Thoracic surgery
A Happy Ending
When Rachel Stratman began to experience lower back pain in February 2009, a cancer diagnosis was the farthest thought from her mind. The 44-year old Milford resident led a busy life, providing inside sales support for a software company, packing for an upcoming move to a new apartment and helping to plan her sister’s wedding.
“I didn’t have time for this!” she recalls of the initial appointments to address her sensitive back pain.
Her primary care physician (PCP) ordered an abdominal MRI, which revealed something they didn’t anticipate… a shadow on her left lung as well as three small spots on her right lung. Her PCP referred her to a pulmonologist who ordered a needle aspiration biopsy that came back negative for cancer. She also had a PET scan that did not indicate cancer.
“Nobody thought it was cancer,” says Rachel. Aside from a very minor cough, she had no other pulmonary symptoms, had never smoked, had never been diagnosed with pneumonia that could have caused scarring on her lungs, and there wasn’t a history of lung cancer in her family.
At the advice of her pulmonologist, Rachel met with Dr. Ciaran McNamee, a Brigham and Women’s thoracic surgeon who is also on the medical staff at Milford Regional, to see whether he could provide a more definitive diagnosis. As a thoracic surgeon, Dr. McNamee specializes in the lungs, esophagus and mediastinum (space between the lungs). Dr. McNamee’s highly regarded expertise has involved him in such complex surgeries at Brigham and Women’s as lung transplants. In fact, he was part of the surgical team featured this past year on the ABC medical show, Boston Med.
In Rachel’s case, Dr. McNamee (whose subspecialty is in oncology), performed a thorough assessment during which he addressed her personal and family history in detail. “He also spent a lot of time studying the MRI, and he listened to me breathe for a very long time,” she recalls. “He took a lot of time to review the scan, and he showed me exactly what he thought raised a red flag.”
Almost immediately, Dr. McNamee suspected that Rachel had an uncommon form of lung cancer. “Even though she had a negative biopsy, in my mind, it still needed to be adequately assessed,” he explains. “I couldn’t exclude the possibility for cancer. The bottom line was that it was best to have it removed and adequately biopsied rather than to watch it and wait to see what happens.”
Rather than retreat into fear, Rachel felt confident in Dr. McNamee. “He made me feel very safe,” she asserts. “I should have been in a full blown panic, but I wasn’t panicking because he wasn’t.”
Dr. McNamee, who considers himself a patient advocate, works hard to ensure patients understand the complexities of their unique health problems. He wants them to understand all the options and not feel rushed in moving forward. He also looks at each diagnosis on a case-by-case basis. “At Milford, we refuse to accept that there’s a barrier,” he emphasizes. “We look at people who are turned down elsewhere, and we offer them hope.”
Each case Dr. McNamee encounters is reviewed by a multi-disciplinary tumor board which includes medical oncologists, radiation oncologists, pulmonologists, pathologists, radiologists and thoracic surgeons. He also consults with surgeons at Brigham and Women’s Hospital in Boston using virtual video technology. “My partners at Brigham are world leaders. We leverage their expertise in handling these cases,” he says. “All of us want to provide the best personalized tailored care to the patient.”
In Rachel’s case, Dr. McNamee suspected cancer and recommended that Rachel undergo surgery. “Surgery was the best option because she’s young, she could tolerate the surgery, and other treatments wouldn’t give her the best outcome,” he says. “This was a decision made by a multi-disciplinary tumor board on the basis of many factors.”
Rachel chose to have her surgery at Milford Regional because she was confident in receiving top notch care locally where her family, friends, and network of support could easily visit and encourage her. Dr. McNamee removed the lower lobe of her left lung and sent it to pathology for further testing.
After meeting with the tumor board for further evaluation, it was determined that a second surgery to address the spots on her right lung was necessary. Following that surgery, in which Dr. McNamee removed the upper lobe of her right lung, the pathology report confirmed Dr. McNamee’s suspicions: Rachel had bronchioloalveolar carcinoma (BAC), which had progressed to stage IV. According to Dr. McNamee, BAC, a highly unusual type of adenocarcinoma, is a form of lung cancer more common in non-smokers or those who have very little smoking history. “There can be multiple treatment options for this tumor,” he explains, “but complete removal, if possible, is the best option.”
Fortunately, Rachel chose Dr. McNamee and Milford Regional where patients diagnosed with lung cancer receive an advanced, individualized treatment program. New targeted therapy based on the individual’s own molecular biology effectively treats adenocarcinomas, such as BAC. “We recognize that the profile for each patient is completely different—even within the BAC category,” he says, “We attempt to identify the specific type of treatment that will best suit each individual and his or her cancer.”
While at Milford Regional, Rachel was impressed by the compassionate care she received. After her first surgery, she says one nurse in recovery helped her sit up in bed so she could cough. “I took a deep breath and coughed to clear my throat. She grabbed me, kissed me on the cheek and said, ‘Wow, that was terrific!’ I thought her response was wonderful,” she recalls fondly. Another nurse spent 45 minutes untangling several tubes to which she was connected so she would more comfortable. “They were so attentive,” she remembers.
Rachel was also impressed by Dr. McNamee’s attentiveness. “I don’t think he sleeps! I had surgery at 8 am. When I opened my eyes in recovery, he was there. A few hours later, he was back to check on me. At 9:30 that night, he was back again,” she says. “He was also very attentive to other members of my family, especially my two sisters who thought they were going to lose me.”
Dr. McNamee, whose personal life has been impacted by cancer, says he understands how it affects families. He enjoys practicing at Milford Regional because he values the hospital’s emphasis on attentiveness to patients’ needs. “In my opinion, there is no one individual who carries this effort,” he states. “The cooperation among individuals ranging from the surgical team to the office staff members is what makes the patient’s experience at Milford an excellent one.”
Today, Rachel feels great and is cancer-free. She was able to go back to work full-time just a couple months after surgery and follows up with Dr. McNamee every six months.
“What thrilled me is what I could still do even after the surgery,” she says enthusiastically. “I played volleyball, and nobody knew I had cancer surgery the year before. I was so excited to be able to play!” She also continues to enjoy riding her bike, jumping rope, swimming and taking walks.
Rachel says the decision to undergo surgery at Milford Regional was one that ultimately saved her life. “I’m excited to be here because there could have been a much different ending to the story.”