STAY WELL & SPARKLE: Nipple Discharge

Editor’s note: We apologize for the fact that the second part of this article was not  showing when it was first published. We’ve since corrected that problem and the entire article has been published. For those who’ve read it, we recommend that you read it again.

“Come with me.” The US Immigration agent in Puerto Rico announced sternly after scrutinizing my passport. My heart was in my mouth. The future of my medical education hung in the balance.

“My student visa – I just renewed it. W-what’s wrong?” I objected.

“Just follow me!” she ordered.

“What happening there, ner?” I thought. I felt everyone was watching poor little me. I could only imagine them whispering, “Look, they ketch one!” I gathered up my carry-on luggage and trudged miserably behind her. We wended our way through the employees-only section – straight to the women’s bathroom.

True story!

“No. I can’t go in there.”

“You’re a medical student, aren’t you?”

“Yes, but…”

“Come; there’s something I want to show you.”

That was when I noticed that she was way more scared than I was. The woman was breathless, her anxious eyes darting from here to there. I had no choice but to comply.

She unfastened a couple buttons of her uniform blouse and tugged her bra down. She took my right hand and thrust into her bosom. “What you think this is?”

I was on the verge of lightening up the situation by giving her an obvious answer. That’s when I felt it. OMG! There was a hard lump in the 9 o’clock position of her left breast, about the size of a lime. That was not good.

Stop the tape right there. What if someone had walked at that very moment? “And it’s leaking too.” she blurted out, before I could dwell further on the circumstances.

“…Is it cancer?” She pleaded.

Nipple discharge is any fluid that seeps out of the nipple. This may be normal in a woman who is pregnant or breastfeeding, but what if she’s not? Discharge can ooze by itself from one or both breasts, or only when you squeeze it. It may look milky and thick, or a watery yellow, green, brown or bloody.

If the nipple discharge does not resolve on its own after the next menstrual cycle, you should make an appointment to see your doctor. However, if you are past menopause, or if you are a man, nipple discharge of any kind should automatically be evaluated, urgently.

Among the benign causes of nipple discharge include infection, injury, fibrocystic disease or a hormone imbalance causing a milky drainage. Excessive stimulation or breast action can sometimes cause nipple discharge. Repeatedly squeezing the nipple to check for discharge can itself stimulate further leaking. So don’t keep playing with it, trying to show it to everybody.

The chances of the discharge being cancerous increases with:

·      Age over 40

·      Lump in the breast

·      Blood in the discharge

·      Only one breast affected

In such cases, your doctor is obligated to do certain tests to make sure the discharge is not malignant.

Another incident stands out. Fast-forward a few years when I was a new surgeon in Ohio.  This insurance executive was a patient of mine. Those were the very early days of the Internet. In fact she was the first person to show me an email attachment – the pic of her first grandchild taken seconds after birth. Her son at a US Army base hospital in Germany had proudly sent it in the early hours of the morning before her 8 AM appointment with me. I still recall SMH at how far technology had come.

Well, she had developed a nipple discharge and wanted answers there and then. I got a careful history, examined her and did an ultrasound in my office. I ordered a mammogram, expressed some fluid unto a microscope slide and processed it for testing.  We reviewed the results at her next visit – no malignant cells. Mammogram was normal. She had brought along a 1-inch thick stack of nipple discharge literature downloaded from the Internet and asked question after question. I did a needle biopsy below the areolar. At her third office, I showed her the results: normal breast tissue.

Mamselle was still not satisfied. I referred her to the distinguished chairman of the department of surgery at the Medical College of Ohio. They had a ‘grand rounds’ conference on this case. The chairman wrote me back a most gratifying letter saying, “Sam, you did everything right.” He was returning her to my care for continued observation.

Some people react to cancer scare like ostriches, burying their heads in the sand. They ignore it in the hope that it will go away. Others, mortified, will restlessly pursue the matter to the extreme. It is all coloured by whatever recent experience they may have had with cancer among their family or friends.

Oh, that immigration agent at the San Juan airport? Thanks for reminding me. Well, once I switched into full doctor mode, I took control of the situation. Thank God we were not interrupted. I asked her several questions. Amazingly, she had forgotten all about accidentally stepping on the prongs of a rake leaning against a wall. The rake handle had flipped up and smacked her hard in the chest.  That was about four months before. She recalled vividly how it had become all black and blue, turned greenish and that eventually faded away. The lump was in the exact spot.

I pounced. This was a classic case of fat necrosis. http://breastcancer.about.com/od/whenitsnotcancer/tp/Breast-Fat-Necrosis.htm.

I was able to reassure her that it was very unlikely to be cancer. Unfortunately, any professional in practice has to endure bad outcomes at some point. But not in this case; this one was special. She took courage and agreed to see her doctor. Talk about a happy patient!

As for me, I couldn’t wait to get out of that women’s bathroom. There was some sanitary dispenser thing on the wall. The place was uncomfortably clean, not a urinal in sight. It was creepy in there! Not me again, boy!

Needless to say, I headed for my departure gate with a skip in my step. I had done my good deed for the day, maybe for the year. Nipple discharge can be quite troubling. However, if it is not bloody, more often than not, it is not cancer. That was not the last time I was detained for my medical activities, but it certainly was the most interesting!

Dr. Sam Christian is a general surgeon and general practitioner opening an Urgent Care practice at 137 Bath Road in Roseau; 440-9133 / 613-8345. His book, Mannafast Miracle, is a faith and fitness nutrition manual focused on maintaining a healthy weight and staying healthy.