NMC Patient-Employee Amanda Wilson Endures Preventative Surgeries

Mammograms and other preventative screenings are often prescribed during annual primary care visits.  Yet for those employed in medical care facilities, the role as patient and as a health care provider can sometimes overlap.

Such was the case for Amanda Wilson, LICSW, during her annual mammogram last November.

“The DI department had openings for mammograms, giving staff access to appointments,” says Wilson, Manager of NMC’s Care Management team.

Wilson, who also serves on NMC’s Cancer Committee, says she has always taken prevention seriously. Not only because her grandmother was diagnosed with, and died from Breast Cancer in her forties, but also because she is a mother herself.

“I have a 12-year-old daughter and want to live forever to be with her,” she says.

Due to a higher risk of inheriting cancer, Wilson was offered genetic testing during that annual screening. Agreeing to be tested the same day, Wilson met with NMC’s Breast Care Navigator, Chelsea Mulheron, RN, who administered the blood draw.

“Because Amanda is an employee, and we work on the Cancer Committee together, she had heard about the program,” says Mulheron. “She knew going into her appointment that this was going to be discussed and offered. So, when our techs talked to her about this, I believe she was more prepared than most patients and had the mindset that she wanted to do it.”

NMC utilizes the ‘MyRisk^® Heredity Cancer Test,’ supplied and supported by Myriad Genetics. MyRisk^® is a multi-gene panel that helps to determine a patient’s risk by evaluating a number of hereditary cancer syndromes, with focus on 11 primary cancer sites.

“This company allows us to test for 54 different genetic gene mutations, covering 11 different types of hereditary cancers,” Mulheron adds. “Along with the genetic testing, it also does a breast cancer risk assessment, which estimates a patient’s lifetime risk for breast cancer.”

For patients with significant personal or family history of cancer, like Wilson, the results of genetic testing provide important information for family members if genetic changes associated with hereditary cancer are revealed.

Patients are notified about results via the Myriad portal, as well as by Mulheron. “Each test has a sheet with instructions to contact a genetic counselor to review their results, which we recommend. This is included in the program and is not an extra cost to the patient,” Mulheron says.

“I tested positive for the BRCA 2 gene (mutation) and subsequently decided to have my tubes and ovaries out, as well as a bilateral mastectomy,” says Wilson.

While every human has both the BRCA1 and BRCA2 (BReast CAncer) genes, a small percentage of people (about one in 400, or 0.25% of the population) carry mutated BRCA1 or BRCA2 genes, according to the National Breast Cancer Foundation.

BRCA genes normally play a big role in preventing breast cancer. They help repair DNA breaks that can lead to the uncontrolled growth of tumors. Those with a BRCA gene mutation are more likely to develop breast cancer, and more likely to develop cancer at a younger age.

For many, the idea of electing to undergo a bilateral mastectomy as prevention seems unfathomable. Yet, Wilson was facing startling statistics: approximately 45-percent of women with a BRCA2 mutation develop breast cancer by age 70. Furthermore, those with a BRCA mutation that endure and overcome Breast Cancer remain at a higher risk of recurrence or developing a secondary cancer.

Wilson says upon receiving her results, she began to seriously discuss life-altering options with colleagues, family and friends.

“The first person I called was Amy Fox, a Nurse Practitioner that works on PCU that specializes in Oncology, and asked her what would you do?”

Wilson says that being both a patient and an employee of NMC allowed invaluable flexibility and support that others may not have the privilege to experience.

“Working for a small, community hospital, we are literally working with our friends, family, and neighbors. Particularly with female colleagues I’ve been able to process and even cry behind my office door,” Wilson says.

“It really helped to have people tell me they would make the same choice if faced with the decision; it helped give me the confidence and courage I needed to move forward,” she says.

“I helped Amanda find a surgeon that she felt comfortable with to have the conversation,” says Mulheron. “I was available to talk when she needed it. A lot of my role is listening to the patients, being a sounding board for them and then supporting their decisions.”

With choices made, Wilson moved quickly to have her ovaries and fallopian tubes removed, as BRCA gene mutations increase the risk of developing ovarian cancer as well.

“Dr. Lowrey Sullivan squeezed me in on a Friday,” she says, “I was back to work on Monday with no restrictions.”

The first surgery was in December at NMC and by February Wilson had undergone a successful mastopexy at Green Mountain Surgery Center. The mastopexy, or breast lift, was the first in a two surgery process with the goal of completing a nipple sparing procedure with prior to the mastectomy and reconstruction. She says she was off work for a week to recover.

Wilson recalls how emotional it was leading up to the bilateral mastectomy and reconstructive surgery, which was scheduled for May at NMC.

“It’s hard to reconcile how much you’re doing to your body as a preventative measure,” she says. “There’s also a lot of grief from not knowing – not knowing when I awoke if I’d have breasts or not, as nothing was guaranteed.”

When the day of surgery finally arrived, Wilson says she was again encompassed with love and support.

“My friend Holly Cooke, an OR nurse at NMC, came in early for her shift to be the nurse to take me to the OR. She was the last face I saw before anesthesia,” she says. “When I arrived for surgery, another friendly face, Sadie Burns, RN, nurse gave me the biggest hug and just held me for a minute because I was scared and on the verge of tears.”

In the OR, surgeons Susan MacLennon, M.D., who serves one day a week at NMC, along with her Green Mountain Surgery colleague, Dr. Julie Alosi, M.D. worked in tandem performing Wilson’s bilateral prophylactic mastectomy. Dr. Alosi skillfully removed the breast tissue, while Dr. MacLennon continued with breast reconstruction.

“Being able to receive such a massive surgery in one place, all in the same day is a pretty big deal,” says Wilson. Recovery took four weeks this time, before resuming work remotely, and returning on-site after the fifth week.

“Even leadership at the highest level remained supportive,” she says, offering gratitude to NMC’s CFO, Stephanie Breault.  “I was able to delegate work and give a leadership opportunity to a team member in my absence. My recovery would come first – I didn’t have to worry about my team.”

Wilson continues to meet with the breast surgeon every three months for follow-up care, yet the support doesn’t end there, she says.

“Our pathologist, Dr. Thomas Suppan, came to my office post-op to ask if I had any questions about my results, and offered to meet with me one-on-one,” she says. “He also told me what I did was courageous. It warmed my heart.”

Wilson got plenty of support from her family members, too, including her mother, a retired nurse.

“Yet, I’m at work all the time, so my work family were the ones spending eight hours a day with me for the six months leading up to the mastectomy. I would have never ever gotten this care at another hospital. I am incredibly grateful and want to highlight what we do well here,” she says.

“I know at times it is hard for patients to seek care from their co-workers. I always feel privileged when co-workers feel comfortable and choose to have their care here,” says Mulheron.

“We talked about being a work family and being there to support each other, this is just another time to offer that support. It just happens to be in a more private and different way and could be the most meaningful.”

Genetic testing can be scary. When someone tests positive for a gene mutation, their siblings and offspring will have a 50% risk of also testing positive. Having a discussion with a genetic counselor about the potential scenarios is important.

“Don’t be scared to find out,” offers Wilson. “The reality of having cancer and chemo would probably be more invasive and all encompassing.”

Wilson is happy to be back golfing and finishing up a great season coaching her daughter’s 7^th grade soccer team at MVU.

“I could not let that be my known path,” she says, imagining her daughter being without a mother at an early age. “It’s the best and hardest part of being a parent, she says, “It hurts in my soul to think of not being there for my kid.”

Wilson says she has learned to embrace each day with gratitude. “I’d always said that if I had the mutated genes, I’d get everything removed. It’s come full-circle and was meant to be this way.”

—

Story by Sarah Parsons West

For Northwestern Medical Center; October 2024