Wednesday, October 5, 2011

And who is in charge?

I believe if it has anything to do with my health, it should be me because it is all about my body. But unfortunately that pesky cancer crap has a way of messing things up. At a cancer diagnosis, you get all kinds of new doctors - mostly oncologists and surgeons - and they come up with a plan of treatment which generally consists of a mixture of surgery, chemo, radiation, and adjuvant treatment (which is a fancy term for Tamoxifen or systemic treatment). This gave me a medical oncologist who is in charge of chemotherapy and adjuvant treatment, radiation oncologist for radiation therapy, and surgeon for surgery. I am still seeing them all. I also have an endocrinologist who I see annually for that other cancer stuff. But for how long do I get to see them all?

There is no standard plan for seeing doctors for follow up after cancer treatment as a rule.  It can be very confusing. The hospital I go to has some standard protocols which help. But if you get your care from multiple medical offices/centers, it can be confusing to the patient.

I was told by my medical oncologist that she wants to see me every 4 months while I am on adjuvant therapy - which is currently the generic form of Femara - until early 2013 and then probably for a bit after that but less frequently because of bone density issues. I see my radiation oncologist annually but will ask her at the next visit for how much longer. That will be four years since the end of treatment. I was also told my surgeon will be the one, or his nurse practitioner, who will order my annual mammograms with a follow up appointment with the NP for life. (This is the annoying part because they always screw up the scheduling and some how make me feel like its my part but that's another post.)

I also see my endocrinologist yearly to have my thyroid levels checked and the standard is an ultrasound every five years. I didn't have an endocrinologist for a long time. Then the standard of care changed and I ended up back at one a couple of years ago (and then there was THAT ultrasound, blah, blah, blah). I will see her for life as well.

In addition fit in a PCP who is currently following me every three months and a pain management doctor for life and the knee doctor and a dentist, etc. You get the point. I see lots of doctors. Some of them will never go away. I realize that but it would be nice to reduce the frequency of visits. Can I ever ditch oncologists and surgeons and turn my care over to my PCP? I am not sure. I think in another year or so both oncologists will be things of the past - I hope. I am stuck with my surgeon for now. I may develop an exit strategy but I am on the fence. They are my last specialized breast cancer care.

I guess I want to be back in charge of my medical care. Can it ever  happen again? Or maybe I just need to ditch a few doctors so I can stop going to all these appointments.

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