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Test Those Breasts ™️
This podcast by Jamie Vaughn is a deep-dive discussion on a myriad of breast cancer topics, such as early detection, the initial shock of diagnosis, testing/scans, treatment, loss of hair, caregiving, surgery, emotional support, and advocacy.
These episodes will include breast cancer survivors, thrivers, caregivers, surgeons, oncologists, therapists, and other specialists who can speak to many different topics.
Disclaimer: I am not a doctor and not all information in this podcast comes from qualified health care providers, therefore does not constitute medical advice. For personalized medical advice, you should reach out to one of the qualified healthcare providers interviewed on this podcast and/or seek medical advice from your own providers.
Test Those Breasts ™️
Episode 78: Revolutionizing Breast Cancer Care: Dr. Colleen O'Kelly Priddy's Passionate Mission
Dr. Colleen O'Kelly-Priddy, our esteemed guest with an impressive track record in breast surgical oncology, shares her passionate journey and mission to revolutionize breast cancer care at Renown in Reno, Nevada. With October designated as Breast Cancer Awareness Month, Dr. O'Kelly-Priddy enlightens us on the critical importance of screening mammograms and breast self-awareness. She also introduces the groundbreaking Conrad Breast Center, which promises comprehensive care with integrated surgical, medical, and imaging services, setting a new standard in the region.
Navigating the complexities of post-cancer life, especially in terms of hormone management, is crucial for breast cancer survivors, and this episode offers valuable insights. We tackle the challenges of securing regular screenings and the power of centralized care facilities like the Conrad Breast Center in aiding seamless healthcare communication. Dr. O'Kelly-Priddy provides expertise on hormone replacement therapy and the use of biomarkers, ensuring survivors make informed, personalized decisions about their health. The episode also touches on the revolutionary oncoplastic surgery approach, blending cancer-removal techniques with plastic surgery for enhanced post-surgical outcomes.
The conversation doesn't stop at medical treatments; it extends to holistic care and community support. For those grappling with the emotional and practical challenges of a breast cancer diagnosis, essential resources like the Nevada Cancer Coalition and Community Health Alliance are spotlighted for their supportive roles.
Breast 360 - a reliable resource for breast patients written by breast surgeons www.breastcancer.org
Donate here to the Breast Imaging Fund:
https://www.renown.org/About/Renown-Health-Foundation/Secure-Online-Donation
Select “Renown Breast Imaging Fund” from the drop-down menu
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I am not a doctor and not all information in this podcast comes from qualified healthcare providers, therefore may not constitute medical advice. For personalized medical advice, you should reach out to one of the qualified healthcare providers interviewed on this podcast and/or seek medical advice from your own providers .
Hello friends, welcome back to the Test those Breasts podcast. I am your host, jamie Vaughn. I'm a retired teacher of 20 years and a breast cancer thriver turned staunch, unapologetic, loud supporter and advocate for others, bringing education and awareness through a myriad of medical experts, therapists, caregivers and other survivors. A breast cancer diagnosis is incredibly overwhelming, with the mounds of information out there, and other survivors A breast cancer diagnosis is incredibly overwhelming, with the mounds of information out there, especially on Dr Google. I get it. I'm not a doctor and I know how important it is to uncover accurate information, which is my ongoing mission through my nonprofit. The podcast includes personal stories and opinions from breast cancer survivors and professional physicians, providing the most up-to-date information. At the time of recording Evidence, research and practices are always changing, so please check the date of the recording and always refer to your medical professionals for the most up-to-date information. I hope you find this podcast a source of inspiration and support from my guests. Their contact information is in the show notes, so please feel free to reach out to them. We have an enormous breast cancer community ready to support you in so many ways. Now let's listen to the next episode of Test those Breasts. Well, hey, friends, welcome back to this episode of Test those Breasts.
Speaker 1:I am your host, jamie Vaughn, and today I am super excited to be connected with my guest, dr Colleen O'Kelly Priddy. She is a fellowship trained breast surgical oncologist, dedicating 100% of her practice to the surgical treatment of breast cancer and related issues. She graduated from Stanford University for her undergrad, the University of Nevada, reno of medicine for medical school and then completed general surgery residency at the University of Washington in Seattle. She then undertook an additional year of subspecialized training in breast surgical oncology at the University of Southern California. She then practiced in New York for five years and California for two, and now she has returned to Reno, nevada, where she lives with her husband, two sons and three cats. You have a full house there. Dr O'Kelley. It's nice to connect with you. How are you today?
Speaker 2:I'm very well. Thank you so much. It's a privilege to be here.
Speaker 1:Well, I'm excited at the fact that getting myself really connected with the breast cancer community here in Reno, nevada. I've spoken at a couple of events for some community members here, and I have interviewed someone from Renown, teresa Schatz, and very early on in my podcast she reached out to me to connect me to a campaign you guys are working on. We're going to talk about that in a little bit, but I would love to hear a little bit more about you, who you are and how you contribute to our breast cancer community. Well, thank you very much.
Speaker 2:I was born here in Reno at Washoe Medical Center back when it was Washoe Medical Center and grew up in Susanville, california. I like to say that the closest civilization to where I grew up is Reno. So then after undergrad I came back to Reno for medical school, had a wonderful four years here and then have been sort of all over the place since then. I was in Seattle for eight years, los Angeles for one, new York for five, back to California for two, and then Renown decided that they were going to create a new breast center and I said I want to get in on the very ground level of this so that I can make sure that it is absolutely top-notch, first-class, world-renowned, if you will, treatment for breast cancer. And so here I am and I'm thrilled to be back.
Speaker 1:I'm so excited about this because, first of all, we have a great medical center here at our medical school here at University of Nevada, reno. I know my own nephew and my niece went to UNR Medical School and they're off doing their thing around the United States now, but I like the fact that you have been to several places so you have gotten to know different cultures with regard to the breast cancer community. But then you came back here. That says something really big, and I personally love Renown.
Speaker 1:Renown has always been really good for me and my family. They treated my mother really well there when she died five years ago, and I just have nothing but great things to say about Renown, and so just having you back here says a lot about how good this is all going to be. I just know that I've noticed a lot of different communities around the United States that have these great breast centers, and people sometimes want to go there because it's so great. So to have something that's being built out and with people like you here in our own community is just super exciting, and I can't wait to hear more about it. So you guys are working on a campaign right now which is something very near and dear to my heart, which is why Teresa reached out to me, and I would love to hear more about that.
Speaker 2:Sure, so happy. October it is Breast Cancer Awareness Month. So happy October, it is Breast Cancer Awareness Month. And so every October, at Renown, we have a big push to try to really inform women about the importance of screening mammograms and the importance of breast self-awareness. So we are right in the middle of that right now, and tied into that is raising awareness within the entire community about the Conrad Breast Center, which is what is being built down off of South Meadows, next to the South Meadows Hospital campus. If you drive past and look at all the cranes, it is going to be really phenomenal.
Speaker 2:So on the second floor of that building are a whole new set of operating rooms, one of which will be dedicated to breast, which is great. And then on the third floor is where the Conrad Breast Center is really going to be and that is going to have breast surgical oncology that's me and my partner, dr Chu. Then there is medical oncology right across the hall and then just down the hall, another step is breast imaging and that includes mammography and ultrasound, and then we have a breast MRI right across the parking lot at the South Meadows. So we're going to have everything right there and eventually this is more on the five to 10 year plan as opposed to the one year plan. We're going to try to bring radiation oncology down to the South Meadows campus as well, so that patients from all over the greater Reno area will have easier access to all of these treatment modalities.
Speaker 1:Will that come with, like infusion and all of that?
Speaker 2:Yeah, infusion is already being built in along with the medical oncology.
Speaker 1:Great. I was going to the Renown Infusion. I still go there for blood draws every month because I developed this really rare anemia. That was not because of iron or anything like that, it was. They found a thymoma tumor in my thoracic cavity. When they found the breast cancer that had been apparently been sitting there for many years, probably growing, it was benign but it was producing these antibodies that were attacking my red blood cells that were already producing too slow, and so I had to go on this medication and so I had tons of blood transfusions and I got those transfusions and I still get my blood draws in that infusion center at Renown, and I love the people in that infusion center.
Speaker 1:So I'm really glad that there's going to be an expansion of that, with amazing nurses and things like that. So for people anyway. So that's really exciting because obviously we know one in eight women get breast cancer, men get breast cancer, and so it's one of the top cancers like in the world. Right, it makes sense to really build that out in all of the communities. I'm so excited about that. Most people know that I am now what they call a lemonista with Know your Lemons, and it's knowyourlemonsorg and it's a worldwide organization that people become aware and they get educated and are able to teach other people tons of people about breast cancer and the importance of knowing your risk early detection, what kind of screenings are out there? Dense breasts, all of that, breast self-exams, how to do it, and so what are your words of advice on why it's so important to be aware and learn so much, even if you've never been diagnosed before? Absolutely.
Speaker 2:So breast cancer can present in so many different ways. There are infinite ways that breast cancer can present. What I usually recommend to patients is don't let your brain fall asleep when you're in the shower and back. You know, back in the 90s we used to hand out those cards that you were supposed to hang up on the showerhead and you had to do this very regimented self breast exam and it just freaked everybody out because breasts are lumpy, bumpy and people thought, oh my goodness, my entire breast is full of lumps. I clearly have cancer. And that's not the case. So what I recommend is know what your lumpy bumpy is, and that doesn't mean memorizing every little ridge of tissue in the breast. It just means know what feels normal, because what I really want is for people to be able to identify when something changes, when the tissue doesn't just move the same way that it normally does, if there is a lump that feels very different than all of the other lumpy bumpiness, if the skin looks different, if, when you raise your arm, the tissue suddenly pulls in one place where it doesn't do that on the other side All of these things are potential signs of breast cancer.
Speaker 2:They're not a reason to panic.
Speaker 2:There are lots of things that can create all of these, but it's worth getting checked out and I really try to reinforce the concept that earlier detection leads to better survival.
Speaker 2:So we sometimes see women who can go through a lot of denial and not really believe that this is a problem, or just put it out of their minds, out of sight, out of mind, not a problem.
Speaker 2:But the truth is, if you come in and you see me when it is a centimeter or two centimeters in size and it's not in the lymph nodes yet, your survival is phenomenal. You're going to be around for the next 10, 20, 30, 40 years until it's God forbid eroding through the skin and has metastasized to the lymph nodes and spread to other organs in the body. Well, my options are really limited as a surgeon in those cases, because I can do a mastectomy, but if I can't close the incision then I'm leaving you with a big wound, and if it's spread to other parts of the body then it's not even necessarily beneficial for me to put you through the operation and leave you with cancer still behind in your body. So the sooner things are recognized and diagnosed, the better the outcomes are, the more treatment options are available and the better you're going to do. So that's why I say just don't let your brain fall asleep.
Speaker 1:It's very good advice and I taught 47 elderly men and women yesterday about early detection and what to look for and the Know your Lemons has like 12 lemons. There's a visualization of what to look for and I never even knew that there were 12 when I was diagnosed and I didn't know there were three kinds of things you might feel in your breast and mine was about two inches and hard. It was definitely different than the rest of my lumpy boobs and so just to learn, even now when I'm doing self breast exams it's hard because I don't have breast tissue anymore. So it's I have to go into my gynecologist, have her check and see if there's anything there, because I do know that if you get breast cancer it can come back, even you know, if you don't have breast tissue. But so which kind of freaks me out because I don't have a plan to get a normal scan or any kind of ultrasound.
Speaker 2:Yeah, so that's really important to know. We can, theoretically, remove a hundred percent of the breast tissue, but that is a barbaric operation that nobody's done since the 50s because it doesn't improve outcomes, and so anyone who has a mastectomy or a bilateral mastectomy should be aware that we are not removing 100% of the breast tissue, and so it is always possible that it could come back on the chest wall. It's also possible that it could come back, but present in the liver or the bones or the lungs or the brain, and there is no, unfortunately, get out of jail free card. Once you have the diagnosis, you will be at risk for recurrence forever. What we try to do is to minimize that risk so that you have the best possible chance of living to the natural end of your life as if you never had breast cancer and not having to deal with it more than once.
Speaker 1:So what does that mean for I mean, I know what that means for someone like me, but I'm curious why is it that and maybe this is a dumb question, I don't know, but I guess there's no dumb questions when it comes to breast cancer why is it that there are some people who, after they are deemed disease-free, that they have scans or ultrasound, whatever it is that their oncologist or their breast surgeon or whatever um tells them to do, like maybe every six months, a scan every year, a scan for like five years? But someone like me, there's no plan for that.
Speaker 2:Yeah.
Speaker 2:So the NCCN, the National Cancer Care Network, produces guidelines, and the truth is that for someone who has had a bilateral mastectomy, there is no indication for routine screening with imaging of any kind, whether it's an ultrasound or an MRI or mammograms and the data do not show any benefit to routine screening in the setting of bilateral mastectomy.
Speaker 2:And so for those patients in my practice, I offer a clinical chest wall exam every six months for at least the first two years, annually for at least the first five years. But I offer it for the rest of the patient's life because, as you know, whether it's implant reconstruction, a flat aesthetic closure or an autologous reconstruction, it feels different than a normal breast. It will never be 100% normal, and so not all primary care doctors or gynecologists are going to be super comfortable with what is normal for a flap reconstruction, what is normal for an implant reconstruction. And so to me it makes sense to say well, I'm the one who did this, I know what it's supposed to feel like and I am happy to continue to see you forever to keep an eye on you.
Speaker 1:Okay. So, with that said, and I know like I really had to find my voice and advocate for myself a lot during the journey. I may have pissed off people, I don't know During the journey, I may have pissed off people I don't know, but I knew that I had to advocate for myself and do what was right for me. With no intention of pissing anyone off, if you will, I was kind of just going through this like people telling me this and I'm just making my decisions. How does someone like me, who got my breast surgery done in New Orleans, do something like that? Like, who do I have to ask to be able to get some sort of screening at least every year for the rest of my life? I don't want to, you know, go about my life being a hypochondriac for the rest of my life. I just want to ensure that I'm at least being looked at and given the same opportunities to be able to be screened in some way. How do I do that?
Speaker 2:Well, you can start by calling Breast Surgical Oncology at Renown, because Dr Chu is my partner. She's been in town for 20 years or so and is obviously very well established. She and I have actually expanded our group and we have hired two physician assistants and one nurse practitioner. They serve as physician extenders so that when they are in clinic we are in clinic and they can be seeing patients and doing a good clinical chest wall exam or a breast exam if the breasts are still present, and then we are available. If there's something they're not sure about, we can come in, take a feel, look with ultrasound in the office and if we decide you know what there's something that does warrant a diagnostic imaging workup, we can offer it. That does warrant a diagnostic imaging workup, we can offer it. Once we're down in the Conrad Breast Center it'll go right down the hall and we'll get you right in to get that imaged immediately, and that is 100% of our practice.
Speaker 2:We are more than happy to see patients who have had breast cancer treated elsewhere, who are only at high risk for breast cancer, haven't even had breast cancer. Elizabeth Kang is our physician assistant who is creating and devoting herself to the high risk clinics. So patients who have a strong family history or a known genetic mutation like the BRCA1 or BRCA2 or any of the other dozens of mutations that we know can impact breast cancer risk. She is seeing those patients every six months. She is arranging for their imaging.
Speaker 2:The cool thing about the way we're setting this up is that we are a one-stop shop for breast health and, based on my experiences all around the country, that's the way to do it. Because so frequently patients can fall through the cracks. They forget to ask about their mammogram. The US Preventative Services Task Force comes out with a different recommendation saying that nobody should ever have mammograms and stuff. Stuff gets dropped, stuff gets missed and because breast cancer is so common, it has such a high incidence in our society. Having one place where you can go to know that everything will be tracked and followed and very carefully monitored, I think it's the right thing to do for the community.
Speaker 1:I do too, and I went to cancer. Or um, what's the right thing to do for the community? I do too, and I went to cancer, or what's the like. I want to forget all about my infusions and everything. Oh my gosh, what is the cancer?
Speaker 2:care specialist, the CCS.
Speaker 1:Thank you. Oh my God, like I told you like the last time I went in there it's like, let me out, yeah, cancer care specialists, and they were great. Like I had lots of great nurses over there. My oncologist is over there, but the one thing that I found was that sometimes the communication between that facility and Renown were not always in line, I guess, if you will. And so having that all in one organization is so much better. Everybody communicates with each other. It's the same system. You're on my chart and all the things. So this is really exciting for our area. I had no idea Somebody had mentioned something about building something, but this is the most I've learned about it so far.
Speaker 1:So what are some biomarkers? You know you and I were talking earlier, when we were before we started recording, about estrogen and when people should have estrogen, when people shouldn't have estrogen. So in my case I was HER2 positive, erpr negative. I had had a hysterectomy before breast cancer only because I had a huge hematoma on it and it needed to come out. They couldn't get to. It was terrible. Then, during my second breast surgery last December, a year ago December, they did an oophorectomy. Now I'm 57. I definitely know that I'm either in menopause or out of menopause. I don't even know. I can't, I don't even know how to tell, but I don't know. Do I need estrogen? I mean, cause? This is a big question. This is such a talked about topic among breast cancer survivors and there's such different schools of thought. Same thing with whether you should have a mammogram or not. Is it going to be dangerous for you, which we know that actually it saves lives but estrogen, how do I know if I need estrogen or not?
Speaker 2:So great question. Having had an oophorectomy, you are definitely in menopause and the way that I think about it is as we go through our reproductive lives, we have our monthly cycles and what happens there? To way oversimplify it and I sincerely apologize to any gynecologists who are listening but what happens there is the ovaries create a big surge of estrogen and progesterone. Those hormones cause the cells lining the uterus to build up and proliferate and make a nice place for a baby to implant. If there's no baby, those extra cells die off and that's you having your period. Something very similar happens inside the breast. So when the ovaries make that big surge of estrogen and progesterone, the cells lining the inside of the lobules and the ducts build up and proliferate. This is why a lot of women feel heaviness or tenderness in their breasts around the time of their periods. That's what they're feeling is those extra cells that are building up, and then, if there's no baby, that extra hormonal stimulation goes away and so do the associated symptoms. But sometimes when those extra cells build up, they don't look right and we call that atypical hyperplasia. Sometimes those funny looking cells will die off right along with the other normal looking cells and they never cause a problem. Nobody ever knows they were there, but sometimes whatever it is about them that makes them look funny also gives them the ability to continue to divide and grow and make more and more and more and more of themselves, and that's when we start calling it cancer. So when you have enough abnormal cells built up such that they're filling and distending the inside of the duct, we'll call it ductal carcinoma in situ in situ being Latin for in place or in position. But over time those cancer cells can develop the ability to erode through the wall of the duct and become invasive ductal carcinoma. And the same progression exists for invasive lobular carcinoma. It's just that the cancer cells started inside the lobule rather than inside the duct.
Speaker 2:So when we talk about estrogen, what I see from that is that we're talking about stimulation of the breast tissue, and the more we stimulate the breast tissue to grow, the higher the risk of cancer. We know that patients who have increased overall lifetime exposure to estrogen so patients who have their first period really early, like eight or nine years old, and patients who have their last period really late 58, 59, 60, those patients are at increased risk of breast cancer. Additionally, in patients who never had babies, they have increased overall exposure to breast cancer because the pregnancy milieu is very different and it is actually a low estrogen state when you're pregnant. So the more babies you have, the lower your risk of breast cancer, and the earlier you have them, the lower your risk of breast cancer. It's not a guaranteed thing. You can't go have 10 babies and say, okay, my risk is zero, but it helps, and so, in my opinion, estrogen is sort of a bad guy for me, coming from a breast cancer treating physician. Now, with that said, there are things that estrogen does that are very good. Obviously, things like vaginal health, bone density, cardiovascular risk all of these are impacted by estrogen as well.
Speaker 2:Estrogen receptor negative, meaning that what was driving the growth of those abnormal cells was the HER2 difference, was the abnormal HER2 expression, and so you could have fed those cancer cells estrogen all day long and they wouldn't look at it, they wouldn't need it, they didn't care, they weren't even producing the receptors for estrogen anymore.
Speaker 2:They were not using estrogen to grow. So in your case, I'm okay with you taking estrogen, partially because you have had a bilateral mastectomy, so the vast majority of your breast tissue has been surgically removed, and because you are more likely to have a recurrence of the cancer you had than to develop a new cancer, and so it is unlikely that by taking estrogen you would be facilitating growth of a new cancer. Now, that's not to say it never happens, but in general I would be okay with it for you and for patients who have estrogen receptor positive cancers, cancers that are using estrogen to grow. We know that the systemic absorption of estrogen that is given vaginally is very, very low, and so I am okay with vaginal estrogen creams for patients who have had an estrogen receptor positive breast cancer because that can help with the chronic vaginal dryness and recurrent urinary tract infections and discomfort and all of that, and it doesn't significantly change the risk of breast cancer recurrence because it's not being fed into the rest of the body.
Speaker 1:Okay, I got to tell you I have never, ever, had anyone explain it as good as you just explained it. It makes so much more sense. The way you explain it helps me visualize what's happening in my body. So, thank you. And I was one of those people like I never had babies, never wanted them. I knew that in high school. It was just one of those things, and I'm a step-mom of three and a dog mom, but I was also told that people who say, were on birth control for more than four years. That could have been part of that. So that's not the case in me, though, because mine was not PR driven or anything like that. Okay, interesting. So my gynecologist who is now retired gave me a patch, and it was a low dose estrogen. That's okay.
Speaker 2:Or should I?
Speaker 1:do vaginal.
Speaker 2:I'm okay with you doing systemic again because you've had the vast majority of your breast tissue removed and estrogen. Your cancer doesn't care about estrogen. Okay, if that's so much more. Yeah, if someone had had someone with your same cancer, had had a partial mastectomy rather than the bilateral mastectomy, then we would talk about it a little bit more. But again, the risk is of the cancer that we know about, not a theoretical new risk in the future, and so I in general would be okay with it for even patients who haven't had a bilateral mastectomy, who have estrogen receptor negative cancer Now if you had estrogen receptor positive cancer and still have breast tissue left behind after your treatment, then that's when I start getting really nervous about supplementing estrogen.
Speaker 2:There would need to be a very compelling reason to give it in that scenario. Very good.
Speaker 1:Wow, all we just talked about in one episode. That would have been fabulous, but this has been such a great conversation. This is so enlightening and I am so thrilled that you and Dr Chu and you guys are building out this team for our area. What kind of surgeries. I know that you would like to be able to get someone in here to do autologous surgeries. I would absolutely love that.
Speaker 1:I was in such a whirlwind of overwhelm when all of that was coming down on me and I was just learning all these things and making decisions, and I'm so thrilled that the effort is being put into bringing someone into our area.
Speaker 1:We so need it and I've had lots of people reach out to me and say, hey, you know, tell me about your surgery. I have had tons of people that I know who have gone to Dr Chu who absolutely love her. She's a fantastic surgeon. I know that she's one of the top surgeons in our area. So I just always want people to have that option, like I want people to be able to say, wow, I can either do go flat, I can do a single mastectomy or I can do a bilateral and I can reconstruct with implants if I want to or I can reconstruct with using my own tissue from my body. These are just things that I never even thought about before breast cancer. So what are the surgical options that we have right now in our area? I'm not sure what is new since I had my surgery, sure.
Speaker 2:So I like to start everything with what we used to do and how far we've come. So 50 years ago the only surgical treatment for breast cancer was a mastectomy removal of all of the breast or the vast majority of the breast tissue and it's very effective. But it's also a big deal, as you know, to go through. It's both physically a big operation and mentally it's a big deal to lose your breast or both breasts. So back in the 1980s we, as the breast cancer medical society in the world, we started doing research to see if we could get away with only removing the part of the breast that has the cancer in it. Most people call this a lumpectomy. The technical term is a partial mastectomy, but I'm going to say lumpectomy just to be super clear. So what we found is if you take two people with identical cancers and you do a mastectomy for one and a lumpectomy for the other one, they both live just as long. Survival is exactly the same, but the risk of the cancer coming back on that same side is higher. In the patient who had the lumpectomy which, when you think about it, of course it is You're leaving a lot more breast tissue behind. So what we found in those studies back in the 80s is that if we add radiation to that breast after a lumpectomy, that reduces the local recurrence risk back down. So in general I can offer mastectomy or lumpectomy with radiation as equivalent treatment options. Now when I can save the rest of the breast, in general that's what I prefer to do. It's an easier operation for you to undergo and recover from. We're not talking about plastic surgery and reconstruction. It's just sort of simpler and easier all the way around, and our surgical techniques for partial mastectomy or lumpectomy have gotten much, much better.
Speaker 2:In my fellowship training I worked with Dr Mel Silverstein, who basically invented the idea of oncoplastic surgery for breast cancer. The goal is to remove the cancer using all of the same oncologic principles that we do, but also bring in plastic surgery techniques to improve the appearance of the breast afterward. Patients are always asking me am I going to have a divot? Am I going to be flat there? And what I try to tell patients is I sincerely hope not. I'm going to work really hard to try to make it so that you aren't having a divot or flatness. The goal is to leave the breast looking as normal as possible and in some cases maybe even better than it looked before cancer, because we can do lifts at the same time as we do the cancer resection and the patient walks out looking and feeling better than she did before she had cancer. So that's important to know. The nice thing that we are currently able to offer here in Reno is that there are two plastic surgeons that we routinely work with who do these oncoplastic cases with us, and they are phenomenal. It's Dr Janiga and Dr Rai. They're amazing.
Speaker 2:Now, in terms of mastectomy and reconstruction, dr Chu and I both offer a flat aesthetic closure which just leaves the chest wall as flat as possible, and then you have the option of wearing an external prosthesis if you decide to. We can also do skin-sparing mastectomies, where we remove the nipple and areola along with the breast tissue under the skin, but leave the envelope of skin so that reconstruction can happen behind that and in the renal area. That's done with tissue expanders plus minus implants. Usually the tissue expander is the first stage of that implant-based reconstruction, and then we also offer nipple-sparing mastectomies, where we remove all of the breast tissue from underneath the nipple and areola remain on the skin and then there's still the cavity that is left behind that the plastic surgeon can put the tissue expander or the final implant into. So what you had done that we don't offer here in reno, unfortunately is autologous tissue reconstruction, where you can take either a muscle-based flap of tissue and bring it up to fill in that space or just soft tissue. So the operation that you had is called a deep flap D-I-E-P, or the deep inferior epigastric perforator flap. That is the main blood vessel that supplies the tissue and keeps it alive.
Speaker 2:That operation requires a microplastic surgeon and they are kind of few and far between. The closest ones we have here are at Stanford and UCSF. I think I heard that they have them at the University of Utah, at the Huntsman Cancer Center, but I don't know that definitively. I'm trying to have Renown and the Pennington Cancer Institute hire two microplastic surgeons. That is my goal, because I want them to be able to take vacation and I want them to not have to be on call 24 hours a day for the rest of their career. Good thing, well, that's why Dr Chu and I work so well together, because we very easily can cover each other.
Speaker 2:But what having those microplastic surgeons here would do is it would enable us to offer every reconstruction option here in town so you don't have to fly halfway across the country or drive six hours and you could just have world-class reconstruction done here. But those surgeons can do cases that also help other cancer patients, like patients with low rectal cancer who have to undergo a really awful operation called an abdominal perineal resection or an APR. But they can do flap closures to help close that up, so there's less risk of wound healing issues after that. They also do a ton of work for head and neck cancers and reconstruction of those areas, and so I'm not being selfish. I don't want them just for me. I mean I do, but they would be able to really offer significant benefit to all of the cancer patients in the greater Reno area. I'm working on it.
Speaker 1:That's so awesome. That makes me really happy. I just want people to be able to have those options, and so I'll be praying for that to happen in the near future. So one thing that I did want to ask you will that center have anything like? One of the big issues is holistic care. Will the Conrad Breast Center have resources for holistic care? Because it is so overwhelming I can't even tell you the emotions that you've probably heard from other people, the emotions that I went through. That just threw me into a completely different dimension of who I am. I really find it very important to have that holistic care mind, body and soul for our patients. Will the Conrad Center have something that can help with that?
Speaker 2:Yes, we are thrilled to have just hired, actually a physician for oncology wellness. It's Dr Madeline Hardacre. She is board certified in obstetrics and gynecology, but she is also board certified in lifestyle medicine and obesity medicine, and so she is going to bring to our group and she just started seeing patients last week that missing piece sexual wellness, sleep, help with maintaining a normal body image after having something very abnormal happen to your body, with maintaining as few side effects as possible from treatments, because in so many patients we have to give them actually estrogen blocking medication to remove that food source for their cancer cells, and that has a lot of ramifications on bone health and sexual health and everything else. And Dr Hardacre is phenomenal. She is now dedicating 100% of her practice to wellness within the oncology sphere, and so we are going to have exercise classes, we're going to have mindfulness, we're going to have yoga, we're going to have mindfulness, we're going to have yoga.
Speaker 2:We're going to have all of these things on that second floor, along with breast surgical oncology, medical oncology infusion and breast imaging, and there is an entire wellness center where we will also have things like hairstyling and wigs and caps and scarves and all the things for patients who are undergoing chemotherapy and are losing their hair. We're going to have all of those options. Additionally, we've just brought in cold caps, which are ways that can potentially help reduce the amount of hair loss that happens during chemotherapy. Wow, so wow. You can't guarantee your insurance will cover it, but we offer it.
Speaker 1:Yes, yeah, I mean because I remember when I found out that I was going to lose my hair, of course I went through all the tears and all that stuff and I had long blonde hair like you and and then I just kept it short just because I ended up liking it. But I remember how expensive cold capping was and I didn't have a lot of time to order it and bring it in. But I do. I have interviewed a couple of people who have done cold capping One who is on my board for Test those Breasts podcast. It's a nonprofit and it worked pretty well for her and all the people that I've talked to. So that's really cool that you'll have that option, because what I noticed was that when I was diagnosed, you know there were all these different places that you had to call and look into and it was so overwhelming. So to have that all in that Conrad Center is phenomenal.
Speaker 2:So thank you yes.
Speaker 1:It's like not that I want to go through it again, but if I was to go through it again, that would be a really perfect place for me to go. Well, you know, dr O'Kelley, this has been so enlightening to me, and I always tell my husband every time I close my laptop after an interview, how much I learned from every single guest. I have 76 episodes now since June of 2023. And every single time I've interviewed someone, I've learned something so phenomenal, and this definitely has been one of those episodes as well. Do you have any piece of advice for people who let's just say, for people who have never been diagnosed and maybe it's not even on their radar? Is there anything that you can add to our advice section of our podcast?
Speaker 2:Yes, that would be know your risk. Because if you are at high risk for breast cancer, there are things you can do to help mitigate that risk, and obviously the big one is getting your screening mammograms and getting them every year. If you come in through the soon-to-be Conrad Breast Center, we can do formal risk calculation for you, risk calculation for you so that if we find that your lifetime risk of breast cancer is greater than 20%, you can also qualify to have an annual MRI of the breasts in addition to the annual screening mammograms, and we will bring you in and do a clinical breast exam every six months. Again, the goal is catching something as early as possible. If you're at average risk, great good for you. Still get those mammograms every year, starting at age 40, because that has been shown clearly in all of the studies that that approach saves the most lives and saves the most life years from breast cancer. So that's how we can do. It is by catching it early.
Speaker 1:So then I have a question to ask you. I have a friend of mine who messaged me the other day and said Jamie, I think I feel a lump and I don't have insurance. She says I do have a mammogram set for next month, and she said that one of her medical providers told her not to tell them that there was a lump because if she does, she'll have to get an MRI, you know, like a ultrasound and diagnostics, and it'll end up costing her more. And, of course, my, my red flags went up and went wait a minute, we're talking about life and death here. To me. That's where I went, and it's like life and spending money or whatever. What kind of advice can I give her?
Speaker 2:So what I would strongly recommend is don't lie, because there are cancers that can be very difficult to find on a screening mammogram.
Speaker 2:If you have extremely dense breast tissue or if the cancer is very posterior, very far back on the chest wall, it can be really hard to capture that abnormality in a mammogram.
Speaker 2:And so it is possible if you say, nope, there's nothing wrong with my breasts, I'm just here for my screening that, yes, you will have a free mammogram, cool, but it could miss the cancer that is already there. And so the reason that we do diagnostic imaging is because it adds in the other modality of ultrasound and additional views within the mammogram that increase the chances that we'll find it. And if I could wave a magic wand and fix the healthcare system in this country, I would do it, but I don't. And so, yes, diagnostic imaging is subject to a higher out-of-pocket cost from the patient because it is applied to your deductible-of-pocket cost from the patient, because it is applied to your deductible and copay and coinsurance and all of that. But again, if we catch it now, as opposed to a year from now or two years from now or 10 years from now, your survival is better, more options exist.
Speaker 1:These are things that I told her and I also gave her a couple of community members. I reached out to Nevada Cancer Coalition. I'm in connection with several people there. There are community members here in town that she should call and I'm trying to remember the names of them now. I told her straight up no, you need to go and get what you need to do. Let's see. Here. It is called Community Health Alliance. I gave her a number to there and also a place called. Oh my gosh, what did they tell me about? There's a couple of places that I gave her Valerie over at Women's Health Connection. So there are two numbers that I gave to her.
Speaker 1:So anyone who's listening to this, regardless of whether you're in the Reno area or not, if you're in that situation where you don't have insurance or your insurance isn't covering something, there are usually community members for women's health in your area. That's who you need to reach out to. So there's like a if there's some community member like Nevada Cancer Coalition, reach out to them and they can connect you to a great place to call to be able to go in and do these things and a lot of them do. Like what do they do in the sliding scale according to how much you make and things like that. So yeah, it just scared me.
Speaker 2:Yeah, at Renown we have a breast imaging fund that used to be funded through the foundation at Renown and then unfortunately it did not get renewed for this year. But there are ways to that. Just community members can donate to that fund. If you go to the Renown Breast Imaging website, there's a link there, so I love it.
Speaker 1:Let's keep that link in the show notes, in the show notes, in the document that I gave to you, and also with Test those Breasts. So my whole purpose is to educate and advocate for people and it's a nonprofit. So ultimately, what it's doing is it's providing funds for me to do this podcast and all of that. But also, once I start getting more and more donations, there's going to be an application process where people can fill out and my board members will make the decision on where these things go. So it will go to people like them, like, look, do you need this for a mammogram, or do you need to buy a wig, or do you whatever it is that you need to do? Maybe you need money for breast surgery or whatever it is. That's what my ultimate goal is with my nonprofit.
Speaker 2:So we just need to all work together.
Speaker 1:Yeah, yeah Well, dr O'Kelley, this has just been such a great conversation. I'm super thrilled about the campaign you're working on and I think it goes real nicely in with who I partnered with with Know your Lemons. And the more people we can bring awareness to and education, the better, so that we can make sure that people actually live after a diagnosis of breast cancer. So, thank you so much. Is there anything you'd like to leave us with before we disconnect?
Speaker 2:Yeah, go get your mammogram. It doesn't hurt, it's okay, you're going to do great.
Speaker 1:No, it really doesn't hurt. I mean, I've gotten a million mammograms. I've had lumpectomies before too, that were benign, but no, it doesn't hurt. It's cold and things like that, but you're actually seeing if there's something in there that's going to kill you. I just like, would rather be able to know and it doesn't hurt, but it does hurt if you don't go in. Yeah, so thank you. Well, thank you very much. I hope you have a good rest of your day and I cannot wait to see more about the Conrad Breast Center. When is it slated to be open?
Speaker 2:So, as with most major construction projects, the timeline has evolved. Right now we're looking at probably May of 2025.
Speaker 1:Very okay, that's not too bad, that's actually pretty good. Well, we're so lucky to have you and Dr Chu in our community and all of the team members that you have working with you. So gratitude to all of you for doing what you do and to my guests. I really appreciate it again for joining me on this episode of Test those Breasts. And again, as usual, please, on your favorite platform, please go and rate and review. It does help with getting this podcast out to as many people as possible. And if you'd like to donate to Test those Breasts, you can go to my testthosebreastsorg and there's a big old donation button on there that's pink. Or you can also go to the show notes in this episode and donate to Renown for the Conrad Center and for mammograms and go get your mammograms. So thanks again and we will see you next time on the next episode of Test those Breasts.
Speaker 1:Bye for now, friends. Thank you so much for listening to this episode of Test those Breasts. I hope you got some great much needed information that will help you with your journey. As always, I am open to guests to add value to my show and I'm also open to being a guest on other podcasts where I can add value, so please reach out if you'd like to collaborate. My contact information is in the show notes and, as a reminder, rating, reviewing and sharing this podcast will truly help build a bigger audience all over the world. I thank you for your efforts. I look forward to sharing my next episode of Test those Breasts. Test those breasts.
