We Go Both Ways…From West to East and Everything in Between!

We were both trained in Western medicine—BA to MD to residency to fellowship. We ran on a linear pathway (admittedly, Sheeva way faster than Jaime!) without even as much as a water break. We spent endless hours burning the midnight oil (that’s why we know all the good coffee spots!) studying, memorizing, and analyzing. We went from the classrooms to the wards, from the laboratories to the clinics, and finally from trainees to attendings—always focused on Western medicine. We believed that cures only lurked in pills or scalpels, not herbs and pressure points. We were smart, but we were naïve. We had no idea how wide the world of medicine was.

We have matured a lot over the past several years (as evidenced by our grey hairs!). We have met many talented clinicians and practitioners who practice ALL types of medicine. We have been awed by their knowledge, amazed by their patience, and impressed by their skill. We have learned that what you eat really matters, that meditation is more than humming in a dark room, that yoga is more than stretching, and that acupuncture is more than a bunch of needles. We are humbled by the genius of the many disciplines we never even knew existed 10 years ago! We feel privileged to have formed relationships with those who have exposed us to medicine and healing from all parts of the globe.

We for sure don’t have all the answers (as much as we wish we did!). We know that, although our training was very, very, very long, it didn’t even come close to touching the surface of medicine as a whole. We recognize that medicine is changing faster than the lead car in the Daytona 500 and there is no way to keep up with it alone.

We are not sure if you noticed this by now, but every sentence in this post started with “we.” We did this to prove how important it is for all practitioners, Eastern and Western, mind and body, to work as one—to listen to each other’s voices and opinions and learn from each other. We have no desire to go back to medical school or pull all-nighters in the library, so we are all ears when we meet new practitioners that have new ideas and new treatment strategies. We can’t wait to hear what they have to say!

Mother’s Day: Enjoying the Moment

In honor of Mother’s Day, we, two mothers who often find ourselves running (literally!) from work to home, from kids’ schools to kids’ soccer practices, and from our offices to our errands, wanted to press “pause” and share with you our most precious mommying moments. These make us stop and forget about the dirty dishes, the unfolded laundry, and the to-do list that’s a mile long. These remind us of why we endured endless hours of labor, weeks of sleep deprivation, and years of dirty diapers (and in some cases, hundreds of shots, blood draws, and ultrasounds to achieve motherhood). So, while our words may never make it into a Hallmark card, here are our Mother’s Day thoughts.

Sheeva:

Work out, take care of patients, family time, sleep. Repeat. This pretty much sums up my day-to-day routine. It can get pretty repetitive. And although routines are soothing (it’s nice to know what’s coming next!), they can also get monotonous. You can lose sight of the little things. However, the little things amidst the regularity of my days have come to be my most special mom moments.

It’s funny. As a mom, these cherished daily moments sprinkled throughout your day of “regular” activities change as your children age. From rocking your baby to sleep to watching your toddler tackle that art of talking to pushing your kids on the swing after dinner, the precious moments change. They transform as your family transforms. And while you will never forget the firsts, sometimes the lasts become just as important. As the mother of an almost seven-year-old boy and 11-year-old girl, now my most precious moments are bedtime.

And although for many years this was probably my most dreaded time of the day (putting a toddler to sleep can be terrible!), now bedtime is our time to lay together, share stories about our day, and talk about what we hope for tomorrow. My favorite moment of late was one night, when my kids were lying side by side (they have their own rooms and own beds but most nights like to share the same room!). I laid next to them and asked what was so funny. They made me pinky promise and then proceeded to tell me their crushes (P.S. my daughter has one, and my son has four)! Their giggling voices still make me smile. As a mother, I hope they always feel safe enough in my presence to share their most intimate moments. I hope our nights are always free from judgment, shame, or holding secrets back.

 

Jaime:

Life moves fast—especially in New York City. We are always running, doing, going. Standing still is rarely an option (or safe; someone is likely to push past you!). And for as long as I can remember, moving forward at a fast pace was who I was and how I functioned. However, despite the efficiency of this pace, this notion of constant movement can breed anxiety and stress—not just for you, but for your little ones.

It wasn’t until a forced time out from work this past summer that I realized just how toxic my “need for speed life” was for my daughters. My constant telling them “let’s go,” “you’re on the clock,” and “move it” did not fall on deaf years. They were listening. I heard this when my older daughter began to use an impatient tone with her younger sister and her friends. She exhibited anxiety, a need to keep on task, and a fear of being late. She seemed, like me, to always be stressed about the next event. Even at the young age of five, she was anxious about fitting it all in. I felt awful. I thought long and hard about how to slow her down, make her less conscious of the clock, and relish relaxation. I soon realized that, to change her, I had to change me. Her actions were not innate but learned—from me. To help her, I had to slow down and take a deep breath.

This summer, I did just that. I stopped, and I tried to take it all in. And although I was not perfect, I took time to watch the sunset, play tag, and color silly pictures. I didn’t rush dinner, and I didn’t stress over how long they took to brush their teeth. I simply enjoyed them and our time together.

We have chosen to share the good and not the bad not because we don’t have endless trying mom moments; trust us, we have many! We by no means want people to think that we’re perfect. We simply want to encourage others to hold on to the good and to let go of the bad, to remember the special and let go of the sordid. The bad doesn’t mean you’re a bad mother; it means you’re normal! Holding on to the bad will put you in a bad place. Try and take a moment to remember the good, the special, and your most precious Mom moments.

Happy Mother’s Day!

Truly,

Jaime and Sheeva

Don’t Worry, It’ll Be Fine: The Power of Peers

Hearing those five (or five and a half, depending on how you look at it) words brings a feeling of “Ahh” and a sense of calmness over most of us. With reassurance, our shoulders drop, our jaws loosen, and our minds are put at ease. This is not CBS’s “Survivor”; no one wants to be left on the island alone. In real reality, we want to be surrounded by others who are also fighting the elements, trekking through the same terrain, and battling the same villains. Fellow soldiers on the field make the foxhole a lot less scary.

Oprah made the “Aha” moment famous; we want to make the Ahh moment famous. While we certainly want you to have your Eureka moments (they’re great!), our primary goal is to help you find that moment of peace—that moment when you realize you are not alone, you’re amongst millions of other women facing similar struggles, and you realize their strength can help you achieve your goal. No matter what we look like, what clothes we wear, or where we live, we ladies are all trying to make it as far as we can in those horrible high heels (Why do we do that to ourselves? They hurt so badly!). And while we can’t help you find ones that are cute and comfortable (trust us, we’ve searched everywhere), we can help you find and build a community of fierce women.

We talk a lot, not only to our patients but also to each other (you would be amazed at how many text messages we send to each other a day!). We are very open about our own experiences,  struggles, and failures. Our personal and professional goals have not only centered on helping couples make families but also creating a community of openness, honesty, and empowerment. Admitting our weaknesses and advertising our fallibilities is never fun; it takes a ton of courage. But it makes us human. And when you take it back to the basics, we are all people trying to survive, find joy, and make our footprint on the world.

While we recommend you letting stuff out and finding your Ahh moment, we don’t recommend turning your life into a Bravo reality TV show (although we do love those Bravo-lebrities!). Sharing your experiences will not only help you but also your fellow femme fatales. Believe it or not, even the most soft spoken amongst us can scream—our voices can empower someone else to make a change, seek support and conquer her fears. We are stronger together than alone. Collectively, we can make a difference.

We are often asked about the obsession with group fitness studios like Soul Cycle and Flywheel. Why do they hit it out of the park repeatedly? In many ways, their popularity is a direct result of the community, camaraderie, and unity their classes create. I mean, why else would you sit in a dark and sweaty room at all hours of the day spinning your legs? It’s because riding next to you are a group of kickass women (and some men) who struggle with the same problems. Their energy and strength will help elevate you to another level. They will inspire you to not be scared about what’s over the next hill. They will motivate you to not hold back because you think you can’t do it. They will encourage you to not limit yourself to only try what you know you can achieve. The fact is that we push harder together, we push longer together, and we break barriers together. Next time you see someone struggling, tell them, “Don’t worry; it’ll be fine.” And then add our three favorite words:  “I got you.”

Acceptance

Weather has a mind, a plan, and a path of its own. No matter how many times we open our weather app, if it’s going to rain, it will rain. We can’t will it away, wish it away, or watch it away (although you can go away and avoid it). It is the ultimate in uncontrollable. For all of us who have planned an outdoor wedding, an outdoor event, or have been derailed at an airport because of weather, you know what we’re talking about. To put it simply, battling uncontrollable elements sucks. Watching and waiting is beyond unnerving. But this is not a piece about the weather; we are for sure no meteorologists. It is about accepting the seemingly unacceptable, making peace with a fate you never dreamed, and learning to work through the discomfort to find a new calm.

On the surface, the connection may be hazy. However, that awful feeling of “I have no control” combined with “I have no idea what will happen” is not dissimilar to what you feel when trying to get pregnant, especially when it isn’t working. And while we are certainly not equating the weather to whether you’ll have a baby (we get how different they are), we are highlighting the similarities in the emotions we feel in situations that we can’t control.

When the pregnancy thing is not coming easily, the first emotion is usually shock. We have heard many a patient say, “I thought I just had sex and it happened. What is going on? Why is this not working?” The reality is that getting pregnant can be really hard. It can be really frustrating, exhausting, and frightening. In this situation, thoughts like “Will I ever be a mother?” run through one’s head on auto-repeat constantly throughout the day.

Additionally, our inabilities to will a baby into our belly can make us angry—angry with yourself, your partner, your friends (especially those that seem to get pregnant when they just look at their partner), and your doctor. These emotions are common and normal. Everything you feel, say, and want to scream is totally legit—for lack of better words, this sh-t sucks.

While we can give you a ton of advice about fertility, a lot of advice about GYN, and a good amount of advice on OB, what we can’t tell you is how to let the anger, frustration, and I-am-so-pissed-off-right-now emotions go. For each of us, it’s different. For some, it’s time. For others, it’s distance; for still others, it’s change. But whatever it is and for whatever amount of time it takes, when you finally arrive, it will be liberating. Acceptance of what previously may have seemed unacceptable will allow you to no longer stand still or move backwards but in fact take a leap forwards. The freedom to let it go is empowering and energizing—with this release, you have the strength to tackle your next steps.

Most women struggling with infertility probably never wanted to undergo fertility treatments, let alone talk to their GYN about why things were not working out. They never imagined doing IVF, let alone something like egg donation or a gestational carrier. The realization of where you are in relation to where you wanted to be can be mind-boggling.

And while we are certainly not minimizing your emotions or making light or your situation, we are hoping to push you forward. As your pacers, we know what awaits you at the finish line. We can see the end way sooner than you can because we have run this race alongside many other women many other times. We have some serious experience on this course and know its ins and outs, turns and curves. We want to guide you to the finish and achieve the dream of parenthood.

There may be no bigger control freaks than us at Truly, MD. Admittedly, we too are type A++++ women who like to check, double check, and then triple check. Gambling is not our thing, and we almost never leave anything up to chance. It’s just not our style. But through years of both professional and personal trials and tribulations, we have had to learn to let go—to give in to the unknown and to say okay to the previously unacceptable.

While we are certainly not recommending that you just go along for the ride on your fertility treatment merry-go-round (we want nothing more than to empower you to ask questions and participate actively in your treatment), we do want to help you close that weather app and accept what’s going on outside. You may not get pregnant on a bed of roses listening to Sade…it may be in an operating room with bright lights and a speculum. It doesn’t mean you failed or are any less of a woman. In fact, most would say you are even more of a warrior woman and will make an even better mom because of all you went through to become a parent.

Although the weather forecast may look bleak, remember, things can change as the days and time get closer. And even if it doesn’t, even if it rains or snows or hails in April, you can get through it. You may need to go to Plan B or Plan C, but at the end of the day, if you hang in there, you will be a parent. You will have a family, and you will reach the end of the fertility journey.
If you can find a way to accept your forecast, the skies will be bright on the other side; you may just get wet on the way.

I Learned to Love Myself by Loving Them: What I Have Learned from Being a Mother

Of all the stories I have ever told, all the advice I have ever given, and all the words I have ever spoken, this one will be the hardest. It will reveal me not as a doctor but as an individual. As a mother who always feels guilty, a daughter who always feels remorseful, a wife who always feels inadequate, a friend who always feels subpar, and as woman who always feels unsure. It will reveal me: my fears, my insecurities, and my limitations. Despite knowing most answers to any pregnancy, fertility, or gynecologic question, I certainly don’t have all the answers when it comes to life, motherhood, and pretty much everything else in between. I struggle, just like we all do to fit everything into my day, to be present in the moment, and to do the very best I can. One of my biggest struggles has been accepting myself, specifically, my physical appearance. For years, I have stared at myself in the mirror, hating the girl that looked back at me—everything looked wrong. From my head (hair too frizzy) to my toes (why do I have those bunions at age 20!), I could find something wrong.

Admittedly I have always been your typical type-A, OCD individual. Always trying to score higher on the test, run faster on the track, and push harder in my life. I always strived for perfection, be it on an exam or in my appearance, so I was, in many ways, your typical setup for an eating disorder. I never felt smart enough, thin enough, or good enough. I wanted (and unfortunately still do) to control nearly every minute of my life, both the big and the little things. Starting in my sophomore year of college, I began my battle with anorexia and restrictive eating. I limited what I ate and whom I ate with. I also amped up my exercise and ran a minimum of six miles per day, no matter what. I also cut off connection with several of my friends and alienated myself from family members. I didn’t want anyone to see me eat, ask me about food or comment about my size.  Ultimately, with help, time, and endless support, I gained back the weight and learned to deal with the many of the issues fueling my disease…sort of. I could eat regular meals, exercise an “acceptable” amount, and re-enter the world. However, in retrospect, my true healing did not begin until I had children and could see the power and potential that our bodies held. Loving another individual so unconditionally and knowing how integral I was in the creation of their life allowed me to respect and appreciate mine so much more.

I am not going to lie. I found pregnancy and the post-partum period very difficult. Watching my body change, although for a better cause, was not easy. Some days were harder to accept than others, particularly after the babies were born. I can remember many a day standing in my closest thinking, Is there anything here that can hide my stomach and tush? I yearned to just look “normal” again, to be my old self. But the more I thought about this, the more those dark days came rushing back. They were anything but normal! It was a life where I beat myself up for every cookie and piece of cake I ate. It was a life where I stared at the scale and hated the number, no matter how low it was. It was a life that I couldn’t go out for dinner with my husband if salad wasn’t on the menu. And it was a life before I had my two beautiful daughters.

Why, no matter how thin I was, would I want to go back to that life?

While I still look in the mirror and think my tush could be smaller, my thighs thinner, and my stomach flatter, I have stopped hating my body. I have stopped criticizing myself for every carb I ingest or for every piece of candy I chew. I realize now how unhealthy this practice is and how negatively it affects me and my daughters. When I heard my older daughter ask, “Are you going running so you won’t be fat?” I nearly died. I know she will grow up in a world where body image is paramount and girls are still judged more on their appearances than their brains, but I want to do everything I can to teach her to be strong, to be proud, and to be confident. I can start by respecting myself, seeing the power in my actions, and loving myself for all that I have accomplished.

I am choosing to share my story because I want to encourage honesty, openness, and realness. Our site is based on two real women, with real lives and real problems, offering real advice. The first step in this process is the sharing of our realities, both the good and the bad, the ups and the downs, and the losses and the gains. So here is who I really am. I am a mom, a wife, a daughter, a sister, an aunt, a friend, a doctor, and a girl who often feels insecure, unsure, and afraid. But I am also a girl who, with the help of others, has come to respect herself, appreciate herself, and love herself. I want to share my voice with you and offer a real perspective on medicine, motherhood, and most importantly, how we feel about ourselves.

Put On Your Bright Pink Lipstick

Since our “birth” nearly three months ago, all of the content, opinions, and thoughts have been exclusively our own. Sure, we have looked to several reliable medical resources (particularly ACOG and ASRM), read a lot of medical journals, and spent many years training, but the sentiments have been from Yours, Truly. Now things are going to change. We are going to feature an individual who has something important to say. Someone who has passion, someone who wants to make a difference, and someone who hopes to empower other women with her words.

We begin this series with Nikol Johnson-Sanchez. Nikol started the blog Not Just A Beauty Blogger: My Fashionable Journey Through IVF. Through her experiences and her honesty, she has connected with many women who, like her, are having difficulty getting pregnant. Combining her passion for beauty and fashion with her struggles with infertility, she has created a “beautiful” blog that is devoted to helping women who are struggling with infertility. In Nikol’s words, she wanted to “put her stamp on IVF. Not the other way around.” And as an already well-known figure in the beauty world (Nikol has a YouTube channel and a blog devoted to beauty and skin care), she was inspired to share her fertility journey. After watching Bobbie Thomas chronicle her journey through IVF (both Bobbie and Nikol are in the beauty industry), Nikol started her blog.  

Pretty quickly, Nikol became pretty popular. She attributes her popularity to the way in which she chooses to address infertility. She has put her personal “stamp,” or shall we say “shade”(for all of you beauty fans), to address difficult topics. As Nikol says, “Infertility can be a dark and depressing place. If putting on a bright pink lipstick gets you out of bed and to your monitoring appointment, then I have accomplished my goal.” Her posts are also devoid of “cover-up” (i.e., she doesn’t hide what is really going on). “I am completely transparent, and I love that I can be so free and raw.” So do her followers!

Sticking with the beauty theme, Not Just A Beauty Blogger, is NOT coming in wearing a colorless lip gloss and beige eyeshadow. Nikol is bold, honest, and direct. She constantly urges women to “fight for themselves and not to take no for an answer. You know your body best. Do your own research and be your own advocate.” Had Nikol not adopted this attitude, she might have never had the surgical procedure that ultimately led to the diagnosis of endometriosis. This discovery not only led to the cause of her infertility but also helped tailor the treatment outcome.

And while it may be hard to find anything positive about the fertility journey (needles, blood draws, and vaginal ultrasounds are not fun), Nikol shared with us how this experience has strengthened her marriage. “My husband is my rock. We have grown so much closer; without him, I wouldn’t have fought as hard as I did.”

In parting, we asked Nikol to give us five words of advice that she would like every woman with infertility to hear. She responded, in capital, bold, red letters, with the following: YOU ARE STRONGER THAN YOU KNOW…KEEP GOING.

Thankful

This month, in schools across America, from pre-K all the way up to 12th grade, kids will take a moment to reflect on the concept of thankfulness. Prompted by projects designed by their teachers (#weLOVEteachers), they will answer the question: What are you thankful for? Whether they draw it or write it, act it or emote it, in some way, they will reveal what is most important to them. And while some of the answers may make you laugh and others may make you cry, they will all make you stop, think, and reflect.

Unfortunately, as adults we don’t have a teacher giving us assignments. You are, in many ways, on your own. There is no one checking your homework or prompting you to think about the positive things in your life. How you live your life and if or when you reflect upon your life is up to you. Sometimes, this practice can be isolating. It can make you lose direction, and it can make you forget to appreciate all the good that surrounds you. You can, albeit unconsciously, miss those homework assignments that forced you to stop and reflect. And although we can’t tap our foot, shake our finger, or prepare our red marker for corrections, we are going to take a moment and play the role of teacher. So grab a piece of paper, pull out a pen, and start working on your Truly, MD, homework.

Your assignment is the following: “What are you thankful for?” We will go first….

Jaime:

“It’s hard to pinpoint the one or two things that I am most thankful for—a good problem, I know! And unlike that never-ending to-do list, there is nothing on my long “thankful” list that I want to cross off—I have been blessed with friends, family, health, and opportunities. I am a lucky girl. But this year, what I am most thankful for is evolution. I have been able to witness my parents evolve into grandparents, my little babies evolve into toddlers and children, my friends evolve into surrogate sisters, and our words evolve into a website. And as these areas have evolved, I, too, have evolved: as a daughter, wife, mother, doctor and now advocate. I will be eternally thankful for the opportunity to not only watch these developments but also to live these developments. What an amazing journey it has been.”

Sheeva:

“I am thankful for my environment. And while I do love myself a fall Central Park day, I am not referring to my physical surroundings. I am alluding to the passion, the conviction, and the endurance of the individuals around me both at work, at home, and at play. Be it to themselves, to others, or to the collective good, those around me are committed. And their commitment has provided me with endless opportunities. I am forever thankful for these opportunities and the chance to make a difference. I promise to use my voice to shape the environments of others.

Truly-MD:

We are thankful that you have allowed us “two girls in the know” to join your journey. Whether it be as you are flying solo or as you are mommying, being there alongside you has been nothing less than incredible. We THANK you for inviting us to share some of life’s most special and intimate moments with you. We are humbled by your honesty and your hospitality. We hope that our relationship continues to evolve and you continue to invite us back to your “table” for years and years to come.

In the words of one of our role models (you know who you are!), we are lucky not only to be alive but also to have the chance to live. Take a minute, and reflect upon what makes you live and what you live for. And while no one is checking your work (this one is straight-up honor code), here, there are no failures. Be thankful, be thoughtful, and be true. That’s worth way more than an A+ in our book.

When Doctor Becomes Patient

I (Sheeva) am a breast cancer survivor. And while I have uttered those words numerous times over the past two years, it is still shocking to hear myself say it. I had no risk factors. In fact, I had all the “protective” factors and a “normal” mammogram only six months prior to the diagnosis. Nonetheless, it happened to me. And because I was a seemingly unexpected bystander, I have chosen to share my story with all of you. Truthfully and honestly. So here it goes, the unedited version.

I was 38 years old with two children, and I was “done and done.” And while “done and done” means different things to different people, for me, it meant doing something for myself. This is the part of the story that makes me somewhat uncomfortable sharing, but I decided to undergo elective breast augmentation. Prior to the surgery, I was required to undergo a mammogram. I did as I was told, and a small mass on my left breast was identified. I underwent a needle-guided biopsy, and as suspected, the mass was benign. Off I went to get my implants.

Fast-forward six months; I felt a very discreet pea-sized lump just under the surface of the skin. I didn’t remember it being there before; it immediately caught my attention. I waited it out for a menstrual cycle to see if it would go away (as a GYN I knew that some lumps and bumps come and go with our hormones). But a month later, it was still there—no change. It didn’t budge. But neither did I. I did have my gynecologist (and my colleague, fellow GYN, and best friend Jaime) feel it—we were both confident it was nothing. I mean, it was smooth and rubbery, and it moved: classic textbook description for a benign mass. Ironically, around the same time, I received a follow-up reminder to check on the benign left-sided cyst that was biopsied six months prior. Now I had two reasons to head back to the radiologist—it just seemed to make sense. One trip, two tests.

And what a trip it was. On this solo venture, I was given the most frightening news of my life. In the words of the radiologist who had performed the mammogram, “This is not normal, and it needs to be biopsied.” Despite my shock, I could piece a few words together and replied by saying, “Are you worried?” Stone-faced, she said, “I don’t know; that’s why we need to biopsy it.” Just then, the ultrasound technician joked about the size of the lump and its proximity to the implant: “The biopsy will probably burst the implant.” This was not a good experience, and it didn’t take me being a doctor to know that. I was not going back there.

I went home and did some research, and within 24 hours I had all my images transferred to a different radiologist. A couple of days later, I went in for both repeat imaging and a biopsy. Within 24 hours, my doctor called and gave me the news: “You have poorly differentiated invasive breast cancer.”  

It’s hard to put into words exactly how I felt at that minute, for the next several minutes, and for the next few days. There was so much that was unknown to me, even as a physician, and it was these unknowns that made it so incredibly frightening. How bad was it? How far had it spread? Will I recover? And through all the unknown and unanswerable questions, the pervading thought running through my head was, I have two young children who need me and who I want to see grow up.

That evening, my support team (my family, Jaime, and her husband) came to my apartment, and we mobilized. We got names of breast surgeons, we made appointments, and together, we moved forward. A few days later, I had an MRI that suggested the tumor was localized to the breast. I found out that my receptor status was positive. (Breast cancers that are positive for estrogen and progesterone receptors have a better prognosis and respond to a medication called Tamoxifen, which can be used to lower a recurrence.) I was scheduled to undergo surgery with an excellent physician at Memorial Sloan Kettering.

I was given the option for a lumpectomy, a right-sided mastectomy, or double mastectomy. Although my surgeon eloquently explained that it was a very small tumor and I could undergo a small surgery, I had already made up my mind to go for the bilateral or double mastectomy. I mean, they weren’t real to begin with! At least this way, I didn’t have to go for frequent imaging of any remaining breast tissue. The last decision came down to the nipples, to take them or to leave them. Although for cosmetic reasons, keeping them would be a plus, I decided to part with them as well. After all, I’m a doctor not a breast model…

While I felt confident about the procedure and the surgeon, hurdles still lay in front of me. Would my lymph nodes be negative or positive for the cancer, and would my oncotyping (other gene profiles related to recurrence risk) be unfavorable? If yes, I would need chemotherapy following surgery.

But I got lucky. My news was good. There had been no spread to the lymph nodes. The invasive lesion was only 7mm, exactly the pimple-sized mass that I was feeling. However, in addition to the invasive lesion I had DCIS (ductal carcinoma in situ; a.k.a. pre-cancer cells) throughout my entire right breast, including the nipple. When discussing these findings with my surgeon, she said, “Your intuition about taking the entire breast and the nipple out was right; if you would’ve opted to keep them, you would have needed another surgery.” The last piece of good news came about two weeks later, when my oncotyping returned as low risk; chemo was not needed.

Over the next three months, I went every one to two weeks to have my “tissue expanders” (the equivalent of an inflatable implant) inflated. Slowly, over time the skin stretches to accommodate the future implant. While it wasn’t necessarily painful, it was an odd sensation. I underwent the exchange surgery, in which the tissue expanders are removed and the permanent implant is placed, and I was left as I am today. The final step in this process is the third surgery to create a nipple, which I for now I will forego.

Medicine wise, I am on Tamoxifen, an anti-estrogen pill that impairs the ability of estrogen to bind to its receptors; it lowers my risk of a recurrence. My relationship with Tamoxifen won’t be short: I am scheduled to be on it for the next 10 years. And while it makes you a bit sweaty (think mild hot flashes), in my mind it is a small price to pay for lowering my cancer return risk.

It’s funny that, while I was embarrassed to undergo elective augmentation and admit it to anyone but my close friends, I truly do believe that those implants helped save my life. The implants are placed beneath the breast tissue. They pushed what little breast tissue I had (and my surgeon attested I was in the group with “lowest volume breast tissue but had cancer”) to the surface of my skin. A foreign object made me more aware of my native tissue. Ironic, huh?

According to the current guidelines and recommendations, I would not have had a mammogram for several years. I was not yet 40, I had no family history, and I was not a BRCA carrier. The American College of Obstetrics and Gynecology recommends that yearly mammogram start at age 40; a breast exam is performed by a health care provider every one to three years (from age 20–39) and yearly after 40. Furthermore, while there have also been advances in mammography (digital mammography vs. traditional film mammography), MRIs for high-risk cases and ultrasounds for women with dense breasts are not routinely used on the “regular” no-risk patient. I was that totally “random” patient who would have been missed. Except for those implants…

In reviewing my case, as both a doctor and as a patient, I have tried to understand what went wrong. How was the lesion on my right breast missed on that first mammogram? First, mammograms are not foolproof. They are pretty good, but tumors can be missed, no matter who is reading them. In retrospect, it appears that my cancer was lateral (far out wide), and perhaps the first time, they did not get adequate views. Basically, they did not go far enough out. But while we can rehash the views and the images, it won’t change my outcome. What we should stress is the benefit of breast self-awareness and self-breast exams. Without them, I am not sure when I would have found the lesion, how big it would have been, or where I would be now.

I am not alone. One in eight women will get breast cancer, and most of us are going to be the “randoms.” We won’t be BRCA carriers, we may not have a family history, and there is a chance we will have no identifiable, real risk factors. All you can do to protect yourself is to be proactive and to follow preventative screening measures. The earlier a breast cancer is identified and treated, the better the patient will do. And unfortunately, many cases are still missed, despite diligent exams and other screening.

I share my story in hopes that maybe one woman or more will be prompted to do her own breast exam, go in for her long-overdue GYN appointment, or get her first mammogram. I’m not writing this for sympathy or pity. I am not a drama queen, and honestly, I’m not too fond of attention. However, by baring it all, I hope to shed light on why it is important to know your body, particularly your breasts. It could make the difference between life and death.

I often say I was dealt the “good cancer card.” Breast cancer is one of the few cancers we can detect early, with excellent survival rates. This is why every October is deemed #BreastCancerAwarenessMonth. While medicine is evolving and our cancer colleagues are making major strides, most cancers simply do not have the same prognosis as breast. This is why I am lucky. I am grateful every day that this was the card I was dealt and by a stroke of fateful events I felt this pea-sized lump. To my sisters out there battling more extensive disease—I send you my love and support. Together, we fight and raise awareness. No cancer diagnosis is in vain. We love, live, and learn more with each life affected.

Awareness

Let’s play a game (and we promise it doesn’t involve balls, bats, or scorecards)! Try to think back to the last time that you sat in silence and were aware of your body, your presence, and your surroundings—a moment where you turned off your computer, forgot about that ever-growing to-do list, and ignored the incoming slew of text messages. For most of us, this is “game over” before the first pitch is thrown.

When it comes to taking time to be aware of ourselves and our needs, we are fighting a losing battle. From work to home, friends to family, and bills to babies, our lives are busier than the NYC streets during UN week. Awareness of anything (except the ticking clock) is nearly impossible to achieve. But in reality, awareness of yourself and your body is the battery that makes your clock tick. Without a reboot or an occasional repair (aka a day off and a check-up with your doctor), the system won’t run.

While most of us view awareness on a personal level (my leg hurts, my car won’t start, or my sink is leaking), awareness has many “faces.” It can be public or private, professional or personal, physical or mental. You can focus on being aware of your partner’s needs as well as the stranger seated next to you on the train all in the same minute.

For us as physicians, awareness denotes prevention, particularly screening for a disease process. And when it comes to screening, there may be nothing more near and dear to our hearts as OB/GYNS and as women than breast cancer screening. In our world, October means a whole lot more than costumes and candy; it’s the month we dedicate to breast cancer awareness and highlight the important of breast screening. We don our pink, and we push women to be aware of their bodies, especially their breasts.

Although awareness may not equal A+ health (unfortunately bad things happen to the healthiest of us) and eternal happiness, being cognizant of yourself, both your body and your mind, will move you much closer to that better place. Try to take time every day (even if just while brushing your teeth!) to be aware of yourself and of your body (#mindfulness). Be aware of what brings you up and who brings you down, what makes you feel good, and who makes you feel badly.

And while we may assign months to awareness of different body parts (#October=BreastCancer), we at Truly, MD, urge you to assign minutes of each day to awareness of yourself. Whatever it takes to take the tick out of the tock—do it. And while you may never actually stop to “smell the roses,” or appreciate the sun as it rises and sets, you might see something in a new light. And who knows, it might even look better that way.

Truth

The truth can be hard: hard to hear, hard to say, and even harder to accept. It’s one of those things that, no matter how many times we cover our eyes and hold our ears, it never leaves us alone. But while the truth can be brutal, it should never be ugly. It should be real, it should be transparent, and it should be unbiased. But it should never be ugly. If it is, you likely waited too long to hear it, too long to say it, or are hearing it from the wrong person. Go out and look elsewhere because what you are looking at may not be your truth at all.

When searching for your personal truths, you must remember to be true to your mind and true to your body. At Truly, MD, we are here as ambassadors to the truth about your bodies. From when they start to menstruate to when they hit menopause, we casually but factually tell you the truths about all things gynecologic and obstetric. We break down the most complex medical topics, answer the seemingly simple questions, and dish on everything and anything in between. Our focus in doing this is simply to tell the truth.

While we may not have lived it all, we have been around the block. We know what you want to know, what you should know, and what you need to know, and we are here to give it to you straight up (with no juice and on the rocks). Although it may burn going down, it won’t leave you tipsy. In fact, it will leave you clear headed and ready to conquer the world.

We will also bare our own selves and share with you our own personal truths, the ones we didn’t learn in medical school but rather as real women. We hope by sharing our truths, both the ones we learned as doctors as well as the ones we learned as daughters, mothers, sisters, wives, and friends, that we are able to create a community that is rooted in honesty, transparency, and truth. Here, there is no judgment, no false pretenses, and no biases, just a couple of girls who have been true to their friendship, their patients, and their passion for empowering others. Our pledge to you is to always tell it like it is. Your promise in return is take our truths and turn them into your realities. Together, we can make a change. And that’s the truth.