Dorothy: [00:00:00] When it comes to mammograms, there’s screening mammogram and there’s diagnostic mammogram and who can tell you the difference between them? Well, this technologist can because she’s been doing mammograms for two decades. Listen to how she explains what is going on when you have a diagnostic mammogram and why it’s so important to have it done the way that it is. Patricia has worked for The Rose for many, many years. She is our lead technologist and she is the one who always puts the women at ease when they’re having one of the scariest tests around.
Let’s Talk About Your Breast. A different kind of podcast presented to you by The Rose, the Breast Center of Excellence and a Texas treasure. You’re going to hear frank just Discussions about tough topics, and you’re gonna learn why knowing about your breast could save your life. Join us as we hear another story and we answer those tough questions that you may have.[00:01:00]
So we are here today. I’m Dorothy Gibbons, CEO of The Rose and Co-founder, and I’m with Patricia Stapleton, who is one of our ace technologist, but she’s more than that. She’s, she’s been a part of The Rose family since 2003. And she’s our lead technologist. She is supervisor over all of the imaging people, and this means every ultrasound, every mammogram person, our people that take the patients back and forth, our interpreters, so, Patricia has a pretty big job, takes care of about 22,000 women a year that we run here at this location.
And so welcome.
Patricia: Thank you for having me.
Dorothy: Sure. Sure. So Patricia, we’re, we’re talking about the person behind the [00:02:00] mammogram machine. And you know, I think when a woman goes to have a mammogram, she has anxiety no matter what. Now, you’ve been doing this, not just since 2003, you came in with another nine years experience.
Patricia: Correct.
Dorothy: So, mammography has been a part of your life for a very long time.
Patricia: Yes, it has.
Dorothy: What made you go into it?
Patricia: What made, it was personal for me. I had a brother who was diagnosed with leukemia at, uh, 15, and one day he suggested that I do radiation therapy. Well, I got to thinking, you know, I don’t want to, I didn’t want to do radiation therapy. You’re with your, you see your patients day in, day out, and you get attached. And I didn’t want that attachment. Went to x ray school, did everything else, did my rotations, MRI, [00:03:00] CT, my first job was a special procedures and cath lab technologist. Well then, my husband being in the military, we moved around every four years.
Moved to Corpus, worked for a private, um, imaging center. And one day, um, he decided he was gonna bring up an imaging breast center and was gonna pay for the mammography registry. Took it, passed it, started training and fell in love with helping other women. That’s where I felt that I made a difference. I just fell into mammography and been doing it ever since. And from there on, I worked at a, at cancer centers or a dedicated breast center.
Dorothy: So, to be a mammography technologist, you have to have already gone through radiology technologist school, right? You have to have had that license.
Patricia: Yes.
Dorothy: And then you have to do another.
Patricia: Well, what I did is I trained on the job. And then I had [00:04:00] my certification. So you do your two years of x ray school, or whatever x ray program you decide to, to sign up for. And then you train on the job and get your certification.
Dorothy: Ah. So, and all of our, uh, mammography technologists are registered, right?
Patricia: Yes, they’re, uh, they’re breast mammographers. And we also Also, all our ultrasound technologists are registered as well. We have several, um, mammographers who are also breast ultra certified, breast ultrasonographers.
Dorothy: So why is that important to be what we call multi modality but it means that you can do more than one, one procedure?
Patricia: Well it, it helps you in the overall care of the patient helps you understand what images and what studies are needed to get the area concerned or get the job done. And it’s just more knowledge.
Dorothy: So I think it’s so interesting that you said you [00:05:00] didn’t really want to be attached. We have patients who come in and go, Patricia’s the only one who can do me. I mean, you know your patients. You talk to them. You, you become a part of their extended family. So. You know, I mean, there’s a lot of difference in doing mammography.
Patricia: Yes, there is. And I was just thinking about that this morning as I was walking about certain family that, you know, I’ve become attached to and we’re friends outside of work as well. Or, this is a month where patients come in and they request myself. And I have to make sure, the schedulers make sure that I’m going to be here. I put them on the schedule and make sure I wait. And even family members, Rose family members that I work with who I do their mammograms and I do their mothers or their grandmothers who make sure that I’m here.
Dorothy: Well, you do have a reputation for being very gentle and taking your time, and I can speak to that personally, because Patricia’s been [00:06:00] my mammographer for a very long time.
And uh, recently I had a magnification view. And I’ve had mammograms since I was 35. I’ve never found them painful, never had a problem with them. Of course, I’ve got very fatty replaced breasts. But when I had to have that done, it hurt. It’s the first time I’ve ever experienced any kind of pain with a mammogram.
And I remember that, you know, I was concerned. And you explained it to me in a way I’d never heard before. So tell me what happens. This is a procedure you do when there’s a suspicious area or calcifications or—
Patricia: Yes. Whenever we do a spot magnification, and spot magnifications are basically done when we see microcalcifications. Micro, microcalcifications are small, specks that resemble salt, depending on [00:07:00] how they’re shaped and formed can determine the next course of action, meaning that these micro calcifications can only be seen on a mammogram. So you have to have your mammogram, they can’t be felt and it doesn’t hurt. It’s only detected by mammography.
So you cut the doctor, read your screening mammogram. You come back for additional imaging, which is a spot magnifications, which is specifically for micro calcifications. We turn an eight by 10 into a 10 by 12, 11 by 14. It magnifies just the area concern. Instead of focusing on the entire breast itself, like we do with the regular mammogram, we’re focusing on the little bitty area, maybe about the size of an orange that we have a compression paddle and we compress just in that area.
So that’s why it hurts. And if I’m compressing anywhere near the nipple, it’s going to hurt [00:08:00] even more. The nipple is one of the most sensitive areas of our breast. And so that’s what hurts. Compression separates your good tissues from your bad breast tissue. So you want to make sure that you have adequate, firm compression.
Now, not super tight compression, but just enough where I’m not able to make an indention with my finger when I touch your breast. Kinda like a really nice blown up balloon. You want your finger to bounce off the breast.
Dorothy: Good tissue, bad tissue, that doesn’t mean a whole lot to me as a layperson. Give me your other example that you used to tell me why it’s so important to compress it.
Patricia: Well what happens is, when I compress the breast, normal breast tissue, which just, either fibrous tissue, which is the tissue that holds the breast together, or glandular breast tissue where all the ducts and everything’s housed in, or housed in, come together. Sometimes they overlap. So what I, [00:09:00] what you do, it’s kind of like this.
Okay, I hand you a ball of putty, Dorothy, a silly putty, and I put a little bitty rock in there and I say, Here, find that rock for me. Well, how are you going to find it? You’re going to have to tear the silly putty apart. Well, I can’t do that with the breast, so smash the silly putty and get a nice firm compression and voila, there’s the area of concern that you’re going to see.
And again, when you’re doing mammography, now that everything’s digital, digital is very unforgiving. Kind of like whenever the newscaster’s on TV and they got a big old spot on their dress, you’re going to see it. Same thing with mammography. You have to have firm tight compression to reduce the noise. And what I mean by noise is all the blurriness. And there’s also certain criteria that we have to meet. And if we don’t get adequate compression or meet certain criteria, it’s going to get kicked back to us from the radiologist. [00:10:00]
Dorothy: Right. And usually you can tell before the patient leaves.
Patricia: Absolutely, it’s instant now. The image pops up on the, on the screen.
Dorothy: And so when a woman hears that she has to come back for more films, that has nothing to do with the first group of films being bad, or having a bad image, or any of that. That has to do with finding that, that area. And I know one time you mentioned that, uh, About the plane and the clouds.
Patricia: Yes, dense breast.
Dorothy: So explain that part to me.
Patricia: Dense breast is a type of breast tissue. It’s nothing bad. You have fatty breast where you can see right through a breast which is a, fatty in the breast is the best thing to have because it’s clear as day, like a nice, clear blue sky. Now, dense breast tissue, if you look up at the sky, it’s just like a big old puffy white cloud.
Now, things hide behind that cloud, just like things like to hide [00:11:00] behind a dense breast, assist a very small tiny cancer. So with dense breast when you come in that’s how I explain what you know, what the tissue is. Dense breast is not anything bad. It’s just a type of breast tissue.
Dorothy: But it, but it can.
Patricia: Yes, it can.
Dorothy: Extra worrisome and many times we do other procedures.
Patricia: Yes, we do. 3D is very good for dense breast. However, if something is ultrasound and adjunct to mammography helps differentiate if we do see a lump on mammography or if we see nothing and you have a dense breast, the radiologist is still gonna recommend you do an ultrasound because it’s gonna pick up that solid or that cyst that’s behind that cloud or that little bird that’s behind the cloud once you, um, start separating it.
Dorothy: Yeah, that was the best analogy I ever heard. You know, it’s a big old plane [00:12:00] has gone behind the cloud and it’s hidden. You can’t see it.
Patricia: You can’t see it.
Dorothy: Right, right. So Good.
Patricia: But it’s just a normal, dense tissue.
Dorothy: Younger women normally have this?
Patricia: Yes.
Dorothy: And older women normally have the fatty replacement? But that doesn’t mean everyone.
Patricia: Correct. And the older we get, we start losing that density in our breast tissue.
Dorothy: And the other thing of it, when a woman sees it on her report, if it says we want to do more studies, don’t be real concerned, but. Make sure you do the studies.
Patricia: Yes.
Dorothy: Okay.
Patricia: It’s a recommendation. I have dense breast and I do an ultrasound every other year unless I feel something or my Radiologist say let’s do an ultrasound just to be safe.
Dorothy: We do biopsies here.
Patricia: Yes.
Dorothy: And in a bit I want you to explain the difference in between an ultrasound guided biopsy and a stereotactic. [00:13:00] These— everybody kind of knows what ultrasound is. Some people know what stereo means, but they sound so, um, intimidating, you know, when you’re, when it’s about your breast. But how do you calm patients when she’s having a biopsy? That’s, that’s an invasive procedure any way you go.
Patricia: Absolutely. Well, you know, just did a stereo this morning and a patient was extremely nervous. We bring them in, chat with them, explain the procedure from start to finish, and we walk them through the procedure as, and mix in a little bit of personal and the procedure as we’re going along to try to take their mind off the procedure. But, Every inch of the way explaining what the next step is as well. And most patients in just explaining the procedure in detail calms them.
Dorothy: Mm hmm.
Patricia: And we [00:14:00] have the doctor and the technologist running the equipment. And then we have a tech assistant who’s on the other side of the patient talking to him and looking at the woman’s facial expression because women are very strong and very stoic. So if a patient is hurting or they’re about to pass out, they’re not going to tell you. So it’s up to us to watch that lady and communicate that to the physician. So we expedite, especially the stereotactic procedure. On the stereotactic, the difference between the ultrasound core biopsy is that the area of concern is better visualized mammographically. So our approach is going to be stereotactically. You’re compressed just like a mammogram, except we have a little bitty compression paddle with a hole in the middle where we have a very low margin of error to position the area of concern. And we take 15 degree angles from right to left, [00:15:00] which tells us exact location and depth of the area of concern.
And again, that’s usually calcifications and asymmetry that’s only seen on one view and it’s not seen by ultrasound. It’s more invasive. You’re compressed. A little bit bigger guide that goes in to collect the sample of breast tissue. At last, we schedule the procedure an hour. It takes us anywhere from 20 to 30 minutes from start to finish.
And we, rush our doctors our doctors rush us to hurry up and get the get the patient in and out.
Dorothy: I mean because you don’t want them to be in that compression.
Patricia: No, I wouldn’t want to be in that compression thinking and visualizing everything the guide going around the breast collecting samples of tissue.
Dorothy: So I think that’s real important whether it’s an ultrasound or whether it’s stereotactic.
You’re actually getting tissue—
Patricia: Yes
Dorothy: —with the biopsy device. It’s a it’s not fluids. It’s not cells. It’s [00:16:00] an actual core biopsy.
Patricia: Yes.
Dorothy: You know, it’s just a day to day term when you’re in this field, but for a woman, it sounds very— It sounds really scary.
Patricia: It is. And we assure the patient, this is the alternative to surgery. I know that when stereotactic first came out was back like in 1984 and I remember that because I was in x ray school. And I had, well not in 1984, and I had to do a research paper. And that was what I did my research on. Lo and behold, all these years later, this is what I’m doing. So it’s wonderful back before they had any of this you go straight to surgery. They’d cut you and take out the right tissue. Or maybe even a mastectomy and—
Dorothy: Right it would be a one day surgery in and out, but it was definitely and cost wise it was Astronomical, yes, and just to go in and [00:17:00] get that core. And the, the results from that core biopsy are pretty darn good. I mean—
Patricia: Yes.
Dorothy: Yeah. They’re, they’re very, um, more, they’re very correct.
Patricia: Yes, they are.
Dorothy: —getting multiple samples and it is core.
Patricia: And, and as we’re collecting the samples, we’re also viewing what we’re collecting. So we know without a doubt, 100%, that we got the area of concern. There’s—
Dorothy: Oh, I can, I can remember when we first got it. It made such a difference with women. But I do. I do remember that you still encourage women to take some time off after the biopsy to, you know, and, and even though it’s that quick and that. You know, it doesn’t take much, but it’s still, why, why do you do that? Cause they could go back to work.
Patricia: Well, they could go back to work, but you know, Dorothy, we go through vessels, ducts and glands in the breast, and we don’t want you to be picking up anything heavy, [00:18:00] not even a four pound bag of sugar. You start lifting. You’re gonna start bleeding and then you’re gonna have a problem. You’re gonna bruise. It’s going to be very painful. You’ll get a hematoma, which is like a little blister like when you bang yourself with the hammer on your finger and you get that little blister. You don’t want to get a quarter size hematoma in your breast because it’s very painful and it takes, you know, a few months for the, for the body to reabsorb that blister.
It’s, and it hurts. So we want you to take it easy at least for 24 to 48 hours. And a lot of our patients, they have, um, physical jobs. So we make sure that we stress and even give them doctor’s notes to present to their employer to, you know, take at least 48 hours off. Even though we don’t make an incision. It’s just a little poke with the biopsy device. It’s uh,
Dorothy: Yeah, it has.
Patricia: We’re right in the middle of your breast.
Dorothy: And [00:19:00] besides, you’ve had a major change. You’ve undergone something you may never go undergo again, or it may be the first time. Why not take some time for yourself? I mean, I think, I think that’s one of the best things we do at The Rose is encourage women not just to take care of themselves. but to give them that self care time.
Patricia: Having the procedure is a big stress, but just thinking about the what ifs is a big deal. And once the procedure ends and you come off of that high or that stress of that procedure, we have lots of patients who pass out just from the stress itself.
Dorothy: Why do you think women put off that annual screening? Now we’re going from biopsies to screening. Help me understand the real difference between those two.
Patricia: Screening, because we women take care of everybody else first, and we put ourselves last. Or we’re, you know, we make excuses such as, I’m too busy, I don’t have time. [00:20:00] Kind of like when you’re on an airplane. And they give that little speech, you know, if it’s going to crash, make sure you put the oxygen on yourself. Well, what do most of us want to do first, just put it on the person next to you or your child, then you can’t take care of no one else. And we see that quite often.
Dorothy: Uh huh.
Patricia: Where the patient has gone a year, over a year or two years, and they come in and all of a sudden, There’s something there in the breast because they’ve missed a year.
Dorothy: Right. But it was going to be there anyway, we just didn’t find it at that year that we might have. Yeah.
Patricia: We didn’t catch it maybe when it was smaller and now it’s bigger.
Dorothy: Right. So that’s one of the other reasons why we really need to come in for our annual and take that time for ourselves.
Patricia: And I’m, and I’m going to be honest. I’ve been known to be six months to eight months from having a mammogram and I’m like right there. And I’m off. When I have it is when I get like my [00:21:00] third Rose reminder letter, or my third call that somebody’s calling to remind me to have my mammogram and i’m going okay.
Dorothy: You know, I think that’s fine for us to admit that i’ve i’ve been there too. Because we don’t ever want to shame a woman. There’s never going to be a lecture from us about why didn’t you come in? We understand. We’re women. We we’ve been there. We experience the same thing. So, uh, I, I think our listeners need to hear that. Don’t keep putting it off, but please understand we’re not going to, we’re certainly not going to make you feel bad about it. We’re going to, we want to make sure we find that.
Patricia: I always tell my patients, well, at least you’re here today. And I’m glad to see you.
Dorothy: So tell me how difficult it is to do a mammogram on a man.
Patricia: Not difficult at all. The most difficult part is, trying to make them comfortable and not feel out of place and making sure they understand that we’re not skipping them and leaving them up front. We’re waiting for the [00:22:00] right room so we can bring them right straight into the room and women aren’t uncomfortable when men come to the back. It’s the man that’s uncomfortable coming to us, but it’s the same as doing a small busted woman. No difference.
Dorothy: No difference. And, and you go through the same process of explaining what you’re going to do and why you’re doing it.
Patricia: Yes, ma’am. We go through the same process. If they, uh, bring their wife with them, we also let the wife come in with them. It, it’s much more relaxing for him and the wife really gets a big kick out of it as well. So, he, he can, he can understand what women go through. It’s, it’s, it’s great. It’s kind of comical.
We had a male gentleman this morning.
Dorothy: So we do see a lot of men.
Patricia: We see quite a few men.
Dorothy: What would you say is the most difficult part of your job?
Patricia: The most difficult part about my job is whenever you have to tell someone that they have breast cancer or you know [00:23:00] just by looking at the images that they have breast cancer. And again, you, most of these patients you wind up knowing something about. about them because they share it with you in the exam room. They have, they just, um, went through a divorce, they have three small children, or they just lost a mom or a sister, and here they are with breast cancer. And knowing that,
Dorothy: Knowing more about them, yes.
Patricia: Knowing more about them and that they’re about to embark on the biggest journey of their life.
Dorothy: You mentioned something earlier when we were just chit chatting about the personality of a mom. So, touch on that just a little bit. You’re the one that said y’all are a little what?
Patricia: ADD. We, uh, mammographers, we’re an acquired taste.
Dorothy: Oh, okay.
Patricia: We are very ADD. We’re constantly moving about and trying to do so many different things at [00:24:00] taking care of the patient that, that’s a hard question.
Dorothy: Well, and I know most women can multitask, but when I listen to Well, how you describe your day or, um, when I go back to the tech area, I mean, there’s like a dozen conversations going on. There’s different patients, there’s calling the doctor.
Patricia: And most of us back in the area, I’ve been privileged to work with these ladies for many years. That, um. We’re a family and that’s exactly how we treat each other as a family and we know whenever we have to bark orders or request things from each other and we get it done.
Even though I’m the lead and imaging supervisor, if they need me, I jump. I know that they’re not going to call me if they don’t need me. Walked in this morning and, uh, one of the Stereotechs goes I need you in stereo, threw my stuff down, um put my gloves on my mask my name tag and ran in [00:25:00] stereo and picked up like nothing. And they give me the same thing back and that’s what we give every patient and our doctors. So with us I know that i’m real pesky And when I ask for something I want it now i’m very impatient and i’ve had to learn to be patient And that I can’t have an answer now.
So You being the CEO, I know you’ve experienced that for me as well a couple of times. But it’s, for me, it’s personal. It’s all about the patient and take care and taking care of the patient. I put myself in that patient’s place and I hate waiting. I hate waiting for results and knowing what I do, I know that results shouldn’t take two weeks.
I know that most And we push our doctors as well. We all have those patients that we need to give a little extra, and we do.
Dorothy: Now, at one time you would call patients to schedule their biopsy.
Patricia: Yes, we still [00:26:00] do.
Dorothy: Okay, and there’s just a different level of discussion when the technologist is calling the patient.
Patricia: Correct.
Dorothy: It’s not just to schedule it. It’s to kind of start that calming procedure right then.
Patricia: And we, whoever calls is by that patient from start to finish to the post calls.
Dorothy: Earlier you said your brother had leukemia. You’ve had a family with lots of illnesses.
Patricia: Yes.
Dorothy: Do you think that makes you more compassionate?
Patricia: Absolutely, 100%. As you know, I just lost my baby sister, and five years ago, she was diagnosed with a rare, a rare cancer, glioblastoma of the spine that left her a pair, you know, she went from being a vibrant, um, mother, sister, wife, counselor, social worker, doing volunteer work to a paraplegic, and then we just lost her in March.
My entire life changed, um, The first three weeks of her life when she was at the [00:27:00] hospital, I really got to see how we had to do better in caring for our patients and listening, and I also learned how to take care of the patient in a wheelchair. It made me more aware. It just made me see things so differently, made me more compassionate, more, um, calming, more, um, empathetic to every situation, personal and professional.
Dorothy: Do you ever find yourself just hating cancer?
Patricia: Hating, yes, and not understanding why it happens, but.
Dorothy: I know it, it’s a real thing.
Patricia: You know, it’s one of those things that I try not to ask why. It’s just one of those things that I put back in a file and as I don’t understand and just leave it there. And try to, try to make a difference rather than, than being depressed or dwelling on it. Try to make a difference in someone else.
Dorothy: You’ve seen patients who have not survived. You’ve had that in your own family. What do you do to take care of [00:28:00] Patricia?
Patricia: Well, that’s a, that, that’s hard. I have learned to say no. I’ve learned to take care of me. And I’ve also learned to let go of those who can’t carry me while I’m here.
If you can’t be here for me the way I can be here for, for you, and I’m the one doing all the giving, then, I probably don’t need you in my life. I’ve learned to let go.
Dorothy: Yes.
Patricia: That’s what I’m trying to say. Um, and that includes family and it includes friends. So I have a very small group of friends who will drop what they’re doing in a minute.
Dorothy: Right.
Patricia: And you know, the majority of them are here at The Rose.
Dorothy: Ah, yes. When you talk about The Rose family.
Patricia: It’s, it’s, it’s the, it’s the, it’s my Rose family and all these challenges that I’ve gone through I wouldn’t have made it without The Rose family. So I do believe in my heart that [00:29:00] being part of The Rose family was no accident.
My husband got me this job, by the way.
Dorothy: He did?
Patricia: Yes, we had just moved from Corpus Christi, and I was getting on his nerves, because I always took six months off to volunteer at my son’s school. Being in the military. Well, he was a junior. He doesn’t want me to volunteer. So, he saw a job opening, set up an interview. I get a call from somebody named Amy, which was a director at the time. And, you know, he goes, he goes, we called, you’re gonna go. So I came, a four and a half hour interview, and she offered me the job on the spot.
Dorothy: Wow.
Patricia: And I have to tell you this story. And the reason I say it’s not an accident is I knew, um, Dr. Melillo. I’ve heard of, I’ve had heard of her. And at the time, Ward Parsons was also our, um, lead interpreting physician. I had heard him lecture [00:30:00] before. Excellent lecturer. Dr. Dixie Melillo— I saw her, um, give a seminar in San Antonio at Lackland Air Force Base somewhere. And I can remember telling my boss who was sitting next to me is, wow, wouldn’t it be awesome to work for somebody like that? And in an organization like that?
Dorothy: Wow.
Patricia: I didn’t realize it was her until after my interview and I went home and I pulled out all my stuff and I was like, Oh my gosh!
Dorothy: We have a saying here. “The Rose picked you” and I I’ve seen it over and over again. So would you encourage any young woman to go into this field?
Patricia: Absolutely. It’s very rewarding.
Dorothy: And it’s good pay.
Patricia: It is good pay. It’s um, no call. And It’s family oriented, I feel. Family is very important to me. And, not only this field, but try to find a place [00:31:00] like The Rose that family is important and they’re going to be with you through the ups and downs in your life. I wouldn’t have made it. anywhere else if I wouldn’t have been part of The Rose family.
Dorothy: I understand that. We’ve, we’ve had lots and lots of, uh, times in our, when our Rose family life and, and in their individual lives that, you know, we turn to our colleagues for help. And that’s really true in most women’s lives. You know, work is 70 percent of your day and it better be good. It better be fulfilling and it better be something that nourishes you and doesn’t pull you down. So what, in that other 30 percent of your day, do you have any other passions?
Patricia: I like to run, I like to shop, I like to read, and spend time with, with my husband and my son.
Dorothy: Anything else you’d like to tell our listeners?
Patricia: Take care of yourself, make time for yourself, if it’s even five minutes. Out of the day to sit and stare out a window.
Dorothy: Thank [00:32:00] you for that, Patricia. You’ve given us a lot of insight on what happens when you’re having a mammogram or a biopsy. And I think I can only echo what Patricia said. We want you to take care of yourself and that’s it for this day.
Post-Credits: Thank you for joining us today on Let’s Talk About Your Breasts. This podcast is produced by Freddie Cruz Creative Works, and brought to you by The Rose, visit therose.org to learn more about our organization, subscribe to our podcast, share episodes with friends and join the conversation on social media using #Let’sTalkAboutYourBreasts. We welcome your feedback and suggestions. Consider supporting The Rose. Your gift can make the difference. And remember, self care is not selfish, it’s essential.