Wednesday, March 16, 2016

Second Opinions

Even though I was completely comfortable and confident in my doctors at Greater Baltimore Medical Center (GBMC, my local hospital), I decided it was prudent to have a second opinion. With the help of my brother-in-law's family subscription to something called HealthNetwork, I got an appointment with doctors at Johns Hopkins for the Wednesday before my first chemo. I was scheduled in their multidisciplinary clinic, where I would see the surgeon, the oncologist, and the radiology oncologist all during the same session.

Since Kevin was going to take off Friday to come to chemo with me, he went on to work and Kevin's mom came with me to the appointments. We got there about half an hour before the first appointment, scheduled at 9, because traffic wasn't nearly as bad as we'd expected. They had me in a room about 20 minutes before 9, where I went over my medical history with a nurse, who put it into the computer even though I'd already filled out and given them the pre-appointment paperwork with all of this information. She then had me change into a gown to wait for the doctors.

The gown is my biggest complaint from my visit to Hopkins. Unlike GBMC, where the gowns were cut in a wrap-front style that provides full coverage despite opening in the front, the Hopkins gowns left me feeling extremely exposed--and would have even without my pregnant belly pushing the bottom open. There was no overlap at all, and the three string ties did very little to keep me covered. It wasn't until just before seeing the last doctor that I realized I could put my sweater on over and zip it up to help me feel more comfortable--and I didn't figure that out until I needed to find the bathroom, which was down a long hallway, through a busy lobby, and halfway down another--and I was not going to do that with my top half on display. Seriously, folks. For as much money as you bring in, you can invest in some wrap-front gowns for your breast center. We're going through enough already.

Rant over. Though the appointments with each doctor had been set for 60 to 90 minutes apart throughout the morning, we saw the second doctor we were scheduled to see first, and still a few minutes before 9. Someone later explained that he was available then and the doctor we were scheduled to see first was running a bit behind, so they adjusted the schedule so I wouldn't have to wait any longer. I really appreciated that.

The surgeon, Dr. Habibi, came in with a couple of PAs or interns, I don't remember which. I explained I was being seen at GBMC but wanted a second opinion, and he asked what they'd recommended. He agreed that a lumpectomy was the better choice, and said the only reason to consider a mastectomy would be if the genetic testing showed I have the BRCA 1 or BRCA 2 genes. Those raise the risk of recurrence very significantly, and that for BRCA+ women, bilateral mastectomy is recommended. He said the chance of me having the gene was still very low, under 10%.

The second doctor was the oncologist, Dr. Jelovac, whom I liked best of those that we saw there. She spent about an hour with us, telling us that she had emailed her colleagues with my specifics and what she thought would be best and asking for feedback. Her only deviation from Dr. D's plan was to space the A-C treatments to once every three weeks in order to avoid having to give me Neulasta, which is a category C drug during pregnancy, meaning it has not been proven safe for use in pregnant women, though no negative effects have been attributed to it either. Debbie asked a question about staging and how it was determined, and Dr. J went through it in careful detail. She agreed with GBMC's diagnosis of clinical state II-A.

One of the social workers on staff came in next, provided information about support groups, wigs, and other programs available to help people undergoing treatment for cancer. She was very friendly and helpful.

The last doctor was the radiation oncologist, Dr. Asrari and her PA. I haven't met with anyone in radiation oncology at GMBC yet, so it was a chance to ask all the questions I had about radiation. First, I will definitely have to have it if I don't have mastectomy. With a mastectomy, there's a lot that goes into the decision. Second, I am not a candidate for any of the newer or somewhat experimental radiation options, based on the type of cancer I have. Third, I will get tattooed for it. That one seemed like an especially obvious question for them, but it wasn't anything I'd been able to ask about before then. Small blue dots are tattooed that are then used to help guide the placement of the machine so that the radiation goes exactly where it is supposed to go. The dots don't indicate where the radiation is directed, just how the machine needs to line up. Apparently, once you've got them, you're not supposed to have them removed, though it may be possible to incorporate it into a larger tattoo, as long as they are still visible.

If I remember correctly, we left the Breast Center before my last appointment had been scheduled to even start. It was an overall very positive experience, and if I was to receive treatment at Hopkins, I'd feel quite confident in my care. However, it can't compare with the overwhelmingly positive and comforting experiences I've had at GBMC. Besides, GBMC is easier to get to, and all my other doctors are there (consciously so, as I've never had a negative interaction with anyone affiliated with the hospital. If you need medical care, and you're anywhere near GBMC, I cannot recommend them highly enough).

Debbie and I had a delicious lunch at a deli around the corner from the office before heading to GBMC for my scheduled Teach Session that afternoon.

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