Unsure of next steps

forestforthetrees

I'll start from the beginning. In early June, one night after dinner (I'm 32, with a 4 and 6 year old) I was sitting on the couch literally doing nothing when all of a sudden I had a pain in my left breast. It felt a bit like when I was breastfeeding and had a clogged milk duct, which I did sometimes get on that side (I had an oversupply, but never had any major issues or mastitis). With the pain came a terrible feeling of doom, what I can only liken to a panic attack, which I've only had once, also this year, when I was sick in February with a virus that took way too long to get over, almost a month. Towards the end of that illness, I also had very tender ribs on my left side, which the doctor said was likely costochondritis, as it hurt to the touch. With the pain, I then took a good look at my breast, and to me it looked and felt smaller than it used to be, and I noticed skin changes. Around the areola and up about to the upper breast/pec area, my pores are more noticeable, though there is no thickening, redness, itchiness, or swelling. Just as if my pores have all gotten darker. Or like my breast is covered in little dots.

Of course between the pain and skin changes and feeling "different", I made the first appointment with my OB I could get, spent a week not eating and head spinning. My OB did an exam, and said it felt like normal breast tissue, couldn't feel any lumps, but agreed the skin changes were "odd" (thanks!) and said he would prescribe an ultrasound and that I should see a dermatologist for the skin changes. He thought the pain was hormonal and would disappear when I got my period. I was relieved, but asked for my IUD to be removed as I had started freaking out about the hormones - I was on birth control for a few years before my first child, and took progesterone shots during my second pregnancy as my first was early. I also asked for some Xanax as by this point my anxiety was out of control - nonstop googling and panic. Whenever I looked in the mirror my heart would start pounding, which is noticeable because I am very thin. I made an appointment for an ultrasound.

The radiologist's office I went to has a policy of two doctors examining every patient, which gave me extra comfort. Both doctors did an exam, and again said the tissue felt normal, though a bit drier to palpation than the other side. They said the skin changes were "subtle" and asked if maybe my skin was always like that. I said that it wasn't, but of course I had never really examined my breasts very closely before as I'm only 32 and never had any issues and have no family history. The pain had gone away at this point. During the exam the technician said everything was looking good, and then both doctors came in after reviewing the images to say that everything looked great - just one tiny cyst on each side. They didn't do a mammogram because they said everything looked normal and they didn't want to expose me to the radiation, but they said "let us know what the dermatologist says". Again, relief. I had some work travel, and made a dermatologist appointment for a few weeks later. Meanwhile, I still had the gnawing feeling, but tried to suppress it.

Cut to the dermatologist, who looked like a deer in the headlights as soon as I took my shirt off. She wouldn't commit to what she was worried about, but just said "she's seen a lot" and immediately took a biopsy. When I pressed, she mentioned Paget's, but that didn't seem right since my nipple isn't red, or flaky, and I have no itching. So, back to skyrocketing anxiety while I wait a week thinking I have IBC. I left for my family vacation. The first few days of my vacation I just stared at the ocean thinking about my funeral and cried after reading books to my kids at night. Then, dermatologist's office calls - some kind of eczema. Relief! But confusion. I tget the cream the derm prescribed and try to start enjoying the rest of my vacation, but of course the cream doesn't make any difference, and now the pain is back, and it has worsened. And now I can't tell whether the pain is from the site of the biopsy, or from the nipple, or what. The nipple is also starting to look different to me, smaller than it used to be, and as if the edges have lightened and are blending into my skin.

So....I have a breast that feels smaller, less sensitive, and uncomfortable - it just looks sick. I have noticeable dimpling (it looks exactly as it did when I first noticed it, no better and no worse), and I have intermittent throbbing pain. All on one side, all that wasn't there before June. But I have no diagnosis. And now I'm questioning everything. I feel like my whole left side feels odd, like my veins in my hand look weird, like my toe aches, I'm nauseous, I get chills after I eat, I am a mess. Maybe it's from being a ball of anxiety for two months, and hyper vigilant, or maybe something is very wrong with me. Before six months ago, I hadn't been to the doctor in 3 years, and I've had more appointments recently than ever before.

What should I do? Call the radiologist and say the dermatologist was very worried but it was just eczema, and ask to go back for more imaging? Go back to the dermatologist, who wants to see me for a follow up? Go to a breast specialist and start over? My friend who is a doctor recommended seeing my GP to "take a step back" especially since some of my symptoms are so strange and since he saw me when I was sick in February, so he has more context than the other doctors, all of whom I told that I had this chest pain in February, but all of whom dismissed as unrelated. I am so terribly sad and frustrated at the chunk of my life this has already taken, and I just want to be able to sleep and be normal at work and with my family. Thank you for listening, it was cathartic just to write this down.

Allison

MuddlingThrough

I think a complete physical might be a good thing to do now. Ask them to order all the blood tests based on what they normally do AND based on what you tell them about recent changes. If you spend time outdoors ask about insect borne diseases and whether that is an angle to explore or not. Before you go, research your family history about all kinds of things, from BP to anything else relatives have had to deal with.

I hope you get some answers.

moth

If the creme you were prescribed is not working & the skin is the same or worse than before, return to the dermatologist for follow up.

forestforthetrees

Thank you both for your replies, I will take both of you up on your suggestions.