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Old 10-13-2015, 08:04 AM   #1
spiritualabundance
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Red face How long is too long...Please help...

I found the lump on 6/6/2015. It wasn't diagnosed until 8/27/2015. I've been getting the run around from my insurance company, and even from the surgeon's office. Nobody seems to be concerned or in a rush except me, and now my husband, who is trying not to freak out, or freak me out, but he is! Anyway, I am PR+, ER+, and of course the wonderful Her2+. The tumor is in the left breast and 1.3cm. I have not felt any changes, nothing bad, other than tired, which a dose of Ensure seems to fix. I can't really say I feel any different and often forget that I have cancer. But, I am REALLY beginning to worry about the recent passing of the 4 month anniversary of finding the lump on self exam. Positive comments are appreciated but so are honest. Please help relieve me and prepare me. Thank you my wonderful Her2 sisters. God bless us all! xoxo
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Old 10-13-2015, 08:28 AM   #2
europa
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Re: How long is too long...Please help...

Hi there,

It's always scary when you get diagnosed. It can be numbing and it's easy to wait for someone to lead you. But I can tell you from personal experience that becoming "THAT" patient that nags and calls and pushes to get in sooner and persists pays off. If you are not getting anywhere with your current doctors, find ones that share the same sense of urgency that you do. If your hospital has a nurse navigator, find her/him and let them be your advocate. They can usually get things done and push the right buttons. My nurse navigator scheduled all my scans ( MRI and PET) within 24 hrs of being diagnosed. She also got me into surgery within 7 days (on the day the surgeon was leaving on vacation!). She made things happen. Don't sit and wait for others to do it...you have to take the reigns on this one and push your way through.
I am not a well liked person at my hospital. But I'm not there to be the most popular one. And because of it, they know not to dillydally with me.
Good luck!
__________________
DX 10/2011
PET Scan + MRI 10/2011
Lumpectomy 11/11/11
Stage 2B +++ ER+(10%), PR+(5%), HER2+++(1 positive node, 1 micromets to second node)
AC started 12/2011 ended 1/2012
Taxol + Herceptin weekly for 12 weeks ended 4/2012
30 zaps of radiation done 6/2012
Tamoxifen 6/2012
every 3 weeks of Herceptin for another year.
Metformin Trial 8/12
10/12 MRI- CLEAR
01/13 BRAIN MRI- CLEAR!
01/13 Neck MRI- CLEAR!
FINISHED HERCEPTIN 1/9/2013...Woot Woot
Starting Walter Reed Vaccine Trial 2/13
CT Scans + ultrasound of abdomen CLEAR-5/13
02/2015 through 11/2015 emergency D&Cs for Tamoxifen induced uterine polyps which caused uncontrollable hemorrhaging
12/2015 blood clot to left leg caused by Tamoxifen. No longer taking it. On Xarelto, a blood thinner
12/2015 Ablation to prevent hemorrhaging from potential issues with Tamoxifen residue in my system
1/2016 continuing journey without hormonal therapy. Reevaluating the option of a hysterectomy and oopherectomy.
4/1/2018 2mm stroke. Yes, stroke! No cause ever found but they believe it was a migraine that went bonkers and created a tiny clot. No deficits. I was back to normal with 24hrs. Now on baby aspirin for life.
7/27/2018 hysterectomy and oopherectomy
01/07/2019 Mastectomy and expanders put in
3/22/2019 Vtach, almost died. Cause unknown.
7/22/2019 New perky boobs put in
7/21/2020 Off of all drugs but a baby aspirin because of the stroke in 2018.


www.mychemobag.org
www.facebook.com/mychemobag

8 YEARS NED
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Old 10-13-2015, 11:09 AM   #3
tricia keegan
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Re: How long is too long...Please help...

I'd agree with the comments above, if this surgeon can't help you find one that will as it seems to me you've been waiting long enough.
__________________
Tricia
Dx July '05 IDC 1.9cm Triple positive 3/9 nodes positive
A/C X 4 ..Taxol/Herceptin x 12 wks then herceptin 1 yr
Rads x 36 ..oophorectomy August '06
Currently taking Arimidex..
June 2011 osteopenia/ zometa x1 yearly- stopped Zometa 2015 as Dexa show normal bone density.
Stopped Arimidex July 2014- Restarted Arimidex 2015 for a further two years on the advice of my Onc.
2014 Normal Dexa scan
2018 Mammo all clear, still NED!
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Old 10-13-2015, 11:09 AM   #4
Carol Ann
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Re: How long is too long...Please help...

Get a new surgeon asap!! Someone who will not put you off.

Everything Europa just said.

Carol Ann
__________________
July 24, 2013: "Infected" Right Nipple and benign cyst removed, pathology report revealed Paget's, DCIS, and ILC 1.25 cm, ER+/Pro+/HER2 equivocal, Grade 2 under benign cyst, previous diagnostic mammo/ultrasound said I was perfectly healthy in both breasts.

Aug 18, 2013: MRI report says Left breast is perfectly healthy "consistent with previous studies".

Sept 2013: I insist on a bilateral mastectomy anyway. Too nervewracking to let left breast remain with higher risk after 3 cancers in right, nipple in right is already gone anyhow.

Sept 18, 2013: Bilateral mastectomy, 11 right nodes removed, ALL negative BUT -- ER+/PRO+/HER2+ tumor, 1.0 cm, Grade 2 found in a piece of "grossly unremarkable" breast tissue from prophylactic mastectomy of left breast, no nodes removed.

Oct 25, 2013: 13 left side nodes removed, ALL negative, Stage 1 across the board, NO RADS needed, YAAAAY! Port also installed.

Nov 25, 2013 Begin 6 rounds TCH.

March 10, 2014 Just finished 6th and LAST Chemo today, YAAAAAY!

March 24, 2014 Echocardiogram to make sure I'm still good for Herceptin every 3 weeks.

March 31, 2014 Echo results NORMAL, first Herceptin all by itself. Now if only my eyes would stop streaming from the Taxotere ... :)

April 21, 2014 Started Arimidex and therapy for "mild" lymphedema in left hand and arm

May 2014 Therapy completed, I have sleeves and gloves for both arms, a Flexi touch lymph pump to hook up to for an hour every day, and I've become an arm bandaging expert. :)

June 2014 Begin Fosamax to prevent osteoporosis; bone scan revealed osteopenia

Nov 17, 2014 FINAL Herceptin!

Dec 4, 2014 My right thigh muscle has been extra achy for days ... I discover a blister rash cluster on the side of my right thigh while taking a shower. Port appointment cancelled until Dec 17, my doc is working me in tomorrow afternoon to see me and the rash. My muscle at least feels less achy.

Dec 5, 2014 Yep, I have shingles. Boo! I start acyclovir and also have a prescription for a painkiller just in case for over the weekend.

Dec 17, 2014 Port is OUT!

January 2016 Shingles again and this time it started where my left breast (where the hidden HER2+++ tumor was!) used to be. My onc nurse got me a same day appointment to see my doc when I called and told her I had a rash on the site. The antiviral meds are working once again, though, so that is good news. :)
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Old 10-13-2015, 01:53 PM   #5
Mtngrl
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Re: How long is too long...Please help...

I can't believe you haven't started treatment yet. Holy cow, what's the delay? I concur that it's been "too long."

Amy
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Old 10-13-2015, 03:25 PM   #6
Nurse4u2day
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Re: How long is too long...Please help...

SpiritualAbundance if these doctors aren't taking care of business then you need to force the issue and or seek other surgeons. From the time I was diagnosed to the time I had my port placed and chemo started was 3-4 weeks and frankly I thought that was to long. Her 2 is aggressive and thus your doctors need to be on it. Remember if you think you are pushing to hard to get treated your not. You are talking about your life. So please make calls,threaten to call the news if the insurance is holding your treatment up. You do what you have to. And yes the nurse navigator should be able to help you move on this quickly.
__________________
]11/13 Dx IDC left breast
11/19/2013 Inflammatory Breast Cancer stage 3c grade 2 Er- Pr- her2+++
Node involvement suspected based on CT
12/13 port placed
12/13 neoadjuvant DD AC xs 4 rounds started
02/14 taxol/herceptin started every week xs 12 rounds
Herceptin for 1 year
Ki67=23%
BRCA1&2 negative
5/06/14 last round taxol/herceptin. Chemo done!!!
5/07/14 clear CT scan
6/11/14 Bilateral Mastectomy Done
6/15/14 8mm tumor post chemo. Removed by bmx
6/15/14 lymph nodes 0/9
6/15/14 officially Cancer Free
7/11/14 emergency surgery to left breast . Wound refused to heal and broke open. New TE placed
7/28/14 emergency medical procedure now to right breast( post op 6 weeks mastectomy ) wound opens.
8/25/14 - 10/07/14 Radiation
11/24/14 CT of Brain clear
01/23/15 One year Herceptin Complete
02/04/15 Diep done
5/01/15 1 year Ct scan- mass in thymus
6/23/15 repeat CT mass in thymus still present
6/30/15 biopsy thymus 7/03/15 mass Benign! Diagnoses Thymic hyperplasia rebound ( chemo at fault, no long term health effects)
7/08/15 phase 2 diep
11/23/15 phase 2b ( reconstructive surgery with lipo)
03/05/18 Vinnie Myer 3 D nipple tattoos complete.
11/19/2018 5 years since Dx of IBC stage 3c remain NED.
11/19/21- 8 years today I officially remain NED and in 12 days I will be having a lymphnode transfer to help decrease some mild lymphedema! Still working, living life and soon to see a day I thought never would happen and that’s becoming a grandparent June 22nd.
11/19/2023 - 10 years since diagnosis and I remain NED
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Old 10-13-2015, 03:36 PM   #7
spiritualabundance
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Re: How long is too long...Please help...

Thank you all for your advice. I have an appt with a new surgeon in two days. I was able to get in with her within 3 days of calling. The surgeon that is holding things up is wonderful, very qualified, and his work is beautiful. However, what good is all of that going to do me if it takes 'too long'. I'm mostly disappointed in the office staff of that surgeon. They have no concern that I first consulted with him on 9/24, and now they tell me I need a new consult because they won't be able to do surgery within 30 days of the first, 9/24, consult. They can't get me in until 10/26 for the next consult then surgery 2-3 weeks after. That means the middle of November. I have to move on. Here's to hoping the new surgeon can schedule something within a week...or sooner. Thank you all!!!!
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Old 10-13-2015, 05:13 PM   #8
jaykay
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Re: How long is too long...Please help...

It's great that you found a new surgeon. I don't want to muddy the waters, but have you seen an oncologist yet? You need to find one, too.

Janis
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March, 2000: 48, Post menopausal (5 yrs HRT) Left breast, IDC 3mm/DCIS 1.6cm, ER+/PR-/Her2+++, mod differentiated, MIB low, lumpectomy, node neg via SNB, rads=33 Stage 1a
June, 2000: Tamox 4.5 years,Femara for 5 years (end in Jan. 2010)
Sept, 2012: 61, Via mamm, ultrasound, biopsy, right breast, 2.3cm tumor, ER+/PR-/Her2+++, poorly diff, KI67 60-70%
BRCA 1 and 2 negative
October, 2012: Bi Mast with tissue expanders, port placement
Final Path: IDC 2.8cm, DCIS, 1/4 sentinal nodes positive (@#$%). Stage IIB
Nov 29, 2012: Begin TCH/6x/every 3 wks, H for 1 year/every 3 weeks.
March 14, 2013: Finished chemo
April 9, 2013: Begin radiation 28x
May 22, 2013: Finished rads
June 1st, 2013: Started Aromasin for 5 yrs.
July 15, 2013: Switched to Letrozole (Femara). Probably for the rest of my life
October 16, 2013: Exchange surgery
October 31, 2013: Finished Herceptin
December 5, 2013: Port removed
Glad this year is over!
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Old 10-13-2015, 05:20 PM   #9
spiritualabundance
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Re: How long is too long...Please help...

Actually, yes! I've met with two, one as a second opinion. I have a follow up apptt on Nov. 5th to discuss chemo final plan. My plan/hope was to have had surgery by then and to have pathology report ready. Surgeon misguided me and wasted weeks. I feel much more confident with my oncologist. Thanks for the great question!
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Old 10-16-2015, 09:10 PM   #10
Catherine
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Re: How long is too long...Please help...

There are lots of great surgeons. Being put on hold because they are too booked up is not acceptable in my book. Not sure where you live. I live in a metro area with lots of doctors. Good luck and keep advocating for yourself.
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Catherine


Found my own lump in the shower
April 2006 at the age of 58
Stage IIB, ER- PR- HER2+++ multi focal tumors, largest 2.3cm
Chemo first: AC/Taxol over 16 weeks
Bilateral mastectomy Sep 06
33 rads after the surgery
1 year of Herceptin completed Dec 07
15 years and no recurrence as of April 2021
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Old 10-16-2015, 09:19 PM   #11
thinkpositive
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Re: How long is too long...Please help...

You stated that your plan/hope was to have had surgery prior to your Nov appt with your oncologist. I had chemo first. Just wondering if you were told that you should have surgery first. It isn't unusual to have chemo before surgery. Just wanted to throw that out there.

Take care
__________________
8/2013 Diagnosed IDC Left Breast ER-/PR-/HER2+ Stage 3C, DCIS ER+/PR+/HER2- Right Breast (54 yr)
8/2013 PET/CT scan shows mass in uterues and suprclavicular nodes
8/20/13 Begin 6 rounds TCH chemo, Perjeta added for rounds 4-6
9/2013 After 1st round of chemo, mass in neck and breast no longer able to feel
11/2013 Hysterectomy, mass from PET/CT scan not cancer (adenomylosis)
12/2013 Finished chemo
1/2014 Double mastectomy with chest expanders
1/2014 Pathology report from surgery and SNB show complete pathological response!
3/2014 Finish IMRT radiation
8/2014 Fat transfer to radiated breast
8/2014 Completed 1 yr of Herceptin
10/2014 exchange surgery expanders removed implants placed
6/2015 3D nipple and areola tattoos
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Old 10-17-2015, 06:47 AM   #12
spiritualabundance
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Re: How long is too long...Please help...

Another big thanks to everyone. First, thinkpositive, no one has indicated to me that chemo is necessary first to treat this. I met with 2 oncologists, now I've met with 2 surgeons, and even a plastic surgeon. None of them have indicated that the route for me would be chemo first. Surgery first is what I've always anticipated. That being said, I did heed the advice of you lovely ladies and instantly found a wonderful surgeon, a little bit further away in the next county. Listen, I'm not saying that a man cannot do a fabulous job but this female surgeon just gets 'it'. I got an appointment with her within 3 days of my first call. I saw her on Thursday and she talked to me for a good half an hour. Then she went out to let me change for the exam. When she came back in, she said, "How would you like to do the surgery Monday?" I was in shock. Thinking I was going to have to wait another 4-6 weeks I wasn't prepared for such an assertive response. She then was worried about sentinel node biopsy privileges at the hospital she would have to perform the surgery (thanks to Humana) so while she was out she also texted a big wig about the AMA regulations. When she came back in to see me, he texted back and told her she does have privileges. She gave me a high five and I said, "see, that's what an advocate does!". I'm so thrilled and relieved. Remarkably, my body and mind feel so much better these past few days. It's unbelievable what a little positive thinking and positive news can do for one's mind and soul.

Thanks again to all of you. I'd add my bio but I haven't figured that one out yet. I'll get to it. I'm pretty savvy just need to find time.

-Diane
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Old 10-17-2015, 07:08 AM   #13
spiritualabundance
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Re: How long is too long...Please help...

Please pray for me this week. Please pray that God works His will in my life and continues to write His symphony of my life to His desires. Thank you ladies!
__________________
6/6/2015-Found a lump in my L breast at 45 years young.
6/12/2015-First u/s
7/2015-Mammogram and 2nd u/s (same day)
8/7/2015-Needle aspiration u/s biopsy. Doctor indicated looked malignant. (thanks doc!! the wait after that sucked)
8/20/2015-Diagnosed w ER+,PR+,HER2+ BC in L breast (now 46 years young.)
9/24/2015-Saw first surgeon, referred by oncologist. Great guy. Office staff not advocates.
10/12/2015-Met w Plastic Surgeon. Amazing doctor. Recommended not immediate due to chemo and 'just get the cancer out first' attitude. Will do recon with him after chemo is complete.
10/12/2015-Called first surgeon's office who told me that it's been too long since the first consult and will need to schedule another consult on 10/24 and then schedule surgery within 2-3 AFTER that date. (BITE ME)
10/12-Found a new surgeon.
10/15-Consulted with new FEMALE surgeon. She was AMAZING! Asked me if I wanted to do the surgery on Monday (in 5 days). Stunned and thrilled!!
10/26/15-Surgery for bilateral mastectomy, port placed, and 3 nodes removed for SNB. 3 drains installed.
10/28/15-home from the hospital to recover.
10/30/2015-Follow up with surgeon. Drains removed. Was told tumor was removed but had more than doubled in size from 1.3 to 2.9cm. 3 nodes removed, all negative. Healthy breast was clear but several suspicious areas on affected left breast. Looks to be Stage 2A. Oncologist appt next week.
11/5/2015-Follow up with oncologist. Planning to start chemotherapy (Herceptin, Taxotere, and Carboplatin together beginning November 30th). Very nervous about side effects, low white blood count, anemia, steriods, etc, etc, etc. I'm not usually one to medicate myself for anything. Not ready for this. Kinda scared.
11/30/2015 - Isaiah 41:10 today for sure. Today was my first day (round) of TCH chemo treatment. Before receiving the cocktail, I saw the doctor who delivered the news that my CT scans (abdomen, chest, and pelvis were all clear). Praise God!! Feeling okay right now after chemo, just a bit sleepy. We'll see how the Neulasta, along with the other effects, rear their lovely heads over the next few days. Prayers please, as always.
12/17/2015-Decided it was time to shave my head and face the music.
1/11/2016-Went in for 3rd treatment. UGG. Spoke to the doctor first. Asked him to reduce the Decadron. Agreed! From 10mg to 4mg dosage. YAY! It still worked and I was able to rest and live. Praise God. I jokingly told him if he felt like dropping some of my treatment, to feel free. Guess what?! He agreed! Agreed to drop my 6th treatment meaning that I now only have 2 left and in March I'll be able to begin the reconstruction process. Additionally, he agreed to schedule me for a brain MRI to just double check for any spread. Anxiously awaiting.
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Old 10-17-2015, 08:04 AM   #14
Catherine
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Re: How long is too long...Please help...

Glad that you have a new doctor and a plan. Getting treatment underway is the most important. After your treatment plan is in place and you get through surgery you can make more choices. By the way, there are some of us on the site that have not had reconstruction and are very happy. This is a very personal choice as I am sure you know, but there is no rush to make the decision. All the best.
__________________
Catherine


Found my own lump in the shower
April 2006 at the age of 58
Stage IIB, ER- PR- HER2+++ multi focal tumors, largest 2.3cm
Chemo first: AC/Taxol over 16 weeks
Bilateral mastectomy Sep 06
33 rads after the surgery
1 year of Herceptin completed Dec 07
15 years and no recurrence as of April 2021
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Old 10-17-2015, 10:10 AM   #15
Carol Ann
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Re: How long is too long...Please help...

What Catherine said. You can do a search here on the forum about choices and others feedback on how their recon went, what they chose and why, and how they are feeling about it once it is finished.

I had no recon and I am glad I didn't. Having said that, I firmly believe everyone should have what makes them feel the most comfortable.

And, as Catherine also said, you don't have to do everything at once; you can always have the recon done at a later date.

Carol Ann
__________________
July 24, 2013: "Infected" Right Nipple and benign cyst removed, pathology report revealed Paget's, DCIS, and ILC 1.25 cm, ER+/Pro+/HER2 equivocal, Grade 2 under benign cyst, previous diagnostic mammo/ultrasound said I was perfectly healthy in both breasts.

Aug 18, 2013: MRI report says Left breast is perfectly healthy "consistent with previous studies".

Sept 2013: I insist on a bilateral mastectomy anyway. Too nervewracking to let left breast remain with higher risk after 3 cancers in right, nipple in right is already gone anyhow.

Sept 18, 2013: Bilateral mastectomy, 11 right nodes removed, ALL negative BUT -- ER+/PRO+/HER2+ tumor, 1.0 cm, Grade 2 found in a piece of "grossly unremarkable" breast tissue from prophylactic mastectomy of left breast, no nodes removed.

Oct 25, 2013: 13 left side nodes removed, ALL negative, Stage 1 across the board, NO RADS needed, YAAAAY! Port also installed.

Nov 25, 2013 Begin 6 rounds TCH.

March 10, 2014 Just finished 6th and LAST Chemo today, YAAAAAY!

March 24, 2014 Echocardiogram to make sure I'm still good for Herceptin every 3 weeks.

March 31, 2014 Echo results NORMAL, first Herceptin all by itself. Now if only my eyes would stop streaming from the Taxotere ... :)

April 21, 2014 Started Arimidex and therapy for "mild" lymphedema in left hand and arm

May 2014 Therapy completed, I have sleeves and gloves for both arms, a Flexi touch lymph pump to hook up to for an hour every day, and I've become an arm bandaging expert. :)

June 2014 Begin Fosamax to prevent osteoporosis; bone scan revealed osteopenia

Nov 17, 2014 FINAL Herceptin!

Dec 4, 2014 My right thigh muscle has been extra achy for days ... I discover a blister rash cluster on the side of my right thigh while taking a shower. Port appointment cancelled until Dec 17, my doc is working me in tomorrow afternoon to see me and the rash. My muscle at least feels less achy.

Dec 5, 2014 Yep, I have shingles. Boo! I start acyclovir and also have a prescription for a painkiller just in case for over the weekend.

Dec 17, 2014 Port is OUT!

January 2016 Shingles again and this time it started where my left breast (where the hidden HER2+++ tumor was!) used to be. My onc nurse got me a same day appointment to see my doc when I called and told her I had a rash on the site. The antiviral meds are working once again, though, so that is good news. :)
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Old 10-17-2015, 10:20 AM   #16
jaykay
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Posts: 645
Re: How long is too long...Please help...

Glad you're happy with your new doc. All my docs except for gynecologist and RO happen to be female. Just worked out that way over the years.

I'm not making gross generalizations, but my experience is that women doctors are better listeners. That's just my experience; certainly does not apply to all male doctors.

Good luck Monday. You will be fine!
__________________
March, 2000: 48, Post menopausal (5 yrs HRT) Left breast, IDC 3mm/DCIS 1.6cm, ER+/PR-/Her2+++, mod differentiated, MIB low, lumpectomy, node neg via SNB, rads=33 Stage 1a
June, 2000: Tamox 4.5 years,Femara for 5 years (end in Jan. 2010)
Sept, 2012: 61, Via mamm, ultrasound, biopsy, right breast, 2.3cm tumor, ER+/PR-/Her2+++, poorly diff, KI67 60-70%
BRCA 1 and 2 negative
October, 2012: Bi Mast with tissue expanders, port placement
Final Path: IDC 2.8cm, DCIS, 1/4 sentinal nodes positive (@#$%). Stage IIB
Nov 29, 2012: Begin TCH/6x/every 3 wks, H for 1 year/every 3 weeks.
March 14, 2013: Finished chemo
April 9, 2013: Begin radiation 28x
May 22, 2013: Finished rads
June 1st, 2013: Started Aromasin for 5 yrs.
July 15, 2013: Switched to Letrozole (Femara). Probably for the rest of my life
October 16, 2013: Exchange surgery
October 31, 2013: Finished Herceptin
December 5, 2013: Port removed
Glad this year is over!
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Old 10-17-2015, 12:28 PM   #17
Juls
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Posts: 563
Re: How long is too long...Please help...

Glad to hear you have moved forward.
As you say positive thinking & positive news makes all the difference.
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Old 10-17-2015, 04:45 PM   #18
thinkpositive
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Join Date: May 2014
Location: San Diego
Posts: 411
Re: How long is too long...Please help...

Sounds like you've got a good plan in place. Waiting is the hardest part.

Most of my doctors were women also. Its so important that you have a team that you are comfortable with whatever the gender turns out to be. I'll be sending healing thoughts your way.

Take care
__________________
8/2013 Diagnosed IDC Left Breast ER-/PR-/HER2+ Stage 3C, DCIS ER+/PR+/HER2- Right Breast (54 yr)
8/2013 PET/CT scan shows mass in uterues and suprclavicular nodes
8/20/13 Begin 6 rounds TCH chemo, Perjeta added for rounds 4-6
9/2013 After 1st round of chemo, mass in neck and breast no longer able to feel
11/2013 Hysterectomy, mass from PET/CT scan not cancer (adenomylosis)
12/2013 Finished chemo
1/2014 Double mastectomy with chest expanders
1/2014 Pathology report from surgery and SNB show complete pathological response!
3/2014 Finish IMRT radiation
8/2014 Fat transfer to radiated breast
8/2014 Completed 1 yr of Herceptin
10/2014 exchange surgery expanders removed implants placed
6/2015 3D nipple and areola tattoos
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