Doctor Visit Number Two - UCLA

One week after visiting Dr. Adashek at Cedars Sinai, Crea and I found ourselves at UCLA visiting with Dr. Yeh. As I mentioned in the last post, the facts seem to be clear at this point and surgery appears imminent. Because of this, I did not anticipate a lot of new information coming from Dr. Yeh but merely Crea determining who she would be more comfortable with as a surgeon. As is with life and certainly this entire situation, reality was not quite as expected.

We arrived at UCLA and it was immediately a different feel. It was a much bigger facility with a lot more foot traffic so we began the process feeling somewhat part of a herd. I think we both were thinking the small office environment at Cedars with 6 or so chairs in the waiting room was a more inviting setting than the 40 chair waiting room we sat in at UCLA. We were greeted at the receptionist stand friendly enough. Crea handed over a packet of information that she had filled out prior to arrival and was then asked many questions........the answers of which were in this same package Crea had provided. I only mention this because it was very funny to watch my wife deal with the scenario. Crea is truly one of the nicest people I know. She is very caring, very welcoming and very friendly. She was trying to draw on all of these characteristics and hide the tremendous frustration she was feeling at having taken all the time to fill out the forms yet verbally have to respond to the same questions........just prior to each of her answers Crea would kindly point to the packet of information sitting on the desk. To the world, Crea appeared fine. To me, I knew she was boiling which for some reason struck me as funny. I could definitely see a Seinfeld episode coming out of the interaction...Seinfeld, Table for 4?

We were immediately called in to the office and were initially greeted by a student. The paperwork mentioned the possibility of student interaction which I know is vital to training our surgeons of the future but we still found ourselves a little frustrated. Funny enough, Crea was yet again responding to questions to which the answers were contained in the packet of information now residing with our student doc. Dr Yeh ultimately arrived and he had quite a personality. Dr. Yeh actually was a self referral for Crea and we were very unprepared. Crea didn't bring a lot of the medical records so we put the Dr. Yeh in the awkward position of having to rely on conversation. Funny enough, one of the papers we did have with us was from the recent blood tests which he noted were processed at a USC Lab. His comment was that the USC Lab is one of the best in the country for this type of test but he still managed to sneak in......."as much as it pains me to say that"........I love USC haters so we have to score one for Dr. Yeh at this point.

We walked Dr. Yeh through the entire history....cancer diagnosis while pregnant, surgery in 2004, radiation in 2005 and all the recent findings. He is very thorough but would definitely be a good addition to the Seinfeld episode. Add to this episode the fact that we were really not sure the proper protocol for getting the opinion of a second surgeon. Do we mention the prior visit? Would it offend Dr. Yeh? Were we committing medical adultery against Dr. Adashek? We were not sure so we remained silent on the topic. We just presented the facts and must have appeared to be medical geniuses with some of the questions we asked.

Dr. Yeh walked us through the evidence based theories on why to operate or why 'not' to operate. He said because of the suppressed growth, Crea might live to be 85 and die of a heart attack if we do nothing. He gave extreme examples where you would probably not operate on the 80 year old in bad health in which surgery posts many complications and you would clearly operate on the 19 year old in good health (minus the cancer) that could clearly tolerate surgery and has a long life yet to live. Enter Seinfeld as Dr. Yeh began to say that Crea is somewhere in the middle of very old and 19 (risky direction here) but then recovered to say she was clearly closer to the 19 year old scenario which would lean towards surgery.

After much discussion, Dr. Yeh wanted to perform his own ultrasound. He actually insists on this so he can see the issues with his own eyes and draw his own conclusions. It is this ultrasound where things started to turn a little south from expectations. The outcome of the new ultrasound was actually the discovery of 3 more cancerous lymph nodes bringing the total identified up to 6. While the doctor was very clear to say this discovery does not change the fact that Crea will be okay, I found the news to be a little disheartening. Maybe 'disheartening' is not the right word. I am confident Crea will be okay but the knowledge that cancer is inside my wife is frightening thus the fact that more cancer is inside my wife than originally thought is even more frightening. I think the other issue is that as a husband, I feel helpless. I can not cure my wife. I can just get my arms around things and try to comfort the situation. When the facts change, it is hard to get to stable ground.

At the end of the ultrasound, Dr. Yeh showed us the pictures he captured. Unlike the ultrasounds I am used to seeing, there was no beating heart of a baby. Instead we had to look at pockets of cancer inside my wife's neck. It is not a lot of fun coming face to face with your nemesis but that is what it felt like. I was staring into the eyes of cancer and it was not a pretty sight. Dr. Yeh then drew a diagram so we could understand where the cancer is in relation to Crea. It is all contained in the right side of her neck. Some is fairly close to the original scar and some is extended a little farther out to the side. From this news, I asked the question as to whether the original entry into Crea's neck could be utilized. Please note I could care less about the scar, where it is or how big it is. I know my wife cares which is why I asked the question. I never even notice her current scar and I doubt others do either....unless they too have had thyroid surgery and are sensitive to the process (kind of like you never notice so many Honda Elements until you actually buy one and then thousands are on the very street you live on).

My question lead to the final detour from expectations. Dr. Yeh has a more aggressive approach and believes in taking out many of the lymph nodes in the area where the cancer exists. His analogy was that if one house in the area is on fire, remove all the houses in the zip code. He presented two scenarios. One was to extend the surgery both upwards and outwards which would remove multiple sections of lymph nodes from the entire right side of Crea's neck. The second scenario was to slightly extend the current scar and take out 2-3 sections of lymph nodes. He ultimately settled on the second scenario because of data which indicates the cancer does not tend to invade the upper section of the neck. Either approach seems more aggressive than Dr. Adashek who believed you go in and get as many lymph nodes that have cancer or look suspicious. Which approach is correct.............I wish I knew the answer but all of this information sent my brain into overload.

-why didn't the first ultrasound catch all of the cancerous nodes?
-would Dr. Adashek have done his own ultrasound to find the additional cancer and should I care?
-if no additional ultrasound was done, would the additional cancer have been found during surgery and, if not, what would the consequences be?
-Dr. Yeh said surgery could wait until January/February but again seemed to indicate not waiting too long. Why? If earlier we were told Crea could live to 85 and die of a heart attack, what is the rush?
-Dr. Yeh said there is a 1% chance of harming the vocal chords during surgery leaving Crea hoarse for the rest of her life. I asked about his personal history and he said it was consistent with the 1%. Dr. Adashek said his history was zero..........why the difference? Is it the aggressive versus non aggressive approach?
-Dr. Yeh would want to examine the vocal chords prior to surgery. I don't remember this being mentioned in the first visit.
-If you go with a less aggressive approach now, and more lymph nodes become cancerous at a later date, is the next surgery more risky due to scar tissue from what is now two operations?

All things to think about. All things that invade my thoughts throughout the day. I am sure both surgeons are fantastic. Maybe there is no wrong choice here but my wife is involved and I just want her to be okay. I want the cancer out and to stay out. I want my wife to know she is beautiful with or without a scar and I want a cure for cancer. That can not happen without all of us committing to making it happen. I am certainly not skilled enough to find the cure but I can run and I can bike and I can sort of swim. I need your help though on this little journey my family finds itself on. I am committed to raising $10,000. For my wife, I will raise at least that much. If you can help with a donation, please click on the link above. If the link is not working, you can go directly to my site at http://pages.teamintraining.org/los/lavatri10/4mywife . If you are not in a position to donate, I completely understand and am grateful for your taking the time to read my long winded words.