INSOMNIACS place to talk in the wee hours

Thanks KJ Hugs, frustrating with brother. He is the poster boy for a life lived healthily. Exercise, diet, weight, you name it. I'm Not. He has always pontificated. He didn't get that a bad gene doesn't care about what you do. He has ignored or blew away the stats I collected on family. It was obvious when I asked if he told the doc about family cancer hx on paternal side. "Well, I told him the few I could remember". I said you are the 23 or 24th primary cancer out of 53 blood relatives. I'm beginning to loose count. Four or five with double hits outside that total number. Of course, I have taken the attitude that it's gonna happen so don't stress, do as I want. It's five o'clock somewhere enjoying my wine as I type.

Thanks Spooks

Melatonin. interesting drug. Interesting how it's produced in the body.Interesting how it has it's own CYP450 metabolism path in the liver. Interesting the connections being found about it and cancer. Interesting.

Thanks Wren. The numbers were less when I decided to do the prophy. Then the prophy turned into a necessary. But the numbers were still off the charts. Had a three way consultation with two cousins while I was with the genetic counselor. It was a study funded at Shands in Florida. Both cousins RN's with advanced degrees. My goal was to get their cooperation on a plan to alert the family that genetic testing and surveillance plans needed to be developed. Totally didn't happen on my cousins parts. I was shocked that they couldn't see the risk was elevated. One -an ARNP when told her risk was 23%(I thought the % was low). Her mom and sister had BC. Had to be couched in hypotheticals b/c her sister was dx'd at the same time as me and newly dx'd cousin didn't want this Rn sister to know. I gave up. One of the RN cousins brother already had prostate and since has developed lung cancer. Her other brother since was dx'd colon cancer. Has a colostomy. Had he been scoped the year I was pushing, he would have been diagnosed earlier(3 years). May have prevented the bag. My brother would only pontificate that if we did this and we did that....every friggen moment was a lecture how he was doing such and such to make sure......

Now in his defense, he has been the greatest protecting brother a little sis could have. He always looked out for us in a horrible life circumstance. Was the one that stepped forward in time of need. He has been the best.

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Okay need to go some more. Soap box item of mine for several years was getting tested for CYP450 metabolism. It was on a thread. It's how your liver metabolizes everything, but it was specific too drugs in this case. Of the six that are most involved with drug metabolism, I have three that are abnormal. Two are in a very small portion of the population--5% and 7%. That's small. Plus, and abnormality in processing Coumadin/Warfarin. Not a small deal when approaching open heart surgery. They didn't tell the doc. THEY have it in their notes. FUCK. Doesn't help if he's not been tested for the abnormalities. They are familial. GAWD, I get so frustrated.

I can't warn him about all the stuff coming, b/c he discounts what I say..... poor guy....he'll go through it and then say......." I have had all these things said, sent, implied, suggested"

Hi Chattie, Not sure how much help I can be, but I'll try. The info in your post is incomplete so it makes a response more difficult.

I've taken a look at info on the net and found some good info and taught me stuff I didn't know. I'll leave the links at the bottom and cut and paste some info as it applies in my response.

To summarize you have a chronic situation that has repeated evaluations by PCP and at least three visits to two breast health centers, one local and one in the city. You have had a two mammogram that were negative and an 5 ultrasounds.

Chit(our word for shit). The info I've found does indicate that you need to be more seriously an aggressively evaluated. You stated " I have nipple discharge constantly- it's usually clear, maybe a little blood on normal days:".

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This info is from BreastLink

"Nipple discharge can be an early symptom of breast cancer, but most cases of nipple discharge are due to benign conditions. The following are guidelines to differentiate benign discharge from discharge that is associated with malignancy:

• Spontaneous Discharge: Discharge that comes out without squeezing is the only type of discharge of concern. If the discharge only occurs with squeezing, ignore it and stop squeezing your breast. Check your bra or night clothes for evidence of spontaneous discharge. If you see a spot, save it and show it to your doctor.
• Color: Worrisome discharge is typically either bloody or clear. Discharge that is green, milky, or other colors is almost always of no concern. Note: if you have large amounts of milky discharge and you are not breast feeding, it should be brought to the attention of your physician. Tests should be done to evaluate for the possibility of a pituitary tumor. Milky discharge with squeezing is not of concern.
• Single verses multiple ducts: If a woman squeezes her breast and notes discharge from multiple spots on the nipple, she can be reassured that the discharge is usually nothing to worry about. However, if the discharge is consistently coming from one spot on the nipple, it is of more concern. This observation should be confirmed by her physician (see link to picture)."

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You describe two sign/symptoms(s/s's).i.e spontaneous, and clear sometimes bloody. The third symptom is perhaps one you never thought to look for. Simply based on this you need a better work-up. What bothers me is this may be new info for me, but a breast health practitioner should know this. That's the point of being a specialist in a field.

The BreastLink web page goes on to describe a step by step approach for the evaluation of your problem. I would add consideration of a breast MRI, and either a strerotactic biopsy or excisional biopsy if the MRI is negative.

Reasons 1. to determine absolutely that no hidden cancer exists. Based on your s/s's and the length of time, you need to get an answer from the specialist as to why not. 2. the study of the tissue will define further action.(histopathology).

What I read is you have been repeatedly placed on antibiotics. But you don't describe and studies of the fluid. If no culture and sensitivities have been done, it's completely inappropriate to randomly prescribe antibiotics. INAPPROPRIATE. Besides bacterial evaluation for fungal, and mycobacterium evaluation should be done. Mycobacterium is not routinely tested.

They're was another study that defined that treatment in the absence of bacteria/fungus/mycobacterium that steroids be used. That doesn't appear to have been part of your treatment plan. That link will be at the end too.

Before I close, you describe that it occurs every two months. That again further supports excisional biopsy to look at the wall of the abscess. Sometimes the only way to keep the problem from recurring is to cut out the whole cyst/abscess wall.

Laboratory studies ought to include a Prolactin level

At this point the PCP should not be managing this case. They are in over their head IMO.

A breast specialist MD, not ARNP should start from scratch to develop a diagnostic plan, and then a treatment plan.

Hope some of this helps, sassy

http://www.breastlink.com/breast-cancer-101/common-breast-problems/nipple-discharge/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3318163/

Rosie, you haven't posted sweetie in a few days. Whatup?