Hi Everyone,
I had a lovely long weekend to welcome in 2026 down to Valle de Guadalupe (wine country in Baja). Unfortunately, it was overshadowed by another illegal action by the U.S. This week is heavy as we mark one year of the Fires and more ICE madness. It’s really too bad that the usual lightheartedness, such as this hot take on New York fitness culture and Heated Rivalry memes, can’t override the algorithms for our first week back to work.
So Cancer…
What a surprise last fall! I felt nothing so I advise those mammograms. Fortunately (or sadly?), I have a very common type of cancer- ER, PR+ and HER2-.
I have already shared via email my not-so-wonderful insurance and primary care provider drama. I am currently going through my receipts for tax prep on what my out-of-pocket spend was to ensure I could move forward ASAP this January with my shining new PPO from Blue California. [Seriously, I’d advise anyone younger than me approaching 40 to start getting used to paying for a PPO.]
I have been seeing two surgeons at two top systems in southern California, one at Cedars-Sinai and one at the University of California (USC), thanks to the help of friends. Again, I cannot have gotten this journey started without so many of you. I am forever grateful for the medical and health business advice. I will also say it is an indictment of America that care and timely attention depend on English proficiency, income to determine how much insurance you can buy, job status, and who just may be your friend.
Quick Summary:
Cedars- Dr. Alice Chung is the surgical oncologist there. I met with her just ahead of Thanksgiving. She is straightforward and seems to be around my age. It was more of a quicker consult than usual since this was a favor to get in with her. So much at Cedars seemed dependent on my insurance. However, she gave me suggestions for reasonably priced work-up options to pursue last fall that helped me move forward as soon as January and my PPO started. I met with her and the plastic surgeon there before they could schedule me for surgery per their requirements last year.
Dr. Chung recommends a less invasive nipple-sparing mastectomy and a limited removal of my lymph nodes as part of a trial she is running. This has a chance to lessen lymphedema risk post-surgery. The plastic surgeon there is informative and does good work. However, he gave me so much information when I did my consultation with him that I didn’t know what questions to really ask. Since then, I’ve been recommended another plastic surgeon, Dr. Jamie Zampell, who is affiliated with Cedars. Sounds like I can get surgery with Dr. Chung and the current plastic surgeon AND still have an option to consult with Dr. Zampell and/or use her for the actual reconstruction. phew! Might not be ideal, but it is possible in some cases.
After originally being given a Feb 2 date for surgery at Cedars, I was kind of fretting and wondering about a second opinion over Thanksgiving. So, I ended up at USC to see a Dr. Fumito Ito thanks to friends. He is a professorial type and soft spoken but seems very serious and to the point. He also seemed more urgent that I have surgery before February. He recommends a current standard of care surgery that is a little more invasive that would remove 1-2 levels of lymph nodes and include a lymphatic bypass procedure to help reduce lymphedema risk. USC’s plastic surgeon was friendly and informative during my consult; it helped that I had more information going into this consult. This plastic surgeon Dr. David Daar has similar training and expertise as the highly recommended Dr. Zampell; the two are even friends and colleagues.
So I’ve been fretting and down Chat GPT rabbit holes this weekend of whether or not to proceed at Cedars with the TAD approach ( a newer approach to cases like mine but has a little uncertainity in full cancer removal and has a 5% chance of lymphadema) or at USC with the ALND + ILB approach (current approach involving more lymph node removal with a 5%-15% risk of lymphadema) since I have not had any pre-surgery therapies/treatments and it would be the most certain to clear out cancer. The Chat robots say my situation is a grey area where good surgeons disagree. So it’s all confusing to trust what is best for me.
I fear lymphedema at my age, given I need to still work and present myself at a time of life stage when age works against you. I have had to work on my self-esteem so much through the years as an Asian in white spaces, a heavier build, and now with the mid-life worries or random weight gain. So it is scary to think about your body being so out of your control in how you appear externally to others. So I want to take the new approach with low lymphedema risk, yet I also only want to do this surgery once and move on to reconstruction and life.
With both surgeons and facilities offering a surgery date by the end of the month and workups happening, I really need to decide today what approach or surgeon to go with.
It’s much easier to share voice memos b/c I’m being given so much information in each appointment and need to talk it out. So here is my Friday, January 9, memo that I have been mulling over the weekend:
And here is my recommendation for media:
The Pitt is back! I know a stressful hospital-based show is just what I need, ha. But really, I think we’ll all feel seen whether we are the streteched-thin health care providers facing lawsuit threats or non payment from insurances, the administors balancing profit and humanity but who have to put profit first, the frustrated patients, the support staff who are way underpaid who clean up vomit and blood, and the nurses at all levels who make things run.
Adolescence cleaned up at the Golden Globes. It is a stunning series that forces us to look at the world we are leaving young children, young boys, and how they are reacting to it. It is a tough watch, but important. The internet is the wild west and how we check in with young people, whether they are our blood or not, can make a difference in creating a better village.
But also, go KPop Demon Hunters!
"When I was a little girl, I worked tirelessly for 10 years to fulfill one dream, to become a k-pop idol. And I was rejected and disappointed that my voice wasn't good enough," Ejae said. "So I leaned on songs and music to get through it. So now I'm here as a singer and a songwriter."
