Hidden Scars from Breast Cancer

Yes there are lots of hidden scars in breast cancer. I have discussed the emotional side a lot - which boils down to PTSD for some. But there is also the physical side. Every time you look at your body and see your cancer scars, you are reminded of  your cancer misadventure. Its only a scar that will fade over time but its still there.

Back in 1984, I found my first breast lump. Due to the limitations of surgery at the time, I had to have an excisional biopsy. And because of my medical history (three years after thyroid cancer) they had to be sure. (And if you are trying to calculate my age, I am still only 37). So I had a lumpectomy (aka excisional biopsy). And it was benign which was good. But it left me with a scar. A big fat red scar.

After surgery, I realized I had a bigger problem than normal in bathing suit shopping. I had this giant scar, 2" long, on the outside of my left breast that ran horizontally across toward my armpit. Bathing suit shopping is bad enough with the unflattering fluorescent lighting, holding your stomach in while you are trying to decide if it will fit when you really do lose those 10 pounds by June. Then you have to add in - will my scar show?

Seriously, it took me a good 10 years for the scar to fade and for me to stop worrying if  someone might see it sticking out the side of my bathing suit. It was a bit of vanity for me. But I already had a scar on my neck from thyroid cancer surgery that could not be covered up in a bathing suit. I really didn't need a second visible scar.

Now surgery is catching up to my bit of vanity. At Beth Israel Deaconess Medical Center in Boston, they have pioneered breast cancer surgery with hidden scars.

"Traditionally, the procedure would place an incision directly over the tumor, making it very visible. But Beth Israel Deaconness Medical Center now offers another option.

"The more we can make the scar smaller, or put it in a place that can't be seen, the better for the patient," said Dr. Ted James, chief of breast surgical oncology at the hospital.

He started offering hidden scar surgery here last year.

"What the hidden scar surgery tries to do is to place the incision in a less obvious or visible location. Under the breast is one location. You can also make it around the areola, that's another place where you can hide a scar, and if the incision is very high on the outer portion, we've actually gone through the armpit," James said."

"Hidden scar surgery can take a bit longer than traditional procedures, but recovery time is about the same."

A lot of progress has been made in treatment of breast and other cancers but I really do like the idea of taking into account the fact that the surgical scars can be a less prominent reminder of our cancers each time we look at our bodies.

Doctors As Patients

I think doctor's make the worst patients. A friend's father, she told me, was a doctor but ignored his own cancer symptoms and said he was fine until he wasn't. I have never met a doctor who rushed to be a patient....

But I think the best training for a doctor is to be a patient - particularly a patient of the disease or ailment they treat. This would provide so much more understanding for them.

Here is the story of a British breast cancer surgeon who was diagnosed with breast cancer in 2015 and finally returned to work in 2017. She never expected to face this diagnosis. I don't anyone ever does.

"Doctors face particular challenges when they become patients—challenges that they are rarely prepared for. It is hard to relinquish control and allow others to dictate the treatments that you yourself are used to doling out. It is crushing to know your own prognosis in the starkest terms—a 65 percent chance of surviving for 10 years, in O’Riordan’s case. It is awkward to see your own former patients while you’re being treated: To strike up a chat would break confidentiality."

I would like to disagree here. I don't think it would be awkward to see your own patients while in treatment. I would not expect my doctor to treat me as a patient if I run into them in the store or something. I just say hello as I would with any other person.

"And it is difficult to be cut off from the same supportive forums and networks that other patients use to share experiences and support; if you let slip that you’re a doctor, you become a source of information, rather than a comrade in illness."

I have had doctors and nurses in my support groups. No one in the support group expected them to be any more 'up' on new treatments or provide constant medical advice because that is not what they are there for. They have occasionally filled in on a specific question or answered a question along the lines of 'should I go to the ER for this'. But that's it. In a support group setting, we can't anyone there to provide medical advice. First because they are there for support and second because they have no knowledge of our medical records.

"How much, for example, should she share with her own patients? O’Riordan had blogged regularly about her cancer. She had even done a TEDx talk. But she practices medicine under her maiden name, so few people would make the connection between her online persona and her professional one. Ultimately, she decided to say nothing at first, revealing her experiences only to patients who have completed their treatments and are dealing with the side effects. It helps them, she says, to know that their doctor fully understands how hard it is to live with breast cancer. “You don’t want to compare yourself to other people,” she says. “But when they’re going through that journey, it helps to know that the doctor has, too.”"
I absolutely think she should have felt she could share her diagnosis if she wanted to her patients with the same diagnosis. My best therapist ever had had breast cancer ten or fifteen years before she started seeing me. Because she opened up about this, while we didn't discuss it often, I felt much more comfortable because she 'got me' through her own diagnosis.

I would be very happy if I knew more about some of my doctors. No, I don't want to know everything about them.  But if I knew they had been through what I was being treated for it would greatly increase my comfort level. (Why is doctor patient confidentiality only one way? That's a question for another day blog post.) This especially holds true for specialists in my opinion.

Think about it - if you knew your gall bladder surgeon had had the same surgery as he was treating you. Wouldn't your comfort level with him go up a few notches? He survived, so can you.

Finally, I would like to state that I do not think that this surgeon was ready to return to work. If her brain was compromised by chemotherapy to the point she could not remember instrument names, I would not want her operating on me. Part of healing after cancer, or other ailments, is getting back to the same physical and mental states.

"Chemotherapy can famously fog the brain for years after the treatments end, so she still finds it hard to concentrate for more than half a day. When she returned to the operating room, she performed all the old procedures flawlessly, but at one point, she forgot the names of her instruments. “I was closing the skin and needed forceps to hold the tissue, but I couldn’t remember what they were called,” she says. “I was doing the action with my hand, and thankfully, with a good scrub nurse, you don’t need to ask.”"
My opinion is that just because she is a doctor it doesn't mean she should give herself clearance to go back to work. She was not able to work independently and needed to lean on her support staff to that extent.

In addition I will go read her blog to learn more about her. She has completed a school of hard knocks.

Pre-Op Day

Today is pre-op day. Tomorrow I am having minor arthroscopic knee surgery. Its no big deal. An in and out procedure that should last an hour or so. Nothing significant. It is to repair my right knee which has been locking up for the last year or so.

What it does mean is that I am going to be limited in my abilities to get around for the next week or so. I do not plan on using crutches because I hate them (and I have lymphedema). I really hate crutches. We live in a raised ranch and I bought a can so I should be able to maneuver around the one floor by myself.

My husband has taken tomorrow and Friday off and then will be home for the three day weekend. This means five days of togetherness. (I think I need to come up with things for him to do so he doesn't 'hover' and drive me crazy.) It is great that he will be home with me because I know I will need some help. Its hard to carry things while using a cane.

I went to the library yesterday and got a stack of books and a movie "Hidden Figures" that I have wanted to see. I have also been filling the DVR with shows to catch up on. I have plenty of knitting to do as well. I did laundry and just have the socks left to sort before I am done.

I am going to the grocery store today and am going to get a chicken to roast for dinner tonight so we can eat leftovers for the next few days. I think I am organized.

This is surgery number 9 for me so I have been through it before. Not including multiple medical misadventures. I know what to expect for the most part. I know what I want to tell the anesthesiologist for which anesthesia did okay for me and which did not. I have figured out what to wear tomorrow - shorts so its easy to get dressed post surgery.

I have found that being organized is the most important thing when you are going to be laid up for a few days. I hate being dependent on anyone for anything. I have everything I need. I can always send my husband out for things we forgot or we can get food delivered (if we get bored with leftover roast chicken).

The one thing I do need to do today is to find out what time I need to be there. They are supposed to call me today with that information as well as the 'do not eat after midnight, no water two hours prior, etc'.

I hope for an early time so I can get it over with. The worst is sitting around waiting for your surgery time and being starving because you can't eat. 

Your Decision, Not Your Doctor's

In years gone by, doctors were regarded as gods. They knew all, were not to be questioned and patients should obey unquestioningly. Those days are gone. Patients are empowered. They learn about their conditions, they question their doctors, and they make their own decisions. They may rely on their doctor's advice but clearly make their decisions.

However, a recent study (because we always need more damn studies) found that doctor preferences for surgery type greatly influenced patient choice in early stage breast cancer surgery.

"Researchers surveyed more than 3,300 women with early stage breast cancer and 349 surgeons who treated them. About 16 percent of the patients had both breasts removed.

Only 4 percent of those whose surgeons heavily favored breast-saving surgery and were most reluctant to remove both breasts had the procedure. That compared to 34 percent of patients whose surgeons were most willing to do the surgery, the study found.

"That difference is huge. Even for a procedure that is very patient-driven, we see that surgeons account for a lot of the variability in the community and those surgeon attitudes really matter in terms of whether a patient does or does not get CPM," said study senior author and professor of medicine Dr. Steven Katz in a University of Michigan news release."

If the reasons given for a bilateral mastectomy are given as "patient peace of mind, avoiding conflict and improved cosmetic outcome", then why are the results so skewed to the surgeon's preferences?

Again, its your body and your decision and not your doctor's

I Forgot To Keep Quiet

Everytime you go to the doctor they ask if you have fallen recently. Do you know why they ask you this? Its not because they want to check if you have skinned your knees or ask if you want an ice pack. They want to know if you are at risk of injuring yourself by falling. Or really are you a fall risk.... Which is very bad.

But you say its only a little yellow bracelet. But no it's not. It means they label you as a fall risk until you can balance on your toes on a paddleboard, a million hours of PT, or something. Its hard to get rid of that label on your medical chart.

Yesterday afternoon, I ran into a particularly slippery section of grass in our yard and fell. I didn't land on my bad knee (the one slated for arthroscopic surgery because it keeps locking up) but on my slightly less bad knee (the one with a torn ACL that can't be operated on). No I am not further damaged other than some sore muscles and jolted body parts.

I had a nicely timed appointment with my knee surgery this morning. I showed up and STUPIDLY told the nurse that I fell on my knee yesterday afternoon. I only did that because I knew they would notice it was swollen.... But I clearly wasn't thinking. I forgot to keep quiet.

The main topic of conversation with the doctor was scheduling arthroscopic knee surgery. I will need crutches for a week or so. I won't be a fall risk (note sarcasm) while on crutches. I will then be teetering around, but not a fall risk.

My Health Complicates Everything

I have too many ailments. Combined they interact and cause all kinds of problems. Normal people can have knee problems and then surgery to fix them. Me? Not so much.

I hurt my right knee skiing in 2001 and had arthroscopic surgery to fix as much as possible. My right knee became my bad knee. After surgery, the surgeon said if it ever stops locking up come back and see me again.

In 2015 I fell in our backyard and tore my left ACL. My left knee became my bad knee and my right knee became my good (or not quite as bad) knee. I then started over stressing my right knee which wasn't happy. In the fall of 2016, my right knee started locking up so I went back to my knee surgeon to talk about that.

Yesterday I went back to my knee surgeon who has been following me for both knees for the past year or so. And here's the bad news.

There is something going on with my right knee which causes it to lock up. It freezes and causes lots of pain. I feel my knee click back in place after a couple of minutes and the pain stops. I explained to my doctor that its not the aching pain that causes the problem its the locking and pain that I am concerned about. (Its not fun when it happens.)

Normal people would have the surgeon go in and clean up any tears that are causing the problem. He thinks its a piece of meniscus that sometimes sticks up and jams my knee. But with my medical history of rheumatoid and osteoarthritis, he is concerned that it won't heal well and I will be left with more problems.

I have to go for a second opinion. I can't wait. I just want my knee to stop locking up. It hurts like hell when it does that. My too many ailments make it difficult for me to be treated. (Never mind my medical allergies as well.)

What I Wish I Had Known

As a breast cancer, or actually any kind of, patient, we often have complained about what I wish I had known before treatment, especially surgeries. I know I have whined blogged about it so many times myself that I can't even begin to list them all.

One big area of complaints is what I wish I knew about surgery before I had it. The lymphedema risk was sort of explained but it didn't sink in. Maybe my brain was preoccupied with 'my overwhelming second cancer diagnosis' so it just didn't register. Or maybe I just thought it would never happen to me, like any cancer diagnosis.

But I would like to make the case on the 'Angelina Jolie Effect' where many women are having prophylactic bilateral mammograms because they can. There definitely are instances where a prophylactic bilateral mastectomy is the best treatment option - especially BRCA positive or strong family histories, but not all.

Now breast cancer surgeons are pushing back on this saying that patients do not understand the full ramifications of this surgery. The doctors agree that women have the right to make the decisions about their body but they really want everyone to understand what it will really entail.

""It's a very difficult decision," ... "We think that any woman who wants to have a prophylactic mastectomy ought to be able to have a prophylactic mastectomy. However, we also believe that if more folks understood the statistics and understood the real facts, fewer people would be getting prophylactic mastectomy than currently are.""

See that's the kicker. Not everyone quite understands that impact of removing both breasts - both surgically and emotionally. Its not a in and out surgery. Its a long surgery, 10 hours even, and then can require numerous follow ups. And it may not look the way the patient expected. And cancer can still recur, even if less frequently.

So how do you make sure the patient understands? I really am not sure. Going back to my experiences with lymphedema, I had a separate appointment before surgery with a nurse on how to help prevent lymphedema immediately after surgery and in the long run. I was given printed materials and directed to on line resources. What else could they have done?

Even if they told me if you trip and fall, do not put out that arm to brace yourself or you will lymphedema. That is what happened to me. I could not have avoided that fall which started the lymphedema lifestyle for me unless I stayed inside all winter (I slipped on ice in our front walk on snowy day).

Last summer I took a fall and ended up fully tearing my ACL in my left knee. Because of my RA, I am not a good candidate for an ACL repair. First of all, the RA would probably leave me with a stiff knee which isn't much better than a less than supportive knee. Second of all, the ACL repair would make the knee replacement (that I really do need) less likely to work as well. It took two surgeons explaining this to me several times until I finally got it.

So what would it take to make sure patients understand what they are requesting? The multiple surgeries, the implants, the reconstruction, potential side effects, and more all would need to be detailed. Meanwhile the patient is sitting there thinking 'get it out of me NOW!'.

Its not easy. The patient is very stressed and coping with their diagnosis while simultaneously trying to figure out which treatment options they would have. I agree with the surgeons here that patients need to have a full understanding of the results of their surgery and that patients really need to do their part and pay attention.

Big hospitals forget who is important - the patient

A while back I read an article about how surgeons at Mass General were double booked for surgery and the hospital policy was okay with this. Double booking is when the surgeon is responsible for two surgeries going on at the same time. A follow up was published yesterday to show the results of this expose and whistle blowing by Dr. Dennis Burke.

"Burke was at the center of the Globe Spotlight Team’s report in October about the propriety and safety of a fairly common practice called concurrent surgery, or double-booking, in which doctors work on more than one patient at a time."
And as long as the doctor is within 1/4 mile of the hospital during both surgeries this is okay. And that's the new policy instituted by MGH as a result of the story. Really? I don't consider this that okay at all. I would not want the patient where the surgeon wasn't even in the room. I assume the surgeon is responsible for the surgery should be in the room at all time.

Burke is uncompromising on the issue. He called it unsafe and unethical, embracing a cautious approach that I think most of us expect from the doctor wielding the scalpel.The hospital's response to this article was appalling. They fired the man who spoke up about this issue. He was a physician at the hospital and ended up moving on to a new hospital, and all his patients followed him.

The hospital disagreed. MGH said it has taken careful steps to assure patient safety. The hospital accused Burke of violating hospital rules and perhaps federal privacy laws by supplying the Globe with copies of some internal records.
Being a whistle blower is a hard thing to do. And by being fired by the hospital, he has become a hero to others. 

"Burke thinks MGH and its advisers blundered by terminating him. “Probably the stupidest thing they did was to fire me,’’ he said. “If they didn’t, this wouldn’t be such a big story.’’

But it is. And that may explain why nearly 300 people turned out at the Fairmont Copley Plaza on Friday afternoon during a risk management seminar sponsored by Harvard Medical School to hear Burke’s version of events and why he believes concurrent surgery is unacceptable.

When he was done, the audience stood as one amid resounding applause." 

Who do you want for your surgeon? One that is up to 1/4 mile away while you are in the OR or the one who said this was wrong? The patient is the most important person here and their safety should be utmost.

What happens when you are sleeping

I think we should all be allowed to have an independent person in the OR while we are undergoing surgery if this is any indiciation:

"About half of all surgeries involve some kind of medication error or unintended drug side effects, if a study done at one of America’s most prestigious academic medical centers is any indication."

That is just plain scary. You go for surgery and then you have a 50% chance of medication error or unintended side effect. That is not good.

"“There is a substantial potential for medication-related harm and a number of opportunities to improve safety,” according to the study, published in the journal Anesthesiology. More than one-third of the observed errors led to some kind of harm to the patient."

But these numbers are pretty real. A recent study was done at Massachusetts General Hospital by observers. Previous studies showed much lower numbers but those were self reported by doctors.

"Drugs delivered during an operation don’t have the same safeguards other medication orders do. In most parts of a hospital, prescriptions are double-checked by pharmacists and nurses before they reach a patient. Operating wards are riskier. “In the operating room, things happen very rapidly, and patients’ conditions change quickly, so we don’t have time to go through that whole process, which can take hours,” Nanji said. While all the errors observed in the study had the potential to cause harm, only three were considered life-threatening, and no patients died because of mistakes, Nanji said. In some cases, the harm lay in a change in vital signs or an elevated risk of infection."

A few more thoughts:

"Not every mistake meant the patient got the wrong drug or an incorrect dose. For example, many errors had to do with properly labeling drugs when they’re drawn into syringes for delivery. Because most medications just look like clear liquids, having several prepared without labeling them poses a risk that the wrong one could be delivered. Those breaches in protocol were counted as errors. In about one-fifth of the problems, adverse drug reactions were considered unavoidable — for example, if a patient had a drug allergy that doctors didn’t know about ahead of time.  The study found that some kind of error was made in about one in every 20 drug administrations. Several medications are typically used in each operation, from anesthesia to antibiotics, so that rate translated into some kind of error or adverse reaction in every other surgery. Operations that lasted more than six hours were more likely to involve an error than shorter procedures."

Okay, I'm good with no more surgeries, thanks.

I'm not that standardized

Here's a new proposal. Give surgeon's a black box to help prevent medical errors, like they have in air planes.

The proposal:

"Inside the operating room, video cameras track every movement. Outside, a small computer-like device analyzes the recordings, identifying when mistakes are made and providing instant feedback to surgeons as they operate.

This is the dream of the surgical "black box." Operations could become flawless. Post-operative complications could be significantly reduced. Surgeons could review the footage to improve their technique and prep for the next big case."

The goal is so a surgeon learns of a mistake when it can be corrected and not after the fact. They get a computer assist. And more significantly they could be adopted in the US without FDA approval as they are not a device or anything.

I'm not saying that I am against improving medical errors or anything. I have myself dealt with a few mishaps in the OR but I do not think the human body is standard enough for this. Each human is unique. That's it. We are all one of a kind.

If someone wants to operate on me, I have many issues - from lack of thyroid, previous surgeries which have left scars, and more. I know they can be programmed into a computer before hand but still.  An individual human being is needed who can interpret the information and unique qualities of the body they have opened up in front of them.

I think of it this way. You are going to a strange place and you program the address into your GPS and start on your merry way. But then the GPS sends you to a road which has a detour and it recalculates around it, so you keep going. It even tells you when you are speeding to give you additional information and recalculates your arrival time. Then it forgets to tell you that the off ramp is on the left and not the right. And then there is an accident ahead so you try to get off the highway and make another detour. And then your GPS sends you down a one way street in the wrong direction.

You needed a human there to guide you to read the signs and notice the detour ahead. Or to tell you about a new problem the patient is having.

A friend had a bad colonscopy and had to have a colectomy. The surgery took much longer than expected because the doctor who removed the polyp at the colonscopy did not note correctly where it was that it happened so the surgeon had to spend quite a bit of time looking for the exact spot. What would that little black box do then? React like the robot in "Lost in Space"? 'Danger, Will Robinson, danger!' That wouldn't exactly prevent much of anything.

There is research going on with these currently in Canada with plans to test them in Canada, Denmark and South America.

But I am really not ready for them to be used on me anytime soon. I would rather have a better trained surgeon than a computer assisted surgeon operating on me.

Double mastectomy or not?

The latest fashionable breast cancer decision is to have a double mastectomy in a preventive effort. Well there was a super secret twenty year study going on about the benefits of that very same surgery.

Basically what it boils down to is that unless you have the BRCA gene or other hereditary breast cancer, there is no benefit to removing a healthy breast. And the potential complications of the surgery can have a negative effect on the patient.


"Tuttle and his coauthors used published data to develop a model for predicting survival rates over 20 years for women diagnosed with stage I or II cancer at age 40, 50 or 60.

According to the existing data, more than 98 percent of women diagnosed with stage I breast cancer will survive at least 10 years, and 90 percent will survive for 20 years. For stage II breast cancer, 77 percent survive for at least 10 years and 58 percent survive at least 20 years.

For all age groups and tumor types in the study, the risk of developing cancer in the opposite breast after diagnosis was less than one percent each year, the authors wrote in the Journal of the National Cancer Institute."

So this study shows that while some women may want an elective double mastectomy, there is no benefit. I was also pleased to see the ten and twenty year survival rates (which are difficult to find) for stage I and II breast cancer. I am moving away from the five year time frame and starting to think about the ten year time frame and longer. And no I didn't even consider a single or double mastectomy.

Gimme the paint!

This may look like a slightly disgusting picture but its a picture of a tumor as it would be inside one's body with and without the new tumor paint.

The left shows a tumor image on an MRI. The right shows the bad stuff lit up with the toxin from the Israeli Deathstalker scorpion (I'm not making this up) and shows the bad stuff - the stuff the surgeon wants to cut out. The other colors represent the good stuff.

This works on brain, breast and other tumors. I find this incredibly cool. Now surgeons go in and look at MRI and other imaging and figure out which are the good cells and which contain the cancer cooties. They would guess and use their experience. But if they took a few too many brain cells, the patient may never be the same. This is also why surgeons have problems getting clean margins because they are doing some guess work.

I love this quote:

'"In a matter of 10 years, surgeons will look back and say, 'I can't believe we used to remove (tumors) by using our eyes and our fingers and our thumbs,' " Olson says.'

Read all about it here. I find this very exciting! I want that paint before any more cancer surgeries.

Can we undo my surgery please?

When I had my breast cancer surgery the sentinel node was tested and came back with microscopic traces of cancer. It was then deemed necessary to have an Axillary Node Dissection where they take out a lot of lymph nodes in your arm pit to see the possibilities that the cancer has spread further in your body. Mine came back negative. But the damage was done.

When that many lymph nodes (20 in my case) are taken, the lymph system in your arm in permanently compromised and the risk of lymphedema is greatly increased. That would be my problem.

Now there is a new study (because the researchers needed to keep working), that says that if the sentinel node is positive, the better outcome for a patient is to have axillary node radiation instead of an axillary node dissection. There appears to be the same or lower risk of recurrence and the risk of lymphedema is substantially reduced.

This is clearly in the category of now they tell me. Damn. I have lymphedema which complicates my life - and has no cure.

I guess this is what research is all about - figuring out how to improve treatment so that they can prevent complications and reduce risks from previous treatment standards.

Let the patients make the decisions

I'm not sure why we continue to let insurers make decisions for us on our care. I completely understand that an insurer wants to keep an eye on expenses and want preapproval so they can count their beans. But they should not be telling us what care we can get - with in reason.

I agree insurers should not need to pay for cosmetic procedures for example. If someone wants to fix their nose, they can pay for it (through the nose). But decisions which relate to life and death care should not be theirs to make.

A new study showed that women on Medicaid are much more likely to have a mastectomy instead of a lumpectomy - 60% of those on Medicaid had a mastectomy vs. 39% of those with other insurance.

Or are the surgeons making the decision for the patient? The study also points out that surgeons are reimbursed 40% less for a lumpectomy than for a mastectomy from Medicaid. The surgeon should provide the information and the advice to the patient to make the decision but they should let the patients think for themselves, not the doctor's wallet.

The patient should make the decision - no one else.

Price shopping for surgery

We all price shop for things. If the gas station across the street is five cents cheaper per gallon, we might go there. If one brand of milk is cheaper than the other, we will probably grab the cheaper one. Some of us coupon clip and research prices online.

We also all have some splurges. Maybe its hand bags, maybe its shoes, maybe its chocolate. These are the items that we purchase regardless of the price. Maybe its that Coach bag or the Manolo Blahnik shoes that we want no matter what. We just blindly get what we want.

So where should our surgery shopping go? If you think about it, most of us have been treating surgery in the second category as a purchase without looking at the cost. Should we be doing this? Or should we shop around and look at price first?

Two recent studies showed the range of appendectomies (done at Washington University) and hip surgery (done at University of California San Francisco). The first ranges from $1529 to 186,955 and the second $10,000 to $125,000. I'm not kidding. My first thought is that there surely must be some sort of quality variance here but if we leave that out for a moment, aren't these ranges amazing?

In any other circumstance if someone said you could get the same car for either $10,000 or $125,000 - which would you take? The $10,000 of course.

But most of us don't seem to apply this same price consciousness when it comes to medical procedures. Maybe we think insurance will cover it so it doesn't matter to me. Yes  your insurance covers it but high priced procedures are on of the many things causing continual premium increases. Or if I go to another hospital will I have to get a new doctor? Maybe a new doctor will be even nicer. You don't know until you try. Sometimes we get stuck in a rut of going for treatment to the same place.

Wouldn't it make sense to pay a little attention to the price? As part of the health care changes still coming into play medical providers will need to offer some price transparency to patients. But that is still a long way off.

Are we overdoing it?

More women are opting for double mastectomies, even if they do not have cancer in both breasts. Here are the numbers:

"The rate for women choosing to remove both breasts when only one has cancer jumped from 6.7% in 1997 to 24% in 2005,..."

"About 70% of women in the United States who have both breasts removed after a cancer diagnosis don't have a proven medical reason for undergoing the procedure,..."

So why are we doing this? Lots of reasons:

• Implants have fewer problems than in the past.
• Plastic surgery has had many advances.
• We want it now mentality.
• The overly hyped awareness of breast cancer

If we look at these last two reasons, they may be the root of all the reasons. In the past decade or so, we have been accustomed to the instant gratification or instant problem solving. Amazon started bringing us our purchases overnight. Problems are more easily solved. We can find information instantly so we want to fix things instantly as well.

Pinkification has also caused more awareness and availability of information.

"A growing awareness of breast cancer survivorship makes undergoing mastectomy not as foreign or frightening as perhaps it once was. An online search shows a seemingly limitless number of breast cancer support groups, with a growing collection dedicated to women considering preventive surgery.

Dr. Mark Sultan, chief of the division of plastic and reconstructive surgery at St. Luke's/Roosevelt and Beth Israel Medical Centers in New York, said he's seen a 20% increase in five years of high-risk, yet cancer-free women coming to his office seeking mastectomies.

These patients often arrive telling him what kind of surgery they want because they've read about certain procedures online, and in many cases, they've viewed hundreds of before-and-after photos as well."

These are examples of how the world of medicine and being a patient is changing. But maybe we are overdoing it. A double mastectomy is not a minor surgery. I have heard of women being in surgery for 10 or 12 hours with multiple surgeons and months of recovery. Never mind the problems of lymphedema and other risks in the future. 

I think I would prefer to keep my body as intact as possible if I possibly can.

Keeping up with the Jones'

If all your friends jumped off a cliff, would you? The latest fashion in breast cancer treatment is to have a mastectomy, even bilateral, at the least sign of breast cancer. The celebrities are doing it, so why shouldn't everyone else?

Because it doesn't necessarily mean the patient will have a better outcome. So why do patients opt for a much more drastic option when there is a significantly easier option?

The answer seems to be fear of recurrence. The professional reply is that 'No doubt, oncologists could do a better job calming women’s fears and educating them on the long and painful recuperation period involved with breast reconstruction following a mastectomy.'

Not so fast. I know many women who have gone through a breast cancer diagnosis who take time to think and make a rational decision that they really want two things:

1. Cancer out of their bodies
2. Not have to have such intense monitoring for the rest of their lives.

I do know some women who have not made as deep a thought process (like me) and did what the doctor advised. But many others have had a bilateral mastectomy for the peace of mind. Its not keeping up with the latest fashion.

Another treatment 'advancement'

The latest suggestion for breast surgery is to use ultrasound guidance during surgery to improve odds for clean margins and therefore local or regional recurrences and the requirement for a second surgery. This sounds good. It is based on a small European study but is now suggested as being the newest standard of treatment.

Well that is just ducky. I mean who wouldn't want an advancement in treatment. But (and of course there is a big but here), I have a few questions on this:

1. When would this become the standard of treatment? Does the FDA have to approve it? Probably not, but probably the Surgeon's Standard Board Association or whatever they are called - the people who set the surgical standards. So this will probably take a while. Hospitals would need to adopt the standard and then individual surgeons would need to be trained -  how do you hold the ultrasound thingy and cut into someone? Even if its held by someone else, isn't it be held on top of the thing the doctor is trying to remove? Maybe its a good idea I'm not a surgeon. (Not that I am any better off as being the patient.)
2. While this has the potential for saving some lives,  is there an increased cost involved? Do all hospital surgery rooms have the right kind of ultrasound machines for this or do new machines need to be purchased? In the age of eyes on increasing medical costs, increased expenses go under the microscope. While I am not trying to put a value on an individual's life but we have to consider this. If hospitals need to purchase more ultrasound machines for this surgery, could that money be better used by them for hiring more nurses to provide better care or a different machine for another use? Yes in an ideal world, hospitals would all have all the money, personnel, and machines they need - but we live in reality, not an ideal place.
3. This was based on a TINY study of 124 patients and one group of surgeons? Is this representative of all patients and all surgeons? Maybe more studies are needed - or at least at more than one hospital.

I am a tad skeptical but would welcome the progress - and just hope I would never need it.

Going for clean margins

Clean margins are the goal in cancer surgery. Clean margins does not mean there is no doodling on the margins of your book. Clean margins mean there is a distance between the edge of the incision and any signs of cancer. Often times they are not discovered until after surgery at the biopsy and require additional surgery. Which is no fun - who wants a second surgery? Not me, thank you.

So someone has discovered a way to solve this problem. But then, it has been discovered. When will it be put to use in my hospital so that if I require more surgeries I can benefit from it.

I like to hear about medical advances but I always wonder if/when I will ever benefit from it. Grrr.

Thank you for making me feel insecure about my treatment

I hate these articles. This one discusses the lack of guidelines for what kind of clean margins are needed for whether a re-excision is needed after a lumpectomy. First let me say, thank you for upsetting potentially hundreds of thousands of women who had a lumpectomy and may or may not have had a needed second surgery or had a second surgery unnecessarily. This isn't something that really can be undone. If a second surgery was needed and wasn't done, there is probably nothing that can be done now. If a second surgery wasn't needed but was done, you really can't undo surgery.

Second, the general media is not the place to discuss undetermined medical guidelines. These should be discussed by the people who practice medicine, not by the patients. As a patient, we assume that we are given proper medical care. We assume our doctors follow guidelines and protocols. We don't want to hear about the lack of guidelines that may have led to improper care.

Also, I assume that the hospital where I am treated has its own guidelines and protocols something that is not discussed in this article at all. It makes us patients feel like we may have been mistreated. I know, as a professional patient and not as a medical professional, that the hospital I am treated at has established guidelines for what is the current protocol for chemotherapy or preparation for some lovely medical adventure. So is this article saying there are no guidelines followed anywhere?

So I am so 'not' comfy with my medical treatment after reading this. I will now go have some breakfast and attempt to think positive thoughts about something else.