Doctor Contact List

There are many excellent doctors here in central Texas. Listed below are a few I feel or believe are excellent. They are either the doctors who have treated or are treating me, or doctors that have been highly recommended. (Disclaimer, choosing a doctor is very personal, and they might not be a good match for you.)

Useful Medical Webpages

As part of my medical adventures I have found the following links to be useful and reliable.

General Medical

General Cancer

Breast Cancer & Reconstruction

Heart, Heart Failure & ICDs (Implantable Cardiac Defibrillators )

Irene's Cancer Experience Recommendations

I hope no one else has to face cancer, or breast cancer. However, if someone does, these are a few things I have learned. If someone you know is diagnosed with cancer feel free to point them to this page and to give them my contact information. I would be happy to listen and to answer any questions I can.

For cancer in general:

• When you get the news: Shock. It feels like a kick in the stomach. Have someone perscribe you an anti-anxiety drug initally. While you are seeing the different doctors and making decisions on your treatment a clear head is required. However having a clear head is nearly impossible for those first couple of weeks without some medical help. Also, pray or meditate.
• Unless you are absolutely sure of your situation, consider getting a second opinion.
• Support: You don't have to listen to everyone's story, but actively seek out and talk to people who have and have been treated for the same cancer you have. It gives you a lot of insight, and gives you questions to ask your doctors and helps you make informed decisions.
• During treatment:
  • Be easy on yourself. Everyone reacts to drugs or radiation differently. Take the time you need and don't feel inferior because you couldn't work as much as someone else.
  • During chemo, drink plenty of fluids, especially the first few days after infusions. This minimizes the chemos damage to your kidneys and bladder. Sometimes during chemo it is hard to drink water because you get that "metallic" or wierd taste. Try tea, sports drinks or diluted fruit juice or anything you can, to get fluids into you. Keeping hydrated also minimizes nausea.
  • Accept support. Cards & emails are great. Let people visit or bring food some or do special things for you. They need to do it and you need to receive it. The connections are good.
  • Continue some sort of routine for healing your spirit (prayer or meditation.)
• Dual path planning: Actually all people should do this, but for folks with cancer or any potentially life threatening illness it is really important. This means when you make decisions, you balance what you do with your time, money and energy; realizing that you might die soon and you might also live a long time. If there are things that need to be done if you were to die (like a good will, or writing some notes or making peace with someone or a reasonable life long dream) then go ahead and get them done. But don't fail to plan for living either. It is by confronting the possibility of death, and taking care of a few critical things, then you are truly free to live and to hope.

For breast cancer:

• Get a Sentinal Node Biopsy as opposed to a full lymph node resection if possible. (I had the full lymph node resection.) You lose less lymph nodes and have less problems like aching, arm swelling and slow healing of that one arm. The only negative is, that if they later find something in the sential node, they may have to do a 2nd surgery to resect the rest of the lymph nodes. They are doing this in most large cities now, but not all doctors trust it yet.
• Lumpectomy or mastectomy? Happily most folks get lumpectomies today. Certainly consider your surgeons advice. It usually depends on the size and location of you cancer and also your family history. Generally lumpectomies have the same outcome (they are just as good) as mastectomies. However, if you have lumpy breasts, you may find you want to have a mastectomy to reduce future stress. If you do need or choose to have a mastectomy, and want reconstruction look at all types carefully, and talk to people who have lived with the type you are thinking of getting. See the next bullet for what I learned and my biases. If you can't decide it is OK to wait, although you will have a little more scarring.
• Breast Reconstruction: The latissimus flap tunnels muscle from the back and inserts (silicone or saline) to rebuild the breast. This has been around a long time, and is still good for very slender women (no body fat to harvest) and for people that must avoid the TRAM flap. The free TRAM flap transplants fat (and a little bit of muscle) from your tummy to the chest. The surgery for this is the most compilicated (requires microsurgery to reconnect the blood supply) but gives the most natural results. (Fat feels like fat, no inserts to have problems with, and because it is natural more nerves grow back so there is more feeling.) This seems to be the surgery of choice in large cities or large cancer treatment facitilites and this is what I had. You get a full tummy tuck with it, and your tummy remains relatively strong. A popular reconstruction surgery (because it is easier and also uses your own fat) is the pedicled TRAM flap. This time the tummy muscle is tunneled up to the chest to provide the blood supply to the tummy fat up there. Much more muscle must be taken so people often have weak tummy muscles or even hernias after this type of surgery. Also, since the blood supply is remote so it could have problems later. I talked to several women with this type of reconstruction and they seemed significantly less happy with it then either the free TRAM flap or the back flap folks. If your breast are small a simpler alternative is the tissue expanders. Some women I have spoken to have been very happy with this. There may be newer options available, please check with your doctor. Unless there is something new that is better, my summary: Best is free TRAM flap if you are a candidate. 2nd is back (latissimus) flap or tissue expanders if you are small. I can't think of any reason to do a pedicled TRAM flap when better alternatives are available.

How to help a person with cancer (or what helped for me.)

• If you know of people with the same cancer, supply names and contact info. The person may not make contact but it is nice to have the resources.
• Be a good listener. Don't push your agenda. Some people want second and third opinions on everything. Others find a doctor they trust and go with them.
• If they are comfortable with you, offer to drive them to chemo or doctors visits.
• Encouraging or just "I'm thinking of you" or "I'm praying for you", cards and email are great throughout the treatment. Email humor is good too.
• Offer to bring meals or shop if the person wants. Ask what sounds good to them, because during chemo what you can stand to eat varies a lot from day to day.
• During chemo your skin gets really dry so lotions get used a lot.
• Other ideas are magazines, the loan of DVD's or videos and books if you know their taste. You have to spend time recovering from surgeries and chemo treatments.

Irene's Specific History & Original Diagnosis

• Breast cancer diagnosed, Jan 2003. Invasive ductal, 2.1 cm
  • Grade: 2, moderately differentiated.
  • DNA: Diploid, total S phase 2.81%
  • ER/PR: Estrogen receptor Positive. Progesterone receptor positive.
  • HER-2/NEU (Hercep test): Positive (2+) but a follow-up FISH test was negative.
  • Low grade ductal carcinoma in situ, solid and cribriform type.
• Bilateral mastectomy, Feb 2003 (Left side, modified radical, right side, simple)
• No lymph node involvement
• 4 rounds chemo (Adriamyacin, Cytoxin & 5FU) and CA27.29 rose
• 3 rounds chemo (Adriamyacin, Cytoxin & Taxotere), CA27.29 stayed high
• Aug/Sept 2003 started Arimidex & Faslodex. CA27.29 dropped to normal.
• Free TRAM flap (tummy fat transplant) bilateral breast reconstruction, Nov 2003

Irene's Current Health Summary

• Leukemia (AML) in remission since Mar 2009 chemo & May 2009 bone marrow transplant. Still take lots of meds, am monitored regularly, must be careful about bacteria, virus & fungi & molds, and also avoid sun to minimize GVHD (Graft vs. Host disease.)
• Breast cancer remission since, Sept 2003. Monitor via CA27.29 breast cancer marker.
• Breast cancer current treatment: Arimidex, 1mg pill daily.
• ICD (Defibrillator) implanted for heart damage (that is now healed - YES!) has been removed. Taking coreg (beta-blocker) to maintain heart strength, manage blood pressure, and minimize supra-vetricular tachycardia.
• Osteoporosis: Treatment suspended until after bone marrow transplant.

Irene's Breast Chemo & Post Breast Cancer Chemo Pictures

For your amusement, here I am with my hair, at various stages of chemo, starting with the "before" picture, going through bald/wig, extrememly short, chemo curls and ending with my current state. Click on any thumbnail picture for a larger view.