Twenty minutes after Professor Oncology nixes chemo therapy, five minutes after Dr. Alpha, the radiation oncologist, calls to tell me that I need a re-excision to get clear margins (you are supposed to have 2 mm) I am sitting in my friend’s garden sipping tea from her bone china cup. I am “in the moment” trying not to mull over all the “what ifs.” The insufficient margin frustration is behind me. Well, almost. My new bosom buddy, the radiation oncologist, took charge of the incomprehensible pathology report. He even called a day earlier than promised to let me know that I , indeed, need a second surgery!
Suddenly, my cell phone buzzes. A Magnolia Cancer Center number.
The way Dr. Guru, my surgeon, puts it to me, one might think that he himself had called my radiation oncologist, to tell him to hold off radiation, not the other way around.
“I am still not convinced you really need this,” Dr. Guru says. “But maybe it is not such a bad idea, after all.” Then in what seems like a vague apology he adds: “I know you are very busy and all and this will be a bit of an inconvenience for you, but we might as well go ahead and put it behind us. “
“Might as well. But when?”
“Next week.” Dr. Guru does not hesitate. “We will schedule this for next week. Joy will call you to arrange the details.”
I feel stupid for being so happy. How much happier could I not have been had I been wrong about the re-excision, and able to start radiation right away? Is it not childish to be happy about being vindicated? After all, I am the one who will be the most inconvenienced, just like Dr. Guru admitted. Also, I feel mildly irritated that Dr. Alpha has to tell me not to hurt Dr. Guru’s feelings by “not rubbing his nose in it.” What other profession is filled with egos so fragile that they need to be perpetually wrapped in velvet and praise? A master surgeon is never to be reminded of a mistake, however slight or insignificant.
![iStock_000000476379XSmall[1]](http://cancerboob.com/wp-content/uploads/2009/11/iStock_000000476379XSmall1-273x300.jpg "iStock_000000476379XSmall[1]")
“Sometimes when I consider the tremendous consequences that come from little things, I am tempted to think there are no little things.” – Bruce Barton
-When will you have your re-excision? my sister-in-law wants to know.
I tell her that I believe Dr. Guru when he says my margins are clear. He says that I don’t need a second surgery despite a pathology report which seems to indicate a margin of less than 2 mm.
I tell my sister in law that my real worry is the prospects of chemo therapy. Of course, no oncology appointment has been scheduled yet. Somehow I am under the impression that Dr. Guru’s office will set it up.
-You need a second opinion, my sister-in-law says firmly. I will call Doctor Weary to schedule an appointment. Now.
My sister-in-law’s friend died from breast cancer. Her margins were never clear despite several surgeries. But her situation was different from mine. She was much younger than me, by a decade or so. Her cancer was, sadly, more aggressive. Her prognosis was more “unfavorable” from the outset.
I tell my sister-in-law that a new surgeon can not possibly figure out margins from an old surgery, now healed. But she will have none of it. She calls me back with two appointments, less than a week out: one with Dr. A, her friend’s surgeon, one with Dr. Weary , a well known oncologist at the hospital that was feuding with my insurance company at the time of my diagnosis. But the feud is over. They will accept my insurance.
Although I cannot for the life of me understand how a second surgeon could possibly tell my margins, I feel relieved. Someone, other than me, is doing the heavy lifting. A mill stone rolls off my shoulders. Appointments have been set for me, whether they make sense or not. I realize how wonderful it feels to have been removed from the decision making process and able to just follow someone’s command
Energized, I decide to also ask the University Medical Center to send my pathology report along with a sample to Vanderbilt University for a second opinion.
Maybe it is not a bad idea to find out more about my cancer cells, given that both the Breast “Care” Center and the University Hospital says my cells are moderately to well differentiated and slow growing. Yet the OncoDX test indicates that they may not be quite as benevolent.
You, too, can send your pathology results to Vanderbilt for a second opinion. Check information below or go to www.breastconsults.com. In most cases, insurance will pay. If not, their fee is quite reasonable.
Q: How do I arrange for my slides to get to Vanderbilt (VUMC) for consultation?
A: Patients wishing to have their slides shipped to Vanderbilt should contact the originating pathology department and tell them you are requesting a second opinion from the Breast Consultation Service at Vanderbilt University (aka. David Page, MD and Associates). Request that they send the pathology slides and all reports corresponding to those slides. Also, ask them to include a face sheet of your demographics and billing information for billing purposes. The address to send the consults to is as follows:
David Page, MD
Vanderbilt University Medical Center
Department of Pathology
C3321 Medical Center North
1161 21st Ave. South
Nashville, TN 37232-2561
615-343-0072 (Phone)
615-343-5137 (Fax)
