Saturday, May 14, 2011


Had my visit with Dr. Rubin on Monday.  As usual our 1 hour appointment ran over to almost 2. 

Bob and I asked him for his opinion what to do with regards to the pathology results and what actions to take based on the tumor board.  At first, he gave us the classic answer we've been hearing of it's your decision.  But we pressed him further... Bob especially. 

Bob and I are baffled by the word 'inconclusive' in regards to the Tumor Board findings.  We come to a doctor for their assessment of the situation and then their educated opinion on what to do.  A recommendation. Not 'it's your decision'.  What am I going to do, look it up on the Internet and read about it?  That's going to make me qualified enough to make this decision?  No. Ultimately, I know I will come to my conclusion, but I want to make that decision with the knowledge that my team of doctors feel one way or another and then weigh all my options.  

We've grown to know and trust my 'team' of doctors over the past few months. Dr. Rubin is a the kind of guy who put up with all our questions and concerns by hearing us out, laughing along with us and guiding us along the way.  If we stumped him, he would research it and get back to us.  This would be no exception. 

He got it.  Inconclusive was not what he was going to be.  He asked permission to speak to his mentor and a colleague to discuss my case and get back to us. Of course, I said yes!  I'm not one to hide much as evidenced by this blog!!!  Anyway,  Dr. R spent the day calling and researching in between his regular appointments so he could make a recommendation to us.  I got the call around 5pm that same day.  Dr. R not only discussed my case with his mentor and colleague, but he decided to call to Sloan- Kettering to speak with Dr. Larry Norton - the Deputy Physician-in-Chief there and an oncologist specializing in breast cancer.  Dr. R didn't know him, he just called and left him a message to give it a try.  Much to his surprise, Dr. R got a call back!  (His excitement about this came flying thru the phone to me!!)  Anyway, Dr. R read all of the pathology to him and before he was finished, Dr. Norton's reaction was - she has to do radiation.  It was clear to him simply by the estimated size of the tumor among many other factors.

There are 3 primary factors that determine whether to radiate or not - 4 or more lymph nodes effected, tumor 5cm or larger, (don't remember #3).   Because I got all my chemo up front - neoadjavant - who knows how many lymph nodes were actually originally effected.  We do know there was one with a small evidence of cancer found in one after 6 rounds of chemo.  The size of the tumor could also have been effected but this is bit more clearly defined.  The tumor gets attacked like shooting a shot gun at it... so it ends up like swiss cheese and edges are still there.  You get the picture, I hope.

Dr. Rubin was confident in what he said next - 'If it were my wife, I'd recommend radiation'.  He strove to gather enough information to give us what we wanted - a real opinion on what to do next.  I cannot believe his effort and appreciate all that he has done for me and Bob. 

But, to my surprise, it wasn't over.  Dr. Norton called Dr. Rubin back a few days later.  Dr. Norton had taken my case and presented it to the Tumor Board at Sloan-Kettering!!  Consensus was - radiation.  Furthermore, he consulted with his go-to radiologist and they devised a plan which he further passed onto Dr. Rubin!  I cannot believe all this myself!! 

Dr. Rubin gave me a referral to a radiation oncologist located next to St. Francis Hospital.  His name is Dr. Koucher.  Dr. R warned me he looked young. I asked, 'Doogie Houser young?'  Dr. R just laughed... well, let me tell you - yes!  Doogie Houser young!!!  He looks barely 17, its almost shocking!  (I forgot to warn Bob... he was pretty surprised himself!)  Young but very knowledgeable.  He talked to us at length about treatment plans, short term and long term side effects, etc.  I left him feeling much better about the benefit/risk ratio.  There really isn't a question any more.  I will have radiation. I just have to figure out the timing.

1 comment:

Lisa Buglione said...

It sounds like you are dealing with some of the best doctors around! It is so reassuring to hear the extent they go to get you any information you need. I am glad Doogie made you feel more comfortable about the decision. That is so important that YOU are comfortable with the decision. Lisa