Decisions, decisions.

It is early. The sun is not quite up yet though I am starting to see the lake. (Have I mentioned that Kelly and Eric live on a little lake?) The water seems calm this morning, like it has had a good night's rest. I wish I could say the same.

Yesterday brought more information into the data pool. Kelly saw another plastic surgeon whose plan for reconstruction was completely the opposite of plastic surgeon number one.

Plastic Surgeon #1 would use implants with flaps of skin, fat and muscle from the back. Plastic Surgeon #2 would probably use no implants and would take skin, muscle and fat from the abdomen, performing a pedicaled flap (just means the blood supply from the belly remains connected even after the tissue is moved to the chest....you don't really want the details). But #2 said that Kelly should be a good candidate for a 3rd type of procedure which is only newly available to the Albany area.

This alternative procedure would involve reconstruction using belly skin and fat but leave the abdominal muscles intact. It would involve microvascular surgery to connect blood vessels from the relocated tissue to the chest wall. This procedure is the latest technology and is called a DIEP free flap. For a young woman, like Kelly, who wants to remain physically active (ready cycling and kayaking), the preservation of those abdominal muscles can be critical.

There is a down side. To consider this surgery Kelly will want to go where the physicians are more experienced than the new Albany group. The most likely places are either Dana Farber in Boston or Memorial Sloan Kettering in NYC. It is a major surgery and will require a 10-14 day stay in the area both as an in patient and as an outpatient until she would be able to travel back home. And there would probably be two post surgical trips. Hopefully most follow up could be done in Albany.

I believe this is the surgery that Kelly really wants but she keeps putting obstacles in her own way. She has a strong faith in her general surgeon in Albany but if she were to elect the "out of town" procedure, she would need to start over with another team in order to have immediate reconstruction after the mastectomy. That, plus the fact that it would be "inconvenient and expensive" for Eric to be there, put Kelly over the edge last night.

Why is the notion of needing to accept help from others such a hard thing to do? As I summarize the drama here, it makes it all seem like a no-brainer. Get the best possible treatment available if your insurance will allow it! In fact, Eric has family in Boston who would be willing to put them up for whatever time is necessary. Eric confirmed that last night. Objection overcome.

Kelly has a connection with a physician, a genetic researcher in breast cancer, who is connected to Sloan Kettering (she used to babysit for his kids). A mutual friend has already reached out to Dr. Jeff and told him that Kelly may need someone to guide her through the system and advocate for her, advising about "who is the best" in what she needs. Yes, NYC may mean some hotel bills, but having someone you know looking out for you when you are in a strange place carries a lot of weight with me. Kelly will try to reach Dr. Jeff for his input. That seems to go a long way to answering that objection.

Eric will call Dana Farber in Boston today to see if they can get an appointment for a consult ASAP. And he will dig deeper into the insurance details to see if there are any restrictions that would rule out an out of state procedure. Surely one of the two major cancer centers in question will be available.

K & E will consult with Dr. K, the primary surgeon here, to see if she has any specific recommendations for surgeons in either/both places. Medical records must be gathered too. All of this can be done and it is time to at least secure one, if not two more opinions on what is the best possible alternative for Kelly. It is not as easy as buying a new pair of shoes, but it is worth the trouble to find what you want and not settle for something that will do.

The sun is beginning to rise; the lake shrouded in fog. As the fog slowly lifts I pray that the fog of these many hard choices soon clears and Kelly finds the right path.