Dr. Armando Giuliano
Dr. Yashari referred me to Dr. Giuliano, a former colleague from St. John's who is now at Cedars-Sinai. Dr. Giuliano is very renowned in the world of oncology; he pioneered the practice of sentinel lymph node biopsy as an alternative to removal of underarm lymph nodes, and we were later to hear from others who consider him to be the best surgical oncologist in LA. Perhaps through Dr. Yashari's influence, or maybe just the kindness of Dr. Giuliano's scheduler, Fernando, I was able to make an appointment to see him on Wednesday, August 27, less than 24 hours after receiving my diagnosis.
The appointment has already become blurred in my memory, but certain things stand out. I remember Dr. Giuliano saying that my cancer is high-grade, which sounds like a good thing but isn't (it means the cancer cells are extremely different from my normal cells). He also said my cancer is HER2-positive, which used to be a bad thing but isn't anymore, because there are new therapies that have been proven to be very successful in combatting that particular kind of cancer - namely, trastuzamab and pertuzumab, and possibly also a third drug that is still in clinical trials. He recommended that I have chemotherapy, then surgery, then more chemotherapy. He referred me to a medical oncologist at UCLA, Dr. Sara Hurvitz, who he called right there in the exam room to make the connection. He also reeled off more tests that he wanted me to have, including a PET scan and a brain MRI.
Because of my mother's breast cancer, I was given the BRCA test. A very nice geneticist named Sylvia gave us some genetic counseling and then took two saliva samples. The results should be available in two weeks.
Another thing that we learned is that the previous week's biopsy of my lymph nodes hadn't been successful - the radiologist missed the nodes and hit the muscle, which I could believe considering how much it had hurt. So Dr. Giuliano ordered a new one, which was performed that afternoon one floor down. This one was easier than the first one had been, and the radiologist seemed confident that it was successful.
By the time I left Cedars five hours later, my head was spinning. I could see that everyone around Dr. Giuliano had huge respect for him, and he had treated me very kindly, in addition to seeming to be confident that my cancer could be cured under his care. But the information he had given us came so fast and with so little explanation, I felt confused and scared, mixed up about the details and with no sense of the big picture. Though he had paused conspicuously several times during our appointment to allow for our questions, it was hard for me to gather my thoughts enough to even formulate a question. Though I had read up on breast cancer when my mother was diagnosed, I now realized how little I really knew about it.
Since I got my diagnosis, I keep bursting into tears without warning. It's not like normal crying, where you start feeling sad, then get choked up, then feel the tears start to well up. It's almost like a physical reflex, like sneezing, where I can barely feel the tears coming before they are pouring down my face. I don't try to stop them; I know I need to experience these reactions so that I can move through them. But I wonder about Ike - is it bad for him to see me cry, when he is much too small to understand grief? So far, I have only cried once while holding him, right when I got the diagnosis - I held his little body close to my heart and rocked back and forth with him while I wept. He didn't seem distressed by it, and it comforted me greatly. But since then I haven't wanted to expose him to my fear and sadness, because I don't know how it will affect him. I don't want him to absorb those emotions from me when he doesn't have the tools to process them.
The appointment has already become blurred in my memory, but certain things stand out. I remember Dr. Giuliano saying that my cancer is high-grade, which sounds like a good thing but isn't (it means the cancer cells are extremely different from my normal cells). He also said my cancer is HER2-positive, which used to be a bad thing but isn't anymore, because there are new therapies that have been proven to be very successful in combatting that particular kind of cancer - namely, trastuzamab and pertuzumab, and possibly also a third drug that is still in clinical trials. He recommended that I have chemotherapy, then surgery, then more chemotherapy. He referred me to a medical oncologist at UCLA, Dr. Sara Hurvitz, who he called right there in the exam room to make the connection. He also reeled off more tests that he wanted me to have, including a PET scan and a brain MRI.
Because of my mother's breast cancer, I was given the BRCA test. A very nice geneticist named Sylvia gave us some genetic counseling and then took two saliva samples. The results should be available in two weeks.
Another thing that we learned is that the previous week's biopsy of my lymph nodes hadn't been successful - the radiologist missed the nodes and hit the muscle, which I could believe considering how much it had hurt. So Dr. Giuliano ordered a new one, which was performed that afternoon one floor down. This one was easier than the first one had been, and the radiologist seemed confident that it was successful.
By the time I left Cedars five hours later, my head was spinning. I could see that everyone around Dr. Giuliano had huge respect for him, and he had treated me very kindly, in addition to seeming to be confident that my cancer could be cured under his care. But the information he had given us came so fast and with so little explanation, I felt confused and scared, mixed up about the details and with no sense of the big picture. Though he had paused conspicuously several times during our appointment to allow for our questions, it was hard for me to gather my thoughts enough to even formulate a question. Though I had read up on breast cancer when my mother was diagnosed, I now realized how little I really knew about it.
~
Since I got my diagnosis, I keep bursting into tears without warning. It's not like normal crying, where you start feeling sad, then get choked up, then feel the tears start to well up. It's almost like a physical reflex, like sneezing, where I can barely feel the tears coming before they are pouring down my face. I don't try to stop them; I know I need to experience these reactions so that I can move through them. But I wonder about Ike - is it bad for him to see me cry, when he is much too small to understand grief? So far, I have only cried once while holding him, right when I got the diagnosis - I held his little body close to my heart and rocked back and forth with him while I wept. He didn't seem distressed by it, and it comforted me greatly. But since then I haven't wanted to expose him to my fear and sadness, because I don't know how it will affect him. I don't want him to absorb those emotions from me when he doesn't have the tools to process them.
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