Maybe Mayberry Ain’t So Bad

A few times on this blog I’ve mentioned that I live in a rural beach resort area, about 2 hours away from places like D.C., Philly, or Baltimore–home to John Hopkins. I live in a small town—think that old TV show about Sherriff Andy Taylor and Barney Fife—yes, sometimes it is like Mayberry here. While I like that, it can be a little limiting when it comes to health care. Rural areas, with their poor financial compensation offers, do not attract many doctors, and breakthroughs in treatment, cures, discoveries, etc., will not happen here. Hell, you could say that we have a severe shortage in health care options, especially since so many folks retire here and with an aging population health issues increase. In short, health care is a different animal in a place like this. I read so many blogs written by patients who went to Dana-Farber, Sloan Kettering, or whatever—and that just is soooo far from my reality.

Before I got cancer, I did not really care very much about that sort of thing—in fact, I would staunchly say that everything, including medical care, was just as good here as anywhere. After my false negative—which was due to human error, not a case of technology not producing an image of a tumor—and after hearing many other stories of misdiagnosis from clients—I began to think that health care is best done elsewhere. But schlepping “over the bridge” (the Chesapeake Bay Bridge, sometimes there is a whole “thing” about which side of it one hails from, as in, those of us on the east, Delmarva, side are just dumb hicks) is not feasible for me, financially or in terms of time to spare, etc.

I am now changing my mind again and thinking OK, maybe diagnostic abilities here are not the best, but treatment is better than I thought.

Not long after completing treatment, I attended a small-time local conference about breast cancer. A doctor gave a presentation and at the end, as almost a footnote, said that more doctors and patients should consider the unusual timeline of chemo first, then proceeding to surgery, upon a breast cancer diagnosis. I remember kind of going “hmmm, that’s funny” as she walked off the stage.

You see, I was told emphatically by the breast surgeon who diagnosed my cancer, and then the oncologist who treated me, that shrinking the tumor with chemotherapy first, and then having surgery and radiation was the best plan. It was of course, my choice, but they stridently urged this course of action, despite my not uncommon desire to “cut that THING out of me as soon as possible!!!” I heeded their advice. It worked wonderfully; there was only a small in situ piece left in the nipple (the devil that started it all) after chemo. That is down from a 6.6 cm tumor that was taking up most of the space in my small breast. Not only did the chemo first approach work for me, it was also implemented for my aunt, diagnosed just a couple months prior to my own diagnosis. My own experience and the experience of a relative closest to me had this “chemo first” plan, so I did not view it as unusual or new (remember, this is back in 2010).

It did not occur to me that surgery first was the most common path. At least not until I started reading blogs and reading how many women seemed to have surgery first. But reading the latest “Cure” magazine interview with Joan Lunden has finally made me go: OK, what the heck?!

Note—yes, there are many things I could be cranky about in terms of Lunden/all celebrity cancer stories, but I’m going to limit my discussion to this one item for now, for this post.

In the article, which I’m sure everyone has read, her decisions about treatment were under the section called “Trying Something New”. Unless I really read that section wrong, it implied that the chemo first regimen is kind of unusual:

“… there is still resistance to deviating from the longstanding dogma of surgery, then chemo, then radiation. The benefits of pre-surgical chemotherapy, particularly in the type of breast cancer Joan Lunden had, are abundantly clear.” – See more at:

When the doctors presented the idea of chemo first to me, they did not do so with any indication that this was a new or uncommon path, or even a deviation from the norm. They merely said that my tumor was so large, surgery at that time would be disfiguring. Chemo would hopefully shrink it to a manageable size. It did not sound like some new-fangled, cutting edge, wowee-zowee idea. No, to me, it sounded like good ol’ country common sense. Glad the doctors I encountered in my Podunk region deviated from the dogma! I was able to have a simple lumpectomy, and while I’m not happy about the removal of my nipple, I recognize my situation could’ve been so much worse—that I am more fortunate than most.

I have grumbled, and will again I’m sure, about the impacts of having cancer in a rural area, but I’m glad to know in this one aspect at least, my care was not so “Mayberry”—even if I did not realize how new-fangled my experience was at the time!

I am still trying to wrap my head around this concept. It seems strange to me that the treatment that I experienced almost five years ago is considered new and is being discussed as such by a celebrity. I’m not sure what I think about it. I’m just glad my oncologist was smart, informed, and open-minded enough to embrace it.