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'Cancer Institute' posts

Becoming a Breast Surgeon

Surgeons are often Type A personalities, the ones who sit in the front of the class, who volunteer for everything, who stay scrubbed in the OR all day with appendicitis and do a post-op check before checking themselves into the emergency department (yes, that was me.) As such, surgeons are often dismissive of the subspecialty of breast surgery. The surgeries are not as complex as cardiac bypass surgery or Whipple procedures for pancreatic cancer. In fact, it’s often a rotation for interns. I was a Type A personality. I had no plans to do breast surgery.

Then, a funny thing happened. I had my first son during residency. Planned with military precision, of course, to coincide with the beginning of my designated research years, as I had hoped to squeeze another baby in there somewhere. After his birth, I would breastfeed, because that is what Type A mothers do these days. It’s the best! Of course, I would do the best! However, like many mothers out there, we had an incredibly rocky start. Poor latch with inadequate weight gain. Triple feeding with pumped milk. Cracked nipples leading to mastitis. As a Type A person, I threw myself into research in an effort to solve the problems. Not just the many, many baby books out there, but Medline searches on breastfeeding management. I learned more than I ever had in my surgery textbooks about the breast, the physiology of lactation that is both incredibly simple and enormously complex, and most importantly, miraculous. I was reminded constantly in my reading of the importance of preserving this ability to breastfeed my son, for his and my health, and how challenging that could be.

I would sit in my office, working on surgical infections research, as I pumped and read about normal breasts and infected breasts and cancerous breasts. Antibiotic rotations in ICUs and glucose control became less exciting than being able to offer targeted medical advice to a frustrated friend in Boston, whose refractory mastitis was being met with shrugs from some of her local doctors until we correctly identified MRSA as the source. Maybe it wasn’t saving lives, but it saved her breastfeeding relationship with her child. Who knows, maybe in the end it would be saving lives! I read more ....

What should I know about radiation if I have breast cancer?

If you’ve been diagnosed with breast cancer, you may wonder if radiation is an option for you.

Radiation is an important pillar of treatment for breast cancer and has never been safer when designed by an experienced team with state of the art technology. Radiation will be part of a standard treatment plan after breast conserving surgery (also called lumpectomy or partial mastectomy). With the addition of radiation to the breast as an insurance policy, patients will do just as well as those undergoing mastectomy. Even after a mastectomy there are indications when radiation to the chest wall and nodes are recommended for best outcome. After a lumpectomy, radiation to the whole breast is the current gold standard.

How does radiation actually work?

Radiation works by aiming it at a target. Free radicals are produced which kill cancer cells, while normal cells have the capability to repair the damage. Cancer cells don’t.

Having the most advanced technology available to precisely plan and deliver radiation to the target will protect healthy tissue for optimal outcomes and the best possible cosmetic result.

How can I make sure I receive the best radiation?

The radiation oncologists treating you should be part of an interdisciplinary team. I, for example, work closely with the patient, the breast surgeons and the medical oncologists. I then design a personalized radiation plan, tailored to the unique characteristics of the tumor and each patient’s personal preferences. The more personalized the treatment the better.

To allow patients to feel their best during and after treatment, I often work with physical therapists, naturopaths, and other support staff (social worker, dietitian etc).

What type of radiation treatment do I need?

Radiation options after a breast conserving surgery can be very confusing. Here is a list that may help you understand the different options:

What you should know about breast cancer and tips for reading online information

Since October is Breast Cancer Awareness Month, I’ve been paying more attention to online blogs about breast cancer and realize there is a lot of information and misinformation out there. How can you know what’s correct, what’s marketing, and what is just plain wrong? Here are some tips:

  1. Be an aware and questioning reader: Ask yourself some of the following questions. What is the source of the information? Does the author have anything to gain financially from the information? Are there studies that provide data supporting the recommendations? Who funded the studies and were there any potential conflicts of interest?
  2. Investigate more than one source: Healthcare has become very politicized and complicated but you can find reliable sources. But realize even with trusted sources the information provided may be conflicting. Some reliable sources include: Swedish Cancer Institute, Breast Cancer Action, National Cancer Institute, and American Cancer Society.

  3. Don’t be taken in by conspiracy theorists: I have practiced surgery for 30 years in a variety of situations and healthcare institutions and NEVER have I experienced a desire to withhold effective tests and treatments from patients. Physicians and hospital systems are not suppressing tests, treatments, and /or cures in order to stay in business. I don’t know a breast surgeon who wouldn’t be thrilled to have to practice another specialty if there was a way to prevent breast cancer.

Here are some things that I think it is important to know about breast cancer:

The Role of Cancer Rehabilitation

When learning that you have cancer, it's easy to forget that your body has trillions and trillions of healthy cells. This is true whether the cancer is stage 0 or stage IV. While this may be hard to believe, it is true. Your healthy cells support you in getting through the rigors of treatment. Too often, however, the support that your healthy cells offer is forgotten in the flurry of activities surrounding treatment and the dramatic changes in your everyday life. These changes are not only physical, but emotional, psychological and spiritual. After all, cancer affects the whole person from molecule to spirit.

At the molecular level, your healthy tissues are subjected to profound physiologic demands, demands that take an enormous amount of their energy. Cancer treatments— surgery, chemotherapy, biologic therapies, radiation—are taxing. Athletes need to prepare well for any physically demanding event. Why then, should it be different for cancer survivors? While a far cry from an athletic event, you may be surprised to learn that the same training principles that apply to athletes also apply to cancer survivors. These principles include the correct exercise frequency, intensity, duration and type, tuned individually to your needs as ...

Seattle Times Publishes Guest Column by Swedish-Affiliated Naturopathic Doctor on Myths and Facts about Echinacea and Cold/Flu Season

SEATTLE, Sept. 24, 2012 - On Sunday, Sept. 23 The Seattle Times published a guest-written Health page column by Swedish-affiliated naturopathic physician Dan Labriola, N.D., headlined 'The cold facts about echinacea.'

Issaquah Run Benefits Swedish Cancer Institute In Issaquah: Join Team Swedish Issaquah

The Rotary Club of Issaquah has selected the Swedish Cancer Institute/Issaquah as the primary beneficiary of their 36th annual 5/10K run/walk event.

All of the funds that go to the Swedish Cancer Institute will be put in a special fund for patients being cared for at Swedish/Issaquah. We know this fund will fill a vital need, allowing Swedish to continue to provide charity care and other resources to patients needing the support.

We would love to have a strong showing at the Issaquah Run, so I encourage you to join team Swedish Issaquah!

Race details:
Issaquah Run
Sunday, Sept. 30
10K Run, 5K Run/Walk & Kids Run

To register for our Swedish Issaquah team, please click here. This link goes directly to our team page, and you must use this link to join the team.

Swedish employees and “friends of Swedish” get $5 off registration. The code for Swedish is SMCRUN and will provide a $5 discount; staff can use this code when registering.

We hope you participate in this important community event and support the Swedish Cancer Institute. For more information and general details about the Issaquah Run, visit www.issaquahrun.com.

Exercise and cancer

There is plenty of research—and it is increasing every day—showing that exercise is beneficial for cancer survivors, whether during or after treatment. In a recent study published in the Journal of Pain and Symptom Management, Dr. Andrea Cheville, an onco-physiatrist (cancer rehabilitation physician) and colleagues at Mayo Clinic interviewed 20 patients with advanced lung cancer about exercise, its relationship to their symptoms, and the role of their oncology team in counseling them about exercise (video). Not surprisingly, participants considered their usual everyday activities as "exercise". While important in helping to maintain function, everyday activities generally do not reach the threshold to help maintain or improve overall fitness. In Dr. Cheville’s study, exercise was defined as "a systematic way of stressing the body to increase flexibility, stamina, and strength.”

Systematic and regular exercise causes biochemical changes in the body, not unlike medicine. The route of administration however, is different. You can't take an "exercise pill", you have to actively participate. The changes that exercise brings are beneficial. For example, exercise can help reduce fatigue. While this may seem counterintuitive, especially while living with cancer, taking it easy can actually increase fatigue. This is because the body becomes "deconditioned"—the less the body does, the less it can do. Add the fatiguing effect of chemotherapy, and you have a recipe for reduced whole body strength and fitness. Enjoyable and regular exercise is a powerful antidote to the fatiguing impact of cancer and treatment.

In our cancer rehabilitation programs, we often hear survivors express fear that exercise might cause physical harm. Some of the participants in Dr. Cheville's study expressed a similar concern. When exercise is done with a good understanding of what is too much, what is too little, and how to modulate its intensity during cycles of treatment, exercise not only enhances physical and mental well-being, but also helps to reduce symptoms related to cancer and its treatment. In addition to fatigue, these symptoms include shortness of breath, pain, insomnia, malaise and reduced endurance.

The study showed...

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