My First Lump Experience, After Mastectomy

Let me start with this, EVERY lump and bump will worry me for the rest of my life.  It's not over just because I had surgery.  If a lump forms, I'm going to worry.  That being said, I'm also going to let you know that this lump I found turned out to be a suspected undulation of the implant, so you can continue reading just for the education and my experience.

Thursday

At this point, I'm seven months post surgery, and overall doing great.  When you have a mastectomy with implant reconstruction, you're bound to still have numb areas of the breast, like I do.  When I get an itch that I need to scratch, its sometimes hard to find and satisfy with a scratch, causing a bit of a comical scene.  Two nights ago (Thursday night), while lying in bed, one of these itching scenarios happened, which led me to finding my first ever lump in my breast.

You're probably thinking, "What?  You can't get lumps after having a mastectomy!"

Well, yes you can, actually.  

As many people may know, the risk of recurrent breast cancer after any type of mastectomy is not zero. A woman who has had a mastectomy can still get breast cancer, although there is a very low risk of recurrence. This is because it is not humanly possible for a surgeon to remove every microscopic cell of breast tissue. The goal, however, of mastectomy is to remove any gross visible breast tissue seen by the surgeon. In contrast, at the nipple all that is left behind is skin. (http://medicine.stonybrookmedicine.edu/surgery/blog/faqs-about-nipple-sparing-mastectomy-what-women-need-to-know)

There a couple types of lumps and/or hardness which can occur after a mastectomy with reconstruction, and I'm learning about all of them now, only because of the lump I discovered (See below for different types of lumps).  When I found it, my first reaction, within those first couple seconds was, no, not possible.  Nothing was visible from the outside; no rippling, no redness and nothing sore.  I ignored it for maybe an hour, but then came back to it, making sure I was feeling what I thought I was feeling.  I rubbed it, tried to roll it between fingers...anything I could do to try and decipher whether it was muscle, a true lump or my imagination.

By User:Starr4ever:) (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

I proceeded to feel all around both breasts.  Smooth as butter...can't feel a single lump, ridge, fiber...nothing but smoothness.  I went back to this area.  Yep, definitely different.  At that point, I got online and messaged my plastic surgeon (thank goodness for social media).  Now, most people would say, you felt a lump, go get it checked no matter what...why are you taking time to get online?  Well, I was in half panic and half denial, he's my breast surgeon and I was alone in my house.  I needed to reach out, get outside of my own head, and seek advice.  He said it could be fat necrosis or scar tissue, but he knows I won't have peace of mind until I have an ultrasound.

I then messaged my GYN who just completed my Oophorectomy on What's App with what I had found and my surgeon's suggestion.  Again, you're asking why her?  Well, it's night time, offices are closed, and she's online.  I needed to talk to someone here, in Singapore, to get some sort of ball rolling.  She agreed with my surgeon and asked if she should schedule an appointment with someone for me.  I don't know why, but I started to doubt myself at this point, and didn't immediately respond to her.  I became embarrassed.  Am I overreacting?  Is this all because I'm terrified it actually could be something, so I naturally want to avoid it?  Am I making a mountain out of a mole hill? ZERO pun intended.   I'll tell you this ladies, no one can tell you how to react or when to be scared when you are high risk and have gone through these surgeries to try and save your life.  

I finally wrote back and told her I'd wait until my husband got home, and have him see if he could feel what I had felt.  I know, why wait and why did I need him to feel too?  For me, it was like my pregnancy test.  I didn't believe the first one, and proceeded to take three more before believing I was pregnant.  I had to wait until the next morning for my husband due to his late nights this week.  

Friday

When my husband felt, he definitely felt the lump too.  He couldn't tell if it was round or not, or if it was muscle or not.  But he could feel something.  After he left for work, I screamed the F word a few times and I broke down, sobbing like a baby for a few minutes.  It doesn't help that I'm sleep deprived and my hormones are out of whack.  I messaged a few close friends, just for support, because it really can be lonely when you live overseas, and I tried gathering some strength from their positivity.  After pulling it together, I messaged my GYN, as well as my physician/oncologist, Dr. Tucker, and let them know that I was ready to move forward in putting my mind at rest.  Because really, how cruel can the world be, after all I've been through?  It had to be nothing.

I couldn't seem to get an appointment anywhere last minute.  I tried my follow up breast doctor, fully booked throughout January.  Dr. Tucker's office tried another doctor, fully booked.  While this was all happening, I noticed my belly button incision from my oophorectomy was red, tender and slightly oozing.  Two weeks post surgery I wouldn't expect this to happen.  So, lets add one more thing onto the plate and message my GYN again.  Bam, I had an appointment scheduled for first thing Saturday morning, 8:30am (today).  I cried a lot today.  It was a mixture of releasing a lot of tension from this year, disbelief that I am actually going through these movements right now and just overall exhaustion.

Saturday

This morning I was on my way to my GYN.  Upon examination of my belly button after the oophorectomy, I was given some ointment to use twice a day to help it heal.  We then got down to business regarding the breast lump.  She felt the left breast first, getting a baseline of what my new implant breasts feel like.  She didn't want me to tell her where the lump was on the right breast, to see if she could discover it on her own.  Sure enough she did...1:00 position, 1/2 in in size.  She got me into an 11:00am slot with her breast surgeon, Dr. Woon, and I was off, yet again, to another appointment.

Upon arrival at the next hospital, it was lucky that the elevator lobby was so crowded that it began sending me into panic from too many people, because I was able to walk the nine flights of stairs which helped me focus, calm down and exhaust myself a bit.  By the time I made it into the doctor's waiting room, I was too tired to panic or worry anymore.  Dr. Woon called me in, went over my history of BRCA1, surgeries and other health history, then had me get on the examination table.  She felt it right away, and she too wondered what it was.  Out came the ultrasound, but she couldn't find a thing.  Everything was smooth and clear.  No cysts.  She seemed a bit perplexed, so poked a little deeper until she saw some undulations in the implant where I had felt the lump.  She then attributed what I'm going through to just that, undulations.  Now, I'm no doctor, so of course I'm going to relay this information back to my surgeon, just so he can help me understand all this, but he's sleeping right now, so an answer will have to wait. :)  

The one thing that rings in my ears from today, is my GYN telling me, "you're allowed to overreact, because its not overreacting in your case.  We want you to be vigilant, we want you checking and we want to be preventive."  So, while some people will never know what its like to feel a lump, thank goodness, others need to know its ok to panic and its ok to seek attention asap.  

By Burningrome (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

Types of lumps:

Fat necrosis: (I did not have flap surgery, but necrosis can still happen with leftover areas)

Occasionally there can be a phenomenon called “fat necrosis” in the newly reconstructed breast mound. That is when the fat from the abdominal flap does not receive enough blood supply in its new position and forms a scar as a result. It will manifest as a hard lump under the breast skin which can feel alarming upon detection. Your plastic surgeon can usually differentiate between fat necrosis and cancer recurrence on clinical examination. If there is any doubt, then you will undergo a needle biopsy or a MRI to arrive at a diagnosis. (http://www.bra-day.com/breast-reconstruction/)

 Capsular Contracture: (remember my Victoria Secret exercises I do?)

If you had implant reconstruction and you feel hardness in the breast area, it may be the result of capsular contracture. Capsular contracture occurs when a hard tissue capsule forms around the implant. It can be small and barely noticeable, or it can become very painful and distort the shape of the breast. Let your doctor know if you see or feel any of these symptoms. (http://www.breastcancer.org/treatment/surgery/reconstruction/screening)

Scaring:

Plain and simple, it could be a bit of scaring from the overall surgery, since there was scraping and disruption all over. 

Calcification Deposits:

Hard lumps under the skin, around the implant.  They can be mistaken for cysts/tumors.

Cysts:

I can't find clear/medical evidenced based information on this right now, but I read a few (ok, a lot) of forums where women find lumps and bumps all the time after mastectomy and reconstruction surgeries, most ending up to be benign cysts.  Yes, it's totally plausible to continue getting these, even after you've had a mastectomy.  Many of the women spoke of these being skin cysts, found in the remaining tissue after surgery.

* Update...nothing was wrong, it was just part of the implant. Everything is ok, but there's no such thing as overreaction when it comes to lumps with a family history.

Two Weeks Post Oophorectomy

"Its as if you woke up!"

This is what my husband says about me now, ever since the surgery.

I've got this lack of sleep thing happening still.  It's technically 17 days post-op, but close enough, and I can't sleep.  Really, its awful.  If I weren't to take any supplements or meds, I'd probably stay wide awake till midnight or 1am!  With Unisom or Xanax, I can sleep off and on through the night, waking only 3-4 times to hot flashes.  But because my doctor doesn't think either of those are good options long term, she had two mixtures made for me.  I picked them up two days ago, so I've only had two nights taking them.  You can see the labels below to get an idea of the strength and what's in them.

For the melatonin, I'm taking 10 drops under the tongue for two weeks, I'll then go down to 5 drops for as long as I need.  Melatonin is completely safe, so she feels this is the best option.  However, she did warn me of one thing...vivid dreaming for the first few nights.  Well, lets break down night one and night two thus far.

Night 1:
I took the pills right after dinner, and the melatonin 30 minutes to bed time (I was shooting for a 9:00 bedtime because I'm really so very tired.)  It took me a while to fall asleep, and once I did, I was up again about 20 minutes later.  This persisted ALL NIGHT LONG.  I think I watched the clock go through every hour.  And because I wasn't sleeping, I was feeling every single hot flash.  My arms are getting stronger from tossing the covers off and pulling them on all night.  Needless to say, the next morning I felt like I was hit by a truck, suffering from overall exhaustion.

Night 2:
I took the pills after dinner, and the melatonin 30 minutes to bed time.  I was up off and on from 9-1am.  But come 1am, I was able to sleep pretty soundly, only waking maybe 4 times to hot flashes, till 6am.  The strangest part was how vivid my dreams were.  Wow!  I woke up and told my husband everything.  I feel so-so today as I'm still very tired and not getting my normal amount of sleep.  The lack of sleep is also causing me to be pretty weepy.  Tears right behind my eyeballs at all times.  I'm supposed to give it two more nights for my brain to figure out this melatonin thing and learn how to sleep again, and the dreams should calm down and I should begin sleeping better and better.

Some may wonder why this is such a big deal, this sleep thing.  My doctor is concerned not only for my overall health and sanity, but because this is nothing like pre-surgery, when I was a sleeper.  I'm a natural born sleeper.  Doctors have tested me all my life for anemia because I sleep so much.  Whether as a little kid, in high school, in college or later...I sleep.  I can sleep for 9-10 hours at night, and still take an hour nap during the day.  I love sleep.  I really, really miss sleep.  What's happening now is not me.  However, my husband loves it as he finally has a partner with which to watch movies and late night TV.

Other than the sleep, everything is pretty ok.  My scars have healed beautifully, my stitches have fallen out, my tenderness is getting much better and my overall health is great.  I'm now on constant monitoring though, with more frequent check ups to make sure my heart stays healthy (higher risk for heart problems), my cholesterol sorts itself out and my bones remain as strong as possible.

Day 10 Post Oophorectomy

Rather than the day by day play at this point, I figured it was ok to let a few days go by before filling you in again.  So, here I am, in my normal writing spot (my bed), ready to fill in you in on the last five days since we last chatted.

I ended up having a second follow up appointment yesterday, as there are some things we're still working out since the surgery.  The number one thing is the fact that I was once a HUGE sleeper, naturally.  Now, I don't get tired.  Seriously, at 11pm I'm asking my husband, "ok, what movie should we watch next?"  This is a problem as it has totally altered my daily norm, including my ability to feel rested and well healed.  My doctor feels this is a problem too, for the exact same reasons.  We've decided to work on this side effect from surgery first.  As we speak, a compound pharmacy is concocting a mixture of a higher dose of melatonin mixed with some tryptophan...yes, turkey sleepy juice.  I will start with 10 drops under the tongue each night and then ween to 5.  I can take it for as long as I want, if it works.  No side effects.  I was going to go on Effexor, but after reading all the negative side effects, I decided to start with this and give it a try.  I'll let you know how it goes.

I've been out and about three times, and all three times were full on long days of walking and being out with the family.  I noticed that about two hours in, my abdomen begins to ache and I'm reminded that I actually had things cut and removed from inside my body while all I focus on are the incisions on the outside which seem to minor.  The scars looks GREAT!  Pin pricks really.  They are very tender though, and as clothes rub on them and I bend and stretch, they get agitated and everything aches.  My fear right now is getting bumped or hit in the stomach...I'm a school teacher.

I've had some major hot flash attacks occur, which has lead me into my second obstacle throughout recovery...anxiety.  Somewhere within the past two years, I've had about ten to fifteen incidences of what I call, panic attacks.  These same feeling are also happening during some of my hot flashes.  After a long discussion with my doctor, she has identified me as having claustrophobia.  My first experience was in an MRI machine 1/2 way into my 45 min. scan a couple years ago.  Apparently, according to my doctor, the major hot flashes I have every so often, put my body into the same exact feeling I get when I have a claustrophobic attack, and my mind therefore reacts the same...I want out.  This has been hard to deal with, but for now, I'm trying to deal with this med free.  As of now, my doctor has given me a full month of recovery time off work, I'm in week two.  I think I'll only last a third week off, and I'll want to go back to work from sheer boredom already.

Other things to note at this time:

Sleep:
Still not sleeping without the assistance of Unisom or Xanax.  A compound pharmacy is making me a strong dose of melatonin and tryptophan as we speak.  I'll let you know how this works.

Pain Killers:
No pain killers, not even Panadol, for the past five days.  The pain isn't bad enough, just achy and tender.

Hot Flashes:
Well, as you read above, I am having them, and they do wake me up when I've finally managed to fall asleep.  I have purchased a recommended product called a cool pillow.  I used it last night, and yes, it did make a difference in my head temperature, but my lower body still got hot, obviously.  However, it was nice to have the coolness against my face.  I really need to work on the panic attacks during these flashes.  I'm constantly throwing the covers off and on throughout the night, so I know my sleep is interrupted no matter what.

Crying:
I don't cry regularly by any means, but I can feel that I am very emotional and if the right thing was said, I'd cry right then and there.  

Physical:
Feeling ok.  Able to go out for a day at a time here and there, although the next day I'm totally exhausted.  Bandages were off two days ago, no real pain...just aching.

No HRT?:

Nope, no HRT for now.  We did talk about the possibility of the progesterone cream if my hot flashes don't work themselves out in the next couple weeks.

Bleeding:
Still bleeding, but doctor says its normal.  It's more of a pain in the butt right now.

Day 5 Post Oophorectomy Follow Up Appointment

* Updated to include my nighttime happenings in day 5.

Hooray for day five!  See, with every down, there must be an up.  Yes, yesterday was an awful day.  I fear, on these down days, that I'll get stuck in them and that's how life will be from now on.  But then, I have these awesome good days, my up days, like today.  The up days are what recharge us, keep us going, remind us what the heck we're doing this all for.  

I had my follow up appointment this morning with my amazing doctor, Dr. Dharshini.  I've said it before, and I'll say it again, she is my comedic relief, but in a totally good way.  She is so real with me, to the point (those of you who know me know that I do enjoy the sugar coating every so often), but makes it palatable, relatable and just digestible.  When you're going through major life changing surgeries, let alone, milestones, you need someone like that in your life.  This time, I brought my husband with me, the first time he actually got to sit through an appointment regarding my oophorectomy (hey, he met my mastectomy surgeon online for the first time, just like me, so this isn't all that strange.)  I was excited for him to meet Dr. Dharshini so that he could share in my enjoyment of my appointments and understand my affinity for her.

I explained everything happening over the past four days...the sweating, insomnia, the foggy brain feeling, the low blood sugar feeling, the crying...shall I go on?  Everything to her, was fine.  She attributed most everything to the fact that I just had MAJOR SURGERY, removing my freaking hormones overnight.  (I stress this part for those of you reading this who think this was a minor surgery and a walk in the park.)  She was most concerned about my insomnia, as sleep is a major factor in healing and overall emotional health, and said that this would be her focus for right now.  This pleased me greatly, as my husband pointed out, I LOVE sleep.  I'd hate to break up with it.

By Andr.V.S. (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

After describing all of my concerns and issues I was having, she did the physical exam in the next room.  I do not look at graphic photos, so I already passed on the surgery photos, but I don't look at wounds, sutures or anything else to do with cutting, bleeding, etc.  So, staring at the lovely plain white ceiling, I twiddled my fingers on my chest while she poked and prodded my surgical sites, removing the bandages and re-bandaging at my request.  My belly button actually felt fine during the cleaning and overall check.  It even felt fine when she pressed on it, several times.  It wasn't until about 20 minutes after the exam that I started aching, more than normal, for the first time since surgery.  She obviously touched a trigger point.

Back in her office, we resumed our conversation about the side effects of surgery, the side effects of the lack of estrogen, and what our plan would be for now.  So, here we go (with updates):

Sleep:
I told her I was taking Unisom the past two nights, and she wasn't too thrilled with me relying on something like that for sleep.  I'm now on Melatonin, nightly, to see if it helps.  If this doesn't help, we'll take the next steps, but she's hoping this does the trick.

* Update: last night was AWFUL.  The insomnia was back, but worse, every 20 minutes I was throwing the covers off and drenched in sweat.  At 1am, I was turning to my online lovelies for support, but tears welled.  This happened with the AC on and the fan pointed directly at me.

Pain Killers:
No more pain killers, and really, I'm on Panadol irregularly now.  Despite the pain I felt after today's exam, overall, I really don't NEED anything.

Hot Flashes:
Interestingly, she mentioned that many women who remove their ovaries like me, preventive and losing estrogen all at once, often don't experience hot flashes like women going through natural menopause.  It's usually much easier, less frequent, if at all.  After talking to women online, I know that I've heard from both camps, so not sure on this yet.  However, I can say that I'm overall generally warmer than normal.  I used to be cold all the time...now, I don't even want my pj bottoms on.

* Update: Yes, they do exist...and for me, it was 100% noticeable all night long.  Perhaps I don't notice them during the day as much because I'm busy, but last night, every 20 minutes and they were furious.  

Gas:
Gone!  No more gas, hallelujah!  Now, just a little bloating from the surgery swelling, but no gas.

Crying:
I didn't cry today, but she did mention it will take a while to regulate all these emotions...about a month, to see how I'm really doing.

* Update: Cried tonight!  Go figure!

Physical:
We went out after the appointment again, enjoying a couple hours out of the house.  It pushed me as I had just had my stomach poked and prodded and was walking through the pain, but it was good for me.  No crying, no hot flashes, no blood sugar issues...just, what I would call, extreme fatigue.  I'm now on daily vitamin B complex to help with my energy throughout the day.  I'm also on 5000mg of vitamin D for my bones, as they are very susceptible to deterioration from this point on.

No HRT?:

Nope, no HRT for now.  Here's how she explained it to me.  I've just gone through major surgery to remove my ovaries, which produce estrogen, which to a person who has had breast cancer or has the BRCA1 gene, is not a good fit.  This is controversial, so I'm only stating what is happening for me, at this time, based on my doctor's recommendation.  For her, putting me on any dose of estrogen right now is basically saying, then why did you even have the surgery in the first place?  She went on to say that if I continue having issues physically/mentally, we'll cross that bridge when we come to it, at which point she might be forced to put me on a very low dose of estrogen.  But for now, she doesn't want to.  It was relieving to hear that fat can help produce some amounts of estrogen...so the fat in my belly is actually helping something!

* Update:  We're gonna have ourselves a little sit down, heart to heart about this.  I will not live like last night.

Day 4 Post Oophorectomy

"I can't reverse what I've done."  These are the words that came out of my mouth today as my eyes welled up with tears.  I must remember why I did this.  I must remember what my intentions were for doing something so drastic.  Today was a hard day, a down between my ups day.

After three days of being house bound, and desperately wanting to feel part of the ringing in of the New Year, I decided it would be fun to venture out to a nice lunch in a part of town we have yet to explore for New Year's Day.  The taxi ride just kind of passed me by as I cradled my stomach for fear of each bump jostling my insides.  I could hear my kids chattering away excitedly, but I couldn't tell you what they were talking about.  By the time we arrived and were seated at our table, I felt as if my blood sugar had suddenly dropped.  I was just a bystander at our table, voices muffled, action happening all around me, and there I was, trapped inside a body I didn't know.  It was warm.  I was getting scared.  My husband asked if I was ok and my kids said I'd be really good at a staring contest in that moment.  All I wanted was my glass of orange juice I'd ordered ten minutes earlier.  I could see the man sitting near us checking me out every so often, I think my face looked of unmistakeable pain.  

By Pink Sherbet Photography from USA (FREE Refreshing Orange Slice Creative Commons) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

As I took my first sips of juice, tears streamed down my face.  I was so thankful for that rush of sugar, that coolness of the fresh juice and for the return of the normal voices around me, allowing me to be a part of the scene.  I can't explain what happened today during those moments.  I've been off medication since 7 pm last night (it's now 5:45 pm the next day), so I know its not an effect of the drugs I've been on.  Is it all part of the hormones regulating, learning how to deal without estrogen?  I also needed a sleeping pill in order to sleep last night as I was WIDE AWAKE at midnight, with no intentions of falling asleep anytime soon.  Hormones again?  Was I having withdrawals of the sleep aid?

The rest of lunch was as it should be, filled with laughter, fun conversation and overall excitement for being together.  We took a walk around the surrounding areas, looking at shops, making a list of other eateries we hoped to enjoy in the future and enjoying the fresh air.  I noticed that I was holding my stomach every so often, feeling my insides rumble and my dressings crinkle.  Walking became a bit slower when I finally said enough is enough.  We were back in a taxi, heading to one more destination before home...the mall.  I know, I should have avoided this at all costs, but we needed a collar of shame for our Yorkie who just had a procedure as well.  

Being in the mall must have been what pushed me over the edge.  I was hot and everything around me became muffled again.  I begged my husband to run and grab me a cold, sugary drink.  While I wanted to pour it all over me, I don't think the surrounding people would have appreciated it, so I drank it as normal.  My stomach ached more with each step and I felt as if something was wrong...not rush to the hospital wrong, but not my normal self.  It was time to go home.  We grabbed what we needed and left.  

I was so relieved to open the door to our home, head into my air conditioned bedroom, peel off my clothes and hop in bed.  I was out for the count, waking up two hours later.  I feel fine now.  But I've been resting.  Perhaps my episodes today were hormones, perhaps it was just post surgical anesthesia adjustment, I still don't know.  I can't find other episodes in blogs I look through.  I'm desperate to find out if anyone else has been experiencing these things the week after surgery.  But what I do know is I did not like any of how I felt and wanted so badly to reverse what I had done.  But then, I'd be back at square one...fearing my future.  So, for now, I'll take this as a down day, turn it around from here, and hope for the best tomorrow when I finally meet with my doctor and hopefully get some answers to what has been happening to me.

Sleep:
I can't seem to sleep without a sleeping pill at night.  I either a) can't turn off my brain enough to relax, or b) begin to panic with shallow breathing and feeling all over uncomfortable.

Medicine:
I'm only on Panadol now...no more drugs.  I'm very sensitive to drugs, so I'm wondering if any of this is just side effects I'm experiencing from pain killers.  The Panadol hasn't even been very regular, so the pain is more of an ache...tolerable.

Hot Flashes:
I don't know if what I'm experiencing are hot flashes.  I do know that I'm the one who is always cold, everywhere we go, and I'm no longer that person.  I am getting very warm in different situations, feeling sweaty palms and the heat rising in my face.  If these are hot flashes, then I'm having them.  If it's anxiety, then I'm having that.  If it's none of the above, then I'm just hot.

Gas:
It's WAY better today!  Now, my stomach still is enlarged, forcing me to wear elastic waisted clothing, but the gas feels so much better.  I can tell its leaving, and hopefully just about done.

Crying:
Well, you can pretty much tell from today's entry that my hormones are out of whack, and yes, I can pretty much cry at any moment right now.  I always thought it was estrogen that made women cry, and here I am crying without it.

Anxiety:
Yep, I'm gonna say I have a bit of that going on here...ok, a lot.  Maybe if I took Xanax during the day, a lot of this would go away.  I haven't tried that yet, I'll ask my doctor tomorrow.

Physical:
The belly button surgical site is now bruising and I can see the bruise peeking out of the bandaged area.  I guess this is part of healing.  It's still the most tender area when strained or touched.  The other two areas aren't very noticeable.  I shower just fine, walk, for the most part, fine and get on with my day without actual pain.  Discomfort is the word.