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    MD Anderson - Over testing - need advice

    Sorry for the rambling but I wanted to see if anyone has any experience with this as I know I have read quite a few stories and we have some medical oriented members here on the green screen. I would like to find out what direction we can go, if any?

    Back story is my wife had breast cancer diagnosed 10/2010 and she was treated at MD Anderson in Houston. Chemo, surgery, reconstruction, radiation and lots and lots of follow up visits. She's doing great and was transferred to the Survivorship Clinic, for all images, tests and health issues. She is no longer in the Breast Center. All visits are with a Nurse Practitioner and been so for a while. Thankfully she has had no real issues. She does take Tamoxifen daily to reduce the risk of recurrence.

    The problem at hand is that we both feel that anytime she deals with the Cancer Prevention Center, she turns into a test subject. We have been over there 3 of the last 4 weeks for testing. We are 99% sure it's nothing but she's been through the ringer. It started out as a simple well woman test. She did mention she had cramping. The next week the NP calls with the negative test results and says shes got to return for an ultrasound as soon as possible. She's a teacher and wanted to wait until Spring Break but NP was adamant it had to be the next week. After our own research and her not having any symptoms, she decided she wasn't going for the US and tried to cancel the visit twice via the online system. The NP called her and talked her into the ultrasounds. She does the US and there was nothing found of concern, just thickening which is normal on the med she takes. We meet afterwards and NP says she needs to do a biopsy the next week, not a big deal but a 30% chance it was cancer in her uterus. NP said it was a simple in office procedure that would take 15 minutes. We show back up last week, we both go back and they ask her to prep for the procedure, out of her clothes and wait on the NP to arrive. We are then notified that the "final" Radiology reports stated to follow up in 3-6 months if necessary. NP says we should go ahead with the biopsy, we are here, she's undressed and ready to go but it's my wife's decision. She goes over the risks, asks her again, says we can follow up in 90-180 days with another Ultrasound or we can do this and be sure and the wife says "I'm here, I am ready, let's just do it." Nothing had prepared her for the pain she endured, definitely was unexpected. She knew it would be uncomfortable but it was bad. She's tough and a fighter but this brought her down, she did some screaming and the NP wanted to stop and start over and she told her just to finish it. She finished and then said she would like to do it again really quick and took another sample. She was green when she came out and I have never seen her that colorless. She also said the NP made the comment, "I don't think I got enough tissue for a good sample."

    We are waiting on those results now. Since last Thursday, some of the clinic notes have posted to her online account. The NP wrote in her notes in January that if the cervical test was negative, follow up in 5 years. Whereas instead, she insisted that she return for Ultrasounds. When the Radiology notes populated, it said all findings are consistent and follow up in 3-6 months if needed.

    It's evident that she has been overtested without a doubt. The last time she complained of constipation(a side effect of Tamoxifen), she wound up with a colonosopy 2 weeks later.

    We have good insurance but it will still cost us a couple of thousand and I am not balking at that money, as long as she is healthy. It sure seems like her patient ID number is more like a debit card at this point,,,,

    Someone mentioned a Patient Advocate but I think that may be for second opinions? Does anyone have any experience with a situation like this? We did complete a satisfaction survey yesterday that came for the initial appointment. My main issue is that she has lost her confidence in that department and doesn't trust any of the results or guidance and that is not a good thing. She said she always felt confident when she left an appointment knowing they were giving her the best care possible and that is not the case anymore.

    Again, sorry for rambling, any advice would be appreciated.

    #2
    No help here.

    My mom is treated there and we have not experienced anything like this.

    My mom can contact her doctors directly at anytime so maybe that's an option. My mom stays in constant contact through email.


    Sent from my iPhone using Tapatalk

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      #3
      Mike I hate and I'm sorry y'all are having to go through this!

      You really have to consider that when it comes to health (especially women) and cancer their is no simple answer. If anyone says to y'all "well we did such and such and this is how it turned out" don't listen to them. No two people or health problems are exactly the same.

      So because I've been close to so many situations I can tell you from what you are saying here the MDA is being cautious and judicious. There is the prodical that's been established for your wife's situation. When they see X or your wife tells them Y that = Z testing. What neither of you or the docs want to have happen is your wife has symptoms that aren't taken seriously and cancer suddenly returns somewhere and is then difficult to defeat. There are way more combinations of symptoms and problems that can occur than you can possibly imagine.

      I would say if you feel like they have run the gamut and you feel like you don't have anything to worry about then call a stop to all the testing. Your peace of mind is worth something.


      Sent from my iPad using Tapatalk

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        #4
        NP's are a lot more cautious than Doctors. Just my opinion. Yes, my wife is nurse.

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          #5
          I guess the only thing I can offer are prayers for you both. I do have a question, how long has it been since she actually talked to a doctor ? I'm ole school and sometimes I don't mold well with modern ways, but I'd expect to see the doctor at certain intervals and not just the NP all the time.

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            #6
            I have dealt with this very same thing with my wife surviving breast cancer. I finally just told my wife that the decisions were hers to make and I would support her decisions. Having said that I would rather them be cautious because an obgyn not taking my wife's complaint seriously is what led to her CANCER being much more advanced when finally diagnosed

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              #7
              Thanks for the updates.

              She got the call at 6:35 this evening and the first thing the NP said was "there was not enough tissue for an adequate test", which my wife knew was coming as soon as she heard her voice. However, the tissues/cells they were able to test were all negative. She then asked her to come back tomorrow or early next week to do another biopsy. The wife reminded her that she took two samples in the procedure and the NP stated that is just wasn't sufficient. The wife stood her ground and told her no, I am not having that procedure done again. NP then stated that she would be ok with another ultrasound in 90 days, wife stated it would happen when she gets out of school for the summer. NP reminded her that if that US was abnormal that she would have to have another biopsy and she said that she'd decide that when it's time and she would consider it with another person doing the procedure if it was that necessary.

              The last true doctor we saw was 9/2013, 2 years post surgery and those were appointments every 3 months and just transitioned to every 6 months. The last 19 visits have been with a nurse practitioner. Her Breast Oncologist left MD Anderson in early 2014, as well as her Surgical Oncologist. She was assigned another oncologist but we have never seen him and he oversees all these NP in the screening department.

              We understand cautious but here is where we are coming from on the overtesting. My best friend is a local general practitioner, as well as my nephew and his wife, both general practitioners and my niece is a Nurse Practitioner. All 4 have dealt with MDA and all 4 are wondering what is going on with this situation and it seems like a money grab.

              Maybe I didn't clarify but my wife has had no symptoms that warrant any of these tests. The first symptom is abnormal bleeding and she hasn't ever had that, ever. She simply went for a cervical screening and it started at that point. The screening was negative and in the NP notes we found yesterday online, follow up in 5 years.

              We found this note below published just yesterday in a screening guideline on the MDA site and it was developed by a team that included the particular NP that we are dealing with,,, ""While it is recognized that women who are overweight/obese, taking tamoxifen or with a prior history of pelvic radiation are at increased risk of endometrial cancer, screening is not recommended for these populations""

              What we are seeing is that for every protocol that has been listed in her notes, they are doing the opposite and ordering more tests. Their clinic notes say follow up in 3-6 months per radiology and that was not done. The NP in her own notes said follow up in 5 years and then calls back and it's an emergency to get the US completed ASAP.

              We are all about being thorough in this but none has been warranted. Overall, she has lost all confidence in this NP and Screening Department and is losing confidence in MD Anderson and that is what bothers me the most.

              dbaio1, I am glad you asked that question as it made me go back into her history and look it over. I think we are both ashamed that it has been 19 visits, that is too long, far too long.

              Comment


                #8
                MD Anderson is a brand. They are better at some things than others. They are not the only good oncologist in Houston but they would have you believe they are the only option on the planet. If I had something really rare and end stage I would likely go there as they excel at research. For post breast cancer follow up they are not likely any better than Methodist or Memorial Herman or any other qualified oncologist who is up on the current standard of care. You have clearly lost confidence in the care they are advocating. Move on, find another oncologist not affiliated with MD Anderson. It really is that simple.

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                  #9
                  My mother has been treated by MD Anderson for the last 10 years. Her lymphoma is in remission for the 3rd time.

                  She has undergone 2 clinical trials along with other standard of care treatments.

                  Mom has had the same doctor for the whole time and has had appointments with the doctor every 3 to 6 months. Didn't matter if she was still undergoing treatment or in remission - she still has an appointment with the same doctor.

                  I've accompanied her to a great number of her appointments, and would not be happy if we were scheduled to see a nurse practitioner. I want to hear it from the actual doctor that knows what's going on. I believe that the doctors there are the best in the world, and have every confidence in them.

                  Now - concerning your main point. Have you seen the news over the last few months? Apparently MD Anderson is bleeding money. They initially blamed it on the conversion to electronic medical records, laid off a bunch of workers, but they are still bleeding copious amounts of red ink.

                  Might they be pushing tests "just to make sure"? At the same time making their bottom line look better?

                  I would hate to think so. But you know - as well as I - when your loved one's life is on the line, you are going to follow the cancer specialist's advice.

                  I believe that if I were in your position I would insist upon an appointment with her original doctor to review what all has transpired in the years since her surgeries. For y'alls peace of mind.

                  Wishing you well,

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                    #10
                    After a bout with Uterine cancer back in 2011, my wife has been cancer free since. Surgery and radiation was done @ MD Anderson. She saw her oncologist/surgeon every three months for two years and then every 6 months for another year and for the last couple years she has been seeing a NP once yearly and 6 mos later, her local gynecologist, the person who first found her cancer. We are thinking about going all local again as she has not seen a Doctor in 2 yrs. We do have an Oncology clinic here.
                    I would have to agree with TXJIM in that if does not have faith in the person/team that is currently treating her, then she should probably find someone she can trust.

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                      #11
                      Mike, my lovely and talented wife, and I, are 6 months into her journey... She had part of her Kidney removed. Her second follow up was clean.


                      That being said, If we were in your shoes, with what you have described, We would request a visit with the Oncologist who treated your wife... Explain your concerns in a firm, but polite manner. Remember, your lovely and talented wife is in control of her care. We would not be comfortable with a N. P. Guiding the boat.


                      I understand the concern about being cautious on their part, but as you stated, your wife has been to heck and back, and the Dr. Will understand your concerns.

                      Please keep us updated on your decisions. It may help us in the future.

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                        #12
                        Overall, she has lost all confidence in this NP and Screening Department and is losing confidence in MD Anderson

                        Of all you have posted this is the one thing that really matters.If you don't have confidence in the people that are supposed to be looking out for your best interest, it's time to move on.Just my humble 2 cents.

                        DJ

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                          #13
                          This is what you need to know

                          I am a doctor and this is what I tell my patients


                          #1 thing is confidence in your doctor. If she is not 100% confident in the treatment that she is getting, then she needs a change

                          Confidence leads to better outcomes and working relationships

                          I am a true believer that the more confident you are about the treatment, that the better the outcome

                          Patients and doctors have to work together

                          My suggestion is find a new doctor and system

                          It took my wife 4 different urologists before she felt confident in one, had a kidney mass taken off and it was cancer. She still trusts his judgement to day

                          Comment


                            #14
                            warrington, definitely our sentiment now. She has always felt very confident when she left the facility, in all decisions, until recently and I guess the changes there are finally catching up to her level of care.

                            She really doesn't want to start over with a new facility as there is so much of her history at MDA but we have decided that before any more testing is done, we will meet with her assigned oncologist in 3 months. Additionally, she is going to seek out her original oncologist that looks to still be in the Houston or Woodlands area and possibly meet with her as well.

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