I freakin' love UCSF.  Thanks to the film department and the doctor's assistant for making things that can be and should be easy...easy. It is very much appreciated!

UCSF POST-APPOINTMENT UPDATE

Met with my breast surgeon, Dr. Cheryl Ewing and the nurse practicioner, Suzy Eder, on Friday. I'm continuously impressed by the balance between efficiency, caring, and openmindedness at UCSF Medical Center. It's just right for me for where I am on my journey. They had a meditation center in the lobby, a place to bring some space and consciousness into your day.


My mindset: I went in ready to listen, weigh options, while keeping my intentions in mind. I wanted to stay true to my short-term goals - which are no trauma, nutritional and herbal approach towards health. This would mean that if they'd asked me to do a biopsy or take tamoxifen, I would have declined. If they recommended a genetic test or further ultrasounds, that would be ok. My long-term goals are obviously to be cancer-free. How I get there may change over time as I see how what I'm doing helps or doesn't help.

The consult: This was a same-day appointment, which means the breast surgeon and her team (nurse practioner, radiologist, etc.) get together and determine what they think is the best route for me. They would perform any necessary tests that day and based on those results discuss and determine next steps. They brought me to my exam room and I sat there for about an hour and a half, close to two hours. I used that time to get my thoughts organized and did a little sitting meditation. When Dr. Ewing and Suzy Eder came to visit me, the consult was only about 15-20 minutes long. Here are the main points:

1. Dr. Ewing recommends a mastectomy: Based on their review of the MRI images (received a week ago) with the radiologist, she no longer thinks a lumpectomy is the way to go and recommends a mastectomy. Reason: the tumor spans a larger area than originally reported by UC Davis. There is a main area around 2cm, but there are tentacles that stretch down the duct toward the nipple; this area, though not a full mass is around 4.3cm long and all contained within the milk duct. I really dislike that word tentacle, but it's really the only word that I can think of that describes it correctly. She also said the MRI from UC Davis is not the best quality (not sure why) and that the radiologist wants to do another MRI to clear the right breast, which UCD thought was clear...apparently, UCSF is not so sure. To prepare for a mastectomy, I will be having a consult with a plastic surgeon, in the next few months as well.
2. Moving forward with Plan B MRI monitoring: Setting aside mastectomy in the short-term, we discussed going forward with Plan B since I have chosen to continue with the Chinese herbal treatment, nutritional, and lifestyle changes. UCSF will monitor my progress with breast MRIs, the first of which has been scheduled in January, which is 5 months after my last MRI and 4 months after I started my herbs and nutritional changes. I'll have another same-day assessment at UCSF after the doctor has had a chance to compare the MRI image with the first MRI image. We discussed that if no progress is shown or if the situation has worsened, we'll move forward with the Plan A mastectomy treatment plan. If progress is shown, then I will continue with my natural treatments and schedule another MRI 3 months later.

They never did ask me to take tamoxifen or do another biopsy, which I had expected for the smaller mass near my nipple since they saw the connection between the main mass and this one, which the UCD may have missed.  Radiologist interpretation of the blacks, greys and whites in images is a whole other topic of discussion. It's kind of a big deal to be able to do this well!  It would be nice to be able to be in the room with the doctors while they are looking at and interpreting the images.  Some additional interesting notes from my visit can be found here.

And then...Some Fun

I had a really good time in visiting some of my family and friends in Sunnyvale, Berkeley, and SF, too. It was a gorgeous couple of blue-sky days filled with laughter, friends, family, food, and art.



This is where I sat to eat lunch near UCSF Mt. Zion

 

The sun in the Sunset district near Parnassus

  

At Berkeley Bowl...have you seen so many heirloom tomatoes?

 

We went to Vik's for lunch on Thursday in Berkeley, best Indian food around...just look at this saffron and cheese cake with pistachio on top (I had a sliver)



Some garden art in Berkeley, CA by whimsical artist and sculptor Marcia Donahue...this is just a taste, her entire garden is really beautiful and worth visiting, part of the garden conservancy and open on Sundays:

   

COMING SOON TO A THEATRE NEAR ME: UCSF

My UCSF same-day appointment is on Friday. I'm staying at Erin's in the sunset, which is quite convenient. Thank goodness for friends in the city!  Not to mention the tasty food that we'll be eating before and after.  This appointment is to review tests that I've had done since the last appointment, which was on 9/15, get some genetic counseling to determine if I want to move forward with genetic testing (I think I do), and get any additional tests done that my doctor wants done.  I think she's going to want a biopsy of the other 6mm suspicious area, *shudder*. All the people I need will be in one place so that I don't have to schedule return visits to get stuff done. Good on UCSF.

I see two goals coming out of this appointment: 1) Find out what the doctor thinks treatment should be now that I've had some tests done (minus the genetic test, which I'll likely get that day) and 2) probably forgo the recommended treatment (for now) and schedule my first MRI to monitor my tumor shrinkage or growth. Now, their ability to support #2 is dependent upon the doctor's interpretation of my hormone receptor tests, which are currently progesterone-positive and estrogen-negative. The estrogen result is arguably a false negative in the medical world. If both are positive, it re-confirms that the cancer is not aggressive and the "Plan B" MRIs can be an option they provide to support and monitor progress of my TCM treatments.

For more information on why it's arguably a false negative, see this article sent to me by the UC Davis pathologist.

Updates post-appointment!

LIFE IS A SERIES OF HELLOS AND GOODBYES

Today was my last day in Atlanta. It was a little bittersweet leaving - happy to be going home but feeling a little something about the city and the people I've met there. It was a memorable time. I definitely learned a lot while I was there - first about my new client counterparts and the project team, and then I started exploring the heck out of the city...tried the awesome restaurants, listened to live music, explored the neighborhoods, said hello to the people. Then I realized at 32.7 I can still meet lifelong friends.

Props to ATL...the city has a lot to offer and is very honest and raw. Sharing a couple of photos from today of the city before I made my way to the airport. It had just rained and the sun was starting to come out and there were these big puffy clouds.

Incidentally, as I my flight was leaving and I was already feeling a little nostalgic (even though I was still there), there was a thunderstorm and it started pouring rain. How fitting.

THE CLEAN 15 AND THE DIRTY DOZEN

 

As you know, I've been making a conscious effort to incorporate many colors of fruits and vegetables into my diet. I try to get my produce from my garden, from local farmer's markets, my local co-op or stores like Whole Foods. I also try to keep it organic but that sometimes that costs a bit more.

 

 

I've been recently gathering information around the part nutrition plays in health and healing. A friend of mine shared with me a LIVESTRONG article about nutrition's affect on disease prevention. A part of the article I found most useful was a list of fruits and vegetables that contain the lowest and highest pesticide residue levels based on a review done by the Environmental Working Group (EWG), a nonprofit in DC. Here are the results:

 

The EWG's Clean 15 are the fruits and vegetables that have the lowest pesticide residue levels that you can feel comfortable buying non-organic. They are:

1. Onions
2. Sweet Corn
3. Pineapples
4. Avocado
5. Asparagus
6. Sweet Peas
7. Mangoes
8. Eggplant
9. Cantaloupe (U.S.)
10. Kiwi
11. Cabbage
12. Watermelon
13. Sweet Potatoes
14. Grapefruit
15. Mushrooms

The Dirty Dozen are the fruits and vegetables that have the highest pesticide residue levels in non-organic fruits and vegetables that you should buy organic when you can. They are:

1. Apples
2. Celery
3. Strawberries
4. Peaches
5. Spinach
6. Nectarines (imported)
7. Grapes (imported)
8. Sweet Bell Peppers
9. Potatoes
10. Blueberries (U.S.)
11. Lettuce
12. Kale/Collard Greens

Or, you know, start a garden. It's both good for your health and easy on the wallet, and not to mention good for your soul. If you do start a garden, don't use crazy chemicals like Roundup if you plan on eating what comes out of your garden. There are plenty of natural ways to keep those weeds at a minimum.

 

INSURANCE INSIGHTS

I called my insurance company and found out some eye-opening things in the process of claiming services:

1. You might see what seem like duplicates on your bills because there is a separate charge for the doctor's services and the facility you were seen.
2. There are multiple procedure codes a facility may use for a single procedure, so you can never be sure which one the will claim, therefore you never know how much it will cost you out of pocket.
3. Each facility charges a different amount for a single procedure, even a single procedure with the same procedure code.
4. While your insurance company can help you look up procedures to see how much they would cost at a particular location, often the listed procedures are either a) so vague compared to the procedure you need or b) the procedure you need has a hundred different codes that don't match key words (e.g., genetic test) that you cannot find a suitable procedure to determine your out-of-pocket estimate.
5. For a single procedure, there may be several accompanying procedures that each have their own code that the facility will claim.
6. For a single procedure, there may be several people involved so the facility will charge for the services of the doctor, the technician, the second technician, and the pathologist, for example.
7. If the facility makes an error or needs to do a procedure again, you're paying for it.

I'm sure there is more that I'll learn...I'll add when I find out!

AND THE WINNER IS...

 

Looks like I'll be getting the MRI in the US and just vacationing in CR!

• Costa Rica MRI = $794
• UCSF MRI (with coverage, and it's covered) = $740 x 15% = $111

MEDICAL BILLS

Medical bills are freakin' expensive. Herbs are not cheap either. Doing both western and eastern medicine approaches together...well, you can imagine.  I need to go through my bills - I got one for $1000 and another for $200 after paying $120 - and check to make sure they are right. Then I need to rethink what I need vs. what the doctor ordered to see if I really need it. I probably need to call my insurance company each time something is ordered to weigh the cost vs. the need (in accordance with the treatment plan I want to pursue). Upcoming for me is a genetic test, the last half of my receptor test, and an MRI.

Does anyone know if there are tricks to this trade? If you do, call me please!

NEXT APPOINTMENT

Same-day assessment at UCSF, Friday, Oct 21, 2011 with Dr. Ewing and crew. :)

UPDATE ON PROGRESS

Since the end of August, I've been taking an herbal treatment prescribed for me by a Traditional Chinese Medicine doctor. Along with that treatment and based on suggestions from the TCM clinic and numerous reads about nutrition and the role it plays in healing, I've made some lifestyle changes - in the name of making my internal  body environment more alkaline and less hospitable to disease. These changes include cutting out refined sugar, dairy, artificial sweeteners, coffee, alcohol and other things that contribute to a more acidic environment in favor of a diet full of whole foods, less meat, and as many colors of fruit and vegetables as I can handle. Additionally, I've made an effort to sleep earlier, drink 8-9 cups of water a day, eat a full breakfast and lunch each day, and an earlier dinner. In short, I've made a conscious effort to take care of my body and watch what I put in it.

For example, at brunch today. When I want to eat this (note: I love this):

I eat this instead:

After a month of doing these things, I've observed some changes in my body. There definitely is a ways to go, but for one, my poop is a lot better - back to where it used to be when I wasn't traveling (although I still am traveling). Generally, it's very good and sometimes twice a day. There is no shame in talking about these things. Poop is serious! :) Also, since I am drinking a lot of water, my pee is the right color - light, clear yellow. I have a ravenous appetite, and yet when I eat these days I don't feel heavy nor do I have a food coma post-meal.  I feel lighter. I feel more healthy. It feels right. Goodbye to toxins, hello alkaline nutrients.  Watch my cancer shrink!