I have my own "McDreamy"

You may not know but I am a huge fan of the TV show, "Grey's Anatomy." For those of you who are not familiar with the show, there is a very handsome doctor on it (Patrick Dempsey) who was called "McDreamy" in one of the episodes which has stuck with him. I am happy to say that I now have my own McDreamy.

Last week, my radiation oncologist sent me to see a medical oncologist at MGH that specializes in breast cancer and hormone (endocrine) therapy. My tumor tested was found to be "weakly positive" for progesterone receptors so I questioned whether or not I should undergo endocrine therapy.

So I was waiting in the exam room after speaking with McDreamy's Nurse Practitioner when in walks this dreamboat with a stunning English accent. He spent about an hour with me going over my history (which he already knew before he came in), explaining what he thought and possible treatment options.

McDreamy (he actually has a real name, Dr. Goss) told me that he strongly believes there is a genetic component to my story. He is having the Genetics Department at MGH review my genetic testing to be sure the long version of the test was done. He rattled off some technical link that he feels may be the culprit because to him it is too suspicious that my grandmother had breast cancer and my mother's type of brain cancer may have some link to this genetic mutation. He explained that I may not have tested positive for a mutation in the BRCA 1 or BRCA 2 genes (the ones they test for and know of the direct link) but I may have a mutation in an undiscovered genetic link. He went on to explain to me what having a genetic mutation of that type really means. Think of your body like a car manufacturing plant. Every cell in your body is a car. Somewhere during the assembly process, the breast cells in your body had something left off. Some may be missing the horn which isn't that big of a deal but some may be missing the engine which is. Every cell isn't quite right which is why it is so important to know for sure if this is genetically linked somehow. In random cancer, it's like a car accident. You go in and clean it up and that's that. In a genetic cancer, there is something faulty everywhere.

After we finished that discussion, we started to talk about the hormone therapy. He offered me a clinical trial but we decided to take what the clinical trial was doing and tailor it ourselves. So I will be taking Tamoxifen for 2 years and then switch to an Aromitase Inhibitor with ovarian suppression for 5 more years with the possibility of extending that length of time. He was so thorough with his explanation of how this all worked.

A woman's body produces estrogen (I know we were talking about progesterone but progesterone doesn't work without estrogen) from two sources - the ovaries and fat. Tamoxifen blocks the door to the cancer cell so that no hormones can enter. His analogy for this one was to think of the ovaries and fat as the "kitchen" and the cancer cells as the "dining hall." The kitchen will still be cooking but the door to the dining hall will be blocked so no one can eat. When I switch to the Aromitase Inhibitor with ovarian suppression, the kitchen will be closed and the dining hall will be blocked. Make sense?

Dr. Goss' business card is filled to capacity with his titles which are really impressive. When I made my follow up appointment with him (in October) his secretary asked where I was coming from. She said that she always tells people who are travelling from far away to see him to buy the travel insurance because he travels all over the world and might need to cancel - he's that good!