Dear girlfriend who just found out you have breast cancer,

Yes, I know, I don’t know you and you don’t know me, but we are now and forever linked by a shared experience, breast cancer.  Your story and my story are probably very different, no two are the same. But no matter how different our journeys, I feel connected to you and that connection makes me want to reach out.

If I could, I would ask you to meet me for a walk in the park or a cup of coffee so we could share our stories in person. But this will have to do.

I am going to tell you my story. My hope is that you find this story when you are up in the middle of the night or early morning in the deep dives of a Google search. My wish is that by reading my story you begin to feel like you are not alone. Because that is what I did, I read stories and called girlfriends walking this path and it gave me comfort.

My story begins with a mom who had breast cancer when I was in college. So when I turned 32 I had my first mammogram.  I have had so many mammograms, ultrasounds and MRIs, that just those records alone have their own folder at my surgeon’s office.

Two years ago, 18 years after my first mammogram (yep, that makes me 52 now!) my story took a turn with the diagnosis of Atypical Lobular Hyperplasia (ALH) and Lobular Carcinoma In Situ (LCIS). Although not cancer, these precancerous conditions increase the chances of cancer by a lot! After 4 needle biopsies and 2 surgical biopsies over the next 2 years, in February 2017, I was diagnosed with PLCIS. That added P to the abbreviation LCIS stands for pleomorphic. I had to practice pronouncing it and turn to Google to figure out what it meant.  What it meant was that I now had breast cancer. But PLCIS is not common, so there is not a typical treatment. In fact, the suggested treatment is to approach it like DCIS. There isn’t even a medical code for it. Some doctors added DCIS to my diagnosis; some just left it at LCIS. All agreed that for me a bilateral mastectomy was the best treatment.

My next logical response was to learn everything I could about mastectomies. There is a lot out there! An overwhelming, where do I begin? Oh my! amount of information.

And this is where my story took an interesting turn.

Just a few day before my surgical biopsy in February, there was an article in our local paper about a new procedure for mastectomy and reconstruction that was being performed by a friend of ours from church, Dr. Paul Vanek. The article told the success story of Georgi Anderson who had recently had the surgery. My mom loves to read the paper and share interesting articles with our family, so when she saw the article, she cut it out and sent it to me. I got it in the mail and gave it a quick look, thinking “that’s nice, but I won’t need that.” I was sure this biopsy, like the 5 before it, would not lead to anything new.  As you already know, I was wrong.

So as I sat hunched over the computer researching mastectomies, my head swirling from everything I had read, I suddenly remember the article my mom had sent me.  Digging through the mail I reread the article. Oh how a few days can change your perspective on the importance of a story.  I read it again and again. Pre-pec nipple sparing mastectomy . . . what? This procedure had not shown up in my searches. So I Googled again. And now I was really lost.  I mean seriously, it is enough to have to wrap your head around the whole, I have cancer thing, now I had more choices to make.

The next part of the story might seem like it is made up. And in fact when it happened, I actually turned to my husband and said to him, “You have got to be kidding!”

My head full, way too full of information, I left for church.  I sat down and not 2 minutes later, our friend, Paul Vanek, the doctor in the article, walked in and sat down right in front of me! Crazy, right! I have witnesses, if you don’t believe me.

You know what is better than Google to help you research a topic to make a decision? A caring, accomplished surgeon sitting in front of you that can answer all of your mind-boggling questions.

And the next best thing? A girlfriend who has been through it. Within a short time after talking to Dr. Vanek at church, I was able to talk with Georgi Anderson, the woman featured in the newspaper article, my mom had given me. Georgi shared her story with me, answered my questions, calmed my fears, and let me know I was not alone.

Fast forward 2 months.

On April 17, 2017, I had a bilateral pre-pec skin and nipple sparing mastectomy with reconstruction.

I know, I know, you have so many questions. What is a pre-pec skin and nipple sparing mastectomy with reconstruction? Why did I choose it? How was it? How am I doing now?

Let me start with what was most important for me, Dr Vanek, his staff and the care team at TriPoint Hospital.

As a teacher, I value knowledge, skill and heart. I want students to leave me with knowledge and skill, but most important I want them to use the knowledge and skill to make the world better.

I hold people to a high standard of knowledge and skill. Because I have known Dr. Vanek for over 20 years, I know through personal experience and the experience of many friends, that he is exceptional at his craft. But what has always impressed me most about Dr. Vanek is his commitment to caring for his patients. And this extends to his entire staff.

When I went to my first pre-op appointment, I was shaking, literally. The whole experience was finally real. I wasn’t just sitting at my laptop Googling; I was making a decision about something that was really going to happen to me.  From the moment I was greeted at the desk, I started to feel the commitment to caring at Dr. Vanek’s office. Kind words, an offer to get me a glass of water, an encouraging hug, reassurance that I was in good hands and would be well cared for. Each and every person I came into contact with that day demonstrated that this was a place committed to caring for patients first. And the person who demonstrated this the most was Dr. Vanek.

Now as you can guess from all my references to Google, I am very committed to understanding and being an active participant in my health. But at this moment in my life, what I needed more than anything was to hear and feel that it was going to be OK.  That I was not alone in this journey and that I was in good hands. And even before I heard all the specifics of the surgery and reconstruction, I was at peace.  

So back to your questions. What exactly is a bilateral pre-pec skin and nipple sparing mastectomy with reconstruction? As a 2nd grade teacher I am hardly qualified to describe this in detail. And so if you click here: bilateral pre-pec nipple sparing mastectomy with reconstruction (need this to be a link to the specifics about the surgery), you can get the medical specifics.

But I can tell you what it meant to me and why I chose it.

This type of surgery meant that I would still “look like me” although a LOT perkier! Birthmarks and freckles and scars from my first 2 surgeries would still be there.  I know this sounds funny, but especially my scar from the February surgery was important to me. That scar, as my youngest daughter said to me, “is your sign of hope.” It meant the cancer had been found and was being treated. Having skin and nipple sparing surgery meant that these parts of me, these signs of hope, remained.

This type of surgery meant I would go under anesthesia with breasts and I would wake up with them.  I know this is not part of everyone’s story. I am very close to women who could not have this experience. I was very grateful for this being a part of my story.

This type of surgery meant that I was off prescription pain medicine within 4 days of surgery and off of over the counter pain meds after 3 weeks. This was important to me not because I am against pain medicine or have a high tolerance for pain, but because of the role pain medication has played in my life previously.  For many years, I struggled with severe headaches and needed over the counter pain meds to treat the pain.  Now, whenever I can minimize the use of pain medicine I do.  Because this surgery placed the implant over my muscle and did not require expanders, my pain and thus the need for pain medicine was greatly reduced.

This type of surgery meant I would not lose muscle strength or mobility. A few years back I lost a considerable amount of weight through changing what I eat and through exercise.  This weight loss and addition of regular exercise was critical in the reduction of my headaches.  Being able to run, lift weights, and do yoga is an important part of how I now live every day.  Having an option for a surgery that would enable me to return fully to these activities was important to my returning to the lifestyle that makes me be the best version of me.

This surgery meant I could get back to life sooner. For me that meant I could be there for my daughter when she had her wisdom teeth out, just 3 weeks after my surgery.  Always the planner, I purposefully, scheduled my surgery with 6 weeks left in the school year so my absence was the least disruptive to my students. Because of this, I did not have to return to work 6 weeks after surgery because summer break had begun. But I feel confident that I could have, if that timing had been different.

During the 6 weeks of recovery, I did need to rest and lay low. The first week, I had a fancy thing called Prevena Incision Management System and drains. I am amazed at the things people invent that make getting better easier.  Don’t be intimidated by these things. They explain all of it to you before you leave the hospital and let you practice anything you need to do.  I was fortunate to have the assistance of my two older daughters, who graciously transitioned from advertising and media professionals to nursing assistants to help me out. After the first week with the removal of the Prevena, I was more comfortable and could take care of myself with little assistance. My drains remained for 17 days. A gift of a specially designed camisole, from the Lake Hospital Systems Breast Center, made it easy to manage the drains. Throughout the 6 weeks, I learned that healing takes time and energy. Even though I did not do a lot, my body was very busy healing and so I found I was tired. I rediscovered the power and joy of naps! I also learned that this part of the journey is very individual. Everyone heals in their own way. If it takes a little longer or you feel better sooner, that is exactly how it should be, for you.

What does my future hold? This surgery was the treatment I chose as best for me. I am now cancer free and do not need further treatment. I am so grateful for this.  I find comfort in knowing that Dr Vanek will continue to be a part of my future. I will see him over the next year, so he can carefully watch over my continued healing from the surgery and make any necessary adjustments.  Sometimes, 6 months after surgery, there is a 2nd simple surgery to add fat around the implants.  And although I appreciate all the generous offers for donated fat, I will be happily using my own! Another important deciding factor in selecting to have Dr. Vanek do this surgery is that he or an associate of his will see me yearly for the rest of my life. Although I love to be in charge, this is one part of my life, where I want to know that there is an expert keeping an eye on things for me.

So dear girlfriend, that is my story for now.  I hope reading it helped to answer some of your questions and brought you some comfort during this challenging time in your life.  I have learned many life lessons the past few months. But the most important lesson is that there are many, many kind and loving people in this world and their love will carry you through this.

I am sending some of that love, to you, right now.

Your friend,
Mary

PLASTIC SURGEON Paul Vanek, MD, FACS, was drawn to the field of medicine at a young age. When he was 8 years old his father suffered a traumatic brain injury, which gave Dr. Vanek a unique perspective on the care that physicians provide. “The doctors who took care of my father and comforted my mother really had that ability to make people feel better, even though it was a very out of control situation,” he recalls. “It was that experience that led me into medicine.”

Dr. Vanek worked as an emergency medical techncian while attending Haverford College in Pennsylvania. “I really loved trauma,” he says, noting that he became more engaged in the area during medical school at the University of Rochester in New York. He trained as a general surgeon and then entered a plastic surgery residency at the University of Michigan. “I was very interested in saving lives and patching up people who were traumatized—having an impact on their lives and reconstructing them.

“I worked in a level 1 trauma center in Rochester, and while I was training I got to see these magical people called plastic surgeons,” he continues. “They would go into a room with a patient who had some very serious problems, and they’d emerge 6 or 8 or 10 hours later, and the patient would be transformed.”

After completing his residency, Dr. Vanek joined the Lake Health System in Lake County, Ohio, where he practiced for one year before striking out on his own. “I always thought it would be best for me to be self-employed. The hospital facilitated me to get my practice going, and I opened Vanek Plastic Surgery in Mentor, Ohio, in 1997,” he says.

The Will To Thrive

An entrepreneur at heart, Dr. Vanek has owned or managed several businesses throughout his life, beginning with a paper route as a child. He worked as a contract trumpet player during high school, college and medical school; ran a landscaping business in high school and college; and founded his own medical billing company, HealthMaxx, in 2001, which he sold as a new attending in 2007 to focus on plastic surgery.

“When I was training to be a physician, I also did research at Columbia Presbyterian and New York University—I regularly had academic jobs at that time,” he says. “I’ve had other ventures along the way, but I always wanted to have practice autonomy. Even though I’m a collaborative soul, I knew I’d be best served if I was able to run my own business.”

The most challenging aspects of practice ownership have been keeping up with compliance issues and the day-to-day management of personnel. “Surgery is the fun and easy part of my day; the challenging part is the massive amount of compliance that goes along with being a physician in the U.S.—negotiating contracts with insurance companies, keeping up with the administrative state requirements of being an employer—as well as handling all the moving parts of a busy office,” says Dr. Vanek. “But I love it because of the relationships I’ve formed. I have people who have worked for me for 14 years—long-term employees who I value.”

He has found that retaining personnel requires more than just logistics and numbers, and he strives to nurture his staff emotionally as well as financially. “People come and go—they get married and divorced and move around, and the only way to keep them is to know what the market pays and compensate them well,” he says. “But you have to structure their bonuses emotionally too by recognizing holidays, being there for their kids, giving them time off and acknowledging their accomplishments. That’s not just economics; it’s the emotional side of the practice of medicine.”

In order to overcome compliance and business challenges, Dr. Vanek stays up to date with local and national plastic surgery societies, and participates in state politics. “Being involved politically means you keep yourself informed; you keep reading and you stay engaged and in contact with your legislators,” he says.

His advice for physicians entering the field is to find a surgeon-mentor who can help prepare them for business ownership. “Residency training is supposed to instill in you the principles of surgery; it doesn’t always foster the most optimal business practices that are required of a surgeon when he enters practice,” says Dr. Vanek. “Something new doctors may not know is that we have a young plastic surgeons section at the American Society of Plastic Surgeons (ASPS). There are certainly surgeons—like me—who are willing to be mentors.”

In order to provide the best care for his patients, Dr. Vanek is constantly on the lookout for new techniques and practices to incorporate into his surgeries as well. He reads the scientific literature, watches instructional videos, discusses the techniques with other practitioners, and attends courses and live demonstrations. “I may do an element of a new procedure and incorporate it into an existing procedure before I do the full-on new thing,” he says. “I find and integrate new techniques by watching masterful surgeons perform the procedures and going to educational symposia. I’ve learned something new every year I’ve been in practice.”

An Atmosphere Of Trust

When consulting with patients, Dr. Vanek’s approach is to educate and inform them every step of the way. “I prefer primarily to engage each patient Socratically: If they’re highly intelligent then you can be very detailed in terms of biochemistry and anatomy; if they’re not as educated, you have to make sure you’re sensitive to their intellectuality without being paternalistic,” he says. “You have to balance the science of your surgical education with the art of communication.”

He employs before and after photos of previous patients who presented with similar concerns, and favors frank disclosure about whether the patient’s issue is common or if a pictured solution may be more difficult to achieve due to unique concerns. “Part of our mission statement is, ‘We operate and fully communicate in an atmosphere of trust and respect, nurturing with love and compassion as we add the highest value to every patient,’” explains Dr. Vanek. “I’m a positive person, and I try to be very straightforward. I want to build patients’ self-esteem and enhance their internal and external beauty.

“Most people are realistic when I have to break the news that if, for example, they are 80 years old I can’t make them look 29,” he continues. “If it looks like they’re star struck by surgical intervention, I make sure to bring them back to earth and show them a range of examples of somebody with the same height, weight or ethnicity. I say, ‘Here’s where they are. If this will make you happy then we’ll move forward. If this isn’t enough, then you may need more than one operation, or you may need to start out from a different place.’”

He’s also comfortable saying no. “Sometimes the easiest way is to say, ‘I don’t think I have the skills necessary to bring you the outcome you want.’ I’m very comfortable with that answer,” says. Dr. Vanek, noting that at times he will even discourage a patient from seeking treatment elsewhere as they will eventually find someone who agrees to operate—but the patient is unlikely to be happy with the results.

If he suspects the patient has underlying psychological issues, Dr. Vanek will schedule a counseling appointment for her. “I’m not just going to say, ‘We’re not doing surgery,’” he says. “I tell them to come back and see me after they discuss things with a counselor in a couple of sessions.”

His strategy for achieving natural-looking outcomes is, “Don’t over do it. You must have a gentle hand and always remember that we can do a little more in the future,” he says.

Life In Motion

Outside the practice, Dr. Vanek manages to keep very busy. He has a wealth of hobbies that range from gardening to travel to creative pursuits. “I scuba dive, I grow orchids, I play trumpet in my church and in a rock band, I sing lead and backup in the same band, and I’m a cantor in my church,” he says. “I love art and photography. I’ve climbed Mount Kilimanjaro and gone on safaris too.”

Dr. Vanek and his wife travel regularly to visit their adult children, and the couple are very active in their church. “I’ve been chairman of the United Way in our county, and I continuously raise money for the Lake Hospital Foundation and through my church for various charities,” says Dr. Vanek. “My mother’s history of diabetes really has gotten me engaged in the diabetes and multiple sclerosis tours—those are long bike rides—which combine my own passion for physical activity with the idea that I can raise money for somebody else.”

After the earthquake in Haiti in 2010, Dr. Vanek joined Project Medishare and traveled to Haiti with $30,000 worth of drugs from Lake Health Hospital and a surgical team made up of an anesthesiologist and two volunteer nurses. “We brought our own instruments, medications and anesthesia,” he recalls. “We operated continuously in very poor conditions almost immediately after this terrible mass casualty. We collaborated with people from all over the world.

“Since then, I’ve participated in many other surgical missions,” continues Dr. Vanek. “Knowing that we are able to help people who have no resources has really changed my life. It made me recognize that an individual person with the will can make a difference.”

Laura Beliz is the associate editor of MedEsthetics. Original Article Here. 

Photo by Cory Sorensen Photography