Question about a lump in the chest

[CrystiWilson]

Hi everyone:

I haven't posted since the end of July......my Mom has been recovering very well since her AVR surgery at the end of June. She is POSSIBLY even going to have her boot-cast removed from her ankle this week! Yeaaa! :D She has been able to walk without the walker or wheelchair for over a month now! Again, :D

So, now, can you believe it? I have another question.....a question of the ominous kind..... :(

She just discovered a lump under the surface of her skin...near the top of her right ribcage/lower breast. She's never had any (cancerous or benign) growths of this kind.....and she's 75 years old! It isn't something that has ever showed up in our family tree history....seems like there has been plenty of heart problems--but no cancer.

It seems that it just "came up out of nowhere". It isn't round....it's more like almost an inch long.....and kind of like a long 'tubular' mass...sort of feels like a piece of tubing or the size of a drinking straw.

The reason I'm describing all this to you, on this board, is because I'm wondering if it could be scar tissue from the surgery. I know that the ribs are spread during surgery......do you think it could have caused a tear and then some scar tissue to form there? It isn't on the heart side of her chest....and it isn't near the chest incision.....

Does anyone have any insight? :confused:

She has an appt. with her g.p. tomorrow.....as she is suffering from another u.t.i. (her third since the surgery and the hospital stay!)....and, she's already told the nurse about the lump. So, tomorrow we will start the investigation process.

Hoping and praying that this is something non-threatening! Especially AFTER ALL she's already been through this year!

Thanks for any help!

Crysti

[Ross]

It could be just about anything. It's best to not even guess and have it checked. :)

[hensylee]

'they' say don't worry til there's something to worry about. yeah, right! She is in my thoughts and prayers. Hope it's something that can be fixed immediately - better yet, that it goes away.

[Mb]

Hi!

Just thought I would add my own experience, althought it is my husband that had valves replaced. I've had four lumps removed from breasts. The first, I was nine years old. I had fallen face first onto some ice, and about a month later I started growing one breast. (too young to have two). It was a tumor, but benign. Around 7 years ago, I walked into the mirror on my husbands truck. (dumb???) - About a month later, I had a HUGE growth on the breast, same area. Removed, and again, from the trauma, it had made the cells go out of whack...benign. It started growing again, same area, about three months later. Had to have it removed, and again benign. Less than six months later, another small growth, again benign. I was told at the time, that the trauma to the chest caused these to grow. Haven't had a problem since.

It could very well be, that during surgery they had a clamp, or other device attached to your Mom, and this might have caused this growth to start. I would think more along those lines, than get terrible scared. Regardless, I think your Mom will be advised to get it removed. For me, there was no choice, as they gew fairly rapidly. On the other hand, it could be scar tissue, again from spreading the ribs.

The vast proponderance of these growths are benign. Keep thinking it, until proven otherwise. May God bless you on this new journey.

Marybeth

[CrystiWilson]

Thank you all for taking the time to answer my post.

We went to the g.p. yesterday......got sent directly over to the speciality center for mammograms and ultrasounds. Within about 2 hours she found out that it is a "suspect" kind of a growth.....showing signs that "could be" characteristic of cancer. So, they scheduled her for a needle biopsy next Tuesday Oct 4th.....they had to wait for a week to get her off the Coumadin for the procedure.

So, here we go......down this road now. She is OKAY, almost on auto-pilot. I think that neither one of us can believe this new hand she's been dealt....especially after such a rough, (sudden) heart valve diagnosis and resulting surgery. We both have lots of Faith.....and we know He understands what we cannot.....

It's still just really hard.

Thanks for all of your support. Sorry that I only show up when I NEED SOMETHING.....I guess I should hang around more to offer advice/support to some of you, occasionally!

I would REALLY appreciate all the prayers and good thoughts that can be rallied....on her behalf.......next Tuesday (and Wednesday as she gets the results).

Thanks,
Crysti

[DuchessBear]

Crysti -- Please, please, please do not let your mother go off Coumadin without bridging therapy. In fact, it may not be necessary to go off Coumadin at all for a breast biopsy. Please read this thread http://www.valvereplacement.com/forums/showthread.php?t=10380 on the topic. This report about stopping Coumadin for a biopsy is mentioned in that thread, but bears repeating here:
http://www.ajronline.org/cgi/content/abstract/174/1/245

Also, you might want to read warrenr's story about his dad who went off Coumadin (without a bridge) for a routine colonoscopy: http://www.valvereplacement.com/forums/showthread.php?t=7895

Warrenr's story will scare the bejabbers out of you, but better scared than mourning. There's too much misinformation spread around about Coumadin, and too many docs who don't know how to manage patients who take it.

Now that I've got you all worked up :) -- let me wish you and your mom all the best. All of us here are fervently hoping for a good report from the biopsy.

[geebee]

Crysti,

Does your mom have a mechanical valve? If so, the "they had to wait for a week to get her off the Coumadin for the procedure" statement scares me to no end.

Is she being bridged with heparin? If she has a mechanical and they are "just taking her off coumadin" without any bridging, she is at extreme danger for clots and a stroke.

Please, please check into this issue immediately.

[CrystiWilson]

Ladies,

Thanks so much for the help. I haven't yet read your post, Duchess....but, I'm on my way there.

I'm very confused when it comes to Coumadin and, I hate to admit it, I haven't spent any real time on the anti-coagulation board on this site. I know that this'll sound terrible.....but, we were so overwhelmed with the details of the heart surgery and recovery....I've been just "trusting" the professionals with her Coumadin care.

Here's the scoop: Just to answer your initial reactions. She DOESN'T have a mechanical valve.....the surgeon opted for tissue (cow) instead. The surgeon also told her that she wouldn't need any more Coumadin after 3 mos. post op. (I think the only reason she was on it this long was because she had one incidence of a-fib right after surgery). Her Cardiologist (not cardio-surgeon) is the one who is making the call with regard to this new development and taking her off the Coumadin to get her thru the biopsy.

I understand that there is definitely a trade-off/balance when a patient is 75 years old, as my Mother is. Do you want the blood to get too thick and risk a heart attack/stroke?......or do you want the blood to get too thin and risk internal bleeding if there are falls, etc? Personally, I think that she should remain on the Coumadin permanently.....as we don't want that stroke risk! But, you wouldn't believe how non-emphatic her drs. have been about the Coumadin thus far! She is starting to get excited, because her 3 mo. post-op period is up at the end of September.....and she was looking fwd to being off the Coumadin for good! I am only just now starting to read on this board about the dangers of that.......and am starting to explain to her that we need more time to do more research about it!

I figured that one week wouldn't matter.....to get this procedure done.....but, I'll go read your posted link right now.....and I'll find out from the doc about a "bridge"!

Thanks so much! I REALLY APPRECIATE YOUR HELP WITH THIS!!!!!

P.S. Her last PT/INR reading was 3.1......within 'range'....and she was on 1 mg of Coumadin per day......until last night, when she stopped it altogether. She's also on antibiotics for an infection.....and the nurse practioner says that those will affect the reading as well. She was 3.1 BEFORE she started the antibiotics (Monday).

Thanks again everyone! I'll get to work on this right away!

[Ross]

I've been just "trusting" the professionals with her Coumadin care.
Lesson Priority Number One---DO NOT TRUST them with her care. Either she, you, or someone needs to be attentive and take charge. Thank goodness she doesn't have a mechanical or she would be in deep deep trouble without bridging.

[geebee]

Whew! I am sure glad she doesn't have a mechanical. If she is no longer in a-fib, then she should be OK to be off the coumadin. Thanks for the update cuz now I can sleep tonight. ;) ;)

[CrystiWilson]

Thanks so much everyone. I went to the anti-coag board and started reading (and I read those links, too, Duchess, thanx!) (btw, it DID scare the bejabbers out of me....but, I guess I needed that!)

I went to Al's warfarin institute site warfarininfo.com (http://) and I found some interesting info. There was one article by Jaclyn Ripley about "Warfarin for Atrial Flutter". It gave 8 risk factors for stroke.....My mom has 5 out of 8 of those! If at risk, it recommended that warfarin be used and a goal range of 2-3 would be appropriate. My mom has had prior t.i.a., her age is now just over age 75, she has been diagnosed with congestive heart failure (though it now seems to be "dormant", if there is such a thing, and she isn't being medicated for it) (?), she has a history of hypertension (although her b.p. is now lower since the surgery), and she also has diabetes.

So, okay, ya'll......I'm convinced. Even though she doesn't have a mechanical valve.....she is still at a substantial risk for stroke without the anti-coagulation. Boy, do I feel stupid for only "trusting professionals" to do all this.....I should've been reading up from the beginning, huh?

Now, where do we go from here?

She doesn't have home PT testing capabilities.....tho' we may have to get that in the works too.

She is already off of the Coumadin as of yesterday. Does anyone know if she should do SOMETHING tonight....aspirin, etc., until we can talk to her cardio or her contact at the breast center.?

I'm sure I'll have lots of questions as we go down this road. Thank you so much for getting me in the right direction, though!

With lots of gratitude,

Crysti

[tobagotwo]

For that type of risk, Coumadin is not the only choice. Aspirin and Plavix come to mind as well. Her doctors can decide what is the best choice for her, depending on her general condition and other medications.

Your mom is not in imminent danger any time she is off of Coumadin, and you shouldn't feel frightened by it. Unless the physicians have grave concerns about her tendency toward strokes (they plainly don't), bridging therapy is likely not indicated for her, nor necessarily a continuation of warfarin after her three months is up. In her case, if other medications are called for regarding the growth, Coumadin may wind up being an unnecessary complicating factor, because of drug interactions or limitations on procedures.

There is a great difference between having a tendency toward stroke and having a mechanical clotting machine running in your heart. Coumadin is required for mechanical valves because to a degree, they actively cause clots. Much of what is on Al's site, and much of what you will read here is based on the higher risk scenario created by mechanical valves. (We are essentially a valve replacement site, after all.) That is not your mother's case. Her valve will not throw any more clots than her original would have.

Warfarin is a very useful drug, and has extended many people's lives. However, it is not the only choice, and may not even be the best choice in her situation. Don't forget, she was intended to be off of it in two days to begin with.

Worry less about the anticoagulation. Don't think of her as a reason to worry: think of her as the person she is. Love your mom. Go with her to her appointments. Talk about other things besides her growth. Be the wonderful daughter who grew up to become her friend.

Best wishes,

[Mb]

Hello!

Have you spoken again to the Dr.? Re: anticoagulation

If it were me, minimally I'd have Mom taking a baby aspirin a day. Just the TIA would prompt me to have her do that.

I've had at LEAST 4 core needle biopsies. I cannot imagine your Mom wouldn't be safe even staying on the coumaden. This is not highly invasive.

I WOULD MAKE SURE SHE IS PREMEDICATED WITH ANTIBIOTICS.

Just my opinion!

Marybeth

[twinmaker]

Crysti, I just read your post so I don't know if this helps or not. I have a mechanical valve so I'm a little different in the respect of the valve from your mom but a few years ago I had to have a biopsy done on one of my breasts. They found microcalcifications on my mammogram. Anyway, my hematologist at Johns Hopkins insisted that my Coumadin be stopped and that I go into the hospital with a Heparin drip for the bridge therapy. They ended up doing a lumpectomy since I was going to be off the Coumadin and on bridge therapy. That way they wouldn't have to schedule another procedure if something malignant was found. In other words, we skipped the biopsy and went straight to the lumpectomy. I know your mom has a tissue valve but if she needs to anticoagulated for other reasons then maybe this info will help a little. As a side note...my hematologist was not a fan of Lovenox (the heparin type injections you give yourself at home). I'll be keeping you and your mom in my prayers. Glad that you are on top of things. Linda

[CrystiWilson]

Hi VR friends:

Well, the "no news is good news" adage won't work with this one, I'm sorry to say.

We've been so busy with "the process"....as Mom has been sucked back into a medical 'whirlwind'. The needle biopsy was done.....it was found to be cancer. So, almost immediately (one week) following biopsy results, she underwent mastectomy of her right breast. She went thru the surgery fine (last Wednesday) and was able to go home two days later, on Friday.

She is still waiting for the results on the lymph nodes (which were removed from her right under-arm area), to find if the cancer has spread there at all. According to the surgeon, if the lymph nodes are "clean", then there is no need to go thru more tests (i.e. bone scan, liver scan). So, of course, that is our prayer at the moment. We will get those results tomorrow. We don't know what course of treatment will be next.....what kind/how much of the chemotherapy.....depending on the 'receptors' that exist in the cancer, etc.

I've got more wisdom to share with you all:

I now pay more attention to things like Breast Cancer Awareness month. (I heard a PSA for it on the radio as I was leaving the dr's office, right after the bombshell of the biopsy results was dropped!) We said to the dr, "But, cancer doesn't RUN in our family, NO ONE has ever had it before, ANY KIND of it." To which he replied "that doesn't mean as much as it used to". Great. Now, heart problems......we are all prepared for that......we've got more than our share of those in both sides of the family.....and, I've learned a little bit about it by now too...... but, cancer is out there too. Our medical histories all changed, effective October 5th, now cancer has joined the ranks. Please acknowledge it......if any of you haven't (or thought like I did, that you are somehow "exempt"!), please do whatever you can to be proactive and stay on top of the recommended tests!

I've also realized that Mom is DEFINITELY the strongest person I know! I guess after open-heart surgery, carotid artery surgery, (along with a broken ankle!), what's one more major surgery?, right? I guess it's all relative, in the 'big scheme of things'. She just keeps on smiling and dealing with it all........what a testimony her life has become, esp. these past 3 months!

She is off the Coumadin now for good. The cardio-surgeon and cardiologist agreed that (remember: she has a tissue valve), it has done it's job, her 3 month post-op period is up, and her INR's are good, and she is also on baby aspirin now. I guess that it will help too.....as chemo therapy will likely complicate things even more, if she were still on the Coumadin.

Thanks to all of you for your help and support.

Moral of the story: People are tough. They can get through almost anything. Never underestimate just HOW MUCH you can handle if you have to.....and if you know from whence cometh your help and strength!

Best wishes to you all!

Crysti

[PJmomrunner]

What a testimony to the triumph of the human spirit! Your mom is such an inspiration, but I have to think that having her wonderful daughter at her side has played a big part in her resiliency. You both just keep on keepin' on! :)

[geebee]

I am so sorry to hear about your mom's cancer. I will pray that the nodes are clear and she can stop having that to worry about. What a raw deal on top of the heart surgery but, you are right, people can get through whatever is thrown their way if survival is foremost.
Please let us know how we can help.

[Nancy]

Give your mom a big hug from me. Almost a year and a half ago I was diagnosed with breast cancer. My nodes were clean, had a lumpectomy, but the tumor was a little larger and needed chemo and radiation.

Just wanted to let you know that whatever your mom needs to have done, it is doable. Not fun, but doable.

I am feeling well now and everything, so far, is looking very well. Last mammo was fine.

I would like to suggest a website, it is breastcancer.org. The forums there are extremely supportive for the person and their family as well.

And please, if you haven't already done it, go and get a mammogram yourself. This is breast cancer awareness month, and it will be a good reminder each year. Mine was found with a routine mammo.

[Mary]

Your mother has gone through a lot during the last three months. She is a very strong lady.
Cancer is a hard disease to acknowledge; facing the news of my mother's cancer was initially harder than the reality of the surgery, chemo, and radiation she underwent. However, as time passed, we all became rather blase about it.
I hope that the nodes are all clean and your mother is able to move on with no further worries.

[Cris N]

Oh my goodness, what an unfortunate turn of events. I admire the spirit both you and mom seem to be exhibiting. I sure hope the nodes are okay & that her upcoming treatment causes minimal distress.

Cris

[Georgia]

Best of luck to your mom - I had BC 15 years ago and it's no fun; but people don't get to be 75 years old without developing strength and character. I'm sure this is worrying you to death, so continue to take good care of yourself.

This is sure a year to remember, huh?

[hensylee]

I am so sorry to hear this. Bless your mother and you, too. You have really been through it this year. Stay strong and give her a hug from this great group.

We have several, including our Nancy, who have had breast cancer and are posting right along. And as Nancy says, never give up.

Blessins........

[KristiinSD]

I'm sorry to hear about this turn of events. I will keep you both in my prayers.

Kristi
mr
surgery in November