Monday, August 22, 2011

Dr. Waisman- Appointment #1

There was nothing typical about my Monday morning. For starters, I actually took a shower, put on make-up and wore something other than my pajamas or comfy workout clothes. Working from home, at least for me, starting my day off with a shower and putting on real clothing is a rare occurrence. On top of that, I actually got in my car and had to drive along with the rest of the working world at 8am. It reminded me how grateful I am that it's not every morning I have to get in my car to go to work.

The drive to Manhattan Beach was mostly fine. Steve was with me, thankfully, and it was a nice distraction for my increasing anxiety. But as we got closer to the appointment, my mind kept wandering and I couldn't really talk with him. It didn't help that we were asked to be there by 845am and due to someone needing to make a stop at Starbucks, we were running late. We walked in the door at 854am, quickly answered questions about the paperwork I had already filled out and before long we were whisked away to the back to get started.

After an initial conversation with Dr. Waisman (who was as wonderful as the woman who referred me to him indicated), I had a breast exam in which I was told "everything looks fine." In the room, where I was asked to undress completely from the waist up, it was me, Steve, Dr. Waisman and a nurse (whose name is escaping me at the moment). I had the most thorough breast exam I've had to date. Which makes sense given all that's going on. I was filled with anxiety and a little bit of embarrassment to just have it all hang out there. But I guess I better get used to that- and quickly. And I could definitely do more sit-ups.


As I was sprawled out on the exam table, I had a million thoughts going through my head. Mostly, I was trying not to cry. The enormity of my new situation weighing heavily on me while I stranger, albeit a very nice one, was examining me in a way I had never been examined before.

It was over rather quickly, although it felt like an eternity, and Dr. Waisman said "everything felt fine." Once that part was over, Dr. Waisman ordered a whole panel of blood work to be done and, not surprisingly, let me know that he'd want me to get both a mammogram and an MRI. Because I haven't had even a mammogram at this point, he thought it was best to get as complete a picture of my breasts as he could. This step allows him to have a baseline of what everything looks like now. So if there are any changes in the future, they can be detected much easier. With those test, Dr. Waisman said, "God willing nothing is found", and then we just continue with surveillance- alternating between an MRI and a mammogram every six months.

Steve & I went back into Dr. Waisman's office where he asked me if it was okay for him to record our conversation. I was blown away and obviously all for it. He assured me he'd provide me with a copy of our conversation on a CD before I left. Of course I agreed and was immediately impressed that this was even offered to me. I loved that I didn't have to worry about writing down everything he said, but instead, could sit back and listen to him and absorb what he was saying. And then I kept wondering "Why the hell don't all doctors do this in important meetings and consultations with patients?"

We spent another 30 minutes going over my medical history. My family medical history. My previous experience with UCLA. And a lot of our time was spent talking about options. Surgical options. Non-surgical options. Whether Steve & I were planning on having kids.

Oh, sorry Mom, children.

As an aside...I was scolded by my mom back in July when I, at one point, said in response to what I'd do if I were a carrier, "I'd probably have a kid and then get my ovaries removed." To which ABC replied with more hostility than I thought the situation called for, "It's not a kid when it's your own. It's a child. Not a kid."

Back to the story at hand.

So Dr. Waisman talked a lot about the whoel child factor. And said that while it's not an emergency and while Steve and I do not have to rush into making any decisions, we'd probably want to think about this over the course of the next year (or two) and decide one way or another. Because if we didn't want to have children, then the theory is that I should get my ovaries removed to significantly reduce my risk of getting ovarian cancer. Although in talking with Dr. Waisman, even with getting my ovaries removed, it doesn't reduce my risk as greatly as it does for the surgical options with the breasts. He mentioned that there's a migration with tissue goes from the abdomen into the pelvis. So there's ovarian tissue that gets left behind and there's a 2 - 3% risk over my lifetime of cancer of the abdomen even after my ovaries are removed. And that's also difficult to monitor.

I was surprised and happy that Dr. Waisman had spent so much time talking about this. I assumed, as a breast oncologist, that he'd focus primarily on that area.

In addition to all the talk about my increased risk of breast and ovarian cancer, and what can be done about that, we discussed some of the other risks. Because with BRCA2 there are other risks.

Prostate cancer in men. Colon cancer. And malignant melanoma.

"And in a fair skinned Irish looking girl, we have to be very careful of that."

What this means if I have to have a full skin mole check from a dermatologist- palms soles, areas of my body that have not only never seen the sun, but that I'd never want someone looking closely at. The fun never ends with this stuff!

As mentioned already, I was super impressed with a lot of things from this appointment. Dr. Waisman, when writing down my family medical history, and got to my dad, said "Wow. That's tough. I'm sorry." in reaction to finding out how old my father was when he passed away. Most people are so clearly not listening and are focused on moving through a list of questions that they don't hear these kinds of things. So I was comforted and impressed that he was obviously listening and compassionate enough to say something.

Also knocking my socks off was the fact that Dr. Waisman took the time during our appointment to call a gynecologist in Santa Monica that he highly recommended. And thank god he did. She's no longer accepting new patients, but because the call came directly from Dr. Waisman, I had an appointment scheduled (for 9/9) by the end of the day. He asked a couple of times during our appointment if it was okay to call Dr. Knox and finally decided to just pick up the phone while I was there to take care of it.

I left feeling very very confident and comfortable with my decision to see Dr. Waisman. And although people recommend "shopping around", I have no intention of doing that. Both Steve & I really enjoyed the appointment- as much as one can enjoy something like that- and felt like I found at least one person to be on my medical team.

From here, I wait to hear from Dr. Waisman's office once they get approval from my insurance for the MRI, and then schedule a mammogram and an MRI. I learned in today's appointment that the ideal window of time for this to happen is seven days after your period because this is when your breasts are the least "active." Which basically means that's when there's the least opportunity for things to show up on an MRI/mammogram that aren't really causes for concern.

Next up is the appointment with Dr. Knox on September 9th. And then after that is an appointment with Dr. Roman (gynecological oncologist) on October 12th. Sometime between there I'll have an MRI and mammogram. And then I see Dr. Waisman again on September 19th. Which will mean I'll have had more doctor's appointments from June - October than I've had in the past 10 years...combined.

But this is the new way of my life. And I just need to adjust and get used to it.


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