Monday, March 18
I see the good Boob Doc again. I have a new lump. It’s about one centimeter in diameter, light pink, and warm and tender to the touch. It is two centimeters to the left of the really big lump. I haven’t had any more episodes of sudden bleeding, and I have been almost completely off the painkillers. I’ve had tolerable pain that comes and goes, but nothing painkiller-worthy. The drainage site has started to refill, so the good Boob Doc drains it again. This is painkiller-worthy. I take maximum-strength Ibuprofen, Tylenol and a Gabapentin pill. It’s a good thing my sister is with me. (Yes, I am a wuss, and I need to have somebody with me for these appointments.)
There is a new development. The initial fluid sample that was sent to the lab and analyzed and found negative for bacteria underwent further analysis. There is a type of bacteria called Corynebacterium. It takes longer to culture than other bacteria, and is more difficult to detect. A small number were found in my sample. They had not been previously detected, so I may have had false-negative results. There have been a few reported cases of Granulomatous Mastitis caused by Corynebacterium. There is a 2011 article in the American Journal of Clinical Pathology with an article titled: Cystic Neutrophilic Granulomatous Mastitis: An Underappreciated Pattern Strongly Associated With Gram-Positive Bacilli. If my case is caused by this bacteria, it is no longer idiopathic. There is an explanation!
As the good Boob Doc explained, there are two possibilities:
1) The Corynebacteria caused my Granulomatous Mastitis. This means I have a pathogen-bourne illness which can be cured with antibiotics. It’s an infection that never manifested with a fever. The different penicillin treatments I had did not have an effect on this kind of bacteria, because it tends to encapsulate and is difficult to penetrate and break down. In other words, you have to bring in heavier artillery: the tetracycline family. The doctor prescribed long-term treatment with doxycycline, starting tomorrow. Doxycycline is a broad-spectrum antibiotic, and it is better at breaking down tough Corynebacteria. She said that if this works, I could be cured in six to eight months (or sooner, or later). It’s worth a shot before we go chopping off body parts.
2) The Corynebacteria found in my sample is due to contamination, which is a common occurrence. This type of bacteria is known for being a sample contaminant. There are more bacterial cells in our bodies than there are actual human cells. We are ecosystems with a diverse bacterial flora. Most of these bacteria are benign, beneficial even. Corynebacteria are naturally found on our skin and are usually harmless. It is possible that some of the harmless bugs from my skin contaminated the sample. This means that this bacteria is not responsible for my Granulomatous Mastitis, and brings us back to “idiopathic in nature.” Furthermore, this means that I take heavy-duty broad spectrum antibiotics for six months completely in vain.
It’s a gamble. A doctor has to do a risks vs. benefits assessment before prescribing medicine. I know that this doctor is thorough. She called the lab while I was there and talked to the pathologist about my sample. Apparently, she thinks that the possibility of a cure that renders major surgery unnecessary outweighs the risks of long-term antibiotic use. It may be a long shot, but it’s worth a try as long as my pain is under control and I am not suffering. I do not like taking antibiotics unnecessarily and am wary of side effects, but I reluctantly agree to try this treatment. This is the same medicine given to teenagers with acne, so it can’t be that bad. As a bonus, I won’t get adult acne.