Medical record: what would you do

I have seen those studies too that show a link between alcohol and the risk of cancer or recurrence, so I suspect her advice is based on medical studies. (she's not just trying to give you a hard time).  FWIW, I've heard there are ways to get the same health benefits of wine from other sources (there's a supplement; maybe certain types of grapes too?).   I'm not expert on alcoholism but I remember seeing a list of some warning signs and one was justifying the drinking by saying you can quit anytime.  (you can probably find the list on google).  Maybe one option is to just try and see? What if you cut back to her recommendation for a few weeks and see how you feel? Maybe you'll find you won't miss it??? Good luck.

I agree with cycle-path with respect to how we all consider risk when we make choices about life style, diet etc. The health benefits to having wine don't pertain to breast cancer. Your wording, ..." I'd find that hard to give up.", with respect wine drinking is a bit concerning. Would you rather not give it up, as a choice or would it truly be hard for you to do? If it is something truly hard for you to do, then confronting the possibility of alcoholism is something you need to explore , for more reasons than bc. AA is not the only path to sobriety. I wish you the best and happy holidays as well.

Caryn

The decision is yours in the end, but I don't think the doc was out of line. My consumption used to be like yours, i.e. 1-2 glasses a day. I cut it out when I was DXed. It unnecessarily burdens my system during treatment and does appear to be linked to recurrence. Especially if there is a family history of alcoholism (in my family too), it is a very good idea to cut it out once in a while, just to remind yourself that you can.

Tarry,

Separate from whether you have a problem, I to would be upset about that particulary wording in my file.  The difficulty becomes if you ask to respond or her to edit, it will just fuel her sense that you have a problem.  I have asked to items removed from medical and schooll records before and it has happened, but alcohol is dicey becasue of everyone's perceptions of what they would consider your denial.  You have to decide how to go on this.

Regarding the use or abuse of alcohol, I was well on my way to having significant difficulty, as was pointed out by both of my kids.  This was before my DX by about 2 years.  I found women for sobriety online and they have been a great source of information and support.  They have very active boards and chats and in some areas face to face meetings. Coming to terms with drinking and where I was has not been easy.  My recommendation is google women for sobriety and join the boards.  You will pretty quickly recognize yourself in others there or not. The philosophy is positive and empowering and based on women's needs. 

Be well on this journey.

Nel

Barbe, I also drink vats of all kinds of green and herbal teas now.

I am rather surprised by the responses to this post. A glass or two of wine per day is not excessive unless each glass is 64oz. These responses are on a website that oftentimes celebrates "better living through chemicals." How many women on these boards are taking chemical-altering drugs like exxefor and cialis and who all knows what. Another group take drugs daily to sleep, wake up, reduce anxiety, etc.

I would probably spend some time thinking about my relationship with alcohol since at least one doctor thinks that you have a problem. Perhaps substituting a citrus seltzer drink for the wine for a week. How does your body respond? How about your mind? 

As to whether or not this particular doctor has over-stepped the doctor/patient relationship, probably not. However, the note that she put in your records sounds like your RO has her own issues with alcohol. If you feel the essential essence of this note is fundamentally wrong, I would ask to have the portions you think are incorrect removed or ask that you be allowed to create an addendum. And yes, I would switch doctors.

Spoken from someone who recurred without alcohol use.

*susan* 

Well, I would have a problem with a doctor misrepresenting what I said in my files.  Tarry, you said you didn't ttell your rad onc that you thought were an alcoholic.  If you didn't say that, that shouldn't be in your files.  There is a hugh difference between saying you don't wan't to decrease your current alcholol consumption versus saying you are an alcoholic.  

In my mind, the rad onc is not qualified to diagnois you as an alocholic.  Her role should be to advise you on your specific risk of recurrence and how continuing to consume alcohol at your current rate will effect you.  Period.  It is your choice what to do.

My onc and I discussed my alcohol use in relation to my risk of recurrence.  I don't think it is worth changing the habits I enoy based on a slight decrease in my risk.  I'll concentrate on exercise as that will have more effect on my chances of recurrence and is something I am more likely to do.

Jumping in here - my beloved sister passed away 8 years ago from bc and she "only drank two or maybe three glasses of wine with dinner" it was "only wine" - well she drank her "only wine" until she died at the age of 60.  I had read many years before that the Junior League had done some research and from that had ascertained that wine and hard liquor had the same effect on women's bodies so I pretty much gave up regular drinking at that time (by regular I mean maybe once or twice a month on a weekend) - now I will drink a little scotch or a glass of wine when I am celebrating something with friends and probably only two or three times a year - the old definition of an "alcoholic" I used to hear when I was in the "oil patch" was "if you can remember when you had your last drink - you are an alcoholic" - tough but probably true.  As for AA's success rate - who knows but it can't hurt to try (or can it????)  As for the oncs notes I'd ask her to change them so they reflect your true conversation with her.

Saw one too many go down hill from 1 or 2 drinks.Especially if it runs in your family.I wish you the best.hugggggs K

Oh Tarry.  I don't think you deserve the attacks you got.  I also don't think you need a trip to AA.  YIKES.  Here is a more balanced view of the subject.

http://ecancer.org/tv/pubdate/364

Remember that everyone is assuming here that alcohol consumption is accurately reported.  My own view is that it is most likely significantly underreported.  I say that because there is a "right answer" and also because we tend to underestimate the exercise we get and underestimate the calories we inhale.

After seeing this, I decided to continue to drink wine, and I mean more than 3 glasses per week.  I am indifferent as to where my risk of mortality comes from.

Anyway, I felt like I was at a Women's Christian Temperence Movement meeting upon reading the earlier posts.

I would ask to get the chart corrected.  Say that there was a misunderstanding, and that you were referring to specific family members.  I would use evidence of why you said this.  This is important.  Say you were sorry about not being clear, and eat some crow.  But don't let them get away with branding you an "alcoholic".

Good luck.  You can make the decision to drink or not drink.  I didn't drink during chemo because of the strain on my liver.  But I am not willing to give up wine either.  I think your RO may need a bit of education too.  The study made major headlines.  It also did not separate out women who have used hormonal therapy, so we don't have a good read there either.  (They didn't have a large enough sample....I checked.)

You have to remember too that advice reflecting alcohol consumption may also reflect the lifestyle of the particular physician you have.  My first oncologist was all about permanent abstinence, whereas my breast surgeon (who greatly enjoys her wine) was about "moderation".

But get your medical record amended. - Claire

Tarry,

I understand perfectly where you come from. I also have alcoholism in my family (my Dad). 

I used to drink - not wine, but beer, 1 or 2 cans every evening (I live in OK so it was the 3% alcohol one). In my youth I used to drink a lot, especially in college, until one day I said "whoa, I don't want to be like Dad" and since then I only had my 1-2 beers.

My "luck" if you want, is that I had to take so many pain killers after multiple surgeries and then have the chemo and more surgeries and I totally HATED the added dizziness. So since then, yes, I might have a beer or two but that would be MAYBE once a month. Or maybe a glass of Irish Cream on the holidays.

The thing is, you came here for advice regarding your medical record, not for us to tell you how much you could or should or not drink. One thing is for sure, none of the replies you got was to criticize you, everybody pitched in because we CARE and want to help another sister.

If I think the RO was stepping over boundaries? yes. You do not treat an adult woman who just went through Hell and back like that. The discussion with you should have sufficed - she's not supposed to be your counsellor, just your physician. She should have referred you to a counselor. The "I told you what to do and you dont' want to hear, I wash my hands" is a very poor approach.

As for my little piece of advice, and please take it as concern and care: did you think of trying to slowly replace the wine with "placebo"? I.e. get some really really good grape juice, and start mixing it with the wine.. First a little bit, and every day or every few days change the proportion, using more grape juice and less wine, until you replace almost all the wine. It might work?

I just listened to that link with Dr. Holmes. That link is from 2009 and utilizes the "Nurse Health Study" that has been used for so many diseases and is becoming obsolete. She spoke about recurrence AND obesity. But didn't mention current breast cancer patients and alcohol. She mentioned nurses without breast cancer being more apt to get breast cancer with alcohol consumption. You have to listen really hard to hear the differences.

We already have breast cancer. What is our risk of recurrence with more than 2-3 drinks a week? I've heard as high as 30%!! With those kind of numbers, I quit. I've also heard that high alcohol consumption (more than 3 drinks a week) IMPLIES a certain 'lifestyle' that puts women at risk; smoking, bad eating and alcohol and drug use. Just because we drink doesn't mean we shoot heroin!!!

Barb.....The Women's Christian Temperence Movement strikes again!  You might want to look at the video one more time.  Michelle Holmes is one of the most respected epidemiologists in the world.

She pointed out that Overall Mortality was no different between women who drank alcohol and those who didn't.  Women who drank up to 2-3 glasses of wine daily were more likely to die of BC, but less likely to die of heart disease.

Then she pointed out that this was consistent with other work she has done.

I just went out and had three glasses of really wonderful Washington State wine from the newest American Viticultural Area (AVA).  So Cabernet Franc from Naches Heights.

I also need to comment on this:

"I've also heard that high alcohol consumption (more than 3 drinks a week) IMPLIES a certain 'lifestyle' that puts women at risk; smoking, bad eating and alcohol and drug use. Just because we drink doesn't mean we shoot heroin!!!"

I came back to a meal of smoked pork shop from the German butcher, red kale, carrots, and potatoes anna.  Plus a ripe persimmon.  I would say that there is also a significant "foodie" lifestyle.   I am steaming Christmas Puddings tomorrow (with brandy)

The only other "drugs" I take are anastrazole and aspirin, again because of the work of Michelle Holmes.  No "sleep aids" and no "antidepressants".  I use exercise instead.

Off to bed in a couple.  No drugs, but will take my new Hot Water Bottle.  This represents the "H" in my case.  I expect to sleep soundly. - Claire

Tarry:  I hope you do not leave such a generally supportive forum over this one topic.

Personally, I see that you did not post this question for advice or comments on your drinking habits.  You clearly are concerned and asking about what is now in your medical record. 

My take: The doctor has the right, and obligation, to note the discussion he/she had with you regarding his/her medical concerns.  However, the comment "She articulates that she believes she is an alcoholic and that she is unable and unwilling to cut down her alcohol use. She is resistant to any and all interventions.", if false, should be removed from your record.  You have a right to have that removed.

I suggest you tell the doctor to do so at your next visit, and if he/she refuses, take it up the chain of command.  It is an inaccurate reflection of your statements.

As a medical attorney, I review and apply patient comments in medical records to legal proceedings.  It is very, very common for me to ask a witness "isn't it true that you reported to your physician that you knew you were an alcoholic and refused treatment for same."  So, yes, if you did not make those statements, they should be removed from your record.  It is good that you noticed it and should push for it's removal.