HealthyU M AG AZ I N E
2011 Issue 3
On her feet again PROSTATE CANCER: Multiple options available MEET THE 2011 Portraits of Life Breast Cancer Survivors
I was walking well the next morning. I bought a walker just because I thought you’re supposed to, but I never had to use it. -Ann Boardman
Hip Check New approach to hip replacement eases pain, rehabilitation ANN BOARDMAN STRIDES THROUGH THE OFFICE, her petite stature unmarked by the total hip replacement surgery she underwent earlier this year. “You should have seen me at two weeks,” she says. “I was already driving! I tell you, that Dr. Arrington, he is something else.” Dr. Arrington is Terry Arrington, M.D., an orthopaedic surgeon who brought to the region a new type of hip replacement surgery that greatly reduces the patient’s recovery time and risk of hip dislocation. The anterior approach to hip replacement allows the surgeon to reach the hip joint from the front of the hip as opposed to the lateral (side) or the posterior (back)
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approach. This way, the hip can be replaced without detaching the muscle from the pelvis or femur during surgery, which can greatly increase rehabilitation time. Mrs. Boardman, 79, says she finally decided to get her hip replaced after struggling for years with debilitating pain, and like any good pa- Terry Arrington, M.D., tient should, she started the Orthopaedic Surgery process with research. She attended a University Hospital Total Joint Replacement Class where speakers detailed the surgical procedure and rehabilitation process. Despite the excellent reputation of the traditional approach to hip replacement, Mrs. Boardman says she was a little apprehensive – to say the least. “You can’t take a bath, you’ve got to have somebody helping you, you have to buy all this equipment, you can’t drive for six weeks … oh, I came away so fearful,” she says. “But I was in so much pain I could hardly walk and so, it was just luck that this guy came to Brandon Wilde and gave this talk.” That “guy” was Dr. Arrington, who just a few days after Mrs. Boardman’s class spent a couple of hours at Brandon Wilde where Mrs. Boardman lives to share details about the new hip replacement procedure. “I kept raising my hand and asking questions, and I called his office the next morning and said, ‘I’ve got to see this doctor.’” Even after learning how much faster recovery and rehabilitation is for the anterior approach hip replacement, Mrs. Boardman says she was still pleasantly surprised at how easy the process was. “I was walking well the next morning,” she says. “I bought a walker just because I thought you’re supposed to, but I never had to use it.” Mrs. Boardman’s recovery has improved by leaps and bounds since her release from the hospital and she’s spent a lot of time talking about the procedure with friends and family, many of whom thought her surgery had been canceled because they saw her up and around so quickly. “I saw Dr. Arrington for a checkup and I told him, ‘If your practice really spikes up, I want a cut,’” she says with a laugh. “’It’s probably because of me.’” v For more information about the anterior approach to hip replacement surgery, call April Matthews, RN, Orthopaedic Nurse Navigator, at 706/774-2760.
Multiple options available for prostate cancer treatment Research looks at surgery vs. active surveillance THE FIRST INSTINCT when someone is diagnosed with cancer is to want immediate surgery. You want it out, eradicated, destroyed. But oddly enough, when it comes to prostate cancer, waiting can sometimes be a viable option. Active surveillance versus early surgery for prostate cancer is of interest to researchers because of the cancer’s potentially slow growth rate. A recent study from Sweden showed that early surgery cuts death by 38 percent in men younger than 65 with low-risk prostate tumors. But this is only the case for men younger than 65, while early surgery in men older than 65 did not significantly improve survival rates. Ben Kay, M.D., a urologist who practices at University Hospital, said determining the best prostate cancer treatment really comes down to individualized care and the patient’s circumstances. “If the patient has low grade, low volume disease, then that patient is a candidate for almost any of the treatment options, and that would include surgery, radiation or active surveillance,” he said. Active surveillance can include checking prostate specific antigen tests every three months, digital rectal exams every three to six months and repeat prostate biopsies at around a year to a year and a half. “We follow the patient closely to check for any upgrading of the cancer,” Dr. Kay said. “If there is a rapid rise of PSA over time, or if the repeat biopsies show an
“If the patient has low grade, low volume disease, then that patient is a candidate for almost any of the treatment options.” Ben Kay, M.D., Urology increase in grade or volume of cancer, it gives us the sign that the prostate cancer may be more aggressive than we first thought and the patient and physician may need to reconsider treatment options.” For men older than 65, there are a number of factors that come into play when determining the best prostate cancer treatment path. Age, life expectancy and overall health all come into play when physicians look at possible treatment options. For even younger men diagnosed with prostate cancer – those in their 30s, 40s or even 50s – Dr. Kay said there is a fine line between jumping straight into surgery and taking the time to watch how the cancer grows. “In my opinion, active surveillance is still an option of treatment for younger patients,” he said. Dr. Kay noted that deciding to utilize active surveillance is based on a number of factors, which makes it vital to have in-depth conversations with your physician before making a choice. “That conversation with the urologist is so important, because the patient needs to know all of his options before making a decision regarding his care plan,” Dr. Kay said. v
2011 Portraits of Life Breast Cancer Survivors Meet 10 women who have faced breast cancer head on ROSANNE GRUBBS, 57 • AUGUSTA IT WAS TINY. That’s what Rosanne thought when she saw the speck on the image from her digital mammogram in November 2009. “We weren’t expecting it to be positive, it was so small,” Rosanne said. “When they came back and said it was positive, there was just an overwhelming feeling of impending doom that quickly passed.” Today, she is cancer free and thankful to the team of physicians and clinicians at University Hospital who helped her get through the disease. That support system kicked in almost immediately after Rosanne was diagnosed with cancer. “Ten minutes after I got the call, Pam Anderson from University’s Breast Health Center was on the phone with me,” she said. “The medical support has been phenomenal and women need to know that they don’t have to do this alone – there’s this support system waiting there for them.” BONNIE MCCAULEY, 56 • MARTINEZ WHEN BONNIE WAS 34 and still living in New Hampshire, she got a piece of advice from her physician – don’t hesitate to ask for a mammogram if you think you need one, even if you’re not 40. That helpful advice possibly saved Bonnie’s life just three years later. Now living in Augusta, Bonnie said she went to her gynecologist after feeling a lump in her breast. When the physician didn’t find anything, Bonnie asked for a mammogram … and kept asking even after being told she was too young. Her insistence paid off when the mammogram
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showed not one, but two tumors. Eighteen years later, Bonnie said she is still a huge proponent of mammograms and makes an effort to pass on her story so others can be educated about the importance of the annual screening. “I could not get this out of my head that I needed to give back,” she said. “I’ve always pushed mammograms, but I think this will be a great way for me to stay active with the breast cancer community.” CAROLYN JENKINS, 58 • HEPHZIBAH CAROLYN WAS LIVING AND WORKING in New York City when the Twin Towers came down on Sept. 11, 2001. For most, this would be all the tragedy a person could handle in one lifetime, but fate wasn’t done with Carolyn. She’d been monitored for nearly 40 years after having benign tumors removed from her breasts when she was just a teenager. She was having mammograms every six months when she made a spur-of-the-moment decision. “I refused to go for my mammogram in December 2009,” she said. “I was just tired of them, so I tried to dodge them, but the doctors weren’t having it.” The physician’s office immediately started trying to contact Carolyn, even going so far as to send a certified letter to her home. “They were very serious, and I certainly thank them for that persistence,” she said. “I finally gave in and went for my mammogram in January … and there it was.” She was diagnosed with cancer on Jan. 8, 2010, and by the end of the month she had undergone surgery and started chemotherapy.
“I knew we were going to take care of this and this was what we had to do,” Carolyn said. “Twenty-four hours after the diagnosis I was ready to fight.” LAURIE PARKHURST, 41 • EVANS WHEN MOST PEOPLE THINK ABOUT BREAST CANCER, they think of a lump, a bump … something under the skin. But in 2004, Laurie’s first indication there was something wrong was on the outside, not the inside. “My breast had just turned bright red, and it was really red for three weeks or so,” she said. “It was kind of tender and swollen and I thought, ‘Something is not right here.’” It was Stage III breast cancer. She made it through the treatments and diligently monitored her health over the next few years until she hit a milestone – the five-year mark without cancer. “We were celebrating and all happy, but I started having some pain in my sternum. If I took a deep breath, I would just start coughing,” she said. Laurie was devasted when she was informed of the results from rounds of scans and tests. The cancer had spread to Laurie’s bones and lungs and is now Stage IV. “I’ve learned that I’m tougher than I thought I was; much tougher than I thought I could be,” Laurie said. “There’s this kind of a force field around me, and I just put my head down and charge on through. Mainly because I have to, I mean what choice do you have, right?” MONA PINNINGTON, 39 • EVANS MONA ROUTINELY DID BREAST SELF EXAMS and that diligence paid off in July 2010 when she found a lump. Many times, women are hesitant to go immediately to a physician, whether it be from denial or fear, but Mona knew she couldn’t wait and took immediate action. She quickly had a mammogram and a lumpecto-
my. Under the care of Randy Cooper, M.D., a surgeon who practices at University Hospital, she was able to get her results within 30 minutes – she had Stage II breast cancer. A small-business owner, Mona prides herself on always being on the go, but she said cancer has a way of making you reprioritize and take a step back. “You know some people say those dirty dishes will still be there in the morning, I was never one of those people,” she said. “I learned that some of those daily things that I thought had to be done everyday really don’t matter. Nobody knows but me.” LISA BYRD, 44 • AUGUSTA LISA HAD BIG PLANS FOR VALENTINE’S DAY IN 2009. She and her husband of 20 years were going to get away from it all with a romantic trip to Nashville and the Grand Ole Opry. But a little more than a week before they were to leave town, Lisa decided to stop by University’s Mobile Mammography Unit. Soon, it was more mammograms and a biopsy. By then, the trip was cancelled and Lisa spent Valentine’s Day at home recovering from a lumpectomy. “Seeing your name on a paper with the word ‘carcinoma,’ is devastating. It’s kind of like, ‘This can’t be my name on this piece of paper,’ but it was. “I was just trying to remain positive and continue to have my mammograms and go to my doctors.” And Lisa finally did get her trip to the Grand Ole Opry – nine months late – but it was more appreciated since she and her husband certainly had something to celebrate – her life. EVON GREEN, 56 • AUGUSTA EVON KNEW SOMETHING WAS WRONG when she went to a local emergency room in April 2000, but she couldn’t have expected her diagnosis. While there, Evon had a mammogram and was told to come back
for a biopsy of a mass in her right breast. The biopsy came back positive. Evon quickly began chemotherapy and radiation after the surgery to remove her right breast, and the treatments wore her down at the time. “They made me a little sick, and I lost my hair of course, but I’ve still got my life,” she said. As a member of University’s Pink Magnolias support group, Evon said the education and camaraderie she’s received has been invaluable. “The support group helps me to be positive, and helps me know what to do if I have to go through this again,” she said. “I know I don’t have to be afraid, and now we’re just family.” ADRIENNE COERSEY, 26 • NORTH AUGUSTA A 25-YEAR-OLD WOMAN expects to be making plans for the future, thinking about her career and possibly marriage, a family and a home. She does not expect to battle breast cancer. But that’s what Adrienne faced when she was diagnosed with cancer after discovering a lump in her breast during a bachelorette weekend in Charleston in May 2010. Because of Adrienne’s age, physicians were fairly confident the tumor was benign, but they went ahead and removed the entire tumor to be on the safe side. It was a good thing they did. Adrienne has a family history of breast cancer, but said she was still shocked and very unprepared to hear the diagnosis. “Everyone was always shocked to hear I had cancer, because I am very outgoing and active and for about six months there were a lot of things I couldn’t do,” she said. The biggest event put on hold was her marriage to fiancé David Lawry, which was originally planned for April of this year. David, along with the rest of Adrienne’s family and coworkers, devoted untold hours to ensuring she had the support system to get her through her ordeal. They got through it all, and Adrienne and David will be married this October.
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RUBY BOYD, 64 •EDGEFIELD COUNTY RUBY IS A WIFE, mother, grandmother and greatgrandmother. She’s used to taking care of other people, but when Ruby was diagnosed with breast cancer in January 2011, she knew she had to focus on herself. “When they first told me it was cancer, it scared me, but I have a strong faith in God,” she said. “I felt like although it’s cancer and it’s scary, something good would come out of it, and it has.” Ruby said she is thankful for getting the chance to meet so many strong women through University’s Breast Health Center, and she’s looking forward to spreading the word about breast cancer to others. “If I could just prevent one woman from having breast cancer then it’s worth it all,” she said. “It’s taught me that cancer can strike you at any time, even if you don’t have a history. It’s just made me a lot more self sufficient and a lot stronger.” CAROLYN BYRD, 50 • NORTH AUGUSTA CAROLYN HAS A UNIQUE PERSPECTIVE on the trials and tribulations of breast cancer. She is a hospice nurse, someone dedicated to helping others through the endof-life process that comes with a terminal illness. Carolyn was diagnosed with breast cancer in October 2009, just five months after receiving an annual mammogram that didn’t show any indication of a problem. “I knew it was suspicious, because it felt very large and it was hard,” she said. “I waited about a week or two before I saw the doctor just to make sure it was not something that was going to go away, and when it didn’t, I went to see my physician.” It’s been nearly a year since Carolyn finished her cancer treatments, and she said time has become even more precious to her, both personally and professionally. “I learned to treasure each day; live each day to the fullest,” she said. “I want to be an ambassador for breast cancer, and I feel like God eased my pain throughout my treatments, and I want to be able to help ease other people’s pain as they go through cancer treatments.” v
Stumbling down memory lane “Chemo brain” shown to be a real side effect of cancer treatment “Active surveillance is still an option of treatment for younger patients. By waiting, they’ll be postponing any of the side effects of treatments.” Miram Atkins, M.D., Oncology
LOOKING BACK, Rosanne Grubbs knew she shouldn’t have been behind the wheel of a car. The Augusta resident knew to expect side effects from the chemotherapy she was undergoing for breast cancer – fatigue, nausea, hair loss – but she wasn’t expecting her memory to turn on her. “It was like there was a fog in my brain, and it’s still there to a degree,” she said. “My memory has definitely been affected and I joke about it, but I can look back now and know I didn’t need to be driving. My attention span just wasn’t there, which can be dangerous when you’re in a car.” “Chemo brain,” a chemically induced, temporary memory impairment, has been recognized for years by the medical profession as a possible side effect of chemotherapy.
“Patients will forget things they usually don’t have any trouble remembering, they feel sometimes they can’t concentrate as well, they may have trouble remembering certain details like dates, or they can’t multitask like they use to,” said Miriam Atkins, M.D., an oncologist who practices at University Hospital. “They feel like something is wrong with them.” That feeling of frustration is temporary, Dr. Atkins said, and it’s important for physicians to remind patients that they’re not losing their minds. “Our job is to encourage them and tell them it’s just the chemotherapy and they don’t have Alzheimer’s, but it can be very scary,” she said. While chemotherapy is a primary cause of the condition, other factors during treatment also can affect a person’s ability to think and process information. “It’s really a combination of things,” Dr. Atkins said. “The cancer itself can cause memory problems. Then there’s stress; the age of the patient; and other drugs used in the cancer treatment, such as narcotics for pain or anti-nausea medication.” Fatigue, depression and hormone therapy can also account for memory problems when they occur in conjunction with chemotherapy treatments. But for all their wreaking havoc on cancer patients, chemo brain symptoms can be managed. “The first option is to tell your doctor so he or she will know what’s going on,” Dr. Atkins said. “Keep using your brain – do puzzles, take a class, read. Get enough rest, and don’t try to do too many things at one time.” Unfortunately, patients can’t necessarily avoid getting chemo brain, but Dr. Atkins made sure to reiterate that it is a temporary condition and managing the symptoms is the best way to stay healthy. “We wouldn’t ever not use a chemo drug just because someone might get chemo brain,” she said. “Patients need to get enough rest and good nutrition, and try to not over tax themselves during treatment. Remember, it won’t last forever.” v
Keeping it small
Breast cancer advances help some women keep their breasts, lymph nodes FOR CENTURIES, breast cancer surgery has stayed essentially the same – remove the affected breast and as many of the surrounding lymph nodes as possible. That changed in the 1970s when researchers began to look at the process of breast- and lymph-node removal and questioned if it was the most appropriate treatment in all cases. “The most important thing for every patient is really to sit down with their physician and talk about the decision whether or not to have additional surgery.” - Matthew Pugliese, M.D., Oncology “What they saw was that some patients with high risk features, such as large tumors and many positive nodes, did well in spite of our poor predictions. Alternatively, occasional patients with the mostfavorable features, such as small tumors and negative lymph nodes, would go on to suffer recurrences,” said Matthew Pugliese, M.D., a breast surgical oncologist who practices at University Hospital. “So this was telling us there was another part of the equation that we didn’t completely understand.” Dr. Pugliese, for whom lymph node research is a particular interest, said the surgical oncology field started to change after a landmark study published in 1985 disproved the notion that radical breast removal was better than smaller surgeries. Within a few years, re-
searchers proved that lumpectomy (the removal of the tumor) is just as effective as mastectomy (the removal of the entire breast) in those patients who were a good candidate for the less-invasive procedure. On the heels of that finding came the discovery of the sentinel node, the first lymph node most likely to be attacked by cancer before spreading to surrounding nodes. “By the late 1990s, most eligible women in this country were being offered sentinel lymph node biopsy as part of their breast cancer treatment plan,” Dr. Pugliese said. But here’s the controversy: Recent evidence has shown that some patients with microscopic traces of cancer in their sentinel nodes, don’t need to have any additional lymph nodes removed. A second round of research followed two groups of patients whose cancer had spread to the lymph nodes – one group had their nodes removed and the second group kept theirs. “What the researchers found over a long follow-up period was that both groups did exactly the same,” Dr. Pugliese said. The caveat was that the patients enrolled in the study had small, early detected breast cancer and they all had lumpectomies with radiation therapy. “The most important thing is really to sit down with your physician and talk about the pros and cons of the different surgical options,” Dr. Pugliese said. “The new information we are obtaining is part of an everevolving field of study that allows us to offer people procedures that will be most effective for their particular situation, while minimizing any potentially negative aspects of surgery.” For more information about lymph node removal, call University’s Breast Health Center at 706/774-4141.
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