. She felt her stomach drop and the air around them seemed to condense. She knew the “Blue” album but it had been too long since she’d listened to it. “Uh…I’m sure I’ve heard it. But I’m…uh…not remembering it now. I’ll have to listen to it again.”
“It’s a great song. You really should check it out.” With that, Brad got up from the scope and walked out of the lab.
Cara, temporarily stunned, stayed seated and tried to figure out 1) what that smirk on Brad’s face meant, and 2) if she should feel flattered. Mostly, she felt confused—that, and flustered.
Before she went home to her disinterested husband, she stopped by a record shop and bought a copy of the “Blue” album. She listened to the song twice on the way home. She listened to it more the next day on her way to work. Again and again she played it.
The song was conflicted. The lyrics mentioned lost love, but also referenced an emotionally fraught relationship—not a particularly healthy one, Cara thought. The line “I could drink a case of you, and still be on my feet.” was the part of the chorus.  To Cara, it could be interpreted two ways. If a person was truly intoxicating, you’d take one sip and pass out. On the flip side, if you could drink a case of someone and still be on your feet, it meant... She wasn’t sure what it meant.
The next day at work, Cara felt more than a little tightly wound, especially in the presence of her boss. In a true Freudian moment, as he walked into the lab and she walked out, they glanced off each other. This resulted in her modestly-sized breast accidentally grazing his upper arm.
“Oh my God! I’m so sorry.” Cara, who rarely blushed, felt her face flush hotly as their eyes met. She did the only thing she could do in her embarrassment, and laughed. Meanwhile she wished she could sublimate into the industrial, grey linoleum.
Without hesitation, Brad assured her, “No, no. It was my pleasure.” He gave her a wide, devilish grin and continued into the lab. She heard the door close and made a hasty path down the hallway.
The coolness of the corridor helped Cara relax. Her face shifted back to a normal state of blood flow and the tell-tale red faded.  She slowed her pace. She’d just brushed her bosom against her boss and he…well, he certainly didn’t seem to mind—that was for sure. Meanwhile, the chorus played over and over in her head. “I could drink a case of you, and still be on my feet.”
 With a few more feet of safe distance between her and Brad, Cara decided, whatever it meant, it just had to be something positive.
*     *     *
Years passed, and whenever she heard the song, Cara couldn’t help but think of Brad. She was happily remarried and she’d heard through a mutual friend that Brad was happily divorced. They were no longer in touch.
Still, whenever she looked back on it, she had to admit, at the time, she’d had a pretty heavy duty case of him.