Breast Cancer

[LCHorn 2,751]

I know there's already a "F'Cancer" thread but I don't want my questions buried.  Would particular appreciate responses from anyone in medicine or medicine adjacent.

1.  If you had the option of obtaining treatment in Houston (we live in Austin), would you expect better quality of care?

2.  If you were seeking treatment in Austin is there anyone (or clinic) in particular with a reputation for excellence?

We got the bad news today from the radiologist (don't know stage or severity but it's in at least one lymph node).  Not that I don't appreciate sympathy or reassurance but I'm really not trying to turn this into shared grief thread-just information gathering.  Wife has wisely accepted my advice to stay off the web and not try to self-educate as that can make you crazy (so I'm doing it instead). 

Also, fuck 2020 😞

[smwhorn 485]

Sorry to hear the news.  My wife (no pics, I'll cut you man) is an 11 year survivor.  Double mascectomy, chemo, then medicine for five years.  It was first detected through a mammogram at Texas Women's.  They saw one spot and wanted to do radiation only.  We had a friend who was at MD Anderson.  Took the film to them and they saw three spots and other issues of concern.  Go to MDA.  

Good luck with this bro.  I give one piece of unsolicited advice -- you are going to have people offer to help in all ways.  A small voice in your head will tell you to tell them thanks, but we got it.  That voice will tell you that you don't want to impose on them because we all have things going on in our lives.  DO NOT LISTEN TO THAT VOICE.  Let people help.

Edited October 22, 2020 by smwhorn

[Spur08 384]

In healthcare, not oncology. I have a friend in Austin who was recently diagnosed w stage 4 breast cancer. I have an anesthesiologist who I work with in DFW whose sister works in oncology in Austin. She saw her and referred straight to MDA in Houston. It is the top in the world and you are local. Take advantage. I'm told you might have to be referred so be aware of that.

Also, I'm hammered but all above is true, forgive brevity

[jimmyjazz 47,203]

Sorry to hear this, and I have no direct experience, but I definitely recall reading about studies showing that results are better at the high-volume clinics like MDA.  I don't remember if they stated that the results were better because of more case load or if the case load was higher because of better docs, but whatever, the correlation was pretty clear.

I'd go to Houston.

[dcbc 14,644]

Very sorry to hear this.  Wife is a six year survivor.  Noadjuvant Chemo (A/C (4 treatments) and Taxol (12 treatments), double mastectomy, immediate reconstruction, and eventually, a full hysterectomy.  Have a friend at MDA, who offered to hook us up there.  She was early Stage 2 and "had what 86% of women who get breast cancer get."  So we elected to get treatment locally (Tyler) with a fantastic MDA trained oncologist.  No regrets on that front since the treatment was the same as what MDA would have done with a shorter drive and easy parking.  In your wife's situation, since there is apparent lymph node involvement or in case she could benefit from clinical trials, I'd probably elect to go to MDA or, at least, get a second opinion there. 

Be ready to contact the insurance company and her PCP about referrals.  Once her team comes up with a treatment plan, it's likely that you will be called and told when your appointments are, and it happens fast.  Don't be afraid to change these docs.  We switched oncologists before the appointment and were very happy with our choice.  But once the plan is in place, things move quickly, like it's preordained.  So be ready.  

One other thing, if they do chemo before surgery, I'd consider strongly delaying reconstruction.  It amounts to a 12% smaller chance of infection, which doesn't sound like much, but when chemo knocks down the immune system like it does, a little delay helps.  We dealt with two post operative infections following reconstruction.  Keep those drains 110% sterile (they tend to leave them in a lot longer in the U.S. than some countries).  That sucked and took more than a year to resolve.  But we got past it.

A relative of ours has been treated since early this year at MDA and has nothing but nice things to say.  So obviously, if you have any reservations about her being treated in Austin, MDA is a fantastic option.

All the best.  It's no fun, but you guys can do this. 

/not a doctor

Edited October 25, 2020 by dcbc

[Armybrat 41,408]

What smwhorn said.Get to MDA ASAP.

My DIL was hesitant to even go to a real doctor locally to have her suppurating egg-sized lump diagnosed. Of course it was too late and she even waited another month to begin chemo & surgery. She died 7 months later on the morning of her 39th birthday, leaving behind my son and their two little boys. It has been very hard. 
 

Best wishes for a clean recovery.

[LCHorn 2,751]

Quick update: we met with the oncologist this morning (well she did, I was in the parking lot on speakerphone, thanks Covid).  Stage 2 by the looks of it but the next week is stacked with tests and with luck it’ll pattern after dcbc’s description above.  
 

If it’s not something rare or hard to treat we’re leaning towards treatment in Austin but have set up a consult at MD Anderson for a 2nd opinion.  Apparently it’s a “9” out of nine on the fast growth scale, which the oncologist said is positive for chemotherapy efficacy but certainty argues for urgency in treatment.  
 

Thanks for the contributions and continue to welcome advice or tips.