Donna Short is a corporate executive at MJH Life Sciences, CURE's parent company. In her role, she works with partners and thought leaders in the oncology space. She was diagnosed with breast cancer in April 2020, amidst the COVID-19 pandemic.

Donna Short

One of the best suggestions I can give anyone undertaking a journey like this is to surround yourself with excellent people:  Excellence in knowledge, excellence in encouragement, excellence in collecting facts.  I did this as a student in school where my peers were smarter than I, dressed better, carried themselves better or conveyed their ideas better.  It caused me to bring my own game up.

 - Months before my diagnosis I realized that my primary care doctor wasn’t cutting it. I knew in my gut that he wasn’t who I wanted to care for me should I need urgent or hospital care. I had inherited him from the primary care center I went to when the physician I had chosen passed away. It was time to do a little investigating and find a better fit. It’s amazing that I found my new primary care provider so quickly and immediately felt he was knowledgeable and respected my inquisitive nature.  And soon thereafter, followed my breast cancer diagnosis.

 - Nurse navigators are a blessing to patients. They provide incredible information for patients that may not fully understand the diagnosis and treatment process. Most centers have nurse navigators. Take advantage of all the information and services they have to offer. The one I met was an incredibly caring and knowledgeable person.

— My genetic counselor showed up in my telehealth appointment looking like she was interviewing for her first job. She was so young and a little nervous, but I could tell she really knew her stuff.  She said I had “red flags and green flags” in my family history. We decided to do a test to determine my genetic makeup. Due to the COVID-19 Pandemic, it would be by saliva which I had no idea they could gather information on 47 genes through a spit test, but how convenient?!?

 — They walk the path before you and share their story. Friends can be a source of comfort or anxiety. I was doing pretty well until a friend of me called to say she had all the same things initially then found she needed more surgery, more aggressive chemo and radiation than originally thought. After she shared stories of hospital admissions and being on disability, I did lose some sleep. Ultimately, I found reassurance in knowing she has come out on the other side tougher than before.

I know a physician that has a sign on his desk that says, “if you consulted Dr. Google and came here for a second opinion, please go see Dr. Yahoo”. How true when we decide what we think we know then want others to justify it. I knew during COVID starting with oral hormone therapy prior to surgery was what they did in Europe. But I sure did get a sense of relief when one day later the American College of Surgeons put out their COVID based recommendations and that was what was exactly on there. 

My surgeon teases me that because I know so much in this area, I am my own best second opinion.  If you do not have strong knowledge in this setting do get a second opinion. Most physicians encourage it and it will do wonders to help you feel you are moving in the right direction on your cancer journey.

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Undertaking the cancer journey is a daunting task with its own challenges and tough questions to face, but that doesn't mean you have to do it alone. 

Surrounded by Excellence

One of the things people ask me about is how I’m doing. Are you ok? Are you feeling sick or anxious?

I felt fine ever since the beginning (of my breast cancer diagnosis), except for that one time my heart jumped in my throat with the doctor that did not have the best bedside manners on the phone.

But I think a lot of it had to do with the fact that I empowered myself with education. I’ve spent my whole career in this space, so I knew some of the terminology and some of the thought leaders.

My first reaction to the possibility that I had cancer was to create a game plan. That is the reason that I felt so confident when I did get the diagnosis. I knew I had a game plan. I knew what my next phone call needed to be. I knew that I needed to let the process play out. I had to wait for my pathology to come in so I could have more information. As I got more and more information about my tumor, I was able to put it all within reason of where it needed to sit.

Everything that came in was very much to my benefit. The fact (the tumor) is very small was positive; the fact that I had targetable mutations like ER and PR was very positive; the fact that I didn’t have the accelerant of HER2-positivity was positive; and the fact that it was low histological grade — my KI67 was less than 5%, so it was very low. The only thing that was a bit concerning was that I had vascular invasion. But again, with it being so small, that’s such a tertiary factor.

I felt very confident knowing what I knew, and the more I knew about my tumor and comparing that to it.

Getting Diagnosed with the 'Big C' During the 'Big C'

” to learn more about her diagnosis during the COVID-19 pandemic.

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“(Feeling calm after my breast cancer diagnosis) had to do with the fact that I empowered myself with education.”
 

Having a Game Plan for Your Cancer Diagnosis

I was already wearing a mask for necessary outings to the grocery store. So, wearing a mask to get my follow-up mammogram was not unusual at that point. And once I had disrobed there was a sense of comfort in having it on, like I was more hidden. Maybe I was fooling myself, like the hippo in “Fantasia” that hides himself behind the tree — like we couldn’t see him. But nonetheless, there was something weirdly comforting about having it on and all the people examining and poking on me having one on as well. 

resulted in my first visit being by telehealth

My first visit with my surgeon was a telehealth meeting. I had my administrative assistant reach out to the surgeon whom I knew through work. I told her to tell the surgeon I needed to cover a little business and a little personal. The surgeon offered to do it through the Zoom account she used for telehealth. It was great, easy to access and I could hear and see her clearly. We did a little business which I did need to do and then I told her about my diagnosis and everything that I knew about it. She shared her concern and was even empathetic. All of this was much better communicated than I would have thought. She quickly helped me figure out whether my “live” visit would be with my medical oncologist or herself. We discussed the potential paths this might take and decided that my next visit with her would be virtual and the next visit with my medical oncologist would be in person. We determined he was closer in distance and located at a relatively sheltered site only seeing cancer patients without any family attending the visit.

I went to visit my medical oncologist and while I was in the examination room, the surgeon called my phone the Facetime. She decided to move my telehealth appointment up so she could participate in my visit with the medical oncologist. We propped her up on the counter so she could share in the discussions. My medical oncologist even turned her away when he left the room for me to disrobe. I found that pretty funny! Like she isn’t going to see more of me later! I joked with her about this while I was changing clothes. The medical oncologist examined me physically and when noting the bruising from the ultrasound wand or from the biopsy site he would grab my phone and hold it up to the site on my body and say to the surgeon, “Do you see?”. They were so collaborative, even in the physical exam, with one being present virtually.

I can envision this version of telehealth being used for patients. Even initial visits being held by telehealth and being received well by the patients are a possibility. I know many physicians need a physical exam that requires palpations and touch, but being able to go at my cancer as a team I found quite unique and helped me hear them both as they discussed the possibilities with me. I felt included in the plan on my cancer.

This was the one change that caught me off guard. When COVID-19 began surging in the Northeast, my company began searching for ways to help employees feel like they were helping others whether raising money for pandemic efforts or meals for front-line workers. One of the events they proposed was a #sleevesup event with the American Red Cross to give blood. We all went online to schedule a time to give blood nearby. My company is in New Jersey and I am in Connecticut. The closest event near me was in May so I went ahead and scheduled the appointment for then, but this was back in mid-March. Then my diagnosis came in April and as I begin therapy, I suddenly found myself unable to give back. That made me very sad. I like to help, or “feel” like I am helping, and it was the first time I felt like this diagnosis was taking something away from me. 

One of my friends told me as a point of encouragement that I was going to kick this bully in the ass. Yes, I will and yes, I did feel suddenly bullied.

A newly diagnosed patient talks about her experience of being diagnosed with breast cancer amidst the COVID-19 pandemic.

How COVID-19 Affected Getting My Cancer Diagnosis

I got a mammogram a couple of months prior to COVID coming through and they called me about a week later and said, “We need you to come back in for a mammogram again. We’re not sure if there’s anything. So, we’ll see.” So, I said, “Sure, but I’m too busy. So I need you to give me some dates/times that are available.” Low and behold, two months later was the first time I could get in.

I got in to see them two months later, but COVID happened in the middle of all of this. So, in all of my travels, I was suddenly home bound. They called to make sure I still wanted to go to the institution to get my mammogram, or if I’d rather go to the breast center. I said, “No, the institution is really small. I’ll just go there.” I kept my original appointment, and I went in to get my subsequent mammogram and an ultrasound to see what they might see. Sure enough, they thought that they needed a biopsy.

I stayed at the hospital and waited until they could squeeze me in for a biopsy. The interesting thing for me is that I’m lying there and they’ve got masks on, I’ve got a mask on, and I’m unsheathed and I don’t have anything covering me. And there was some comfort in having the mask on. There’s something about all women’s exams where you just kind of having to bear everything and it’s a little embarrassing. They try to make small talk, but it’s just really uncomfortable. So, I felt a little protected by laying there with my mask on. I couldn’t really tell their reaction because they had a mask on.

I could tell they were seeing something on the ultrasound: They were measuring it; I saw her putting markers on it to measure the size. So, I knew this was something that I was going to want to follow up on.

They took some biospies. In the middle of all of this, I had gone through a transition of my primary care provider. So, my first physician was someone that when I originally sat in the room, it felt like I was the smartest person in the room. And that made me uncomfortable. So, I was seeking a different primary care provider. Between the first mammogram and the second mammogram, I had found a second primary care provider.

But an hour after I got home from my biopsy, the first primary care provider called me and said, “This is Dr. ‘not the sharpest tool in the shed,’ I just got your report and I’m not happy.” It’s the first time in all of this, getting a potential diagnosis, that my heart jumped into my chest. I thought, “Oh my God, what does he know?” I quickly said to him, “I have transferred primary care providers. I need you to make sure my new one has this information. If you could please share this with him that would be great.” And I got off the phone with him and after that quickly got on the phone and called the nurse who assisted with the biopsy. I said, “What is he talking about, I just got this phone call?” And she said, “You have to be kidding. They haven’t even picked up your sample yet.” And we realized that he was only just now reading something from my mammogram two months prior. So, again, just making me more confident about changing my primary care provider.

It did cause me to seriously think, “What if I get that phone call and someone says they aren’t happy with what they found?” So, mhy biopsy was on Friday and I spent the weekend thinking, “What if?” I’ve been in the oncology space for 30 years. I’ve talked the talk. I work with a lot of different providers and now I get to walk the walk. Everywhere I’ve ever lived, I’ve always thought to myself, “If I had this, I would go see him or her.” And I had not done that since I moved to Connecticut.

So, when this came to be a reality, I just sat back and thought, “Let me take a moment to say if this comes in positive, I need to say what will my game plan be?” So, I thought about it for a. while and came up with a medical oncologist I thought would be reasonable for me to see, collaborative with the surgeon I decided to see, and also knew enough about the community setting and had enough clinical trials at his fingertips in case I needed it. I’ve worked with him a bit in the past and felt comfortable with him. That’s what I did from Friday to Monday, trying to figure out if I needed a game plan, this is what I had.

It gave me a lot of peace and comfort knowing that I could sit back and relax and know that I had a game plan.

Monday, they called saying, “You have invasive ductal carcinoma.” They wanted to send me to a surgeon, and I said, “Let me think about this and I’ll follow up with you.” I immediately placed a phone call in to the surgeon who I wanted to work with that was about an hour away, but I still felt like that was reasonable, someone who is well respected in the space. She immediately made time for me. I shared with her what I knew and told her as things came in we’d be sure to get those things to her. Immediately she got on the phone, got the ball rolling, had nurses calling me, setting up appointments, making sure the medical oncologist I had chosen was going to be in the loop as quickly as possible.

We just started making a game plan on Monday, not knowing a lot of data yet, but making sure I had the confidence knowing I had access. That made me feel better.

On Tuesday, I found out from the nurse navigator from the local surgery center, that I had ER-, PR-positive breast cancer, and the HER2 had not been done yet. So, I made her aware that I already reached out to a surgeon and she could take me off her list. Her concern was that I was not falling through the cracks and that I had a game plan. She quickly figured out that I knew what a KI67 was and the difference between HER2 and ER/PR. I did find out I had vascular invasion. She shared with me that I was histologic grade 1, nuclear grade 1 and that the size was 0.8 by 0.7 by 0.6 centimeters. When I told my surgeon that I thought it was less than 1 centimeter, she said, “We need the specifics because less than and being less than are very different.” So, sure enough, I was less than and she felt better about that at that point moving forward with the game plan.

I found out on Wednesday, from my new primary care provider, that was HER2-negative. He had followed up with me just to check in and make sure that I had a plan. He was going to make an appointment for me with the same surgeon locally, and I ensured him that I had a plan and he felt comfortable with that. He just asked to be kept in the loop.

On Friday of that same week, I went into the medical oncologists’ office to see him at his center, about 30 minutes from my house. The surgeon (video-conferenced) in on my cell phone. We propped her up on the counter and she participated in the exam and consultation. I had both of them in the same space, coming together to talk to me.

The same thing happened to me with my medical oncologist: He had a mask on, his nurse had a mask on and I had a mask on and there was something about going, “Here they are!” and not being as timid or shy or all the body conscious things that women go through. Because of my COVID mask, it was interesting to be able to feel a little bit of protection, anonymity a little bit from having the masking on. And having my surgeon consulting with me on a cell phone looking at my body as well, it was just interesting having that all play out.

We had an excellent conversation there in the office. Interestingly, the cancer center was very quiet and sparse and bare. There were individuals sitting by themselves with one chair available and two chairs covered in blue plastic, and then one chair available and two chairs covered in plastic for social distancing purposes. They took my temperature when I went in before I could even enter the center. So, they were doing all of the things they could to make me feel that they were protecting me and themselves.

Getting a diagnosis during that time, the suggestions the doctors gave me were also very different from what they normally do. They called it the European model, and instead of starting with surgery, they said I can start on chemotherapy if I felt comfortable. Apparently, a lot of women feel the need to get this out quickly. I didn’t feel that way because it wasn’t anything that I felt. The mammogram found it. Also, because I couldn’t feel it, it’s something I was fine with: the possibility of chemo or hormone therapy could shrink it down prior to surgery.

They left a marker in when they did the biopsy, and that marker will be what the surgeon looks for if they can’t find the tumor because it’s shrunk down so small. That’s my hope: that she can’t find anything but the marker.

So, currently I’m taking tamoxifen and I have a consultation set up in June with the surgeon. And we’ll see how that goes.

A newly-diagnosed patient talks about her experience of being diagnosed with breast cancer amidst the COVID-19 pandemic.
 

Donna Short

Surrounded by Excellence

Having a Game Plan for Your Cancer Diagnosis

How COVID-19 Affected Getting My Cancer Diagnosis

Getting Diagnosed with the 'Big C' During the 'Big C'

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