Appointment with surgeon - more questions than answers

solfeo

I saw the surgeon yesterday. It didn't go exactly how I thought it would, and I probably didn't ask enough questions because once she made her recommendations all I could think was that I need to speak to the oncologist before I decide anything. The questions didn't come to me until I got home. Help please!

Suspense is over regarding my HER2 status: FISH 1.1 Negative. So I'm ER+(100%)/PR+(100%)/HER2-. I guess that's pretty good news?

We still don't know the grade because the mitotic score has been deferred until they test the whole lump. We still know it's at least Grade 2 from the other markers. It will remain 2 as long as the mitotic score is less than 3.

The tumor was 2.8cm x 1.6cm in the ultrasound, but when she measured it yesterday from the outside, she got 4.5cm x 4cm. OK, even I know it has grown but I don't think it's that much. I think she might have been measuring some of the surrounding lumpy breast tissue, because sometimes even I can't tell the difference unless I change positions. But she could be right.

She agreed with me that the BMX is a good idea given my history. We talked about reconstruction and I think she may have changed my mind about that. I'll be talking to a plastic surgeon.

This is where it gets less clear to me. She wants me to have chemotherapy first. She said if I have the BMX I can't start chemo until after it heals, and given the large size she measured she doesn't think I should wait that long. She said because of the size it's likely that some cells have already traveled to other parts of my body that wouldn't show up on any scan because they would be microscopic at this point. Assuming it hasn't already obviously metastasized, of course, which she feels good about because my lymph nodes feel normal.

How will they know what kind of chemo to give me if the cancer isn't yet staged or graded? Is there still a chance I wouldn't need chemo if no nodes are involved? And what role does the tumor size play in that possibility?

Is chemo first good or bad for the lymph node situation? It would kill any cancer in my nodes, right? Would that mean none would need to be removed? I guess that would be good, but how do they stage the cancer if they never know how many lymph nodes were involved? Someone please educate me because I know I'm missing something here.

This also doesn't give me much time for a second opinion regarding the full treatment, because the lump will still be in there growing. I was thinking about flying to UCSF but if this thing really is growing that fast it can't just be left alone with no surgery or chemo while I plan a trip that could take weeks. Plus I need to be fully staged to get the 2nd opinion. Am I right? I had been thinking do the BMX, then I would have time to heal enough to travel and get my second opinion, and the chemo could wait that long once the cancer is out.

The last thing is that she ordered a Total Body Bone Scan and a CT Scan of chest/abdomen/pelvic with contrast. That leaves large areas of my body unscanned. What about my brain, or if I have swollen lymph nodes elsewhere in my body? Some people talk about them finding thyroid nodules, but those tests wouldn't find that.

Will the CT scan give us a definite size of the tumor since there was such a large discrepancy between ultrasound and her measurements? If decisions are being made based on the size I want to know exactly what size it is.

Any thoughts or suggestions are welcome, as well as ideas for questions to ask the oncologist on Monday.

Holeinone

Solfeo, someone else will come along & give you a more through explanation.

Many women receive chemo first. Very common. Most women recieve Adriamycin & a Taxol type chemo. If you look on our sig lines, at the end of our posts, you can see what chemo drugs we have gotten.

I had a lot of Cancer in my axillary. I did have a PET scan to look for mets. I have never heard of anyone getting a scan on there brain. That would only happen if you were stage 4 and was having symptoms of brain mets.

None of this is easy. I did not get a second opinion. I live in a rural area, wanted to have the surgery & start treatment NOW, so I went with the advice of my Drs. Hang in there, one day at a time.

ShetlandPony

Hi, it's me again. Thank you for the update; I was wondering how it went yesterday. I will offer what knowledge I can, and I'm sure others will be along shortly.

Yes, ER+ PR+ Her2- is good.

Regarding reconstruction, I don't have personal experience since I had a lumpectomy. There is a lot of information here on BCO. From what I have read, it seems that surgeons are quite likely to recommend reconstruction, but may minimize what is involved. So do your homework. It is a very personal decision.

Chemo first makes sense to me. The most important thing is to get rid of any possible rogue cells/micromets. I don't think the stage and grade have a lot do with which chemo regimen is recommended. I think there are a couple standard cocktails. You are right, chemo could turn positive lymph nodes negative and mess with staging. You might ask the doctors how that might that impact treatment decisions now and in the future. But I think you could have a sentinel node biopsy before starting chemo, maybe at the same time as port placement if you are getting one.

I suspect the recommendation to have chemo is based on tumor size and grade 2, even if lymph nodes are clear. (Over 2cm and less than 5cm is T2.) Do ask both surgeon and medical oncologist this question.

Now for scans. It is great that the doc is offering you the scans. It will help you know exactly what is going on. These scan results will be important for treatment recommendations. And most likely they will be good news and help you feel less worried. It seems sensible to not do a brain scan since there are no brain symptoms. They are not done as commonly as CT or bone scan. Also, your subtype is not so likely to have brain mets (more likely with triple negative, for instance). The CT will check the important places like liver and lungs. (Even at stage iv my PET-CT scans are just "eyes to thighs".) I think it will give good info on tumor size, especially since you have IDC and not ILC.

I think you have enough information for a second opinion. Maybe it would not take weeks? Worth looking into?

I'll come back later with possible questions for Monday.

You are doing a great job with all this, Solfeo. Take care.

solfeo

Thank you Ms. ShetlandPony.

I want to have scans but I don't understand why most here seem to be offered MRIs and PET scans for staging rather than CTs. I do want my thyroid scanned because I have some trouble swallowing and it feels like my thyroid might be enlarged. I indicated that on the history form. That was one of the things I went to my PCP for originally, before I said BTW, I have this lump so let's just get that out of the way first so we can concentrate on what's really wrong. Obviously assuming it was another benign something to get over with so I could move on.

What I did was change the scan appointments from Tuesday to Wednesday, so I have time to to cancel the CT if the oncologist has a different idea of what type of scan I should have when I see her Monday. I don't want to feel rushed into doing something that isn't as thorough. And I don't want to have more scans than necessary because they didn't look at everything in enough detail the first time.

It's a dilemma about the lymph nodes. I like the idea of not having any removed to avoid lymphedema (my aunt got it and it is not a pleasant thing to deal with), but I also want the cancer properly staged. I guess that's a choice I will have to make after discussing the pros and cons with the onco.

Regarding the 2nd opinion, UCSF is on my insurance's mainland network so that won't cost me extra but I need to book the plane ticket in advance or it's gonna cost a bundle. Unless the airlines offer a discount for medical travelers. Anyone know?

As for the appointment itself, both doctor and assistant were wonderfully cheerful and helpful. The assistant actually asked me why I started going to the other surgeon. I decided it wouldn't be very productive to remind her that she wouldn't give me an appointment the last three times I tried, so I just smiled and said, "He's closer." She must treat everyone that way because she didn't seem to remember doing that to me. At least now i know it was nothing personal. I did wonder if there was something I had done that made them not want me back after the surgical biopsy I had done there in 2009. So I think everything will be fine now and I made the right choice.

solfeo

A side note about my aunt's lymphedema. When she had the lump removed they found cancer in one node so they removed the other 13. It ended up only being in the original 1, but now she has lost all of those nodes and has to live with the lymphedema for life. Is there another way that could have been done to avoid taking so many nodes? If there is I would like to make sure they conserve as many of my nodes as possible.

plumster1

Solfeo-
I'm not sure how long ago your aunt was treated. Many women have sentinal node biopsies of their lymph nodes. They inject your breast near the tumor with a radioactive isotope and/or blue dye. This process helps find the first or sentinal node that the tumor "drains" too. The BS removes that node and maybe another if they "light" up. They are sent to the pathologist who quickly does a preliminary test for cancer. If no evidence of disease, no further lymph nodes taken. I had that procedure and only lost 1 lymph node.

solfeo

Hi plumster1 and thanks. It was in 2009 so not the stone ages.That would be very sad to know the less invasive procedure may have been available.

trying2staypositive7

Hi Solfeo. I'm sorry that you had to join the club no one wants to but please know that you've come to the right place. there are so many smart and brave women that are on this site and they are more than willing to offer their advice and expertise. that said, I just wanted to offer a little bit of info. A lot of times breast surgeons do an MRI to determine if you have lymph node involvement and to determine how large your tumorous but this system is not infallible. I know in my case my surgeon went into thinking I had no lymph node involvement and when I got out of surgery 10 out of my 15 lymph nodes were positive. she was surprised, I was surprised so chemo I had to do. Its hard at this stage for you to not be scared and want answers right now. But to be honest with you things in the cancer world move a little slow sometimes. I think that when you go to your doctors appointment take someone with you and record what the doctor is saying. that way you don't miss anything.I hope that your appointment goes well. I think that sometimes CT scans are ordered vs PET scans because the insurance company tends to not approve those sometimes. good luck with everything. if you have more questions please feel free to ask. I'm sure someone will come along with more information

Hopeful82014

Solfeo - in the past if even one node was positive on biopsy the surgeon would recommend a full lymph node dissection (Axillary Lymph Node Dissection - ALND). Many times it was found that only the single node was positive, yet women had to deal with the addition morbidity caused by the removal of so many node - as was your aunt's case.

More forward looking surgeons are moving towards removing only the sentinel nodes and advising nodal radiation (or/or chemo) if the sentinel node is positive. Studies have shown equivalent overall survival, with less morbidity. You can discuss this with your surgeon. By the way, it's possible to have more than one sentinel node. I had five and they were scattered well beyond the axilla. A close friend had a similar situation.

solfeo

I need to get some work done today before a very busy week of appointments, so I'll just say a big collective thank you to everyone for your responses. I have read every word and taken it to heart. I'll try to update after I see the oncologist tomorrow afternoon.

kayb - I guess I can see some value in not knowing the precise staging information. I have wondered before if the survival statistics they give you could actually be limiting as to the amount of hope a person allows herself to have. If they don't tell me I have a 49.3% chance of surviving 5 years then I have no reason to expect I can't live out my natural life span. Statistics never apply on an individual level anyway.

ShetlandPony

Solfeo, you have gotten some great input. I hope my comments reach you in time. Don't worry about typing a response.

Some possible questions for you to ask. Quotes are from 2015 NCCN Guidelines. By the way, it looks like you would be assigned stage II at this point even if the sentinel node is positive.

1. Would adding PET or MRI, to CT and bone scan, give us useful information? How about for lymph nodes status? (Not all facilities have the equipment for these, but UCSF would. But insurance might not approve them.)

"The use of PET or PET/CT scanning is not indicated in the staging of clinical stage I, II, or operable
III breast cancer. FDG PET/CT is most helpful in situations where standard staging studies are equivocal or suspicious, especially in the setting of locally advanced or
metastatic disease.
i FDG PET/CT may also be helpful in identifying unsuspected regional nodal disease and/or distant metastases in locally advanced breast cancer when used in addition
to standard staging studies."

2. Would doing a sentinel node biopsy before chemo and surgery give us useful information? Would a positive node affect the recommendation for how aggressive my hormonal therapy should be and how I would weigh side effects issues vs. recurrence risk? (tamoxifen vs. AI etc.)

3. Is there a way I can avoid axillary lymph node dissection even if the sentinel node is positive (either before or during surgery)? For example, if I have lumpectomy plus rads and chemo after? Or if we plan radiation after BMX? (Radiation and systemic therapy have replaced ALND in many cases. cf. Z0011 study and others.)

"For patients with clinically negative axillae who are undergoing mastectomy and for whom radiation therapy is planned, axillary radiation may replace axillary dissection
level I/II for regional control of disease." (page BINV-D)

4. Would it change my treatment plan is the tumor is grade 3 instead of grade 2?

5. Do you recommend that I go to UCSF for anything?

6. What about my thyroid? Please include thyroid tests in blood test order. Include in imaging?

7. Is there any value in doing an Oncotype or other test for me?

8. What chemo protocol do you recommend for me and why is it better than other possible protocols?

9. For surgeon. How would you do things differently if I am planning reconstruction vs. going flat? Can I see photos of typical outcomes? How would my choice affect my physical ability to do my usual activities?

solfeo

Thanks SP, I did get back here in time and I have my list of questions ready to go. Much appreciated.

I actually have two appointments Monday. PCP in the morning to go over my blood work, and oncologist in the afternoon. My thyroid hormones are in the normal range.

solfeo

I'm not really back yet, but quick rant between appointments. The PCP's office wouldn't give me a copy of the report the surgeon sent them. They are not custodians of the records and are not authorized to release another doctor's records. Records pertaining to me, the patient, when I was standing right there in front of them. Luckily I read it while I was in line to check out, because it was in the stack of paperwork the doctor gave me to hand the front desk. She did a good job of summarizing everything I reported to her.

So far all the HIPAA privacy laws have protected me from is access to my own medical information. Do not like unnecessary bureaucracy! I'm going to ask the oncologist's office the same question and see if they will give it up (she is not a part of the same large system as the PCP). If they do give it to me I'm going to complain to the bureaucrats about making things unnecessarily complicated for patients.

solfeo

First things first - YES, the oncologist's office gave me the surgeon's report with no question whatsoever. Just copied it for me right while was standing there. There is obviously no law against giving a patient her own medical records, just needless bureaucracy at the PCP's office for no reason at all. I will be complaining.

I didn't get as much time for the appointment as I should have because they made an error checking me in. That meant I wasn't able to ask all of my questions. She was a very fast talker who kept telling me, "You're so cute!" every time I asked a question. And by the looks of everyone in waiting room I wouldn't be surprised if I really was the only one to ever bring in a list. I was the only healthy looking person in there. I hope I don't leave their care looking like everyone else!

Regarding my options, she thinks everything that was discussed in this thread that i asked her about is a viable choice for me. She said it is up to me. She didn't see any reason why I couldn't do surgery first if I wanted to, and she didn't think it would be dangerous to wait to heal first. Said there are no studies that show a benefit to neoadjuvant therapy over doing chemo after surgery. One consideration would be if the surgeon needed the lump to shrink so she could successfully perform the surgery, but that wasn't her reasoning. She said nothing to me about the size of it except that it would be better to treat it sooner than later.

Quoting the surgeon's recommendation, in her own words from the report:

"Since patient could probably benefit from systemic therapy, we discussed the option of neoadjuvant systemic therapy. Although there may be no survival benefit with neoadjuvant systemic therapy, in her situation, neoadjuvant systemic therapy may:

• Serve as a surrogate for prognosis based on tumor resonse to therapy
• Reduce the need for complete axillary node dissection by downstaging nodal status
• allow for earlier systemic therapy for occult micrometastatic disease as compared to systemic therapy in the adjuvant setting."

That sounds OK to me, but what is this "could probably benefit from systemic therapy" business? I'm not having chemo because I probably need it. They need to know for sure!

So anyway, at this point I'm still confused. She did add a brain MRI and a CT of my neck to check out my thyroid. That will be done tomorrow and Wednesday, then I'm meeting with the oncologist again to get into the more specific details about the treatment she recommends depending on what shows up (or hopefully doesn't) in the scans.

Tonight I'll try to process it all and come up with a new list of "Cute" follow up questions.

Thoughts and opinions welcome. I did leave some things out or I would be writing all night, so please do ask questions if there is more you would like to know to form an opinion. I might not have all of the answers until Thursday.

ShetlandPony

Aarrgh! I fired my first oncologist, in part, for always saying, "It's up to you" when there were important decisions to be made. They are supposed to say, "I think x is the best plan and here's why." How much is a ticket to San Francisco?

As far as the "probably benefit" thing, that's just how they write everything: may, might, could, blah blah further studies are needed.

solfeo

My aunt had a good idea to see if I can get my records evaluated at UCSF without making the trip. That would save me some money for the alternative treatments I want to do, and it will probably happen faster. I'll call the UCSF Cancer Center and see what they are willing to do. The oncologist did say I should just go now if I want to - she didn't act like anything had to be done immediately, like the surgeon did. She got similar measurements to the surgeon though, so it probably has grown quite a bit just since the biopsy three weeks ago. I don't want to leave it in there growing and end up with a 6cm tumor before they even get started on anything.

I have a few days to think about it before we get the scan results.

ShetlandPony

I agree that you don't want much delay. I would call UCSF right away about scheduling an evaluation or appointment, even before scans are done. I don't know if they are allowed to advise without seeing you or whether they ever do phone appointments. Social workers often have ideas about practical resources, so maybe you could contact a UCSF breast cancer social worker and ask about funding for transportation. And if you can't get an appointment there soon enough, it might be worth seeing if UCSD is also on your insurance. It is also a NCCN center. (It is rated #23 by US News, compared to #9 for UCSF.)

solfeo

UCSF does need to see me, and needs 5-10 business days to review my records before they can schedule any appointments. UCSD can do it in 5-7 business days.That's not gonna work for me. By the time the scans are done, and I meet with my oncologist to get her treatment plan and the referral, and everything gets sent, we're probably looking at the 1st or 2nd week of September before I can even get an appointment. I don't think I can wait that long.

I think what I need to do is find another oncologist here for the 2nd opinion. I have more choices for oncos than I did for surgeons. The main thing I want is clearer answers to my questions and more help deciding the order of the treatments. As for the chemo, I want to make sure I'm getting the safest and least toxic treatment that is appropriate for my situation. One issue was that my liver enzymes were elevated in the blood work, and
I know chemo is hard on the liver to begin with. If there is any way to
be kinder to my liver I would like to hear about it. Otherwise I look healthier on paper than I should for an overweight middle-aged woman with
cancer. My PCP was pretty impressed with my numbers.

I can't say I won't get more of that information from the current oncologist since we we were rushed yesterday and weren't able to finish our conversation. Hopefully I'll feel more comfortable with what she has to say on Thursday, and then I'll only need the 2nd opinion for confirmation that the treatment I will be getting is in line with my priorities, which are:

1) extending my life as long as possible; 2) preserving as many lymph nodes as possible; and 3) doing the least amount of long-term damage as possible to the rest of my system from the chemo. I would be looking for the least aggressive but still effective treatment possible, and I do realize there may be some trade-offs to achieve this. All I need is enough information to decide what I'm willing to trade.

It shouldn't be that difficult once I feel I have a clear understanding of what has been recommended.

Chinese Medicine Doc today at 3 to evaluate the liver situation. Brain MRI at 4:30. I don't even want the damn brain MRI after what was said here, but after I started asking questions about the appropriateness of CT alone for my situation, the oncologist didn't want to miss anything in light of my back and liver pain. I think this waiting is going to be worse than any other so far.

solfeo

Hi kayb - I wasn't thrilled by that either but from her it didn't come off as condescending because of her personality. I go into these appointments very cheerful and try to inject as much humor into the situation as possible, but I'm also professional and well-informed and want to know the reasoning behind everything they say. I took it as a clumsy way of saying she found my approach refreshing. Not everyone could have gotten away with saying that, like any male doctor for instance. She is sweet and warm, unlike a lot of doctors, and a bit younger than me, but not young enough to think of me as a cute old lady. If we get along otherwise I would just find a diplomatic way to tell her that could be taken two ways.

ShetlandPony

Yes, a local second opinion sounds like a good plan. You have outlined your priorities very clearly. It sounds like you will have your plan and begin treatment soon. Good. Yeah, we understand scanxiety.

Later, when things have calmed down, it would be interesting to hear about your Chinese medicine appointment.)

windingshores

I have questions and not answers, and some on this forum know a lot more than I do.

But here goes. You are 100% Er and Pr positive. That is really really good. Maybe you could have surgery and do tamoxifen or an aromatase inhibitor before, during, after. Maybe that could hold you. I would want the tumor out asap or at least would want something like a hormonal med to keep it from growing while you deliberate on chemo.

Are you having an Oncotype done? That takes about two weeks and can be done on biopsy or surgery and these days really guides treatment. But I don't know how that applies to larger tumors. I do know the Oncotype determines no chemo for some node-positive people.

ps here is a chart showing that smaller tumor size does not mean low Oncotype for 40%

http://breast-cancer.oncotypedx.com/en-US/Professi...

here is info on the Oncotype for positive node(s)

http://ww5.komen.org/Breast-Cancer-News/Oncotype-D...

lynn61

I saw this regarding "Chemo before Surgery for Larger tumors" on the John Hopkins Breast Center Forum. This was the experts answer.

Doing chemo first provides the ability to verify, with the shrinkage of the tumor, that the chemo drugs are working against her cancer. When given after the tumor is removed then we operate in good faith that the cancer cells that might remain behind somewhere within her body are also being destroyed by these specific chemo drugs.

You can also submit a question. I did and they answered on their site in 2 days. You can find lots of information there in reading all the Q&A's.

http://www.hopkinsbreastcenter.org/services/ask_expert/chemotherapy/

solfeo

It took four 1mg Ativans to get me in the darned MRI machine. The tube was pretty roomy, but that mask they put over your face! The first time I started to have a little panic attack and made them pull me out. The 4th pill did the trick and I just closed my eyes and pretended I was somewhere else. Too much racket for a peaceful beach, so I opted for a transport pod in space. You can go anywhere you want with that much Ativan!

The visit with the TCM doc went well. She is also a holistic MD and acupuncturist. Born and raised in China. She is a big part of my "Mind, Body and Spirit" approach to curing this cancer because what she does encompasses all three, but in a completely non-toxic and non-invasive way. I could tell something was not right with my liver before the BC diagnosis and I have been taking supplements for it. I assumed fatty liver, and that could still be what it is because the swelling and discomfort has died down since I started the Chinese herbs and other supplements. Yesterday was to get some new blood work ordered as a progress check. She's also doing some hormone tests to see how out of whack my levels are since no one else has done that yet.

Then she taught me a stress relief technique called EFT (plenty of info online), and gave me a quick acupuncture session to help the back pain and to relax me for the MRI, which I went to directly after. The acupuncture did help but not enough to get me in the machine without chemical assistance.

winding shores and lynn 61 - I am leaning toward doing chemo before surgery. After reading what the surgeon wrote in her report it does seem like a good choice for me. Getting it over with will also get my body back into healing mode sooner rather than later. I do wonder what the effect might be on healing from the surgery, with my immune system already destroyed. Pros and cons to everything. Oncotype and other tests will be discussed on Thursday.

Bone and CT scans at noon into the evening. Then I get the results tomorrow when I see the oncologist again. At least that news is coming fast. Whatever it is I just need to know and get it over with.

ShetlandPony

Kayb, I'm that kind of look-for-some-humor, high-information patient, too. It's so great to have an onc who is not threatened by that. And I have let her know that though I want to understand everything, and do my research, I value her expert advice and don't want to make decisions on my own. So we are working well together, which helps my emotional state tremendously.

Solfeo, I think that your Mind, Body, and Spirit approach, and a healthy lifestyle, will really help you tolerate and recover from chemo, and heal well from surgery. I'm so glad your appointments are moving along now. May I ask whether you are pre- or post- menopausal?

solfeo

I am pre-menopausal still at 51. I guess not for long!

I'm also radioactive from the bone scan. Apparently I have to avoid small children and pregnant women for the next 24 hours or I will make them glow in the dark. What a bummer, I think most kids would like that.

Scans were uneventful and everything went smoothly, so not much to tell until tomorrow when I hopefully get the results. The onco said she would have them. If I walk in there and she tells me something was delayed, she better duck and cover because I am at the end of my patience with the waiting game.

ShetlandPony

Ok, so you get a two-for-one deal with chemo. It may very well punt you into menopause, which of course is good for ER+ PR+.

I know, I go around singing "Radioactive" after my scans. My kid hates it that I will not hug. But I like to tease the nurses by asking if they would like a hug. I hope this doesn't bother anyone: I heard a really funny story about a guy receiving radiation therapy for prostate. He surprised his wife with a glow stick under the sheets...

doxie

solfeo

I nearly spit tea on my keyboard picturing that glow stick! Sounds like something my husband would do.

Weird thing happened. I found my bottle of Ativan open in the side pocket of my purse last night, and the pills were spilled out. 3 of them were missing. I know exactly how many I had because I had counted them for my PCP on Monday because she likes to keep track of how much I'm using. I know how many I took Tues and yesterday for the scans and I'm as sure as I can possibly be that I screwed the lid on tight, because it is my routine to check that the childproof cap is secure. They couldn't have fallen out of the pocket because it is deep and not loose enough for anything to get out without taking it out. That compartment has a magnet instead of zipper and is easy to reach a hand into, though.

For my MRI they gave me a locker to keep my purse in but for the bone scan the guy told me to put my purse on the chair, where I couldn't see it for the next hour I was on the table, because I wasn't allowed to move my head. Plus I fell half asleep while I was lying there. I think he took those pills, but instead of taking the whole bottle, which would definitely be suspicious, he left it open and dumped out the contents so I would think they were lost.

He was joking around with me before the test, but afterwards he was acting differently. I noted it at the time because that worried me that it meant he saw something in scan. Now I wonder if he was feeling guilty.

I can't complain with no evidence whatsoever, and I would never want to get anyone into trouble if I'm wrong, but I will always insist on a locker in the future if one is not offered. And if I ever get the same guy again, I will do so pointedly so he knows I know what he did.

ShetlandPony

That's kind of creepy. I guess you'll need to tell your PCP if that's going to make you run out of pills. I wonder what she will think.

BrooksideVT

Perhaps call the radiology department anonymously? And not identify the technician? I suggest anonymously because if you give your name they will be able to identify the technician.. They would be able to keep an eye out, or at least move the chair.

solfeo

She gave me a refill Monday so I have another bottle. I thought the same thing: would she believe me? She knows I haven't abused them so far so I guess I could get away with one far-fetched story. Probably not that far-fetched really - a lot of hospital employees are addicts, including doctors. What a rat, stealing meds from a cancer patient.

At 1:45 my time I get the news from the scans. I'll definitely be drugging up in advance for that.