Female Health Issues After Breast Cancer
Marilyn: An orthopedic, yeah, okay.
Dr. Elena Kamel: …get more a clear descriptive. Typically ultrasound is not a great test for evaluating bone. Typically either CT or MRI is a much better test for bone.
Marilyn: Now would this be something that would be totally separate from my chemo or…
Dr. Elena Kamel: I think you always want to keep your oncologist in the picture because obviously hope that this has nothing to do with the breast cancer, but we always are concerned when someone with breast cancer has bone pain. So I think that I would keep them in the picture, but I think you need to go and be evaluated.
Marilyn: Can I ask you just one more quick question?
Marilyn: I had a mastectomy and for like about the past month to six weeks it has been painful even just to wear like a tank top against it.
Dr. Elena Kamel: How long ago was your mastectomy?
Marilyn: July 17th, so almost 12 months.
Dr. Elena Kamel: You had the mastectomy but no reconstruction?
Marilyn: No reconstruction.
Dr. Elena Kamel: The pain has just all of a sudden surfaced?
Marilyn: Uh-huh. It’s like so uncomfortable for clothing to even touch against it.
Dr. Elena Kamel: You have had no follow-up with either your surgeon or oncologist with respect to exams?
Marilyn: There’s been… Since I had… The surgeon looked at the mastectomy site and when my just regular family doctor did my Well Women Exam, she did like the breast exam. She’s the only one that’s ever looked at my breast. I’ve switched oncologists, neither one of them have looked; and I don’t have an OB/GYN, so I’m wondering…
Dr. Elena Kamel: I’d say it’s a little unusual that 12 months later, we’re basically almost at 12 months you’re having pain.
Marilyn: Yes.
Dr. Elena Kamel: It certainly should be looked at it and the surgeon should be the one I would start with the surgeon. Sometimes people can have discomfort and it may be due to muscle use or nerve endings. Those are some of your common things. But what’s unusual in what you’re describing is that you were fine and now all of sudden the pain has come, has all of a sudden appeared. That should be looked at.
Marilyn: I’m also experiencing, I don’t know if it’s related, but like just even the muscles in my arms and my legs, if I just stretch my arm out to pickup something, either arm, the mastectomy side or not, they’re hurting and I’m having a lot of back pain.
Dr. Elena Kamel: Are you taking any medicines right now?
Marilyn: Related to the pain?
Dr. Elena Kamel: No, just in general what medicines are you taking?
Marilyn: I take digoxin. I take Herceptin weekly. I take…
Dr. Elena Kamel: Did this pain start with the Herceptin?
Marilyn: No, I’ve been on the Herceptin since the beginning of December and I have had different things come up, but they can’t quite relate them one way or the other to the Herceptin or not.
Dr. Elena Kamel: Right. Well, again, what I would say to you is you need to go back. You’re on a good amount of medicines and any discomfort in the arms or chests when someone’s on digoxin makes me want you to have your heart looked at. In women chest pain can be very ubiquitous, so you should go back to your primary care person and say, “Take a look at me. Help me figure why I have these aches and pains.”
Marilyn: Okay, so don’t just stop if they just… If they can’t find something, I need to pursue it.
Dr. Elena Kamel: Don’t stop.
Marilyn: So if I leave like the family practice person, who would I go to next? What kind of doctor would you think?
Dr. Elena Kamel: Well for the bone issue, I’d see the orthopedic surgeon; and for your chest, you should see the surgeon that did your surgery because they really need to look at it. They know it well. Then for these kind of generalized aches and pains, that’s what your family doctor is for.
Dr. Elena Kamel: They should all… Your team needs to talk to each other.You need to make them. You need to be a vigilante and tell them that you have to have a team that takes care of you. You are not an island and they need to do their job. You can tell them Dr. Kamel said so.
Marilyn: Okay. I live in a really small town and they just don’t have time to do all that and both oncologists have told me, “No, they’re not going to talk to any other doctor.”
Dr. Elena Kamel: In my profession, if someone picks up the phone and calls me, I never refuse their call. So maybe you take the person there that you like the best and seems the most malleable and you ask them to please call the others. It would be unusual that they won’t take the call. How about that?
Marilyn: Oh, okay, that sounds really good.
Dr. Elena Kamel: Okay, best of luck to you.
Marilyn: Thanks Dr. Kamel, I really appreciate it.
Operator: Our last question comes from Linda from Illinois. Please go ahead.
Linda: Three cheers for Illinois. Three cheers for Northwestern, that’s where I’m a patient at.
Linda: My question is this: I have a prolapsed cervix and I know need surgery, but I’ve just been diagnosed with breast cancer. I’m trying to find out how soon or when can I go ahead and have the surgery for the prolapsed cervix?
Dr. Elena Kamel: Well have you had your breast cancer treated?
Linda: No, I had the surgery for the lump removal, a lumpectomy, and I start chemo, matter of fact, this Friday.
Dr. Elena Kamel: Well typically we don’t like to operate on someone who’s undergoing chemotherapy. But what you could do as an interim, kind of a stop gap measure, there is a little plastic device that’s called a pessary, P-E-S-S-A-R-Y. It reminds me of a diaphragm, like what people use to try and not get pregnant, that pushes everything back up inside. So for the interim while you get your chemotherapy, you could be fitted for a pessary and that would help your prolapse and then once you’re done with your chemotherapy you can certainly have your prolapse addressed.
Linda: Should I finish radiation also?
Dr. Elena Kamel: I would finish all your treatment first.
Linda: But will I be more at risk since I’m a cancer patient when I have surgery, the cancer returns?
Dr. Elena Kamel: Not if you do your surgery for the prolapse after you’ve finished your therapy. But during chemotherapy because there are times where your white count is low, your neutropenic, you really don’t want to operate on someone at that time if we don’t have to.
Linda: So it’ll be six months or a year?
Dr. Elena Kamel: That would be my suggestion.
Linda: Okay, I’m sorry.
Dr. Elena Kamel: But I will tell you, the pessary is a lovely interim measure for you.
Linda: I didn’t hear the part when, should I wait six months after treatment or a year or what?
Dr. Elena Kamel: No, I would from a point of view of once you’re done with your treatments, at that point usually we give you a couple of months to wait but then thereafter you can go ahead and have your surgery. There’s no six months, a year after chemo or radiation’s done that’s mandatory to wait. You just want to allow the body to heal, to get strong so that it can take on the next surgery and that’s usually just a month or two.
Linda: Okay, thank you.
Arline Kallick: All right, at this time we are ending this portion of our call and we would like to thank Dr. Kamel for her very insightful and excellent presentation on “Female Health Issues After Breast Cancer.” Because of the generosity of healthcare professionals like yourself, Dr. Kamel, it’s possible for Y-ME to provide such useful information and assistance and so we thank you again.
Dr. Elena Kamel: My pleasure. Have a great evening.
Arline Kallick: Everyone, please stay on the line for our discussion groups and I’d like to remind everyone that Y-ME has a 24/7 Hotline with peer counselors that are available to answer concerns and questions. Again, that Hotline number is 800-221-2141. We hope you will participate in our discussion groups, all you have to do is stay on the line. Thank you for attending tonight and hope to have you all with us again next month. Thank you.
