8/7 - MD Affirmation

It is clear entering any one of the many buildings that make up the vast MD Anderson Cancer Center that you are in a special place. From the building's directory board, which list an exhaustive collection of cancer disciplines, to the diverse groups of people whom have congregated here in search of answers from around the world, there is a unique energy.

At around 8:15 am we arrived at 1515 Holcombe Boulevard (coincidentally the same street number as Kristine's cousin, Cris, with whom we stayed during our visit). We spent about 20 minutes finding our way around the hospital building. Upon arrival to the Sarcoma Center, we completed the standard set of paperwork and procedures before being placed in the examination room. And Kristine answered the standard set of questions regarding her medical history, treatment timeline and symptoms, first for the Primary Nurse and then again for Physician's Assistant.

Dr. Shreyaskumar Patel, Director for the MDA Sarcoma Center, entered the room. We immediately got a sense for his dry wit in his opening reference to his relationship to Dr. Staddon and their recent discussion about Kristine's case. He preempted our questions with a long monologue about his thoughts on Kristine's cancer. He was deliberate and decisive as he walked us through his evaluation. He addressed Kristine's case in separate parts, taking the time at each stage to focus on the most probable scenario and his advised solution.

Generally speaking, Dr. Patel’s evaluation and recommended treatment plan were consistent with our current approach. He agreed with Kristine's current diagnosis and acknowledged that the treatment was having a positive effect in reducing the tumors based on his own review of her scans. However, in his opinion, he felt that we could be more aggressive with treatment in a couple of key areas.

First, he felt that the eight weeks between Kristine's last chemotherapy and her surgery was too long. Even if the tumor appears to be inactive there is a small chance that active cells still exist. And even this minor risk, he felt, was worth more aggressive tactics to prevent future recurrence. He recommended that Kristine either receive another cycle of "adjusted" chemotherapy before her surgery (using only one of the two drugs Kristine had been getting) or move up the date of her surgery.

On the matter of surgery, he encouraged us to stay the course. He, naturally, had a bias toward the surgeons he most frequently works with, but he felt that it was in our best interest to avoid (a) losing more time (the time it inevitably takes to move through a new health system) and (b) potentially spending more money (our insurance provider declined to cover our visit to MD Anderson, future treatment at the center would require a fight). Although Kristine and I had reached a similar conclusion before our meeting -- that she would be best to get surgery in PA based on time and insurance -- the doctor gave us the validation we needed.

Dr. Patel also addressed the specifics of surgery. He confirmed Dr. Staddon's opinion that surgery was a necessary next step not only in the Heart but also in the vein beneath the clavicle. His justification was simple. No doctor can be absolutely certain that any of these apparent masses is active tumor. Therefore the most logical approach, in his opinion, is to be aggressive and remove the "monster," as he put it.

We had several questions, but there was one in particular to which we got a surprising response. We were curious to get his opinion on treatment (chemotherapy or otherwise) after surgery. Dr. Staddon had not ruled out post-surgical chemotherapy, but he had not stressed its necessity either. Dr. Patel, on the other hand, once again recommended an aggressive approach. He strongly suggested that Kristine receive 2 to 4 cycles of chemo after surgery.

Overall, we were both satisfied with the outcome. Dr. Patel supported Kristine’s current treatment path both clinically and surgically. However, he suggested a slightly more aggressive treatment schedule to minimize even the smallest risk of recurrence. A few hours after our appointment, Kristine got a call from Dr. Staddon’s office. Dr. Patel had called Dr. Staddon directly to convey his thoughts. In turn, Dr. Staddon, in agreement with his assessment, put the wheels in motion to move Kristine’s schedule up. It was interesting to us to see just how quickly this transaction occurred. It highlights one of the major faults of our health system – that the patient has to get a second opinion in order to force doctors to cross-collaborate and share opinions.

As for Kristine, she is landing somewhere in the middle, wishing to take a moderate stance. Although she subscribes to the aggressive tactics suggested by Dr. Patel, she also believes that reacting at this point could cause more harm. Her surgery will likely move up one week (potentially overlapping with her birthday) and she will likely seek to continue some form of chemotherapy treatment after surgery (this still needs to be discussed with Dr. Staddon).

Ryan