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Posts with tag surgeon

Thought for the Day: Choosing the best surgeon

What do you think is the best way to choose an experienced and quality surgeon? Some researchers think it's by reputation. That's how I got mine. A friend told me who he'd use if his wife or mother developed breast cancer and then more and more people began recommending the same surgeon. It seemed logical I'd use him too. And I'm glad I did.

A study published in the January 20 Journal of Clinical Oncology reveals that women who actively choose their surgeons by reputation are more likely to be treated by experienced surgeons in hospitals with comprehensive cancer programs. Reputation even beat out accepting referrals from other doctors or health plans.

On cancer, waiting, and walking away

Walking into my cancer center waiting room is one of my most sobering experiences. I enter this room -- jam-packed full of men, women, and children -- every three months for a breast cancer follow-up. It never gets easier. It always startles me, stirs my emotions, makes me realize how so many people are touched by such a treacherous and all-consuming disease. The fact that I sit in this room, that I am one of these many people, still doesn't seem real.

It's been almost three years since I got a phone call from a surgeon declaring, "You have cancer." I didn't believe it then. Even after all I've been through -- surgery, chemotherapy, radiation, and more -- I hardly believe it now. But it's real. I have scars and new hair and a whole new set of worries to prove it.

Walking into that waiting room proves it's real. There's nothing like it. There's also nothing like walking out, with a clean bill of health and the promise of three more months.

Get an experienced surgeon for prostate cancer surgery

We all want an experienced surgeon, of course, but are you sure your surgeon is experienced enough?

In a recent article published in the Journal of the National Cancer Institute, patients with prostate cancer who have a prostatectomy performed by a more experienced surgeon tend to have better outcomes.

A prostatectomy involves removal of the prostate gland and surrounding tissue. A study was done to evaluate the total number of prostatectomies a surgeon has performed and if this indeed had influence on recurrence rates.

It seems so, patients who had a surgeon that performed less than 10 prior prostatectomies had a recurrence rate of 18 percent. Patients who had a surgeon that performed over 250 prostatectomies had recurrence rates of only 10 percent.

I think the take home message here is, no matter what kind of surgery you are getting -- ask your surgeon how many times they have done this specific procedure. If it seems very low you might want to consult another surgeon who has more experience.

Are women lacking knowledge about breast cancer treatment options?

A survey sponsored by CancerCare, a national non-profit cancer support organization, stated that a majority of women surveyed said they know a fair amount about breast cancer however, many remain unaware of the recent progresses made in treatment. Fewer than one in four women in the survey have heard of new therapies available for breast cancer, revealing a gap between awareness and information that women can use toward getting a better treatment plan for themselves.

Diane Blum, executive director for CancerCare, says "While great progress has been made in breast cancer awareness through public education and increased media coverage, women with breast cancer would benefit from more information about advances in treatments after surgery".

Key questions to ask your physicians when diagnosed with breast cancer:

  • What kind of breast cancer do I have?
  • Which treatments are available to me?
  • What are the risks and benefits of those treatments?
  • What is the risk my breast cancer will come back or spread to another part of my body?
  • Where do I go for support when I need it?

For the full survey results visit CancerCare.

Sunday Seven: Happy Father's Day to seven dads with cancer

It's Father's Day. And all dads out there deserve a pat on the back, a sincere thank you, a celebration in their honor. But there's one group of dads to whom I'm giving special attention on this fine Sunday, June 17 -- dads with cancer.

Having been a mom with cancer, I know how parenting becomes doubly difficult when a life-threatening illness crowds into the picture. The usual mommy and daddy responsibilities are hard enough on their own. Add cancer and all sense of balance, control, and even joy can fly out the window.

Holding down the daddy fort while battling and surviving cancer is no small task. So let's honor some of the dads who manage this feat. Here are seven of them.

Continue reading Sunday Seven: Happy Father's Day to seven dads with cancer

Cutting Remarks: A surgeon's blog

Sidney M. Schwab, M.D., the author of Surgeonsblog, is a mostly retired general surgeon. With his blog, his intention is to inform, entertain, and possibly educate the reader about the life and loves of a surgeon.

He also has written a book, Cutting Remarks; Insights and Recollections of a Surgeon. It's about his surgical training in San Francisco in the 1970s, aimed at the lay reader with the goal of entertaining with good stories, informing with understandable details of surgical anatomy, procedures, and diseases.

Here is a little taste of what you can find on the Surgeonsblog --good stuff!

Continue reading Cutting Remarks: A surgeon's blog

Cancer questions

If you have just been diagnosed or are ready to go through treatments it is important that you understand your disease and the therapies recommended. A great website, www.webmed.com has a list of questions that you should bring along to your next appointment.

Remember -- Knowledge is power!

10 Cancer Questions for Your Medical Oncologist About Chemotherapy, Hormone Therapy, or Immunotherapy

  1. Why are you recommending this treatment for me? Why is it preferable to others?
  2. What does this treatment do, exactly? How well does it usually work?
  3. What are the risks and side effects of this treatment?
  4. How long will I need this treatment?
  5. Where will I go to get this treatment?
  6. What should I expect from the treatment itself? How long will it take?
  7. Should I bring a friend or family member with me to treatment?
  8. After treatment, will I need time to recover? Will I be able to drive myself home? Will I need to miss work?
  9. Should I make any changes to my diet or lifestyle during or after treatment?
  10. How can I reach you if I have concerns or further questions?

10 Cancer Questions for Your Surgeon or Surgical Oncologist

  1. Why are you recommending this surgery for me? Why is this treatment preferable to others?
  2. What will this surgery accomplish, exactly? How well does it usually work?
  3. What are the risks of this operation?
  4. How should I prepare for this surgery?
  5. What will happen during the procedure?
  6. How long will I need to stay in the hospital?
  7. What will my recovery be like?
  8. What complications should I look for?
  9. When can I go back to work?
  10. How can I reach you if I have concerns or further questions?

10 Cancer Questions to Ask the Radiation Oncologist

  1. Why are you recommending this treatment for me? Why is it preferable to others?
  2. What does this radiation therapy do, exactly? How well does it usually work?
  3. What are the risks and side effects of radiation therapy?
  4. How many weeks will I need this treatment?
  5. Where will I go to get this treatment?
  6. What should I expect from the treatment itself? What will happen? How long will it last?
  7. Should I bring a friend or family member with me to treatment?
  8. After treatment, will I need time to recover? Will I need to miss work?
  9. Should I make any changes to my diet or lifestyle during or after treatment?
  10. How can I reach you if I have concerns or further questions?

Thought for the Day: Give it up for the gut

My gut hasn't always guided me through life's most difficult decisions and dilemmas. It wasn't until I felt a lump in my breast more than two years ago that my gut kicked into gear and told me something very important.

"It's cancer," my insides told me one week before the surgeon who did my biopsy called.

"It's cancer," the surgeon said. I didn't tell him, but I thought it: "I know."

I also knew prior to surgery that my cancer had not spread to my lymph nodes. My gut told me this too. It also told me the chemotherapy drug Taxol was not right for me -- since my cancer had not spread -- despite the urging of one oncologist that I accept this treatment. I would have gone on gut instinct alone in my rejection of this medication but another doctor weighed in and agreed with my gut, so I had solid backing on this decision.

Many have dismissed hunches like these and have written off those who believe in them as screwballs, says writer Chip Brown in the March 2007 issue of The Oprah Magazine. But as Brown shares after peering into the world of gut instinct, there are 100 million nerve cells in the gut. They run on autopilot, regulate digestion, play a critical role in the body's immune system, and control mood-altering neurotransmitters identical to those in the brain.

The gut is essentially a second brain. It was a "gut feeling" that led Fred Smith, founder of Federal Express, to begin exploring the possibilities of overnight delivery and Howard Schultz, founder of Starbucks, to begin mass marketing coffee. Wall Street professionals make millions on their gut feelings, sportscasters make startling predictions based on gut guidance, and entrepreneurs launch thriving businesses because of the inklings that rumble in their tummies.

You may or may not be a gut thinker yourself. But I've stumbled upon a gut exercise -- thanks to psychotherapist Nancy Napier --and I'd like for you to consider it the next time you find yourself stuck at a crossroads, unsure of where to turn. You never know, the direction you seek may be swirling around in your midsection, just waiting for a call to action.

Think about this:

You are wavering between two choices. Find yourself a quiet, serene place where there will be no disruptions. Now sit down. Take a moment to settle and focus on the issue you want to explore. Then choose one side. Think about this side and notice what happens in your gut. Do you feel a tightening and gripping or a softening and warming? Are the sensations pleasant or uncomfortable? Notice your thoughts. Are they positive or negative? Give yourself some time to feel your gut and your mind responding.

Now shift to the other side. Think about the previous questions, and try to chart what your body gut is saying.

While you may not get a gut answer at first, if you come back with the question several times, you'll likely hear just what your gut wants you to know.

Doctor diagnosed with disease that grew his career

One of my cancer doctors has cancer. I'm not sure why this surprises me -- it seems many people I know develop the disease in some form or another -- but it does surprise me. And I can't stop thinking about it.

It seems a cruel twist of fate for this man -- a well-known and respected cancer surgeon -- to suffer a blow from this disease after spending his entire life saving others from it. And so it's shocking to know he is now walking in the footprints of those for which he has cared, to know he is now undergoing treatment, to know his life will sprout in directions he may have never imagined.

I sent this kind man an e-mail today to let him know I am thinking about him. And I told him I hope he finds himself in the hands of people who are skilled and talented and loving -- just like him. Because it is no small thing that I am alive today. And I thank him for that.

Dr. Len's cancer year in review

Dr. Len Lichtenfeld, MD, is the deputy chief medical officer for the American Cancer Society. He is also a blogger and authors his very own blog -- called Dr. Len's Cancer Blog.

Dr. Len writes on his blog about all sorts of topics related to cancer. He shares his opinion on the recent drop in breast cancer cases (December 15, 2006), he promotes the Great American Smokeout (November 14, 2006), he sounds off on lung cancer screenings (October 25, 2006), and he urges parents to always slather sunscreen on their children (October 5, 2006). He has so much more to say -- and his blog is a great stop for those wishing for more information on hot cancer topics.

As this year comes to a close, Dr. Len offers a review of what he believes were the hottest cancer topics of 2006.

Dr. Len reflects in his blog about decreased cancer death rates that represent real progress in the fight against cancer. He calls the HPV vaccine a breakthrough and he recaps the STAR trial -- a comparison of raloxifene to tamoxifen to reduce the risk of recurrent breast cancer in post-menopausal women -- with emphasis on how raloxifene proved just as effective as tamoxifen, but with a better safety profile. He calls new targeted therapies a dream -- with a hefty price tag -- sure to garner debate and discussion in 2007.

Dr. Len reviews the Surgeon General's report on second-hand smoke -- it's harmful to non-smokers, the report says -- and he marvels at the capability of science to approach an understanding of what makes a cancer cell a cancer cell. He also remarks on how remarkable it is that chronic myelogenous leukemia is in fact chronic and no longer fatal, thanks to the drug Gleevec.

Of course, there is ample attention given to the declining incidence of breast cancer, reportedly due to less women using hormone replacement therapy, and the risks weighing on those who are overweight and obese, and survivors and supporters who gathered for Celebration on the Hill -- the site of one incredible American Cancer Society event.

Dr. Len closes his review of 2006 with recognition of three celebrities who lost their lives this year to cancer --
Dana Reeve, Ann Richards, and Ed Bradley. And while he recognizes there are other lives and other stories that deserve mention, there is simply not enough time or space for him to do justice to every noteworthy item.

"What we have seen over the past year is an incredible leap forward in cancer research, diagnosis and treatment, and I suspect there are going to be even more exciting developments in the coming year," says Dr. Len who looks forward to 2007 -- a year that is sure to deliver more hope and more progress in the fight against cancer.

Time for a climb up the family tree

Americans are urged to know their family medical histories -- and to share them with their doctors.

Spearheaded by the U.S. surgeon general's office and other public and private agencies, this urging is critical -- because knowledge of family history can lead to more frequent and earlier screenings for particular cancers, to changes in diet and exercise to combat onset of heart disease and diabetes, to more formal genetic counseling and testing if warranted.

This Thanksgiving marked the third anniversary of Thanksgiving National Family History Day, a day the surgeon general's office has reserved for family discussion and documentation of medical histories.

"Family history itself is the first and best genetic test," says Sharon Terry, president of Genetic Alliance, a non-profit group in Washington, D.C.

Brigham and Women's Hospital in Boston has started a work-place initiative regarding medical family history. In the past year, about half of the 13,000 employees -- from physicians to file clerks -- have completed the computerized family history forms developed by the surgeon general's office.

Acting surgeon general Kenneth Moritsugu says, "knowing your family history can help you make better health choices. Much of what we do in American health care is treat chronic diseases, many of which involve choices over a lifetime."

It's probably nothing

I think I was the only one who truly believed the lump in my breast was cancer. No one else -- my mom, my sister, my husband, my doctors -- believed I was a candidate for this disease. I was young, had no family history, had no known risk factors. It just wasn't likely, even after an ultrasound revealed something suspicious.

The surgeon who performed my biopsy was in the same camp. It was probably nothing.

November 2004

On November 23, I had a biopsy. A large needle was placed in my breast and a piece of the lump was pulled out. The doctor had a hard time getting a piece, however, because it moved around so much. He said this was a good sign -- the movement. He sent the tissue to pathology and told me to call his office the next afternoon for the results.

Lumpectomy technique saves patients from repeat surgery

On Sunday, for the very first time, I read a magazine article about the hospital where I received treatment for breast cancer. I had never before seen mention of my hospital, my doctors, my city in anything other than local and regional newspapers and on area television stations. I figured news about Shands Hospital at The University of Florida was out there -- in more areas than my own -- because it's a well-known facility. People travel from all over to receive treatment here. So I know it's a good place. But to see in the October 2006 issue of Good Housekeeping an actual blurb about a new kind of lumpectomy -- pioneered right here in Gainesville, Florida -- is exciting.

I am the happy recipient of this new kind of lumpectomy -- which really is not new at all. It was developed 20 years ago by the surgeon who performed my own lumpectomy, and it allows women who undergo lumpectomy the chance to avoid return trips to the operating room.

The method is called frozen section analysis, and it was first used by Dr. Edward Copland III, first director of the UF Shands Cancer Center, who was tired of waiting for pathology reports and tired of operating on patients two and three times to ensure clear tumor margins.

It all happens like this -- a surgeon removes the breast cancer tumor, takes tissue samples, freezes them in an embedding compound, and sends them to a pathologist for immediate analysis. In a typical case, this frozen section process adds just 15 minutes to the operating time. If pathology reveals more tissue must be removed, the surgeon returns to the patient, still under anesthesia, and continues surgery. The patient does not need to return for more surgery.

Surgeons at most institutions rely on a method called permanent section analysis to determine whether or not cancerous cells remain along the margins of a tumor. The technique is labor-intensive, takes days to complete, and requires patients to return for additional surgery if margins are not clear. Surgeons using the frozen section method still consult permanent sections to confirm margins are clear -- but they are mostly certain of their findings during frozen section.

Studies show frozen section analysis to be safe and effective -- and it adds just $851 to the cost of surgery, a savings considering the cost of returning for surgery as a result of permanent analysis.

There are many advantages -- but the procedure is tricky and on occasion can fail to detect some cancerous margins, indicating frozen section should continue to be used in conjunction with permanent section. Opponents of the practice say false positives could result in unnecessary mastectomy. But Copeland says this has never happened at UF -- and he would never remove a woman's breasts until permanent section confirmed it was necessary.

Despite the promise of this method, only a handful of institutions make practice of this surgery-sparing technique. Shands at UF is the only hospital in North Florida where breast surgeons perform frozen section analysis on a regular basis.

The procedure -- which is not risky, is not harmful, and clearly saves patients from returning for surgery -- is the exact procedure I received almost two years ago. Dr. Copeland removed my tumor, froze tissue samples, sent them to pathology, and 15 minutes later knew my tumor had clear margins and had not spread to my lymph nodes. He visited my family in the hospital waiting room just after surgery and told them the good news -- clear margins, no spread, a 1.1 cm. tumor, stage I. And while other tumor criteria, such as ER/PR status and HER2 status, did not come my way immediately, I at least knew the basics when I woke from surgery. No waiting. No worrying. No complaints.

A diagnosis he didn't expect to hear

He an unlikely breast cancer survivor -- because he is a man. But still he developed the disease that roughly 1,700 men will contract this year. And while that statistics pertaining to women and men with breast cancer differ -- women are 100 times more likely to get the disease -- the biology of the disease is exactly the same. Under the microscope, breast cancer is breast cancer. It does not behave any differently in female and male bodies. And detection, treatment, and survival rates are nearly identical for both sexes.

Bob Riter, 49, was diagnosed with breast cancer in 1996. Now in remission, he works as the associate director of the Ithaca Breast Cancer Alliance in New York where he speaks out and educates the public about this widespread disease. He believes his personal story, with its different twist, prompts people to really listen.

Riter's audiences learn that breast cancer in men usually presents itself as a lump in the chest, dimpling of the skin, or changes in the nipple. Doctors can perform breast exams, mammography, and biopsy to investigate the possibility of the cancer that typically strikes men between the ages of 60 and 70. Treatment includes mastectomy to remove the tumor and surrounding lymph nodes, chemotherapy, radiation, and hormone therapy.

It was the presence of blood coming from his nipple that sent Riter to his doctor -- and then to a surgeon who declared a diagnosis of breast cancer. Riter is somewhat of an exception because he reported to his doctor immediately. Most men do not. Many do not even realize they are at risk of breast cancer so they ignore symptoms. They also may go underground with their suspicions of breast cancer because of embarrassment. Both can lead to diagnoses of more advanced diseases.

Riter is doing his part to enlighten both men and women that men are not immune to breast cancer, that they should be active in monitoring their breast health. "I really like to go to national breast cancer meetings," he says, "because a lot of people know that men get breast cancer in theory, but until you have a face to associate with it, it's fairly abstract. And so I'm sort of that face."

Breast cancer cases keep surgeon busier than ever

My sister recently ran into the surgeon who removed my breast cancer tumor almost two years ago -- on December 3, 2004. He asked my sister how I was doing, recalled the unprecedented rash I developed from the latex and Tegaderm tape used during my lumpectomy, and then talked about how terribly busy he has been.

This surgeon -- who spends countless clinic hours with women whose breasts are somehow diseased and then spends day after day in operating rooms trying to remedy these diseases -- said he is amazed and at how many breast cancer cases are consuming his time. It's sad -- the amount of women showing up with breast cancer -- but there is a silver lining to this cancer cloud, because according to this surgeon, the vast majority of these breast cancer cases are early stage. This means they were caught swiftly and quickly. And for the women behind these cases, there is a good chance of long-term survival.

And so maybe all the pink and all the press surrounding breast cancer is working. Maybe it's inspiring women to pursue self-breast exams, clinical exams, mammography, and other screening options. Maybe all the persistence and passion about breast cancer is the reason for this early detection -- the key to a good prognosis.

My surgeon closed his chat with my sister by telling her to call him if anyone in our family ever needs anything. But he told her he hopes he never has to hear from us. My sentiments exactly.

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