Meeting Dr. Ahrendt

First, let me say that I actually drove to the wrong hospital this morning.  Our city hospital system is enormous, and there are probably 50 different locations.  Most of my appointments are at four of these locations (Presby for Rheumatologist; Montifiore for PCP; Magee for Surgeons, Mammos, and Gyn; and Hillman for genetic counseling).  I headed to Presby this morning even though my appt was at Magee.  Luckily, they’re only a few blocks away from each other.  But I worry that this is more overwhelming for me than I think it is, and that I need to be more focused and keep my head on straight.
I think I should start keep track of how much this is all costing.
Costs for today: $10 copay, $5 parking

When the nurse came to get me in the waiting room, she said “You didn’t bring anyone?” There’s that nurse pity-voice again.  No, I did not bring anyone.  I know my husband wants to be here for all of these appointments.  But the simple fact is that his job is inflexible with time off, and he gets a very limited amount.  We need him to be saving these days for when I have the surgery so he can be home as long as I need him to be.

Also, she gave me a gown missing half the ties, so I sat there completely exposed.  Yay.

Dr Ahrendt entered the room and also asked if I was alone.  I asked her why everyone was asking me that in such a sad voice.  She apologized and said she didn’t mean it that way – just that most women bring an army with them.  I explained my husband’s work situation and she understood.

Impressions of Dr. Ahrendt: she’s great; so understanding; really nice; not condescending; explained everything in an understandable way. She had read and retained my entire file and family history.

Do I need the biopsy if I’m doing this in May?
She recommends it so there’s no surprises.  This will determine if lymph nodes need to be checked/removed as well.  If the scans are normal, they don’t remove any lymph nodes.  If the calcification shows high-risk, then she’d check lymph nodes when she does the surgery.  If it comes back fine, can have surgery in May.  If it comes back atypical (not cancer, but high risk change) – can have surgery in May.  If it comes back in-site-2 cancer (not invasive, contained, not spreading) – waiting til May would be ok, but she’d rather do it sooner or later (takes 4-6 weeks to schedule it anyway).  Also wants me to have an MRI before any surgery, again to avoid surgery (can possibly do this at the time of the biopsy).

If biopsy is positive, do I need treatment?
She suspects that it should not be cancerous, at the least it’s not invasive – it should not require any chemo or radiation even if it is cancerous.

Do you do Skin saving? Pros and cons.
Yes, it would need to be done, because of tosis (the way the nipple is pointing). Pros – more cosmetic, looks better, contour is more natural.  Cancer prevention – a skin sparing is just as effective as taking the max amount of skin. Leaving the skin will be 95% effective in preventing cancer.

Do you do Nipple sparing? Pros and cons.
Cannot because of the size of breast.  Those would be reconstructed and then can be tattooed.

How far up the neck, under arms, etc.
Anatomical boundaries – she knows them.

Rec for plastic surgeons who do DIEP.
Hard for her to schedule with De La Cruz.  Otherwise Gimbel or Ngyen.  Her secretary will schedule appt for me with all three.

How to schedule surgery? Friday before Memorial Day is when I’d like it.
I can schedule it now if I want – typically on Monday.  Memorial Day will not happen.  Will probably be the Monday after Memorial day.

Where is the surgery done?
At Magee – Mastectomy part is short, but total is about 10-12 hours.

What’s the recovery without reconstruction?
Four weeks should be at 80% of normal activities.  With reconstruction is twice as long because of the abdominal flap.

Are there muscles I can strengthen to make recovery easier?
Core, arm muscles.  Good nutrition.

How many have you done?
Probably thousands.

Next steps:
Get the biopsy
She’ll set me up with MRI
Joey (Sec) can set me up with Plastic Surgeons
Dr. Jankowitz or Dr. Ahrendt will call me with the results and then figure out what to do.

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