Posted by: Duke Raleigh Hospital | May 24, 2013

My Journey with Breast Cancer; One patient’s story

My Journey with Breast Cancer

pink-breast-cancer-ribbonBy Pamela Wilson

When I went for my annual physical last January, the physician’s assistant noticed a lump during my breast exam. She said it felt like a cyst and referred me to get a mammogram.  Both the mammogram and an ultrasound confirmed it was nothing to worry about.

I was referred to a breast specialist, Dr. Gayle DiLalla at Tolnitch Surgical Associates, who drained fluid from the cyst and told me it was normal for women to have cysts and that as long as the fluid was clear (and it was), it was fine. She instructed me to come back in six weeks.

About four weeks later, the cyst was back and larger than before. I returned to Dr. DiLalla, and this time, she sent the fluid she drained to be tested. The results again came back negative. This was on a Friday, and by the time Dr. DiLalla called me back – less than a week later – the cyst had returned. She performed a procedure in her office to remove the cyst walls so that it would not come back. During this procedure, she mentioned that some tissue looked abnormal. The following Monday, she called to tell me the test came back positive.

I had cancer – invasive triple negative breast cancer (right side). Apparently, the cancerous tumor was behind the cyst and not visible during the mammogram or ultrasound. Fortunately, the tumor was aggravating the cyst, which caused it to recur. Dr. DiLalla suggested a mastectomy followed by chemotherapy and radiation. She referred me to an oncologist, Dr. Spiritos of Duke Raleigh Cancer Center, and I met him later that day. He suggested eight rounds of chemo every other Friday, which I started last March and completed last June.

I originally thought I’d have my right breast removed and just wear a breast prosthetic. However once my BRCA results [genetic testing] showed I had a genetic mutation – increasing the chances of recurrence – I decided to have both breasts removed and get tissue expanders for silicone implants. Talking to survivors in my support group helped me confirm this decision. I also had my ovaries and fallopian tubes removed due to increased risk of ovarian cancer.

There is no history of breast cancer in my family; however my mother did the BRCA testing as well, and she also has the genetic mutation. My treatment was pretty aggressive. Every other Friday for 15 weeks, I had chemo, and on Saturdays, I would go for a shot to help increase my white blood cell count. By, Sunday I was pretty sore. Mondays were usually my bad days, and I would come around by Tuesday and be back to work by Wednesday.

I could not stand the smell of food cooking and didn’t eat a lot of meat. Grilled cheese sandwiches were my food of choice, along with lots of fruits. I made sure not to eat any of my favorite foods for fear they would taste horrible. It got to a point I was eating food only because I knew I needed to eat, but I could barely taste anything. My nails turned dark, I lost my hair, and I had tingling fingers and toes and decreased energy – the typical side effects.  I didn’t have much nausea, thankfully.

I couldn’t have asked for a better support system than my family, friends and Red Hat coworkers. I never had to drive myself to my chemo treatments. My mom, Ruby, stayed with me from Friday evening through Monday evenings on my chemo weeks. She did my laundry, changed my sheets, cleaned my bathroom, swept, mopped and dusted. I joke with her that I sure do miss that now.

My sister, Kesharra, and niece, Aleah (6) live with me in Knightdale. They made sure I ate and took my meds. Aleah was my little nurse. Whenever I felt really bad, she had a way of knowing and doing something extra special for me. My cousin, Emerald, who is like my daughter, kept my nails and toes done since I couldn’t get them done at the nail shop.

My manager, Dorothy, her manager, Paul, and his manager, Charlie donated paid time off so I wouldn’t have to go without pay.

The hardest part of the chemo was the uncertainty of how it would affect me. I must say, I was given good information and was not really taking by surprise. The nurses were excellent and let me know what to expect.

If you get a diagnosis of breast cancer, realize that no two women will have the same journey. You have to deal with it in your way. As women, we often take on so much, but this is one time you have to take care of yourself first. Allow others to help you. Take time to rest and let your body react to all that it is going through. Find a support group. Love hard, play hard and enjoy life.

I am still trying to figure out how to live life as a survivor. Right now, I think about it every day, but I’m sure one day I will wake up and just be Pam and not think about the cancer. I pray one day there is a cure.

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Posted by: phumble | May 20, 2013

New Treatment Option at Duke Raleigh Puts Fluttering Hearts Back on Track

Atrial fibrillation or AFib is the most common heart rhythm disorder, affecting around 2.2 million Americans. Some people with AFib describe the symptoms as a feeling like the heart is fluttering or skipping a beat. Now, thanks to new bi-plane technology at Duke Raleigh Hospital, patients can get their heartbeat back on track, closer to home.

“Atrial fibrillation makes you feel like your heart is going to go somewhere it doesn’t belong,” says Raleigh resident Mike Rieder about the condition he’s had for 15 years. Rieder was the first patient to have an AFib ablation in Duke Raleigh Hospital’s new bi-plane lab.

Although Rieder was on medication (an aspirin regimen and medications to slow his heart rate), AFib was impacting his quality of life. “[Having AFib] really saps your energy, he says. “Your pulse rate increases; mine would go up as high as 140. It’s hard to concentrate. It raises your anxiety levels.”

Rieder was referred to Kevin Jackson, MD, an electrophysiologist at Duke Cardiology of Raleigh for an ablation, a minimally invasive procedure that uses a catheter to burn away unwanted tissue.

Dr. Kevin Jackson

Kevin Jackson, MD

“The new lab allows us to do complex ablations, including atrial fibrillation ablation, closer to home for Wake County patients,” Jackson says. “Previously we would bring patients to Duke Hospital in order to use these advanced technologies. Now we have an identical facility available at Duke Raleigh.”

“Dr. Jackson explained [the ablation] to me—the risks involved, the fact that it works about 75 percent of the time,” said Rieder. “I was really impressed with his ability to anticipate my questions. He made me feel like I was his only patient for the day. I had great confidence in him.”

Rieder explains the process leading up to the ablation, which he had on November 13 of last year. “First, they did an MRI of my heart, which they can see in 3-D. That led doctors to discover I had three veins going into my heart instead of four, which most people have. That was very important to know. A day before the procedure, I had a transesophegeal echocardiogram, or TEE, to determine I didn’t have any blood clots. The ablation itself was a four-hour procedure. They go in your blood vessels through your legs to your heart.” He was out of the hospital the day after the procedure and back at work within a few days.

“After the procedure, I thought, ‘Wow, they used to have to do this through open-heart surgery,” he marvels.

The risks of leaving a heart rhythm disorder untreated can range from an elevated heart rate to a weakening of the heart muscle and blood clots, which increase the risk of stroke. Rieder, in fact, suffered a mild stroke, in May 2012. Since then, he’s been on Coumadin to prevent blood clots.

As Rieder knows, matters of the heart can never be taken lightly, but now—thanks to Duke Raleigh’s new facility—they can be treated close to home.

Learn more about atrial fibrillation.

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Posted by: Duke Raleigh Hospital | May 15, 2013

Back in the Swing

A golf-loving attorney returns to the links after successful surgery

 

Randy Doffermyre, a Dunn personal injury attorney, was still an ace in the courtroom. But his back troubled him to the point he had to give up his beloved game of golf.

In a thank-you letter he sent, post-surgery, to William Lestini, MD, an orthopaedic surgeon with Triangle Spine and Back Care Center, he said: “I gave up golf years ago. I had been a scratch golfer all my life. It was real work to just get to work. I avoided many work opportunities because I did not feel the benefit of it was worth the pain to get the job done.”

Although Doffermyre had unofficially given up golf in 2003, he couldn’t turn down a friend’s invitation in 2009 to play the storied Augusta National course – the site of the equally storied Masters tournament. “I had to crawl,” he said of the effort that game took. “But I wasn’t going to miss that opportunity.”

One member of his foursome was just getting back to the links after hip replacement surgery. And he shot 5 under par. That was the impetus it took for Doffermyre to investigate surgery. A friend referred him to Dr. Lestini, and Doffermyre liked his honesty and his assessment of his chances of success with surgery.

His surgery was in December 2009 at Duke Raleigh Hospital. He says, “I had a 4-level spinal fusion. My three-day admission went very well, and I had little pain. Even the day after surgery when the nurse told me it was time to get up and walk, I was able to do so with minimal pain.”

The hard-charging attorney was back in the office – for short periods – the following week. “I took gradual steps in what I tried to do, and by January of 2010, I was back at work for about the whole day,” he says. He returned to the courtroom for work in January – but using a walker. “By mid-March, I was 95 percent pain free and completely pain free in mid-April. In May, I started hitting the golf ball again, easy at first and gradually a little harder.”

He’s careful to note he made every move – at the office and on the golf course – with the blessing of his doctor. He asked Dr. Lestini how he active he could be and then followed the doctor’s orders closely.

“My life has changed,” he wrote to Dr. Lestini’s office. “I can do what I used to do, and my mental status has gone from depression to clear optimism. I owe this all to Dr. Lestini and to God. They were a great team!”

And his golf game? Since his surgery a couple of years ago, Doffermyre now shoots 1 over par, but expects to break par consistently this summer. And, he’s anticipating an invitation to return to Augusta National this in October when the course re-opens. This time, he’ll be able to enjoy the beauty of the course and play his best game.

Learn more about Triangle Spine and Back Care Center.

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Posted by: Duke Raleigh Hospital | May 7, 2013

The Science of Healthcare Delivery

Rick Gannotta, president of Duke Raleigh HospitalBy Rick Gannotta, NP, DHA, FACHE, Duke Raleigh Hospital President

Our current healthcare environment is undergoing tremendous change.

The paradigm shift includes a move from what has been a historically volume-driven care model to a value-driven care model.

This transition will impact overall health care costs and shift those costs into new areas of growth which presents both challenges and opportunities.

In a value-driven and patient-centered model, healthcare providers focus care on patient needs through new and innovated models including Patient Centered Medical Homes (PCMH). The Patient-Centered Primary Care Collaborative defines a PCMH as a “model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety….  It is a framework for achieving primary care excellence so that care is received in the right place, at the right time and the manner that best suits a patient’s needs.”

That will provide the “scaffolding” for a population-health – realigning care to best meet the needs of different patient segments cared for by experts with specific skill sets.

Early estimates indicate that a patient-centered, value-driven care model could eliminate upwards of $500 billion in non-value-added functions.

We are already seeing these transformational changes begin to take shape, and Duke Medicine and Duke Raleigh Hospital are committed to applying the great expertise found within our system so that our patients have the best experience possible.

I am encouraged by the prospect these changes offer for our patients and for the future of healthcare delivery in our country.

For more information about the changes in healthcare, visit North Carolina Hospital Association. Also, check out Healthy Hospitals and Healthy Communities to learn more about the vital role hospitals play in our community.

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Posted by: Duke Raleigh Hospital | May 3, 2013

How-To Guide: Your Regular Check-Up

By Heidi Doyle, PA-C, North Hills Internal MedicineHeidi Doyle

A recent medical study¹ called into question the value of something many of us have long believed was essential – your annual check-up. The news, combined with recent updates in cancer screening guidelines², left many people confused.

There’s no stock answer to how often you should see your healthcare provider for “preventive maintenance.” Regular check-ups are important to maintaining good health. And establishing a relationship with your doctor leads to individualized counseling and, ultimately, to better long-term care.

Age, family history and disease risk all factor in to how often to get a physical.

Let’s take a closer look at the guidelines:

  • If you’re under 30 and healthy (meaning, you don’t smoke, you don’t have disease risk factors and you’re not on prescription medications), then getting a check-up every two to three years is fine. If you’re a woman and sexually active, get a Pap smear to screen for cervical cancer beginning at age 21. Discuss with your doctor how often you should be screened thereafter.
  • If you’re healthy and between the ages of 30 and 40, a physical every other year is acceptable. Baseline mammograms are now recommended for women once they turn 40, and they should be repeated every one to two years.
  • If you’re 50 or older, an annual physical is a good idea. That’s also when men and women should undergo colonoscopies to screen for colon cancer. Repeat every 10 years unless there is a family history of colon cancer, colon polyps or the test results are abnormal. In that case, you should have one more frequently. How often depends on your family history and the results of your test.

If you’re on prescription medications and have chronic disease risk factors, an annual physical is strongly recommended. Your doctor will likely want to run blood tests to check the effectiveness of your medication and adjust it, if needed.

Being overweight, as you know, puts you at risk of high blood pressure, high cholesterol, heart disease and diabetes. It also influences how often you should get a physical. Guidelines suggest the annual physical is still a smart idea for individuals who are not at a healthy weight.

Here are a few ways you can make the most of your check-up:

  • Be on time.
  • Maximize the time you spend with your doctor or PA. Have medical questions and concerns ready. Write them down in advance if you need to. Know that it may not always be appropriate or there may not be enough time to address every concern at a single visit.  Physicals are primarily for preventative care and not to address acute problems.
  • Know the names and doses of any medications you are taking, including over-the-counter supplements. Bringing your medications with you is always a good idea.
  • Bring your vaccine record including when you got your last flu shot (annual), tetanus (every 10 years) and pertussis (in the last 10 years).
  • Know the dates of your last cancer screenings including mammograms.
  • Be candid. Being honest about your emotional and mental health and your habits (smoking and drinking, for instance) gives us the information we need to serve you.
  • Be ready for your doctor to suggest lifestyle changes, where he or she thinks they may be needed. Changing your behavior is always more effective than any pill I could prescribe.

Heidi Doyle is a physician assistant at North Hills Internal Medicine, a Duke Primary Care clinic conveniently located on the Duke Raleigh Hospital campus.

1. “A Check on Physicals” by Jane E. Brody featured in Health|Science section of NYtimes.com on January 21, 2013

2. Guidelines for the Early Detection of Cancer by the American Cancer Society

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