MEET THE INDIVIDUALS WHO MAKE UP THE BLUE SKY SUGICAL TEAM

Image

Our team of eighteen have been  amazing. Seven in our group were here 18 months ago and we vowed to return. There were 7 of our 10 returning on this trip. (of the three that did not return, Flo had a baby, Diana had family commitments and Mike Coletta had the lame excuse that he couldn’t leave medical school for a week. Seriously!!)

Our fearless leader

Dr. Tony Coletta

Senior Vice President of Blue Cross

Image

Tony came to Haiti seven years ago having answered the call from his nursing colleague, Beth who happens to be with us on this trip. On his first day of his first trip, Tony had the great fortune of being able to change the course of a 55 yo mans life by repairing a hernia that was incarcerated. (meaning it was stuck and without surgery this man would have certainly died) An operation that in the USA anyone who presented to the emergency room regardless of their ability to pay, would have certainly been repaired as it is a surgical emergency. In Haiti this would have meant this man would have left his 5 children and wife prematurely. So from that day forward Dr. Tony has a bond with the Haitians that is palpable.

Cal James

Humana Regional VP provider development

 Image

Cal had the great fortune to meet Tony when they were in a meeting of “the suits” at a leadership institute in California right when the earthquake hit. He was drawn to Tony’s passion for the Haitians and wanted desperately to go to Haiti with Tony immediately after the earthquake but lacked the proper vaccinations. Cal and Tony are the dynamic duo and make things happen. Cal is in charge of all things mechanical, the instruments, the air conditioning, the food for the team and most importantly patient transportation (inside joke for the team).

Cal is in charge of logistics and is Tony’s wingman. As a former military pilot he is the perfect wing man and has vowed to be with him on all of his future trips.

Dr. John Sauter

Anesthesiologist United Anesthesia Services

 Image

John is another team leader and heads up our anesthesia department. He is an amazing anesthesiologist and has learned to do a lot with a little. He also is skilled at recruiting the right nurse anesthetists. John came to Haiti the first time with Tony just two months after the earthquake in March 2010. He had know Tony from Bryn Mawr and knew that he was a skilled surgeon and decided to answer a blast email from Tony who was looking for a team of skilled and passionate care providers. John has been here many times over the past 4 years and I am certain that this won’t be his last Haitian rodeo.

Dr Beth DuPree

Breast Surgeon Holy Redeemer Health System

With my beautiful patient Marjorie.

With my beautiful patient Marjorie.

I joined the Haitian surgical mission because I believe that making a difference one person at a time is a worthy cause. I came to Haiti 18 months ago and realized that Haiti has done more to enhance my life than I could ever do for the people of Haiti. The surgeries that we perform when we are here are often life changing for our patients and their gratitude and love is endless.

Dr Shashi Kumar

Pediatric Surgeon Surgical Services Holy Redeemer Health System

Shashi

Shashi is a retired pediatric surgeon who assists me in the OR at Holy Redeemer. He has been listening to me talk about Haiti fro the past 18 months and when the email went out to participate in this mission trip he was one of the first to commit and  has not looked back. He is a gentle soul who brought his skill, compassion and sense of humor with him and all of the team loves working with him. The children of Haiti are blessed to have him here. Me thinks he will be back!

 

 

Deb McTamney

Nurse Anesthetist United Anesthesia Services

Image

Deb told John Sauter that she was going on his next Haitian mission before he could even send an email looking for volunteers. She had always wanted to participate in a surgical mission and decided to answer John’s call and came on aboard. She was with us on our trip 18 months ago and it filled a piece of her heart and she returned this year with her skill and her passion. She found in serving the Haitian’s that a part of her that was missing had returned. She received more from the trip than she gave and will continue to return  on future mission trips. Deb is the hardest working anesthetist and has made difficult MAC cases run smoothly. (That means that patients aren’t asleep but receive sedation and local anesthesia). Deb exudes  Shibumi. (that stands for effortless perfection just incase ya didn’t know what it meant)

Leslie Edwards

Nurse Anesthethetist  United Anesthesia Services

Image

Leslie received John’s email and immediately asked her hubby of he minded if she took a week to go to Haiti to perform surgery on those in need. He said sure and that was it, she  was on her way. She is a skilled anesthetist who is easy to work with a total team player. You cannot tell that this is her first surgical mission!

Barb Thompson

PACU nurse from Bryn Mawr

Image

Barb is a seasoned PACU nurse who’s children had reached and age where she was able to look outside of her family to make a difference in the world.  She had known Dr. Coletta for years and knew that he was an excellent surgeon, but she says that something changed in him after his first trip to Haiti.  It wasn’t just a sense of humility that she saw, it was a sense of purpose for something bigger. She knew she needs to be a part of the mission trips and has been on 5 trips including this one. She was my pre-trip partner in crime as we worked to make certain that we had obtained all of the supplies we needed to be successful in Haiti. The minute you meet her you feel as if you have known her FOREVER>

Beth Johnson

OR nurse who is now in the business of developing surgi-centers.

(she’s the one who asked Tony to Haiti for the first time so THANK YOU BETHY!)

 Image

Beth has been coming to Haiti for more than 11 years and has participated in 9 surgical missions. She began her trips to Haiti with her church and answered the call to serve as the amazing healthcare worker that she is. Beth continues to return as each experience is unique and she is  able to impact so many lives. On this trip, she was so brave and bold as she helped our 38 yo patient who required a mastectomy. Beth had the great fortune to be treated for breast cancer in the USA where she was able to have reconstructive surgery. She helped Marjorie to begin her healing journey by showing her what the mastectomy scar looks like and giving her hope to go on. Beth has a tremendous faith and told Marjorie to be strong for her children as they need her. Beth is a survivor, THRIVER extraordinaire and she reminds me so much of my Donna in my office who is also an amazing survivor / THRIVER. They share the same MOJO!

Robin Nelson

OR nurse Lankenau Hospital

 Image

Robin is a piece of work. She tells it like it is but is hard as a nut on the outside but is soft and squishy on the inside. Her HEART is huge and she brings her A game to the OR. Last trip she sucked it up and worked in the PACU ( post anesthesia care unit) where she wasn’t as comfortable just to be able to come on the trip. This trip I have the pleasure of working in the OR with her as my scrub nurse and circulator. She ROCKS.

 

Anne Marie Patton

Cape Regional Medical Center Cape May NJ

Image

Anne Marie was recruited by Barb Thompson who happens to be her neighbor at the beach. This is Anne Marie’s second trip and she came as she has always felt that she can be of service. She was willing to participate in any mission trips and when Barb asked she answered the call.  She loves the people and will continue to serve. Among the group we are convinced that she is really Sister Mary Pat, a nun in disguise. She has a laugh that is unmistakable and brought enough snacks fro a small army.

(She is also a wicked UNO player!!)

Molly Viall

Blue Bell Surgery Center OR nurse

 Image

Molly is an OR nurse who was recruited by Deb. She has years of experience and can handle anything that is thrown at her. She came on the trip with heart, soul, skills, passion and the best baked goods that you could ever want. She is used to a fast paced day and thrives in chaos, perfect skill set for Haiti where anything can happen. I watched her ding needle point and ate her baked goods so when she opened her mouth in the OR and had some of the funniest OR humor ever even I had to blush!

Cate McKee

OR Nurse Lankenau

 Image

Cate is a new bee to the trip. She is 28 years old who is always looking to grow as an OR nurse and loves a challenge. She is warm caring and loves what she does. She came on the trip as a recruit of Dr. Sauter. You cannot tell that she is new to this work as she performs like a seasoned veteran. She will be back. ( If she was younger I would scoop her up as a daughter-in law! I told Dean that if he brings home a woman like Deb or Cate that he would be making the best choice of his life! My son Tom already has an awesome babe, Hannah!)

Tina Schwoebel

EP Lab The Philadelphia VA Hospital

Image

Tina is Dr Coletta’s niece and can eat anything in sight and does not gain an ounce! She has come on several mission trips with Tony. She is organized and hard working and brings years of experience to the team. She shares with all of us the experience that she has when patients are awakening from anesthesia. She is overwhelmed by the gratitude that they express and that they all say ” GOD BESS ALL OF YOU FOR WHAT YOU DO”. Tina simply gets it done!

Manny Jean-Louis

Emergency Room PA The Philadelphia VA

 Image

Manny was born in Haiti. He lived here until he was 13 when his mother passed. He was then raised in Brooklyn and returns to Haiti to serve his native land. His creole is nothing short of amazing for being in the USA for so long. This is his first trip here as an assistant / interpreter. He answered the call from Tina to come along on our journey to help and heal Haiti one individual at a time. He is a true healer and has been touched by this experience. I know that he wants his children to understand how blessed they are to have privilege. He has busted his butt to get where he is in life and coming back he sees how his life might have ended up had he not moved to the USA.

Yvon Lebroun

ORA II  assistant at Bryn Mawr Hospital

Image

Ivon is an orderly at Bryn Mawr hospital who initially told Tony that he should not go to Haiti. Having left Haiti in the 70’s he did not feel he would want to go to Haiti. He has come back 3 times as an interpreter and realizes that coming on the surgical mission makes him part of the solution to the health care problems in Haiti. His brother, a college professor from Rutgers, retired here and we were able to meet him last evening. Yvon has been an essential member of this team and we are so blessed to have him allow us to communicate with out patients.

Shawn Snipes

OR CST II El Camino Hospital

Image

Shawn was recruited from Cal’s former hospital. He has been on one prior mission and came in not knowing anyone in our group.  His last mission trip her was with one other nurse and seems to love being part of our Haiti family. He brings his skill and passion to everything he does. He is multilingual and can pretty much communicate with anyone that we run into.

Craig Bunting

Senior Moravian College Senior

 Image

Craig’s dad is Tony’s dentist and came home after a seeing Tony in the office and told Craig that there was an opportunity to join the mission team. Craig was 20 at the time he felt that the trip was better than expected. He chose to come back at 22 as he realized the importance of the role of logistical support. ( He really just wanted to spend another week with Cal and his dry sense of humor. We call then the Calisms) He says he will definitely come back again.

Dean DuPree

Senior Council Rock North High School  (also my youngest son)

 Image

Dean initially came on the trip as part of his community service hours required for graduation. ( 60 in total) Last evening as we were sharing our experiences of the week to date, Dean admitted that he initially came along to fulfill the requirement and now he wants the time to go slower as it has been far more enriching of an experience than he could ever have imagined. When Dean was finished there wasn’t a dry eye in the room as everyone was touched by his sincerity.

(He was able to watch me perform surgery for the first time and had to comment that I talk a lot while I am operating. John Sauter came to my rescue and said that surgeons can talk as long as they keep working and don’t slow up the day!) I think he will be back again.

Pierre Dilus

Interpreter

 Image

Pierre serves as our Haitian command central and an Interpreter.  Tony has been working with him for the past 7 years and he is part of our team. He makes things happen. ( Today he made Mangos appear and they are out of season). Pierre worked hand in hand with me in the clinic evaluating and preparing patients for their impending surgeries. His skills are invaluable and we consider him part of the TEAM.

The TEAM from Haiti  is part of our team as they have interspersed themselves within our group and they are teaching us as we are teaching them.

Included below are a few of the TEAM.

Image

Gertrude Metellus, RN

Elsie Mede, RN

Sonique Metellus,RN

Adrienne Raymond, RN

Suze Jean, lab tech

Yvena Auguste, wound care nurse

Gladys Bien Aime, pharmcist

Lizianie Bovais, administrator

Wedline Ceant, RN

Magalie Darius, RN

Mirlaine Auberjuste ,auxiliary Nurse,

Woodny Auberjuste, auxiliary Nurse

MacKendy Telusma, lab tech

Eddy Fontain, pharmacist

Dr. Bendgy Louis, MD

Cliford Francois,MD

Charlot Armstrong,  MD

Peter Pierrot, MD

Nadine Cineus, housekeeping

Wilio Jecrois ,  archives

Anothalie Cineus, housekeeping

Benite Edmond, housekeeping

Marcel Anilus, housekeeping

Marie Lourde Louis, lab tech

Salvant Alexandre Junior, Dentist

Monique Saint Louis, MD

Gibsie Pierre, Secretary

Feeling welcomed in this clinic has been a gift from God.

Every morning there is a devotional outside the clinic and although we cannot understand the language, we understand that we are all simply messengers of the divine speaking different languages.

We Came, we “Cut” because we Care

Blue Sky Surgery’s first day was remarkably fluid given that these 18 individuals have not worked together before. Breakfast at 7 AM consisted of mystery meat, American cheese and fake white bread. I ate a banana with peanut butter, my dear son ate the aforementioned mystery meat. Others were complaining about the coffee, but it was hot and black, (like my trainer Vaughn) and the caffeine worked.

 Image

We arrived in clinic at 7:45 and began to “build our schedule”. We saw patients all day long and actually performed 10 surgeries day one as all of these people who came for evaluations were NPO after midnight. (NPO stands for nothing per oral aka nothing by mouth!) By the end of the day, we were a TEAM working together to care for amazing individuals with incredible stories. (I wish I spoke the language so that I could speak to the patient’s without the interpreters)

Image

I came to Haiti prepared for general surgical cases. So here I am the breast surgeon, who last trip was doing the hernias and circumcisions, this time I have already performed two breast surgeries. I have a mastectomy and another breast case on the schedule for tomorrow. Same stuff in a different venue!

Rubin, the principle of the school that Dr. Tony has supported for years, came to visit over lunch and was presented with a generous donation from Focus Fitness Mainline  where Deb does yoga. Deb Mctamney, the nurse anesthetist that the universe clearly wanted me to meet ,held a fundraiser with her yoga class from Focus Fitness for the school. The money will purchase books for the semester and  pay the teachers salaries for the month.

Image

Dr. Shashi Kumar, or Shashi as we fondly refer to him, had his first full day in the Haitian OR. Shashi trained me to perform pediatric surgery during my residence at Einstein. He retired from pediatric surgery but keeps his hands active assisting us in the OR at Holy Redeemer. He seemed to love his first day and I am certain that Haiti loves him.

Image

LOVE WHERE YOU WORK AND WORK WHERE YOU LOVE

Image

The reason that Double Harvest is different from our prior clinic, is the medical infrastructure. There are nurses, support staff and an amazing young physician who loves where he works and works where he loves . Our nurses this week are Sonique, Gertrude and Elsie. Dr Peter is obviously the guy!

Image

Dr. Peter Pierrot, Dr. Peter as he is called, is the physician who is running the clinic. He has evaluated most of the patents that we will operate on and will be here to see them in follow up in the weeks to come. He has had a smile on his face since the minute we arrived and to him nothing is a problem.

He gave us a tour of the facility upon our arrival and basically said that the place is ours for the week and let him know what we need.  I passed him in the hallways all day long and at the end of the day, I was evaluating a 42 yo gentleman who had obvious jaundice ( his eyes are yellow ), dehydration (lack of fluids) and was very thin. He complained of abdominal discomfort and came in with a CT scan disc. The lovely gentleman has something blocking the duct from his liver to his bowel, that’s why the bile cannot get through and he is yellow ( jaundiced).

I was in Dr. Peter’s office calling a nun who will help us get this gentleman to a hospital that can take care of his urgent needs. We administered fluids through an intravenous and God willing he will be admitted to the hospital tomorrow and obtain the care that he needs. ( We simply do not have the equipment to perform the procedures that he needs. If you are curious he needs an ERCP that will determine what is blocking his duct.)

It took several calls to Sister Dianna to finally connect and while I was waiting to reach her I had the chance to get to know Peter’s story. We all have a story, but very often we are too busy to take time to get to know the “whys” that make us who we are.

Peter grew up just up the road from the clinic. He was just a boy when they built this clinic and has been an interpreter since day #1. When he was just 6 years old, he lost his father to typhoid fever. He said that as a child his father was such a hard worker and he rarely saw him. His dad would leave for work very early and return home very late. One day he did not come home and Peter lost his father to a disease that Peter would research and determine was completely preventable. It was then that he decided to become a doctor. Without any funding it is impossible to go to medical school as a Haitian national.

He studied very hard in school and worked every chance he got as an interpreter for medical missions and services such as ours. His effort and passion paid off as he was given an opportunity to go to college and medical school thanks to Double Harvest. He went to medical school in the Dominican Republic, classes in Spanish no less, then training in the USA in English and his payback was to return to Double Harvest and work in his native language, creole. Dr. Peter’s passion and purpose is to make a difference in the lives of those in Croix de Bouquet.

He said that he has no desire to be anywhere but here in this clinic as these are his people and he loves where he works and works where he loves! We are blessed that he has welcomed our team into his clinic so that we can make a small but meaningful impact in the lives of amazing Haitians.

So Dr. Peter proves what I know to be true that if you do what you love what you do and do what you love then  YOU WILL NEVER WORK A DAY IN YOUR LIFE!

Image

Dr. Peter Pierrot and his team of nurses and support staff are my Haitian Heros

Haitian Customs: So the Adventure Begins

Our flight to Haiti was delayed for mechanical reasons. Who wants a plane to take off if something isn’t working?  (There were a few unhappy travelers who lost their stuff!  I was Ok with waiting for something that was broken to be fixed. Just sayin)

 I tried to get on the Internet to get the NBC 10 interview with Dr. Anthony Coletta but it wasn’t posted at the time. (Watch the video yourself.) I used my time to obtain Internet access and down load Monopoly on my iPad. It gave Dean the opportunity to put me to shame once again playing one of my childhood favorite games.

 

We landed in Port au Prince Haiti and were greeted by Yvon’s cousin Andre who works at the airport. (Yvon is one of our interpreters and his day job is working in the OR at Bryn Mawr hospital as an orderly). The goal was to have a smooth transit through customs with all of our medical supplies. The transition was not exactly seamless, but Dr. Tony did an amazing job of getting us through the process with all of our medications and supplies in hand.Image

 

The five-mile trip to Double Harvest took 45 minutes as the Haitian Department of transportation’s care of the roads is about as advanced as the country’s access to medical care. Despite the unpaved roads and lack of traffic control, we arrived safely and were pleasantly surprised at the accommodations that awaited us at Double Harvest. The clinic is clean, air-conditioned and we have hot water to shower! (A veritable Four Seasons compared to our last surgical mission accommodations)

 

 

 

We had on average 3 bags per piece. (18 volunteers X 3 at 50 lbs per piece. ImageThat’s 2700 lbs of supplies. Our personal items were in our carry-ons!) The distribution of all of those items to their pre-surgical resting place was completed in record speed by the end of our first surgical day! The OR’s, and the prep areas were readied. We were prepared for our first day of surgery by 6 PM. Our dinner the first evening created quite a stir in the group as goat was on the menu. (Dean loved the roasted goat BTW. The goat has created recurrent fodder for Cal as he gotten a lot of mileage in comments simply out of the poor goat we ate for dinner!)

 

We were feeling very divinely guided and I found a painting in the clinic that reminded e of this guidance. Every surgeon that I know who can move beyond ego realizes that we are not alone in the OR.Image

BLUE SKY SURGICAL HAITI 2014

Image

Blue Sky Surgical 2014

Why do we go to Haiti??

Read on my friends and follow our journey and you will know WHY!

Image

Remembering 2012.Image

When I left for Haiti in June 2012, I didn’t know how strong the call to go back again would be. Spending 7 days in the OR with surgeons, anesthesiologists, nurses and support staff that I barely knew became a life changing, scratch that, life enhancing experience.

Vanessa's extra digits before the surgeryThirty-four surgeries later we were a TEAM! Dr. Tony, chief surgeon, is our fearless leader. Dr. John is the lead “gas passer”; aka anesthesiologist makes sure everyone we put to sleep wakes up. Cal simply an amazing soul is head of logistics, which translates into he fixes anything and everything. Then there’s me “the breast surgeon” fixing hernias, performing circumcisions and whatever else needs to be done. (Thank God for You Tube to remind me how to perform said operations) just kidding!

As the week goes on I will introduce you to all the members of our TEAM. The first new member of Blue Sky Surgical is my son Dean. He is joining Cal’s logistics team and will excel in this as he has an engineering mind,

Heading to PSU in the fall to study mechanical engineering, this surgical mission experience is just what the doctor ordered.  I am not sure the Dean knows exactly what is in store for him but his big bro Tom has convinced him that medical missions ROCK. Having my children share in medical missions has given this work an even greater meaning.

Dean’s track team has qualified for states therefore he will be training for his winter state track meet while we are in Haiti.  His distance medley relay has qualified again this year for states. (Last year they took silver!!)

Despite missing an entire week of school last week due to weather, he is ready to head to Haiti to make a difference!

The PREP

Preparing for the trip this year was challenging and required the intervention of many angels. My June 2012 trip was a chip shot for preparation in comparison. This year I assumed the role of one of the leaders and with that new responsibility came a host of challenges that against all odds we have succeeded in obtaining enough supplies to care for 60+ individuals who are in need of our services.

We will be operating under the non-profit Double Harvest. Our schedule has been set by the local physician in Port au Prince, or so we think.

My initial assignment was to obtain half of the surgical equipment that we require to be able to perform the surgeries. I am so fortunate that I have CEO at Holy Redeemer, Mike Laign, who believes in making a difference n the world. I went to the companies who manufacture the products an asked for their assistance, and Ethicon graciously donated the suture and proline hernia mesh systems through a non-profit MAP. Joe Benonis was my connection in the supply acquisition and he made this process so simple. Despite an initial hiccup, half of my list was missing when I picked up the supplies; all of the materials I needed to provide for our journey were readied for the trip.

Less then three weeks prior to our departure, my colleague Dr. John was unable to obtain the medications that he needed to provide state-of-the-art anesthesia. I went back to Mike, my CEO at Holy Redeemer and angel #1, and asked if HR could possible acquire and or donate the medications that we required. He sent an email and passed the baton to angel #2, Randie Oberlander our pharmacy director. I know Randie through senior leadership meetings and have always felt she had “good mojo”. After two and a half weeks of her being our guardian angel, I can say that she has “great mojo”.

Randie not only ordered the meds, she was instrumental in getting all of the clearances we needed with the DEA. We started this process January 27th and on the DEA website it said allow a minimum of 4-6 weeks. (It’s Feb 9th and you can do the math) Randie introduced me to our DEA angel #3,Jean, who were it not for her personal investment in our mission trip, we would not have the medications that we need to follow through with our trip. I shared my story with Jean and she became our ally and I consider her a member of Blue Sky Surgical as she has been and will be with us in spirit.

Sparing you all of the details, our hospital pharmacy endured a flood, just days before our departure. On Friday the 7th in the midst of the pharmacies clean up I found out that a letter was needed and more forms needed to be completed for us to get the DEA letter. Randie had to write a new letter to the DEA and redo our forms that Julia, my amazing breast care coordinator, had to fax to the DEA. Jean then had to wait fro someone official to break from a conference to sign said documents to allow the letter to be written that would let Randie release the drugs to me. All this was happening during my office hours that were jam packed with patients due to the historic ice storm. My email pinged at 1:35 PM and our ANGEL JEAN came through and the letter was in my email. Randie could not open the document but a quick response from Terry Donovan our computer guru at HR allowed this leg of our journey to be completed.

Suffice it to say that these trips are divinely guided and angels are everywhere all you need to do is ask for their guidance. Friday evening my amazing husband Joe cooked a fabulous meal for our family and friends Brenda and Mark Darling while we were busy reorganizing our supplies and packing our bags. A few hours later I was feeling less stressed about the process when I realized that we had compressed our supplies to fit into eight bags none of which weighed more than 50 lbs.

A heartfelt thank you to Holy Redeemer for their generosity

Dean and I slept at the PHL Airport Marriott as there was a threat of snow and I didn’t want to make Joe wake up at 2:30 AM to have to drive us to the airport. We were on the 4 AM shuttle from the hotel to the departure gate and clearly our huge luggage load was an issue for the other shuttle passengers. I saw one man shaking his head and making a comment that I thankfully could not hear. Some of their bags needed to be placed in the van where we were sitting and I was just waiting for him to make a snide remark. It only took about 1 minute 30 seconds out of the driveway for him to say, “ You people don’t believe in packing light do you!” I replied, “ I always try to pack with a carryon only, but we are on our way to Haiti to perform surgery on individuals less fortunate than we are who do not have access to surgical care. Our bags are filled with surgical supplies. All but the small red bag which is our clothing and scrubs for the week.”

Suddenly we weren’t the ignorant over packers that he had assumed we were and the others on the van made a point of saying how awesome it was that we were doing this. A woman on the van has a son who is working with Operation Smile this summer and ash let us know so as to distance herself from the first gentleman’s comment.

Moral of the story “do not ASSUME as it can make an ASS out of U and ME”. In this case it was HIM.

We met our Philadelphia based TEAM and we are 14 strong. The other 4 members will meet us in Miami for the next leg of the adventure. Our entire luggage is tagged and on the plane and our Blue Sky Surgical TEAM is on a mission from God.

“You must be the change you wish to see in the world”

Gandhi

THE CLIFF

Image

Barb thought that she should be elated that her breast cancer treatment was completed. Her surgery was four months ago, the radiation finished two weeks ago, and she didn’t need chemotherapy. Her skin did not burn, her cosmetic results were excellent, and she didn’t lose her hair. She arrived for her first post-treatment appointment at my office and couldn’t figure out why she was having trouble “keeping it together”. She had taken her diagnosis as a trooper, barely shedding a tear. And here she was back in my office, where this journey began, and she was falling apart.

She could be any patient after any prescribed course of treatment that has just hit the next bump in the road of cancer.

I have been caring for women and men with breast cancer for more than 20 years and have come to recognize this place I call “The Cliff.”  Everyone who goes through the treatment of breast cancer, or any cancer for that matter, arrives at this place when the physical treatment of his or her cancer is complete.

I define the cliff as that place that my breast cancer patients’ reach anywhere from two weeks to two months after their treatment has finished. It is when fear sets in and rational thinking flies out the window. Somehow being on treatment is like a security blanket since you are actually doing something to “treat” the cancer. Suddenly you are done and nothing in your life is recognizable. The life you had before the diagnosis of breast cancer is gone and your new life is plagued with fear. Most of the time you can keep your game face on, but in reality you are standing at the edge of the cliff scared that you are about to free fall to a place that you is unknown.

I know that the cliff is coming for each of my patients and I specifically schedule an appointment two weeks to two months after their last treatment whether that treatment is surgery, chemotherapy or radiation therapy. I use the appointment to empower them to embrace the cliff. The cliff can be daunting. It’s a long way down to the ground–that is, if you are even brave enough to look over the edge. There are three options for those with cancer who find themselves on the cliff, looking out toward their unknown future.

Option 1- Remain paralyzed with FEAR on the edge of the cliff, hanging on for dear life.

Fear is really False Evidence Appearing Real. It is our mind getting the best of us. The relentless tickertape of the brain is replaying every decision: Should I have had a mastectomy? Should I have had whole breast radiation therapy? Maybe chemotherapy would have benefited me…….. Is my cancer coming back? How will they find it if it does? Am I going to see my children grow up?

Option 2-Free fall to the ground, landing wherever you land, smacking your head as you hit.

Surrendering to the cancer and believing that no matter what you do you are doomed creates a sense of hopeless, helplessness, and despair that others can palpate when you walk in to the room. (Like Eeyore from Winnie the Pooh.)

 Option 3- Strap on a pair of wings and learn to fly. It is by far the best choice as I see it. You may not know how to fly initially, but if you choose to don the wings you will feel the wind beneath them as you take flight and soar from the cliff to the new life that is being created after cancer.

Option 3 requirements- first and foremost is releasing the fear. Fear paralyzes our lives and robs us of our most precious commodity, our joy. When you have done all that you can to treat your cancer, it’s time to let go of the fear of it coming back and begin to be present in the moment for that moment is truly all that any one of us is guaranteed. Spending your days worrying about recurrence doesn’t make it not happen; it simply robs you of joy. We cannot go back and change the past and we cannot predict our future but ruminating and worrying just deprives us of the gift of the present!

Cancer can be a gift if you chose to see it as such. Cancer gives you perspective. The trivial things that previously pushed your buttons suddenly aren’t so important. Your priorities realign and you have to make yourself the most important person in your life so that you can care for those you love. We all have baggage in our lives and cancer you the opportunity to clear the clutter that you have been holding on to for way too long. You need to look deep inside and find your passion. Then you can allow it to blossom and make your heart sing. Creating a purpose-driven life allows you to feel meaning in all that you do. Some times it takes perseverance to create the changes to truly heal. In the end, it is all about creating joy in every day and finding peace in your heart.  Live the life that you deserve.

So let’s get back to Barbara’s story. After her exam and the reassurance that she had completed her prescribed breast cancer treatments, we got down to the business of healing. I had to remind her that although she was fortunate to not need chemotherapy or to lose her breast, she still needed to allow herself to “heal”. She was experiencing a bit of survivor’s guilt as she had met so many women and men on her treatment journey who had a much more tumultuous course of treatment. She was also keenly aware that her life had been changed with the diagnosis of cancer, and although her physical appearance had not changed, she was a different person from her experience. Others around her assumed that she would go back to “normal”. But Barb’s new normal is different, and can be amazing if she is able to find the gifts that her diagnosis had brought her.

She had not used her healing certificates (five one-hour individual sessions provided by The Healing Consciousness Foundation- www.hcfbucks.org – to women and men treated by Comprehensive Breast Care Surgeons of Holy Redeemer. www.comprehensivebreastcare.com) because she thought that her cancer was not “bad enough” to deserve them.

     My recommendations:

  • Use her healing certificates with integrative practitioners
  • Pack her pre-cancer baggage and get rid of it!
  • Embrace forgiveness. We forgive for ourselves—not for others—and then let it go.
  • Become the number one priority in her new life centered on self
  • Rid her life of  “energy vampires”
  • Love herself exactly as she is at this moment
  • Realize that self love will attract more love and joy
  • Love and be loved!

 

Then, and only then, can she and all breast cancer survivors become THRIVERS!

Published in the January edition of the Breast Cancer Wellness Magazine January Edition page 6.

Join me on the 8th Annual Breast Cancer Thrivers Cruise

Image

EVERYDAY IS A GREAT DAY

Arenas Del Mar

“Buenisimo!!”

” Every day is a GREAT Day”

Arenas Del MAr

Manuel Antonio Costa Rica.

The owners of Arenas Del Mar graciously donated an off-peak week at their spectacular  hotel to The Healing Consciousness Awaken to Healing event in 2012. My neighbors Topper and Betty bid on the week and we were fortunate to be chosen as their travel mates.  What an Amazing slice of heaven we found at this “carbon zero” “five sustainability leaf” award-winning  rainforest beach resort. Truly nature in balance with business of tourism!

I needed a break from my day-to-day hectic life. My summer was far more trying than I had ever bargained for, but a week in Costa Rica was just what the doctor ordered. I hadn’t really done my vacation homework so I didn’t know what to expect when we arrived. It was almost nice to not have preconceived expectations about a destination and just go with the flow and live in the moment.

Spectacular Views

Arenas Del Mar is  gently nestled into the Costa Rican rainforest that abuts the ocean. From the beach, the resort is barely perceptible. You can see just the top of building seven, which gives that building the bird’s eye view of the spectacular beach. This is not just a resort tucked away in the jungle, it is a magical place where the people who tend to your needs while on vacation, treat you more like family and friends than customers or clients. My health system, Holy Redeemer, is in the process of reevaluating every service we provide in health care focusing on providing an exceptional experience for our patients.

The staff at Arenas Del Mar takes customer service to a whole new level. Jorge Arietta, the general manager, is an amazing individual who is respected and revered by his staff and his employers. You can tell when someone leads by example and makes his employees want to be the best they can be. He made sure that each and everyone who was staying at the resort received personalized attention. One evening I commented on our way to dinner that the candles around the pool were such a nice touch. That evening upon our return to our room, the  bell boy had filled out jacuzzi tub and outfitted the room with candles and flowers creating an amazing ambiance. I don’t know who overheard the comment and who was truly responsible for that surprise at our room, but I suspect that all of the staff work relentlessly to make each persons stay individualized and special. Kudos to Jorge for being the leader and role model that he is!

The Ambiance IMG_0927

Apparently trip advisor is how most people come upon Arenas Del Mar and from talking to the other guests the reviews were spot on. Several of our friends from VMS, (Vaughn Hebron’s workout group in Newtown, had visited the resort in August. They had “formally” initiated the manager Jorge and naturalist Ersel to “the workout”. My family, friends and patients know that Joe and I have been doing “the workout” with Vaughn for nearly 6 years now. I usually exercise on vacation, but this week we used the hills and the fabulous beaches to crank up the workout just  a notch.

On the afternoon of our first day, we had just gotten into our room when we ran in to Jorge heading up “heart attack hill” to workout. (The hills are workout enough for those who are not fit. Thank God they had the ‘jitney’s’ , aka golf carts, for Topper and Betty as the hills got old fast for them) Jorge invited us to workout and I joined them day numero uno and the rest is history. Joe became out VMS leader and his buddy Dave emailed us the new workout from PA so that we could stay on track. Somehow we managed to work around the rain and we were able to get 5 full VMS workouts during our week. (two warm ups on the hills and that means exponential expenditure of energy and massive pain in your legs for 48 hours)

So what is there to do at this place???

EAT,EAT and EAT

Amazing cuisine
We were fortunate to be present for one of the resorts celebrity chef events. Top Chef contender Jason Chicinoski of Ela in Philadelphia provided three evenings of delicious and artfully presented dishes. Don’t know how he did it as he was on the beach in the afternoon and by 7 we were eating 5 course gourmet meals. He visited the local markets and Villa Vanilla, an organic spice farm and intertwined the delicacies of Costa Rica into his dishes. I could live on his lobster bisque! Had I not been walking the hills, beaches and doing the VMS workout, I likely would be returning to the USA with a few more pounds on board.  We cannot wait to go to Ela upon our return to Philadelphia and I encourage you to try it too. I hear the Sunday brunch is a great way to become introduced to Ela!

IMG_0940

Villa Vanilla “The Organic Spice Farm”

Walking Stick

We did three day trips and they were all spectacular. My workout buddy Claudie highly recommended the Organic Spice farm. Giselle gave is an all-encompassing educational tour of Villa Vanilla. The property was started  by a Peace Corp volunteer on the 1970’s and has developed into a sustainable ecosystem with flora and fauna that were simply divine. If you are in the area, you need to take the time to visit. I purchased spices for my sons for Christmas as they are both chef’s in their own right in the kitchen.

The Organic Spice Farm

IMG_1012The dance of the huge walking stick was a bonus on the tour and the tasting was over the top as you could truly enjoy each of the ingredients from the Ceylon cinnamon tea to the vanilla ice-cream and chocolate candy. ( No carbohydrate watching that day). I must have returned from the trip with palpable enthusiasm as one of the owners of the resort planned a trip the next afternoon with his own chef’s and celebrity chef Jason. They were not disappointed.

We then had the opportunity to learn how to make sea bass ceviche from one of the resort chefs. In addition to the cooking lesson, we were entertained by the howler monkey and the raccoons who live in harmony with Arenas Del Mar.  Joe had a particularly special end to his day with rum tasting. (The day before we did coffee tasting and that too was a value added bonus to staying at ADM)

This trip was planned months in advance when I found out that Comprehensive Breast Care Surgeon’s as well as The Healing Consciousness Foundation were being honored by Professional Women’s Roundtable for making a difference in the lives of women.
The PoWeR of Connections
Stacy and Catherine represented our group and Lauren and Lauren represented The Healing Consciousness Foundation.I returned home to another beautiful glass award to adorn my office shelf.

PoWeR

The same day CBS 3 aired a segment taped earlier in the summer regarding advances in breast cancer care.

“Rainmaker Rainforest Hanging Bridges and Water fall experience”

Our workout buddy Ersel  Aguilar did have a real job besides making us sweat in the early AM.  He is the naturalist for the resort and apparently his name is all over trip advisor as one of the highlights of an ADM visit. He was perpetually bird watching or educating the visitors.

When we left the resort it was raining on the coast so I assumed we would be walking in the rain.
The day that we went to the rainforest was magical as we were the ONLY ones there and we had sun during our entire trip and the rain began upon our return to the pavilion for a delicious local lunch. Topper and Betty did not join us as Betty hates bridges and we had to cross several hanging rope and cable bridges. The waterfalls, birds and wildlife were awe-inspiring. Ersel even got us to eat a termite. ( Spicy yet satisfying! Good protein and they come packed with flavor)

The hike concluded with a waterfall back and shoulder massage.

(Second only in comparison with the massage that I received by Priscilla at the resort (Muy relajado)

Nature's Massage

The massage

I have to say that in all of my years of travel and people who I have met, Ersel is hands down the nicest most genuinely happy individual on the planet. His love of life, his passion for the planet and all of its creatures is so inspiring. His knowledge of Costa Rica and its many ecosystems makes him indispensable to Arenas Del Mar. This 26 yo has truly learned to live in the moment. He started every morning 6:30 AM workout with  his declaration that “Everyday is a great day!” and from his heart of hearts he means it. I cannot wait to have him spend time with our sons when we return to Costa Rica. I hope he gets a Visa soon so that we can return the favor when he comes to the USA!Hanging bridges

Zip Lining with MidWorld Costa Rica

Zip LinersTopper had zip lining on his bucket list and we crossed it off in the rainforest. Betty hates heights so she was out and Joe is recovering from a finger injury so it was Topper and I off for an adventure. Again we lucked out as it was off-season and we had a personalized zip line with Freddie and Marshall. Freddie picked us up from the hotel and we stopped in town to sign the waiver in case of death or limb loss. Freddie is a 20 yo who was not only our guide, but lives on the road to the zip line and helped build this Costa Rican Adventure.   We saw his grandmother sitting on the porch of his house as we drove past. Everyone has a story and if you don’t make the time to listen to theirs, you are missing out on a piece of life that is rich and real. His english is amazing for someone who has never studied out of the country. Freddie was wise beyond his years and another wealth on knowledge about the ecosystem of the rainforest.

Zip Line King

In healthcare we live in a culture of safely. We have a call daily at Holy Redeemer to discuss our opportunities for improvement and to go over any events that were deemed to be near misses or potentially harmful. At MidWorld Costa Rica they do the same type of process. The cables are inspected first thing in the AM and Freddie was one of the inspectors so we felt safe in his company. After our safety lecture, Topper and I were loaded into the king cab truck bed that was shipped to Costa Rica from Cheyenne Wyoming. That’s when the rain began and the cold set in. I was single-handedly wining the wet “T-shirt” contest as I was the only woman in our group. Luckily Topper was distracted by his mounting fear and anxiety about what he had gotten  himself into.

I had at one time a fear of heights. (Unless of course I was the one flying the plane) Some sort of control issue I think but I could be wrong.  Zip lining is a let go and let God experience. Once you are convinced of the safety of the double cable system and the triple safety line ,all you need to do is sit back and LET GO!! For those of you who know me letting go is not so easy, but something in the rainforest of Costa Rica allowed me to have Zero Fear and total trust in being in the moment. Despite the torrential pelting rain for half of the tour, it was exhilarating and exciting. Topper called it exhilarating and frightening wrapped up in one exceptional experience.

After our second repel out of the trees, we were once again treated to a spectacular lunch of sea bass, rice beans and squash as well as a dry towel. The food was simple divine and the hospitality of the Costa Rican people was over the top. During high season they have upwards of 100 people Zip lining and we have the auspicious honor of being there by ourselves, how cool was that.

Luis’s story

All of our wait staff was exceptional. Luis’s story is one worth sharing. Luis is in his mid 50’s. He was always pleasant, attentive and so eager to make your experience special. He had once had a farm on the border near Nicaragua and due to forces beyond his control, his land was lost and he is now a full-time waiter at ADM. In his youth, he was in contention for the Costa Rica’s Olympic Team. (We found this out from one of the other ADM employees) One evening at dinner we asked him about it and the passion and animation of his story was priceless. I should have taped it for you to hear in his words but thankfully I will always have in my heart. Luis ran the 800. I a particular race, he was told by his couch that despite his swiftness, it was not his time to win. Thankfully he disregarded the coach and took off in a race that he so animatedly shared with us. His arm gestures and word inflection as he recounted the race where he would pass the guy on the curves and be overtaken on the straight away were memorable. He recounted the two lap race turn by turn second by second and 1 min and 55 seconds later he won the race. His pride was palpable and his smile from ear to ear. (I actually think it took him 5 minutes to tell us the 1 min 55 second story).  Unfortunately he never did get to represent Costa Rica in the Olympics due to lack of funding, but for us he is a GOLD medalist!

Imaging the number of people who you meet in life who have a story as compelling and thrilling as Luis that you never hear about because you do not take the time to listen.

Walking up and down the hills and up and down the hills again to end up on a stretch of beach sprinkled with volcanic rock structures at the edge of the rainforest preserve IS  heaven on earth.

The Beach

Living in balance and harmony with the white-faced monkeys, iguanas, poisonous dart frogs, squirrel monkeys and so many beautiful and harmonious birds is a true testament to the visionaries of Arenas Del Mar. They have created a sanctuary for humans to live in equilibrium with nature.

 IMG_0899 IMG_0904Nature at it's finest

“Everyday is a great day !!”

A Blissful existence is our birthright!

Buenisimo

The “Present” is a ”Gift” if you can Learn to Live in the Moment

Image

2014 Breast Cancer Wellness Cruise is in the works and I am the co-director

So what exactly is wellness? Look up wellness in the dictionary and you will see that well·ness[wel-nis]  is a noun.

1. The quality or state of being healthy in body and mind, especially as the result of deliberate effort.

2. An approach to healthcare that emphasizes preventing illness and prolonging life, as opposed to emphasizing treating diseases.

I would add to this definition that wellness includes health in body, mind, and spirit. When the body, mind, and spirit are all in alignment then you have the “trifecta” of healing. Wellness to me is the exact opposite of illness. It is an active state of being conscious in your life, living with intention, and constant focus on “being”.

A breast cancer diagnosis is a wake up call not only for the individual who is diagnosed, but also their entire family. As seventy-five percent of breast cancers occur in women who have no family history of the disease, a diagnosis comes as a surprise. We know that lifestyle plays a crucial role in not only the prevention of recurrence, but in the prevention of the disease overall. So here’s my message: why wait for a breast cancer diagnosis to create wellness in your life? “Make Wellness the WAY!”

Creating a life of wellness requires a huge commitment to self-care. Making yourself the most important person in your life is often a foreign concept. When I have a newly diagnosed woman or man in my office, I ask them a crucial question at the end of the consult: “Who is the most important person in the world?” I get a variety of answers: my children, God, my husband ??? The answer I am looking for is “me” (the patient themselves not me as the doctor!). Once they answer the question, they realize that if they fail to care for themselves completely then they may not be here to care for those they love. It’s an aha moment for them and, for the first time in many of their lives, they have to put themselves in the #1 position of the most important people in their lives.

Making yourself the most important person in the world is essential in the process of creating wellness in your life.  Self-love is not the same as  being self-centered, instead it is the process of being centered on self.  Self-love allows you to spend the time to care for your physical health, emotional health, and spiritual well-being. Remember, wellness is the quality or state of being healthy in body, mind, and spirit especially as the result of deliberate effort! So you can see that wellness does not simple just show up, you need to invest time and effort to create wellness.

So lets break this wellness concept down into the three components: the physical body, emotional or mental well-being, and the spiritual or soul’s journey.

The physical aspects of breast cancer <BODY>

When diagnosed with cancer, you first need to treat the physical body and rid it of the disease. This involves the possible use of one or a number of therapies such as surgery, chemotherapy, and radiation therapy. Treating the physical body to eliminate the cancer is just the first step.

Once the physical body has been completely treated of the cancer itself, you need to take steps so that work actively to not only prevent cancer from recurring but to live the best life you can live. Lifestyle plays an important role not only in decreasing the recurrence of breast cancer but also in decreasing the risk of developing breast cancer in the first place.

The majority of breast cancers are estrogen sensitive and therefore estrogen produced in the body can act like a fuel on the fire. Very few people understand that our fat cells in our body are actually tiny “factories” where substances are converted to estrone and estradiol, the forms of estrogen that can stimulate cancers to grow.

Think of your body as a “temple” worthy of being worshiped.  Your soul has chosen to reside within your body.  Therefore, you need to maintain the “temple” in good working order. You need to nourish your body with healthy foods, strengthen it with physical exercise, and rest it with adequate sleep.

Food is our best medicine and making wise choices that help the body’s immune system are essential. Eat to live, don’t live to eat! Eating whole foods and avoiding processed foods is a good start.  Attaining and maintaining a healthy body weight is essential to long term health and wellness.  Over the past 50 years, our activities of daily living have changed causing us to no longer have enough physical activity in our typical daily routine to maintain a healthy physical status. Five hours of cardiovascular exercise a week combined with resistance or strength training three times a week is suggested to maintain a healthy physical status.

Our body also requires adequate uninterrupted sleep. A clinical study of nurses revealed that interrupted sleep patterns was linked to increased risk of breast cancer.[1][2] We know that individuals who do not sleep well also have a difficult time losing weight. So in order for us to create wellness in our physical bodies, we need to create balance with appropriate nourishment, exercise, and sleep.

Stress and the breast cancer connection <MIND

A diagnosis of breast cancer creates immediate fear. Fear paralyses you from living your life and, when not addressed, can keep you from healing far after the physical cancer is gone. These fears include the loss of physical aspects of one’s body, but more significantly, of premature death or recurrence of cancer. Oftentimes health care providers are successful at treating the physical manifestations of cancer but are less successful at guiding patients to release the fear and live life in the moment, in the present. In reality none of us, even those of us without cancer are guaranteed tomorrow.

Stress is a factor that is also part of the mental and emotional aspects of cancer care. It may be the financial stress that cancer brings or an increase in the stress and anxiety that existed prior to the diagnosis. An eleven year study looking at alleviating stress through psychological counseling and stress reduction has been shown to decrease the risk of recurrence by 45% and death by 56% in patients with Stage II and  III cancer![3]

Focusing on the joy in one’s life and remaining positive are extremely important in the healing process. I recommend gratitude journals to my patients to help them maintain focus on all of the blessings they have in their lives.

Too many of us choose professions that do not foster our passion and purpose in life. I am blessed to be in a profession that allows me to fuel my passion daily. Although my day job is being a breast cancer surgeon, my soul’s passion is empowering everyone I meet to find healing in his or her life.

It often takes a diagnosis of cancer or some other adversity to bring about the awareness that you are not living an authentic life. One of my favorite quotes from Paulo Coelho’s “The Alchemist” is “when you follow your heart’s passion the universe will conspire in your favor”. Often times we have chosen professions that increase the monetary value of our bank accounts while spiritually bankrupting our souls.

In order to obtain emotional and mental peace after the diagnosis of breast cancer, you must release the fear: the fear of the loss of one’s current life and the fear of recurrence and premature death.  You must live life in the moment for the “present” is the gift.How we relate to the world <SPIRIT>.

Organized religion may have given you the opportunity to begin your spiritual practices, but cancer gives you the opportunity for spiritual mastery.  Understanding that each of us is a spiritual being having a human experience is oftentimes eye opening.  As a physician, I cannot always cure my patient’s cancer.  That does not make me a failure as the physician, it makes me a spiritual being having a very human experience.  Cancer places a soul on the fast track to healing. Spending time in meditation, prayer, yoga, or whatever spiritual practice resonates with that soul is the key to healing.

Come join us on this year’s Breast Cancer Wellness Thrivers Cruise and be inspired to create your own reality! We will meditate, practice yoga, become educated about integrative nutrition, exercise daily with a two-time super bowl champion Vaughn Hebron and so much more! I look forward to meeting each and every one of you on Royal Caribbean’s Liberty of the Seas.

 Image

I am thrilled to be a co-director of this year’s “Breast Cancer Wellness Thrivers Cruise”. This year’s cruise is going to be a true journey to wellness. We are anticipating that it will be not only well attended but also be an inspiration for all who attend! For some, it will be the beginning of their journey to wellness and, for others, it will be a confirmation of their path already in process. Transition from surviving after a breast cancer diagnosis to “thriving” after a diagnosis requires hard work and a commitment to creating wellness.

 


[1] Dickerman B, Liu J. Does current scientific evidence support a link between light at night and breast cancer among female night-shift nurses? Review of evidence and implications for occupational and environmental health nurses. Workplace Health Saf. 2012 Jun;60(6):273-81; quiz 282. doi: 10.3928/21650799-20120529-06. Review. PubMed PMID: 22658734.

[2] Bonde JP, Hansen J, Kolstad HA, Mikkelsen S, Olsen JH, Blask DE, Härmä M, Kjuus H, de Koning HJ, Olsen J, Møller M, Schernhammer ES, Stevens RG, Åkerstedt T. Work at night and breast cancer–report on evidence-based options for preventive actions. Scand J Work Environ Health. 2012 Jul;38(4):380-90. doi: 10.5271/sjweh.3282. Epub 2012 Feb 20. PubMed PMID: 22349009.

[3] Andersen BL, Yang HC, Farrar WB, Golden-Kreutz DM, Emery CF, Thornton LM, Young DC, Carson WE 3rd. Psychologic intervention improves survival for breast cancer patients: a randomized clinical trial. Cancer. 2008 Dec 15;113(12):3450-8. doi: 10.1002/cncr.23969. PubMed PMID: 19016270; PubMed Central PMCID: PMC2661422.

Living in your “GENES”

Angelina Jolie and The Dirty Little Secret of the BRCA related cancers

You can read about Angelina Jolie and The Dirty Little Secret of the BRCA related cancers on More.com

No one wants to hear that they have breast cancer. Many women don’t  really want to know that is not “if they will get breast cancer”, but “when they will get breast cancer.” Our mothers and grandmothers didn’t have the choice to know if they were carriers of the BRCA variant genes when they were young as the testing did not exist.  What they didn’t know did hurt many of them but they didn’t have the difficult decisions to make about their futures that

We do!

If only my crystal ball was working...

If only my crystal ball was working…

If it could tell us the day before the cells decide to stop dying at the appropriate time  and cancer was beginning its uncontrolled cell division. We would choose not to get breast cancer. We are able to choose the pair of jeans to house our legs, but we have no choice over the pairs of genes that make up our DNA. ( at least not yet!)

The BRCA I and II hereditary breast and ovarian cancer genes are the genetic variants that we know of at this time that are the most common genetic mutations that cause and increased risk of  breast and ovarian cancer. Who’s at risk? Great question. There are several red flags that alert us as clinicians to offer testing to individuals who have a significant risk of carrying on of these genetic variants.

Personal history of breast cancer < age 50 years

•Family history of multiple cases of early onset breast cancer

 •Ovarian cancer (with family history of breast or ovarian cancer at any age)

 •Breast and ovarian cancer in the same woman

 •Bilateral breast cancer or 2 primaries in same breast

•Ashkenazi Jewish heritage any age ( 1/40 AKJ individuals carry the gene compared to 1/500 non AKJ)

 •Family history of male breast cancer any age

•ER-, PR-, Her 2 neu- ( aka triple negative breast cancer) < 60

•Personal hx Pancreatic cancer any age with 2 close relatives with breast/ ovarian or pancreatic CA any age

•Limted family structure  ( adoption, death of women by 45)

The BRCA I and II variants are found on chromosome 13 and 17

The BRCA I and II variants are found on chromosome 13 and 17

If you feel that you fit the above criteria, talk to you healthcare provider to be referred to a physician or genetics counselor to discuss your personal family pedigree and determine if testing is right for you.

If you are found to carry one of the variant genes, you are at increased risk for breast and ovarian cancer

—50% chance of breast cancer by 50
—87% chance breast cancer by 70
—44% chance of ovarian cancer by 70
—Significant increased risk of a second cancer
—Relatives need to be tested
—Options carefully weighed
Understand medical surveillance is an option

Making a decision to have risk reduction surgery is personal and you are the one who has to live with that decision every day. Everything in life has risks and benefits and all of them need to be taken into consideration when a decision is made. Many women chose to have close clinical surveillance with mammograms, MRI’s and clinical breast exams. Tamoxifen, an estrogen blocker can decrease the risk of an estrogen sensitive breast cancer by nearly 50%. We have innumerable patients who are followed clinically and they are quite comfortable with their decision.

BRCA gene-related breast cancers are associated with a high incidence of triple negative tumors. These are fast growing cancers that can appear suddenly as large tumors in just a few months. BRCA positive patients follow a six month screening routine alternating between mammogram and MRI. Triple negative cancers can pop up in the interval between screening exams. This is one reason that more and more women who carry a BRCA gene choose to have risk reduction surgery with reconstruction. Surgically, we are often able to preserve the nipple complex providing patients with risk reduction and excellent cosmetic results. Triple negative cancers account for approximately 75% of the cancers that occur in BRCA I carriers and 30% of the cancers in BRCA II carriers.  (Less then 11% of breast cancers in the general population are triple negative.) These cancers are fast growing, aggressive, and almost all require chemotherapy as they lack certain cell surface proteins that can be targeted by medication such as Tamoxifen.

So what’s the buzz on ER-, PR-, Her 2 neu-  aka triple negative breast cancer.

Triple negative breast cancers are cancers that begin in the breast and do not have cell surface proteins that receive signals that can either stimulate or block the cells production.  Triple negative is short for ER- (estrogen receptor negative), PR- (progesterone receptor negative) HER 2 neu – (Human epidermal growth factor receptor 2 negative). This means that these tumors lack those cell surface proteins therefore specific targeted treatments will not work in these tumors.

Triple negative breast cancers account for only 10-15% of all breast cancers. Triple negative cancer growth is not stimulated by the hormones estrogen and progesterone, therefore medications to block those receptors will not work in triple negative breast cancer. Herceptin is another “targeted” therapy but is ineffective in Her 2 neu negative tumors as the cells lack the Her 2 neu surface protein.

Triple negative breast cancers are also considered to be more rapidly growing tumors and therefore need to be treated aggressively. They are often call “interval cancers” as they can develop and grow to be quite large (3-4 centimeters, the size of a small lemon) between annual mammograms. The risk of recurrence for triple negative cancers is significantly higher within the first 2 years after the initial diagnosis, and decreases after this time interval.  Hormone positive cancers however, may not recur for 5-15 years after their initial diagnosis.

Triple negative breast cancers are frequently seen in younger women, although the distribution is similar in all age groups.  African-American women are twice as likely to develop a triple negative breast cancer. These tumors are also more likely to be associated with the BRCA I and BRCA II breast and ovarian cancer genes. Approximately 75% of BRCA I carriers and 30 % of BRCA II carriers who develop breast cancer will have a triple negative cancer. For those reasons women who develop this subtype of cancer need to be tested for the BRCA genes.

The local, or breast and lymph node, treatment of triple negative breast cancer is the same as any other breast cancer.  Breast conservation therapy, lumpectomy and radiation, or mastectomy with reconstruction both with evaluation of the lymph nodes is the options.  One important difference, however, is that research has shown that triple negative breast cancers are very responsive to chemotherapy, thus making this treatment option a cornerstone of triple negative breast cancer therapy even with very small tumors that do not involve the lymph nodes.  While chemotherapy is not always a part of the multi-disciplinary care associated with hormone positive breast cancer, along with surgery and radiotherapy, it is an integral part of the treatment of triple negative breast cancer.  Neo-adjuvant chemotherapy, or chemotherapy before surgery, is also frequently used for treatment of triple negative breast cancer to shrink the tumor to allow for better breast cosmetic outcomes.

Triple negative breast cancer has a lower survival rate than other breast cancers. Many factors play into survival rates. According to studies cited at Breastcancer.org, women with triple negative breast cancer have a five-year survival rate of 77 percent, compared to women with other subtypes of breast cancer, who have a five-year survival rate of 93 percent. Having a triple negative breast cancer does appear to raise the risk of death within five years of diagnosis compared to women with other subtypes of breast cancer, but after that five-year time period, the risk diminishes. Unfortunately, mortality rate among African-American women with triple negative breast cancer is much higher than it is in Caucasian women.

If you or a family member has been diagnosed with a triple negative breast cancer, take a deep breath and know that this cancer is treatable! My advice is that although this is an aggressive subtype of breast cancer, there are combination therapies for this particular tumor type that offer her a potential long-term survival equivalent to stage matched hormone positive breast cancers when diagnosed early and treated aggressively. Know that chemotherapy is a cornerstone of treatment and that frequently chemotherapy is given in advance of other therapies such as surgery and radiation therapy.  A team of doctors, including a breast surgeon, a medical oncologist, a radiation oncologist, and frequently a genetic counselor will be involved in the multi-disciplinary care of her health through this difficult time in her life. Genetic testing and counseling are a must!

OVARIAN CANCER RISK

BRCA carries have a 44% risk of developing ovarian cancer by the age of 70. We cannot gloss over the risk of ovarian cancer in this conversation as the ovaries are hidden away in our abdominal cavity and are virtually impossible to screen for cancer. Ovarian cancer strikes silently therefore it is recommended that women who have had their children and carry the BRCA I or II gene have their ovaries and tubes removed at a time determined by their physicians based upon several personal factors. Their risk after removal goes from 44-50% down to 4%. ( The risk is never zero as our abdominal cavities can still produce some progenitor cells that can turn into cancer. < aka primary peritoneal carcinoma>)

KNOWLEDGE IS POWER

Get educated, be empowered. Make decision based on knowledge not in reaction to fear.

“Take risks in life based upon what you may gain, not what you fear you may lose”

A New Day

A New Day

Women Who Make a Diffference

May 12th, 2013

Happy Mother’s Day!

To everyone who reads this who is a mother, know that you are giving the greatest gift to another human being, unconditional LOVE. To everyone who is reading this who has a mother, so unless you were hatched, I mean you… take a moment and thank your mother for all of her love and wisdom that she has given to you whether or not she is still with you. She will hear you even if she is in spirit.

This is my Mom Helena Baughman and I was blessed to spend the day with her.

Every day is a gift, Stay present in the moment.

My Mom Helena

My Mom Helena

Kudos to the YWCA of Bucks County for honoring Women Who Make a Difference!!!

I had the honor and pleasure of presenting two of Bucks County’s Treasures to the more than 300 individuals who attended the YWCA Awards ceremony May 9th, 2013.

Heidi Volpe

Heidi and Beth

Heidi and Beth

Holy Redeemer Health System chose to honor a woman that I could not live without. Heidi Volpe is an amazing nurse, mother, daughter, friend and is the administrator who not only successfully runs the Bott Cancer Center but is the queen of community outreach and simply cares about every aspect of our cancer program!!

Heidi was joined by her father at the award ceremony and was surrounded by patients and friends from the HCF. She sits on the HCF board as the Holy Redeemer representative.

Mary Lou Gilmour

Beth and Mary Lou

Beth and Mary Lou

The Healing consciousness Foundation honored Mary Lou Gilmour as a woman who makes a difference in so many of our patients lives.

Mary Lou is an energy practitioner who provides healing services for our breast cancer patients. She is a vital link to healing from breast cancer and anything that life has thrown at someone. I can physically remove a cancer, but Mary Lou energetically creates the path for healing.

She is humble, exudes love and is absolutely a woman who makes a difference with every breath she takes. I am, so blessed to have her working with us through the HCF.

And lastly, I am humbled and honored to have been inducted into Drexel University’s Alumni society The Drexel 100 on May 4th 2013. The Drexel 100 class of 2013 was a pretty amazing group of individuals, I am proud to be one of them.

Janet works for the alumni office and as the day progressed, she realized that I had performed surgery on one of her very dear friends!!

Beth and Janet

Janet and Beth

Drexel 100 Medal

Drexel 100 Medal

It’s A Wonderful Life!