Tuesday, August 28, 2007

Accessories

The last two days I have been at clinic. The most interesting patient was a 19 year old who came in for "lumps in the arm pits". I went in to see her--she was seven months pregnant, and had a mass under each armpit which had been swelling and becoming more painful every since she became pregnant (this is her first pregnancy). She had never had swellings like this before, and each day the masses could be soft and mildly tender, or hard and so painful she couldn't rest her arms at her side. She had no medical problems, specifically no history of breast disease, and no one in her family had a history of breast cancer. On exam, she had a tennis ball shaped and sized mass hanging from the underside of each arm in her armpit. They were very soft to touch, not like lymph nodes, and they were tender to palpation. She didn't have any breast masses/pain/discharge, but I did note she had an extra nipple on her right breast (when embryos develop there is a milk line that runs essentially from the axilla down the chest to the abdomen, and nipples/ductal tissue can form anywhere along the line) which I thought was interesting but didn't make any connections. I was totally stumped. I went to talk to the nurse practitioner who immediately realized that the swellings were actually extra breast tissue that had developed in the woman's arm pit. When we looked closer one of the masses did have what looked like a very small, poorly developed nipple. As the woman's breasts have been swelling with pregnancy, the extra breast tissue did as well causing a lot of discomfort. Unfortunately, since she plans on breast feeding her infant, she's going to have the pain for quite a while. Once her infant is weaned, she can see the surgeon and have the extra tissue removed to avoid this with successive pregnancies. The NP told her not to be surprised if she finds milk leaking from her armpits once the baby is born.

On a totally different note, my pastor is starting a Sunday School series on courtship/marriage. To start the series, last Sunday he read the following article: Let's Have More Teen Pregnancy. The author's premise is that society's opinion today is that people aren't mature enough to get married until their late twenties, a belief she finds ridiculous. She talks about the benefits of marrying young (18-20) and uses as an example the fact that she is 49 and has 4 grandchildren already. I don't think I agree with her premise however, at least in my circles, singles in their twenties are single because they haven't met someone they want to marry, it has nothing to do with not believing that they are mature enough for marriage. The vast majority of singles I know desperately want to get married, and most of their families want them to get married too.

1 Comments:

Blogger MD Views said...

Breast tissue along the milk line and in the axilla is quite common. You will see it again and again, especially if you go into OB/GYN.

Fredricka Mathewes-Green is a Christian writer and pro-life speaker who used to write (and maybe still does) for WORLD magazine. I am impressed that she is a clear thinker, worth the read.

It's fun for me to read your comments as you go through medical education. Although I have been out of medical school now nearly 30 years, I can still feel the sense of discovery as you learn and run across new problems.

Enjoy the learning!

9:29 PM  

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