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Mar 15, 2019 06:11PM
Stellawt57 Oh heavens, I am not insulted at all. This forum is a safe place to discuss all of our challenges. I was just sharing my experience. On my journey, I definitely want the absolutely most knowledgeable person for every intervention. I do happen to have two RN's, one NP and an MD in my family. We talk a lot about scope of practice and knowledge and skill sets and how they vary in medicine. You should get to see the provider you are the most comfortable with, always, no question.
I had a surgical PA see me once for a follow-up appointment after breast surgery. Otherwise, only MD's for surgeons and oncology consults. I wouldn't have wanted anything except my actual MD Oncologist to guide me through treatment and inform me about all the choices and risks along the way. He's an excellent communicator, and I trusted his very deep knowledge and experience completely.
My oncologist's clinic offered something called Survivorship Counseling, about 1 month after PFC. This was a one-on-one, hour-long counseling session with an oncological Physician's Assistant. She sees patients just like an oncologist does, although she hasn't been a provider for me. Anyway, she was absolutely great. She gave me a solid hour of information, and answered all my questions. The general topic was how to move forward, what to watch for (recurrence symptoms and signs), and how to live in a way that reduces my risk of any recurrence of my cancer. Specifically diet, exercise, mental health, social engagement, alcohol use, and management of all side effects current and future.
Honestly, the first thing I asked her was how I was going to live with this shadow and terror of recurrence from now on. She was very calming, and told me all the positive aspects and good statistical probabilities about my treatment plan. Basically, by giving me a lot of information and reminding me of how I can help my own statistical odds by making specific choices, she calmed me down and made me feel more hopeful and as if I had some tools to manage moving forward.
We had a long discussion about my specific diagnosis (grade 3 tumor makes my diagnosis especially icky) and why AI is so important in my treatment plan, and how we'll manage any issues that arise related to this medication.
She taught me about which things are shown to be beneficial in reducing our recurrence of a breast cancer. In my case, a 'recurrence' would be probably metastasis and instantly Stage IV. I've had a BMX, so I have an extremely low risk of a new breast cancer or any breast tissue cancer, but there's a small possibility.
Examples of what she said will lower my risk of recurrence: 5 hours of exercise per week, fewer than 4 alcoholic drinks per week, eat cured meats only infrequently (=maybe a few times a year), be aware of all the ways that metastasis presents and where, and what symptoms to notice, realize that many metastatic breast cancers can be successfully treated to extend life and continue good quality of life, aim to have a normal BMI (oops, I could lose 15 pounds and be a lot better on that one). I asked: should I become a vegan? She said: We have no evidence that it prevents breast cancer recurrences, although vegans have a slightly lower risk of colorectal cancers than meat-eaters.
She summarized all current research and conclusions about all this, and also discussed all aspects of my AI medication and its benefits and risks. This seemed like a great way to fill a gap. There's no way an MD is going to sit for an hour with a patient, and this PA had every bit of necessary knowledge and interpersonal skills and experience to fill this role really well. I needed a lot of facts, had a lot of questions, and the idea was to empower the patient, going forward, to manage all aspects of breast cancer and how it affects us in many ways.
3/2003, IDC, Right, <1cm, Stage IA, 0/2 nodes, ER+, HER2-
6/10/2003 3DCRT: Breast
8/8/2003 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
4/25/2018, IDC, Right, <1cm, Stage IIA, Grade 3, 0/2 nodes, ER+/PR-, HER2-
5/22/2018 Lymph node removal: Right, Sentinel; Mastectomy: Left, Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
6/25/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
11/6/2018 Arimidex (anastrozole)
1/2/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant