The Swedes have it

(Left: Dr. Astrid Morris, Swedish Hospital)

My appointment at Swedish Hospital in Seattle was re-scheduled to Monday, September 8th. I couldn't believe that I was actually excited about going to another doctor's appointment! But I got up in the morning feeling excited that I was going to the mecca of cancer research and hopeful that the Mammosite therapy would work for me.

My husband took the day off work to accompany me to my 10:45 a.m. appointment. I was scheduled to meet with Dr. Astrid Morris, a radiation oncologist, and then Dr. James Hanson, a breast surgeon. I had already picked up copies of my MRI films and mammograms to hand off to them when I arrived.

We arrived at Swedish over an hour early (we had left plenty early to beat Seattle's morning traffic) and found a place nearby in the huge parking garage.

As we walked into the tall building with the words "Swedish Cancer Institute" inscribed over the door, I had the strangest feeling and thought, "What am I doing here?" When we got inside, I remarked to my husband, "I think I'm in denial." When he asked me why, I replied, "Because I can't believe that I have to go to a cancer institute!" (Isn't that a place where other people go--you know--the ones with cancer? Not "normal" people like me.)

Swedish Hospital has got it all over any other medical establishment I've seen. Down to the last detail, at least from what I observed from my first visit.

To begin with, the receptionist was the epitome of graciousness and efficiency. Dealing with constant interruptions (including a mentally-challenged young man who kept insisting that she tie his shoes), this wonderful black woman was Florence Nightingale, Joyce Brothers, and Margaret Thatcher all rolled into one. I mean, this woman had it goin' on.

From "command central," she had an overview of the entire lobby (something akin to an airport check-in counter), while positioned in front of a computer that had been elevated to use from a standing position.

While dealing with us and typing our information into her computer, she must have been interrupted 15 times. She was unflappable and never missed a beat. Each time she was required to respond to someone else, she again turned her attention to my husband and I and sweetly apologized or thanked us for our patience. She was perfect for the job. (I hope she is paid well.) We were even offered coffee, tea, water, or hot cocoa. Any place that offers chocolate anything can't be all bad.

While we waited in the lobby, she told me that I could go downstairs to pick up a "goodie bag" for first-time patients, which I did. I returned with a basket full of lotions, comfy socks, lip gel, a stationery, a lavender stress ball (now there's something I can use), and most importantly, a chocolate bar (which didn't make it home that day).

We were called into our appointment with Dr. Morris 15 minutes early. I was weighed and then shown to a patient room. Funny thing: my husband hasn't known my weight for several years. I just never talked about it and he never asked. I think he assumed I still weighed the same thing I did on our wedding day . . . yup. Now he's seen me weighed on every scale west of the Mississipi-or so it seems. Isn't that some kind of invasion of privacy? (Never mind that he's seen me expose my chest for every doctor west of the Mississippi in the last two months).

Shortly after, Dr. Astrid Morris entered the room. She is a tall, lean, dark-haired woman with a slight German accent. She was very personable and informative. She spent quite a bit of time with us explaining the Mammosite procedure. At one point, she left the room and brought back a Mammosite catheter and balloon for us to see.

When I saw the size of the catheter, my eyes about popped out of my head. I had envisioned it MUCH smaller! It appeared that it would be like having a knitting needle inserted into my body (not on my list of top ten things to do).

She mentioned that the pathology slides that had been requested from my Skagit County doctors had only just been received that day (not surprising, but irritating). Because of the delay, the Swedish pathologists hadn't had time to do their own review, so she would have to wait for that.

She also said that the cancer-free margin around my tumor was 2mm at the minimum. She said that 2mm is the absolute minimum required and if her own pathologist determined the margin to be even slightly less than that, the Mammosite procedure would be out unless I had a re-excision (more surgery). This frightened me since she remarked that margins of only 2mm have a higher rate of recurrence. This was the first time anyone had told me this information!

However, I was impressed with the unhurried feeling I got from my visit with Dr. Morris. I felt that I was given all the time I needed to ask questions and chat with her. There was no feeling of being pressured or talked down to.

I was then asked to go to the 4th floor to see Dr. James Hanson, a breast surgeon. He would also need to determine whether I was a good candidate for the Mammosite procedure. He would measure the size of the tumor cavity using ultrasound and find out if the size and shape were amenable to the therapy.

Shortly after noon, my husband and I were shown to a room in Dr. Hanson's office. My husband perused a National Geographic magazine and did a running commentary on the photos while I tuned out and stared at a large breast cancer poster on the wall. I guess he didn't notice that I was a little preoccupied.

Fortunately, Dr. Hanson soon entered the room and talked to us about the Mammosite procedure. He took out a balloon (the one that would be inserted into my tumor cavity) and used a gigantic syringe to inflate the balloon with air. I was a little stunned when I saw the size of the inflated balloon--MUCH bigger than I had imagined!

My husband made a remark about how he would have loved to use that syringe for water fights when he was a kid. I remember feeling embarrassed and wondered if the doctor would ignore the remark and continue on with his very professional demeanor. Imagine my surprise when the doctor responded with, "Oh yeah, the ones we used to love were those big, orange surgical tubes. We'd hook those up to the water faucet until they got really big." (Good grief, there's a little boy in every man.)

He then proceeded to the ultrasound and pointed out what he was looking at so that my husband and I could follow along. Basically, he determined that the tumor cavity was fairly small and still "squishy" (I loved his medical terminology), which was good for our purposes. But it was very close to the chest wall, which had been one of my concerns. Using the measurement tools on the ultrasound machine, he figured that I had about 1cm of "padding" between the tumor cavity and muscle and/or ribs.

This information didn't bode well for getting the Mammosite procedure, as the higher levels of radiation used in the treatment would then radiate to the chest wall, which would not be good.

So we spent some time discussing the pros and cons. He said that he could try injecting some saline solution into the tumor cavity to see how "uncomfortable" it was for me. Uh . . .no thanks. When I saw the difference in size between the tumor cavity and the inflated balloon, I knew it would be dicey.

I made the decision to forget the Mammosite procedure and the surgeon seemed to concur. I was a little disappointed, but not much. It just seemed too risky.

However, Dr. Hanson mentioned that I could still avail myself of Swedish's "accelerated partial breast radiation therapy." Basically, the idea is that since most tumors recur in the same area, radiation is directed solely at the tumor bed rather than the entire breast, thereby sparing damage to normal tissues and organs. The accelerated partial breast radiation is also done twice a day for 5 days (same as the Mammosite treatment).

Dr. Hanson called Dr. Morris and then asked me to return to her office so that we could talk some more. When I returned to see Dr. Morris, she asked me if I might be interested to hear about a study that was being conducted at Swedish for women undergoing partial breast radiation. If so, she would send in a nurse to explain the study to me. My husband and I agreed to hear about the study.

A few minutes later, a rather young-looking nurse came in and introduced herself. She reminded me of someone who just graduated from college (maybe so?). She smiled a lot and seemed a little flustered when I asked for her business card and she had to dig through her purse and couldn't find one.

At any rate, the study she presented was intriguing. She explained that Swedish is doing a study using the "Calypso" method with breast cancer radiation. I was offered an opportunity to volunteer for this experimental treatment. So far, it's only been done on 10 women, but with good success.

Basically, the Calypso method would involve insertion of two small catheters into my breast. The catheters contain three "beacons," each about the size of a grain of rice.

The beacons would be situated (via ultrasound) in a triangular shape in my tumor cavity. When the partial breast radiation is begun, a homing device hones in on the beacons to make sure that the target area is being radiated. The radiologist can tell immediately if the tumor area moves out of target (due to normal breathing, a cough, sneeze, or anything else). Without the Calypso method, the target area often moves slightly off-center and the radiologist has no idea.

I was given paperwork to take home and read and to consider. I was told that if I decided to participate in the study, any mileage or hotel expenses would be funded by a Swedish research grant.

I admit that I was interested, but wanted to do my own research and think about it. The nice thing was that the partial breast radiation didn't have a time urgency, as did the Mammosite therapy (within six weeks of surgery). I also wanted to meet with my oncologist in Mount Vernon to find out the results of my Oncotype test before I made any final decision. If my risk of recurrence was determined to be low, the partial breast radiation sounded like a feasible idea. Otherwise, I didn't want to take any chances and figured I'd go with the conventional radiation.

We left the hospital at about 2:30, having been there for over five hours. We asked if there was a good place to eat nearby and were directed to a sandwich shop across the street. As it turned out, we never made it that far. We saw a taco place and ate there instead.

On the way home, my husband said that he would go for Calypso study if it were up to him. When I expressed some reluctance about going through another invasive procedure, he said that it's been proven (in prostate treatment) and they already know it works. He felt that it offered the most cutting-edge treatment available and that I should go for it. However, he also knows that I am much more methodical than him and that I need to come to a decision on my own. I read the study materials on the way home and did a lot of thinking.

One thing I will say is that I'm very fortunate and thankful to have options available to me. So I have decided to keep my appointments with the oncologist and oncology radiologist in the next several days and get more information from them before making a final decision.

My prayer is that God gives me wisdom and discernment to make the right choice for a procedure that will have very long-lasting and significant implications in my life.