Preparation for breast cancer surgery starts long before the patient reaches the operating room for both the patient and the surgeon. 

I have made it a habit to call patients at home with the cancer biopsy diagnosis as soon as it is available to us—usually within 48 hours.  Most of the time, I have performed the biopsy myself in the office using minimally invasive techniques and have developed a rapport with the patient. 

Chit-chatting about things that are important to the patient e.g., children, grandchildren– while doing the procedure helps me develop that rapport (as well as serving to distract the patient from what I am doing).  

 

I know that a phone call may not be the perfect way to give “bad news”, but on balance it seems the best way.  These women are waiting for the answer.   The phone call resolves the uncertainty immediately. 

The patients are at home in a private, safe environment, usually with family and friends to offer hugs and support.  And they don’t have to be concerned about walking out through my waiting room stunned with tear stained eyes.

Another real benefit is that when they do come into the office, the shock and sadness have receded somewhat and they’re in a much better position to talk about just how we’re going to take care of this problem. 

I don’t want the cancer diagnosis to be a surprise to patient.  If I am fairly certain that a mass is cancer, I will tell them that early on.  That concern eases the transition to a diagnosis. It also lets them know that I will be honest with them.  In my experience, most people don’t want things sugar coated – they want an honest opinion. 

Having said no sugar coating, I do always try and find something positive to say about the diagnosis, and  – believe it or not -  you can. 

If it is small, or noninvasive, I emphasize that.  I emphasize that the breast can usually be conserved.   

If it is Estrogen receptor positive, I emphasize the better long term prognosis and the ability to treat with hormone blocking agents. 

If it is an aggressive tumor, I emphasize the better response to chemotherapy because the cells are more rapidly multiplying and have more cell cycles for chemo to work its magic.    

After that phone call with a brief discussion of options and outlook, I meet with the patient and her family or friends in the office within a day or two for a very intensive discussion.  As you can imagine, it’s a very intensive discussion.

We discuss surgical treatment options and map out in general terms what lies ahead.  I break it down into phases of treatment—surgery, post surgery adjuvant therapy, and long term treatment.

I focus on the “one step at a time plan”, which really does make sense.  Otherwise, it overwhelms very quickly.

After the technical questions are answered, we get down to the heart and soul of the matter.  Patients are understandably anxious and wary.  I try and set a few psychological ground rules.  I tell them that having breast cancer is not a death sentence.  Yes, I say the word death out loud so it is not hovering unspoken in the room. 

I ask them to stop imagining scenarios that may never happen.  I emphasize that thoughts are powerful and your body can’t tell the difference in what is real or imagined.  By that, I mean that different emotions cause the release of different chemicals from the brain.  Imagined trauma releases the same chemicals as real trauma and has the same negative effect on the body.  That is not what a body already under stress needs. 

Women say I can’t help it—it is just the way I am.  I ask them to try and at least identify when they find themselves going into that worry mode—and say to themselves—STOP–DON’T GO THERE—to exercise the control they really have. 

I also use the phrase coined by one of my favorite authors Joan Borysenko—don’t AWFULIZE!  Patients often will smile at that and get the point.  

This does not mean that a woman should not grieve for herself and the effect that this illness will have on her family. It does not mean she has to be continually positive.  She needs to be able to express the emotions of the moment openly and honestly.  Sometimes it takes a good cry in the arms of a loved one to accomplish this task.

We end this session together with gift giving.  My practice provides a copy of Dr. Susan Love’s breast book to our breast cancer patients.  My own book is on the way. 

I also give them a guided meditation that I recorded to use repetitively before their surgery.  This teaches about the relaxation response—an innate antidote to the stress response we are all so familiar with and leads them on a pleasant journey which helps decrease blood pressure, pulse rate, respiratory rate and decreased stress hormone response. 

The second part leads the patient in a progressive muscle relaxation and speaks of a being part of a loving universe. 

I tell them about studies that have shown a benefit in decreasing perioperative anxiety, blood pressure levels during surgery, postoperative pain requirements, and length of hospital stays in patients who practice these techniques.  

One of my patients has also started a nonprofit organization called Positively Pink that provides a lovely bag of gifts – from journals, to soothing music, to healing books –  because she wanted every patient diagnosed with breast cancer in our town to know that they were being thought of. 

This gift giving often brings the patient to tears—a random act of kindness.  I encourage patients who have a spiritual practice to step up their activity—whether it is yoga, rosary praying, or prayer circles. 

And so the journey begins.   
         

 

 

 

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