NOTES FROM ONCOLOGIST APPOINTMENT 11/21/08

1) Again much paperwork to fill out, busy office, crowded, friendlier overall feel. Appointment was a 1:30, didn’t get seen until 2:00, stressed because Judy needed to be in the city for After School Matters at 4:00, and I had told them I would be back at work around 2:30. Did I mention that we couldn’t get an appointment in the Barrington office, but had to go the McHenry office which is 30 minutes north of Barrington?
2) We were called back in by Dr W’s nurse Cara who introduced herself by name and role title and told Judy how sorry she was about her diagnosis. (Someone who cares!). She looked through Judy’s paperwork, took her temperature and blood pressure and told us Dr W would be in shortly.
3) Dr W came into the room, introduced himself to Judy as Tom Weyburn, shook hands with her and told her how sorry he was about her diagnosis. He then shook hands with me and told me that he was sorry to be seeing me under these circumstances (I work with him at the hospital).
4) He asked Judy what she knew and understood about her diagnosis. She stumbled on a few points and he said “that’s ok, this is not a test.” He said that he would be covering a lot of information, and asked who wanted to start. Did we want to start with questions or did we want him to start. We asked him to start.
5) He had already reviewed her pathology results, her mammograms and ultrasounds and her MRI. He had already spoken with Dr Witkowski (the general surgeon). He sat and looked through all of the paperwork Judy had filled out, commenting that she is overall very healthy.
6) He said that based on the MRI he felt that Judy is not a candidate for a lumpectomy (also called breast conserving therapy), but that she needed a mastectomy due to too large of an area of involvement and too many areas of involvement (multi-centric tumor, meaning many centers.
7) He said that post surgical treatment could not definitely be determined until after surgery. The need for chemo is determined based on the size of the invasive tumor (2cm or greater needs chemo), on the MRI it appears that the tumor is between 1.5-2.0cm. Chemo is also determined based on whether or not the cancer has spread to the lymph nodes which will not be known until after surgery. He said it is not definite that she will require chemo, but he indicated that his feeling is that she likely will. There is also a possibility that she will require radiation therapy which will also be determined by lymph node involvement and by whether or not they get “clean margins” (the outer edges of the tissue removed are free of cancer cells), he felt that based on the MRI the surgeon will likely be able to get clean margins.
8) We discussed the bad experience with the plastic surgeon Dr B. He empathized with us and answered more of our questions than Dr B had answered. He said that after implants, to check for breast cancer recurrence they do MRI’s because the implants prevent you from getting a good mammogram film. He said that he has never met Dr B., but he has seen patient’s who have had reconstruction by Dr B., and that technically Dr B. is a good surgeon, has good outcomes and his patients end up with good results. He recommended a second opinion plastic surgeon with a question to the plastic surgeon if there is any contra indication to immediate breast reconstruction with the possibility of radiation therapy. We asked his opinion about the urgency of scheduling surgery and he feels that it should be scheduled in the next week or two.
9) He definitely recommends genetic testing based on Judy’s age, but he does not think she is high risk for carrying the breast cancer gene, since I did not have breast cancer pre-menopausal, nor did my sister, or any of my aunts, and since Cathi does not have breast cancer.
10) He discussed the hormone receptor positive and the HR2 negative status of her tumor and said that these are two very good signs which indicate that this is a less aggressive tumor type.
11) He examined her and like everyone else who has examined her was amazed by the almost insignificance of the exam compared to the significance of the mammogram and the MRI. He said that based on the MRI he was expecting to see an enlarged, inflamed breast. He said that he was not able to palpate any lymph nodes, which is another positive sign.
12) He spent an hour with us, at no point did we feel rushed, at the end he asked if there were any other questions we had, and encouraged us to call with any questions if we thought of any. He will see Judy next after her surgery.
13) He told her that he feels that she will do well with this cancer, and just needs to get over this “bump in the road.”
14) We both really liked him. I felt encouraged and more positive after seeing him. I saw him again later after I returned to the hospital and he was seeing his patient’s at the hospital. He asked how Judy was doing after their appointment and all of the information discussed. He said again that he felt that the plastic surgeon we saw (Dr B.) was technically very good, that on his exam of Judy he noted that her abdomen was indeed flat & tight (which might indicate that she is not a candidate for a TRAM), that she needed a second opinion and that he hoped to see her scheduled for surgery in the next week or two. He also gave me a release (at Judy’s request) for her to have a massage or to participate in yoga at the Wellness Place (a resource/support center for Cancer patients). All of their services are at no charge.