Automated Breast Ultrasound & Hypermobility

My annual mammogram appointments have been yielding a “dense breast tissue” diagnosis. While, thankfully, this is not unhealthy, it does mean that further screening is required each year. Today was my first breast ultrasound general screening. And now, I am dealing with a flare-up of significant pain.

This is a photograph of the poster that has been hanging on the walls of all UVM Medical Center Mammogram facilities since the spring of 2016, when Gov. Peter Shumlin signed into law a bill requiring women with heterogeneously or extremely dense tissue to be notified of the limitations of a mammogram in detecting cancer cells.

I’ve had a breast ultrasound before. About five years ago, my mammogram revealed a “spot” that needed further investigation. That first time, I was scared of what they would find. My husband came with me for emotional support and to help me digest any information the radiologist may need to share. The ultrasound tech used a handheld wand (the same that is used for abdominal ultrasounds during pregnancy.) Not unfamiliar with the “pulling, pushing & compression” of the tissue a handheld wand creates, I was prepared when the sonographer manipulated my breast tissue in various ways to get the necessary angles of the spot.

Today, the tech used an automated breast ultrasound (ABUS) for the screening. At first, it seemed to be a more efficient means of imaging a larger tissue area. She explained that I would feel a wide area of compression where the large ultrasound head is placed. The first pass seemed okay. But as the pressure was released, I realized that I might be in a bit of trouble.

I have a long history of joint hypermobility. During my teenage years, I was forced to quit gymnastics because every time I raised my arm over my head, my sternoclavicular joint would “pop out.” In this position, I had no stability to bear weight on my hands. However, it was not until a few years ago that I sought an official diagnosis of Hypermobile Ehlers-Danlos Syndrome. hEDS is a genetic connective tissue disorder that is caused by defects in collagen protein. Collagen is one of the two primary elements of connective tissue. The weakened connective tissue (ligaments, tendons, fascia, etc.) creates joint instability. Subluxations (incomplete or partial dislocations of joints) are a common occurrence for me. For the last couple of months, I have been dealing with rib head instability in the front and back of my rib cage.

When the pressure from the larger ultrasound head was released, I realized it was more than my breast tissue getting squeezed. Multiple ribs on a single side were compressed while my spine was in a rotated position. This put my hypermobile rib heads in a very precarious position.

I immediately let the sonographer know what I was experiencing. Thankfully, she was able to reduce the necessary compression for the remainder of the scans. She checked in each time to make sure I was okay. After all the scans were done, the ultrasound goo was all washed off, and I was redressed; the tech told me that if the screening was too hard on my rib cage because of my hEDS, I could request future ultrasounds be performed with a smaller hand-held wand.

I am so grateful that none of my rib heads subluxated today. However, my nervous system and muscles surrounding my rib cage are on “high alert.” The tone of the muscles in my back and chest is increased and prepared for further assault. So, I am going to be gentle and attentive to my body for the remainder of the day. Feeding it with soothing sensations to let my system know that it did a great job dealing with an unexpected situation. Also, letting it know