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FirstHealth of the Carolinas
Sisterhood of hope




of hope




by Kathy Batton

This is the story
of a sisterhood,
but one that most
would prefer
not to join. If
you do, you may
come to see it is
a sisterhood of
hope. That’s how
Patti Friedman
sees it.

Patti joined her sisterhood in January 2007, when she was diagnosed with breast cancer. The vivacious, energetic wife and mother of two had never considered herself a likely candidate for breast cancer. There was no family history, she ate right and exercised, and she was only 47 years old.

But cancer follows its own path. Patti’s journey with breast cancer began in October 2006 with pain and then a small lump in her left breast. She rationalized the symptoms as fibroids, which she had had before, and soreness from aerobic exercise. When October became November, Patti noted that the pain had worsened but still wasn’t intolerable and that the lump had changed a little.

She told herself she would get through the Thanksgiving holiday and then have it checked out.

December became a blur of doctors’ appointments and tests. The first week of the month started with an appointment with her OB/GYN, who scheduled her for a mammogram the following week. A second mammogram and ultrasound followed during Christmas week. By New Year’s, she had had a guided biopsy.

Next came an appointment with a general surgeon. The visit confirmed Patti’s fears: breast cancer.

Breast self-exam

Simple steps
for self-exam

Self-exams are cost-effective (because they’re free) and easy to perform. To conduct self-exams, follow these simple steps:

  • Lie down and place a pillow underneath your right shoulder. Place your right arm behind your head.
  • Use the finger pads (the top third of your fingers) of the three middle fingers on your left hand to feel for lumps or thickenings in your right breast.
  • Press firmly enough to know how your breast feels (ask your doctor if you do not know how hard to press). It is normal to feel a firm ridge in the lower curve of each breast.
  • Move around the breast in a pattern to ensure that you feel all areas of your breasts. You can use one of the three patterns shown in the chart below. The arrows show you how to move your finger pads on each breast.
  • Now examine your left breast using the finger pads on your right hand.
  • Check your breasts again while standing up, with one arm behind your head. (You might want to do this part of the BSE while you are in the shower. It may be easier to feel for changes when your skin is wet and soapy.)

Things continued to move quickly as Patti had more tests and then underwent surgery—a mastectomy and removal of 12 lymph nodes.

Later, as she recovered at home, Patti sat in her recliner (the most comfortable place she could find) and had a number of conversations with herself and with God. Those talks became a deciding factor for her new journey as she decided to fight the disease with everything she had.

Patti chose a local oncologist to help her in her fight, and she started her on a course of treatment that included both chemotherapy and radiation therapy. And Patti — well, Patti started studying, devouring any information she could find about the disease and asking questions of her medical team.

Determined to meet her disease head on, she looked into the clinical trials being offered at FirstHealth Moore Regional Hospital and was accepted into one.

Throughout her journey, she continued to work, scheduling her treatments on Thursdays so she would have a long weekend to overcome the side effects. She chose to see the glass as half-full instead of half-empty and began cutting her red hair into shorter and shorter styles, knowing that it would eventually be gone. When it was, she found she loved the freedom of being bald.

She and other “Thursday regulars” at radiation therapy formed a support system, helping each other out when needed. She was overwhelmed by the support of her family, church, co-workers and friends.

Through it all, she kept repeating the phrase that had become her personal mantra: “Keep fighting, keep the faith and keep positive.”

It has been more than two years since Patti’s breast cancer diagnosis. Since then, she has attended two Cancer Survivors Day celebrations as a selfdescribed “newbie” awed by 10- and 20-year survivors. She realizes the type of cancer she had will more than likely lead her down more rocky roads as the chance of a reoccurrence is high. But that’s OK, she says; she knows what to expect now. No matter what path her journey takes, she still has her sisterhood—her sisterhood of hope.

Patti Friedman is director of the FirstHealth Center for Health & Fitness-Richmond.

Advanced diagnostics and treatment options at Moore Regional Hospital

Because one in every eight women develops breast cancer and because early detection and appropriate treatment greatly increase the chance of a cure, FirstHealth Moore Regional Hospital offers digital screening mammograms as well as advanced diagnostic procedures and a complete arsenal of treatment options.

In addition to digital mammography, radiologists at Moore Regional use computer-assisted detection (CAD) technology to help them spot possible abnormalities in the breast. The CAD system acts as another set of eyes and, in a major study, was found to significantly increase the detection rate for early stage breast cancer.

If a mammogram shows a possible tumor, then a radiologist usually orders specific diagnostic images that focus on that part of the breast. The next step is typically an ultrasound exam to provide the radiologist with more information about suspicious area. These additional images determine if a biopsy is needed, says radiologist Carolyn Maynor, M.D.

With a biopsy, the physician removes a small sample of tissue for laboratory analysis. In addition to ultrasound-guided biopsy, Moore Regional offers stereotactic biopsy, which provides a three-dimensional image for even greater precision sampling. In some cases, an MRI may be ordered to help with the final diagnosis and a treatment plan.

Depending on the size, location and type of tumor, breast cancer patients at Moore Regional have a number of treatment options.

“We may recommend radiation therapy, infusion chemotherapy, oral chemotherapy, hormonal therapy, biologic therapy or surgery,” says medical oncologist Ellen Willard, M.D., adding that a combination of therapies is often used.

Radiation oncologists at Moore Regional use CT scans for treatment planning to help them precisely target beams of radiation that kill cancer cells. “This allows us to focus the radiation on the tumor and areas at risk while avoiding damage to the surrounding tissue,” says Sushma Patel, M.D.

For some patients, physicians recommend a method of delivering radiation called brachytherapy. With brachytherapy, a balloon is placed inside a lumpectomy cavity to deliver high doses of radiation. The balloon is temporarily implanted in the breast and removed after the treatment is complete. Moore Regional was one of the first hospitals in the state to offer brachytherapy for breast cancer.

Some breast cancer patients require surgery, and some of them have mastectomies (the removal of the entire breast). For many patients, however, surgeons at Moore Regional are able to perform a lumpectomy, meaning they remove the tumor while leaving most of the breast intact.

Centralized care at the RMH Women’s Imaging Center

Mention the Women’s Imaging Center at FirstHealth Richmond Memorial Hospital to John Tucker, the hospital’s director of Imaging, or to Radiology Department Medical Director Scott Hees, D.O., and both will quickly clarify one thing—comprehensive women’s imaging, not just breast health, has been the center’s focus since its June 2004 opening.

“I am proud that we have focused on women’s imaging at RMH,” says Dr. Hees, a staff physician since July 2002. “Essentially, the center is a separate area of the Radiology Department that was expanded and renovated to house mammography, ultrasound and bone densitometry.”

“Richmond Memorial relocated these units to the Imaging Center to provide a more private setting for the imaging modalities that are primarily used by women,” says Tucker. “Abnormal testing results easily produce anxiety, and we try to make the overall experience better for women.”

Indeed, maintaining privacy is critically important for any RMH patient dressed out in a hospital gown and transitioning among treatment areas. The center’s centralized screening and diagnostic area was intentionally designed not to be associated with other RMH imaging services, allowing gown-clad female patients to discreetly cross the hall from mammography to ultrasound. For the center’s four rotating radiologists, three mammographers and a clinical supervisor, its adjacent location to the Radiology Department also enables ease of transition between daily clinical and administrative duties.

By way of the Women’s Imaging Center, Richmond Memorial’s mammography unit became the first within the FirstHealth system to boast both computer-aided detection (CAD) technology and digital mammography. When it first opened, the center began using CAD’s digital conversion to better detect abnormal findings, although it remained a film-based mammography service. In May 2008, the center acquired digital equipment and became certified to begin offering diagnostically superior digital mammography.

“Richmond Memorial was the first hospital in the region and the first in FirstHealth to integrate CAD technology and digital mammography,” says Dr. Hees. “Both have been shown to increase the detection of breast cancer.”

Dr. Hees’ push for improved patient adherence to mammography comes up throughout the discussion of his work. Both he and Tucker especially value the center’s practice of having a hospital radiologist speak directly with all mammography patients following any diagnostic study—whether the findings call for a second round of evaluation or not.

“An abnormal screening mammogram can really generate anxiety, and I think it’s important for the patient to know the results the day of the exam,” says Dr. Hees. “The anxiety is relieved if the study is negative, and steps can be hastened to determine a definitive diagnosis if it is positive. Whether at Richmond Memorial or elsewhere, women need to start getting a yearly mammogram after age 40.”