Knowing a woman’s lifetime risk to get breast cancer is 1 in 8; Dawn Barra’s anxiety instantly skyrocketed after her Obstetrician-Gynecologist Dr. Karen Kohatsu from Palomar Health detected an abnormality during her annual breast exam.
Dawn immediately went for a mammogram, (a low dose x-ray) which confirmed Dr. Kohatsu’s suspicion that something was abnormal. The definitive answer would come through an ultrasound guided breast biopsy, where a small tissue sample is removed from the suspected area and diagnosis confirmed by a pathologist.
Unfortunately the diagnostic imaging center she was working with couldn’t follow through.
“There was all this unknown. You don’t know if you have cancer or not. Then the place says they won’t do it (the biopsy),” Dawn said.
She went online, found the Jean McLaughlin Women’s Center at Palomar Medical Center Poway, and made a call.
“This beautiful woman answers the phone,” Dawn remembers.
After telling her nightmare story of delays and insurance debacles, the woman on the phone (who happens to be Program Assistant Nancy Jenkins) said, “she would deal with it,” Dawn said.
Nancy went to the imaging center Dawn had been working with, got the records, and coordinated a biopsy at the Women’s Center during Dawn’s spring break (she is a grade school art teacher).
“I had been treated like crap (at the other clinic) and Nancy scheduled the biopsy within the month,” Dawn said.
Within a week of the biopsy, Palomar Health Certified Breast Health Navigator Susan Gimbel had the results and gave Dawn a call. As a nurse navigator, Susan works one-on-one with Women’s Center patients, sharing options, referring services, and explaining hard to understand procedures. With a caseload of less than 100 at any given time, Susan is able to provide personal attention.
“I remember her asking ‘are you alone, are you sitting down?’” Dawn said of her phone conversation with Susan.
After telling her the biopsy had come back positive for breast cancer, Susan began educating her on the plethora of options. Susan answered all Dawn’s questions, from the simple to the most technical.
“She’s so knowledgeable. She went over every question (in detail),” Dawn said. “When I told people I had a nurse that was with me every step of the way, they said they’ve never heard of that, they didn’t have that.”
Because Dawn is of Jewish ancestry, Susan let her know she was at risk for a genetic mutation, where the cancer has a high probability of reoccurrence, or possibly developing in the opposite breast. To test for such genes, Palomar Health is one of only three local health systems that employs a genetic counselor. Susan made an appointment for Dawn to see her.
“That freaked me out a little,” Dawn said of learning that she might be at increased risk for the breast cancer returning even after surgery or developing other possible cancers, like ovarian cancer.
Dawn met with Palomar Health Licensed, Certified Genetic Counselor Cheryl Cina in the Women’s Center, where they discussed Dawn’s genetic history in detail and took an oral DNA swab. The good news is that the genetic test came back negative, meaning Dawn did not carry the genetic mutation.
After going over all her options with Susan, Dawn chose Dr. Stefan Moldovan to be her surgeon. Together they decided a mastectomy would be the best option. Due to the negative genetic mutation test, they would only remove the affected breast, but chose the more invasive mastectomy (total breast removal) over a lumpectomy (partial removal).
Dawn made the difficult decision after consulting with her husband Valentine, who happens to be a molecular biologist.
“There is no one right answer,” Susan said. “It’s a personal decision.”
Dawn says she felt very comfortable having the surgery at Palomar Medical Center Poway (formerly Pomerado Hospital) because she’d birthed her son there and both her son and husband had previously had successful surgery there.
“I liked Pomerado. I requested to have my surgery there,” Dawn said.
That didn’t mean she didn’t have anxiety. A few weeks before Dawn went in for surgery, a friend of a friend died in a fluke accident on the operating table in a Los Angeles hospital. It was on her mind the days leading up to her surgery and she kept needing reassurance she wasn’t going to die.
“The anesthesiologist Dr. Kim was so wonderful,” Dawn said. “I told him ‘I am afraid to die.’ He assured me I wasn’t going to die and taught me how to breathe (to overcome the fear).”
After Doctor Moldovan removed the cancerous tumor and all breast tissue, Dr. Abhay Gupta performed the plastic surgery, reconstructing her breast. She was then rolled into the recovery room.
“When I woke up I thought I was in heaven,” Dawn said. “The recovery room nurses were amazing.”
Now two years post operation, Dawn still attends the breast cancer support group, led by Susan, at the Women’s Center every chance she gets. Women in the support group are in different stages of the process. It was here that Dawn was “showered in concern” before she had her surgery from people she didn’t know who’d been through it before.
“Who else can be there in that way for you?” Dawn asks.
“Having the support I got… there’s no amount of money that could replace the team I had at the Women’s Center.”
Sara White delivered her twins at Palomar Medical Center Poway and couldn't have been more pleased with the experience. Here's what she had to say about our Labor and Delivery/NICU:
"It's been an amazing experience at the Birth Center at Palomar Medical Center Poway. It was the best labor and delivery birth that I've had, and I've delivered at three different hospitals. Having them being cared for in the NICU here was nice. They got a lot of attention. I loved that I could be here with them whenever I wanted to be here. My favorite time to come in was after shift-change at night. I would come in for a couple of hours at night, rock them, feed them and feel like I got to put them to bed. I'd then go home and be with my big kids and then come back and see the babies again."
"They have a big brother and a big sister at home, two and five years-old. Together, they'll all be relatively close in age and at some point they'll all be teenagers at once, but that's for another time. Everyone on staff has been great. They have a wealth of knowledge and everyone has every answer to every question that you ask. I've always felt welcome to call, I've always felt welcome to be here. I knew where everything was, where the blankets were, where the bottles were and everything else that the babies needed. It never felt like I had to ask permission to do things with my babies. I just got to come be with them."
"The first night we left them was really hard. I was a nervous-wreck. As soon as I got here and I saw the two nurses, I was relieved to know that they were being taken care of and loved, too. This hospital came highly recommended; it's not just tolerant of mom's birth plans, it's really supportive of how they want to birth. We sought it out for sure."
"We delivered at three hospitals now, and we want to be here. Giving birth, I got to labor the way I wanted. I did get taken to the OR to have them, as is usual with multiples. I was talking to one of the nurses after. It was a really peaceful OR. Going from laboring in a nice quiet, dim room, and going to the bright OR was still very relaxed. It didn't feel stressful or scary. Whenever I come in to see the babies, the staff is always asking if I want juice or water. I felt taken care of the whole time. I'm sad to be leaving. I love all the nurses here, and I'm sad I won't be seeing them as often. "