My Breast Cancer Stage IV experience

My name is Vered, I am an Israeli, aged 48, married with 3 children. Three years ago, I was diagnosed with breast cancer, and since then I have embarked on a long journey, and have gained a lot of experience, hence I feel an obligation to share this experience with other women whom may benefit from the information provided. The initial cancer was detected in the left breast as Infiltrating Ductal Carcinoma with Tumor measures 2.3*1.5*1.4 cm, where the IN SITU carcinoma represents about 60-65% of the Tumor. In addition one lymph node out of 24 that where removed, showed metastasis of carcinoma involving the entire lymph node and invading adipose tissue. In professional terms this is defined as T2N1M0. Unfortunately it was several months since I felt a lump, until finally I was diagnosed for Breast Cancer, and 2 weeks after I was diagnosed , the head of surgery in Kaplan Hospital Israel, Dr. Mavor removed the tumor (performed lumpectonomy) and removed 24 lymph nodes (about a third of the nodes) of which one showed metastasis cancer. This is real bad news and I can not emphasize the importance of early detection of breast cancer as crucial to provide a chance of full recovery. The first instinct one has when finding out one has breast cancer is to remove the tumor. Then comes the complimentary part, meeting with an Oncolgist. In Israel there are several leading Oncologists, Dr. Noa Efrat Ben Baruch in Kaplan hospital, Prof. Moshe Inbar in Sourasky medical center (Ichilov hospital), Dr. Bela Kaufman in Tel Hashomer hospital, and Prof. Tamar Peretz of Hadassa hospital are all definitely on the top of the list and there are others. The Oncologist is a person whom you might have a very long term relationship with, so it is important that you choose one that is a top notch experienced professional, that you have chemistry with and that is preferably relatively close to your home, and is accessible for ongoing consultation. I found both Dr. Ben Baruch and Prof. Inbar to be very committed and experienced Oncologists and I strongly recommend them both. Dr. Ben Baruch has been following up for 3 years on my treatment and has always been accessible, and responsive to the long path I have taken, and Prof. Inbar has been an excellent second opinion expert for me, and at a later stage provided me unique expert opinion, that ultimately resulted (following my personal decision) in my being operated in Memorial Sloan Kettering Cancer Center in New York. After the initial operation performed by Dr. Mavor to remove the tumor and the 24 lymph nodes of which one was malignant, and hearing the advice from Dr. Ben Baruch and Prof. Inbar, I was diagnosed as being triple negative , e.g my cancer does not respond to two type of hormones and Her 2 to which there is targeted medicine. ( Triple negative is another piece of bad news in some 15% of cancer diagnosed women) . Hence I started the conventional chemo therapy protocol treatment for this case which would have been 4 rounds of AC (pronounced Adriamycin and Cytoxan) and 4 rounds of Taxol plus radiation to the lymph nodes and the breast. My Oncologist stopped after 4 rounds of AC and 2 rounds of Taxol, because Taxol was causing problems at nerves at the edge of my finger tips called Neuropathy). The radiation was performed in Belinson hospital and done in approximately 30 sessions. The chemo was done first and radiation only begun about a month after chemo ended. The general feeling during radiation was much better than the miserable feeling during chemo, not to mention the loosing the hair bit and wearing a wig which was a lot of "fun". A few statistics I took down from my consulting meeting with Prof. Inbar at that stage included some interesting facts and statistics which I noted down. Just remember these are only statistics and noted as I perceived them. In similar case of breast cancer 90% of the women diagnosed are still alive after 20 years. The infected lymph node takes off 8% and that’s with natural recovery with out chemo. The chemo should return half of the lost points. Bottom line in 80% of women the surgery of removing the tumor solved the problem. Some 20% will have some form of metastasis, and metastasis cancer in crucial parts of the body like liver, lung, bones etc is not curable. If we are to have a recurrence, than the preferable place is the breast. Most important year is the first year, and then first 5 years. The important part of the tumor e.g. the real size is the portion that was not IN SITU, e.g. in my case 35% was not in SITU so it really was a 1cm tumor. A word of caution about the statistics. They are only statistics, and one has to be very careful in taking them too much in to account when making a game plan for recovery .e.g. now I am a much more "senior" Cancer patient with Stage IV metastasized cancer. The statistics are much more frightening in this department. So what were the odds that I develop stage IV etc, but statistics work both ways and should play only a minor part of the decisions on how to proceed with this new entrepreneur start up we just established named: "Lets save my ASS Technologies". (A quote I borrowed from one of the funnier books on cancer I will mention later on). So much for the standard treatment for that phase of the cancer. After several months, I developed in my breast and left arm what is called Lymphedema, which is a swollen breast and very swolen hand because of improper functioning of the lymph system , which was severely damaged from taking out a third of the lymph nodes as well as harm done during radiation. The lymph system is a very complex system, and the hand got swollen very quickly and very much, despite excellent treatment by my physiotherapist Iris. Initially I loaned a machined called lymphapress which massages your hand, I late purchased the machine, and I was very fortunate to come across a person named Eli Vikelman, who played a major role in my being treated in the best places in the world for specific problems. Eli introduced me to Prof. Campisi in Genoa Italy, who for some 30 years has specialized in dealing with Lymphedema by microsurgery, creating a bypass of the lymph nodes for the arteries, connecting the lymph system to the arteries by microsurgery. There are very few places in the world that do that and Prof. Campisi in Genoa is the leader in this field worldwide and does wonders. So there I was traveling to Genoa for a consulting session, a year and a half after being operated on for removal of a cancer tumor, and later traveling for 3 weeks to have a microsurgery operation done by Prof. Campisi and his assistant Dr. Bocardo. This had immediate positive effect on the size of my swollen hand that today looks normal, even though for precaution measures, I am still supposed to wear a pressure glove until 5 years after the surgury and visit Prof. Campisi for follow-up treatment twice a year to ensure maximum results. The importance of International Medical Insurance, I will cover later on in my description, but already in the relatively straight forward Genoa experience, I was introduced to the importance of extensive, reliable, Insurance, provided to me by Clal Insurance and DavidShield International medical insurance and the personal assistance of the people there involved. To those who are actually interested in Lymphedema complications, I found an interesting piece on the net: An Elective Experience: Nichola Farinola - Genoa, Italy, 2006 , which describes the experience of an Australian Student who traveled to Genoa to learn of the innovative techniques developed by Prof. Campisi The article can be found at the following link: http://som.flinders.edu.au/news/feature/archive/f0020.htm This year around March 2007, almost 3 years after I was diagnosed for Breast Cancer, I started feeling pain in the front of my chest. I was sent for tests such as X-Ray, Mammography and Ultrasound of the chest. All of this showed nothing unusual. Only later on when pain continued and I just knew something was wrong, I was sent again to CT, which showed nothing and then an Ultrasound of the Sternum, which showed something irregular. I was then sent to a bone scan and later to a PET CT and both of these clearly showed, I have metastasis e.g. a tumor in my Sternum bone, and maybe in the tissue surrounding. Cancer in the bone is of course bad news. The first thing to know is that breast cancer that reoccurs in the bone is still breast cancer and not bone cancer. It is breast cancer that has metastasized to the bone which is the most popular place breast cancer spreads to (other being the liver, lungs, leg bones, spine bones or head). Thus my stage II cancer, has now become a stage IV metastasic breast cancer. What a slip down the slope. The initial information provided to us by our oncologist is that cancer in the bone is not curable and is treated with Chemo therapy for life, that stops it from spreading for a while, but ultimately cancer wins. (It stops it in one of 10,000 patients…). In addition medication is provided in addition to chemo to assist the bone cells to grow. So, the next stage would be to do a biopsy to validate that the reflection seen in the bone scan and PET CT in the bone, and soft tissue which resembles that of a secondary tumor, is in fact breast cancer and related to the original cancer and not some form of unidentified primary cancer. In my case the biopsy had to be performed as a surgery as it was from the bone, and the soft tissue was to close to the lungs, hence dangerous to do a biopsy by needle. I was scheduled for operation in Asaff Ha Rophe hospital. After surgery, I was told that it would take some 10 days for results, as for the bone some process has to happen, where the calcium is dissolved first , so it took a good 2 weeks to get a result from the biopsy that confirmed, there was a cancer tumor in the bone. The soft tissue around did not seem to be malignant. This is a horrible period to be in, where you do a biopsy, the doctors that came out of surgery, actually cautiously mentioned that in their eyes, they did not believe the bone or tissue was malignant, so that gave me a lot of hope, but think of the anxiety, when you have to wait two weeks to hear the result. So finally after 2 weeks I had a follow up meeting at the outpatient center in Asaf Harophe, where I was notified that the bone was actually a cancer tumor and that the tissue around looked ok, however the pathology lab could not determine which kind of cancer this was, e.g. was this a new Unidentified primary tumor in the bone or was this metastasis of my breast cancer, and for this I was requested to obtain a copy of the paraffin slides from the previous hospital ( Kaplan) who kept the slides from my previous operation some three years ago. I went to Kaplan, they told me that there are many, it takes a couple of days to make copies as originals are not provided, and after the first batch of slides, it wasn't enough and we had to repeat this for a second different batch of slides. By this time I had established a personal relationship with the biopsy lab in Asaf Ha Rophe and the head of the lab Dr. Sandbank and her secretary Zipi were wonderful and went out of there way to provide us with prompt decisive results, and also prepared slides for us once we decided to travel to the United States. So finally, after feeling pain somewhere is March 2007, on September 6th 2007, I had my official results. I had stage IV metastasic breast cancer in my Sternum. My oncologist Noa Ben Baruch, recommended I take a mild Chemo named Xeloda, provided in pills, and maybe later consider adding Avastin, which is known to make Xeloda more effective and in addition send me to see if I can have some more Radio Therapy performed on my Sternum. This sounds like a simple solution provided to a well defined problem, so lets complicate it a little. There are publications that show that Aviastin makes the chemo such as Xeloda work better. What is does is it stops the supply of blood to the tumor cells and hence the chemo is more effective. Small problem , in Israel Avastin is NOT recognized for Breast Cancer, hence not included in what is called "Sal Ha Briut" e.g. funded by the state, hence costs some 30,000 NIS ($7,500) a month…, for life…Even private Health Insurance Policies have an upper limit for the amount to be spent on drugs. So there is an alternative and that’s to join in on an experiment for Avastin, but If you join the experiment, there certain conditions to qualify and certain rules. e.g. it must me a measurable tumor, and you can't have radio therapy as well ( as the drug company does not want to work in two dimensions not knowing what the true impact of Avastin is). In addition there is an experiment for a drug that assists bone cells to grow where cancer ate out the bone. This also has conditions and in addition if you participate in the Avastin experiment , you can't participate in the other experiment and visa versa. At this stage you probable understand why one feels obliged to go for a second opinion, because choices made here are non reversible, and potentially huge expenses are involved. Several weeks back we had scheduled an appointment for second opinion with Prof. Inbar for September 6th, not knowing this is the day we would finally receive the results of the biopsy and so three hours after receiving the biopsy results and consulting with Dr. Noa Ben-Baruch, we found ourselves sitting with Prof Inbar, who wrote the following letter: Prof. Moshe Inbar Sept 6 , 2007 Head Division of Oncology Tel-Aviv Sourasky Medical Center For Dr. Noa Efrat (Ben-Baruch) And Prof. Eyal Fennig Belinson Hospital Regards, This is a 2nd opinion consulting for the young fascinating 1959 born lady. Diagnosed 3 years ago with Breast Cancer left breast T2N1M0 Triple negative. Received 4 AC plus 2 Taxol ( out of 4) because of Neropatia. Received radiation in Belinson Hosp, according to Vered 25 in each breast plus lymph glands plus boost. I believe the total is 50 to the entire Breast with our knowing how much to the Sternum. Now has a secondary tumor in the Sternum (Manubrium). The Oncologist Dr. Ben-Baruch prescribed radiation plus Xleoda plus/minus Avestin. I am not sure how much radiation the bone can still take and not entirely sure the purpose of radiation – maybe for cure, but if so resection of Sternum can at least bring full cure. I talked to Dr. Jerry Weiss head of plastic Surgery in Ichilov, and Sternum resection is a common surgery ( not for cancer, but for heart bypass). Dr. Wiess asked to perform a CT with window to the Sternum bone. Other options researches targeted at triple negative such as cisplatin plus erbitux when erbitux is given in one arm immediately and if fails the other arm is given cisplatin. Question if applicable when tumor is only in bone. Other research Athena chemo plus Avistin again questionable for same reason. Bottom line, I am inclined towards the surgery and would not hesitate to leave patient only for follow-up after surgery. I am far from being a believer of chemo for a metastasis of Non symptomatic disease. Prof Moshe Inbar Quite a bit of information for one day, wouldn't you say? This was truly a day of elevation. On one hand we were bombarded with information, on the other hand, here was a leading Oncologist in Israel, actually suggesting we remove the Sternum, e.g. take out that nasty malignant tumor and hope for the best. This was truly a sign of light in the tunnel. True, there were a lot of questions hanging out there, e.g. could the sternum really be resected ?, what if the soft tissue turns out to be malignant as well, what is the disability involved with resection of the Sternum and many more questions. With the assistance of several acquaintances, especially Prof. Eran Littersdorf Dept head for Internal medicine in Hadassa Hospital, and Dr. Dgani from Sourasky medical center, Prof. Josseph Klausner of Sourasky medical center , and a dear friend Elinoar, all of which were kind enough to contribute valuable information, ideas and personal thoughts on how to put this event in the correct perspective, with respect to the original Breast cancer 3 years ago, what the important questions to ask are, and what is the correct course of action on which to proceed. The kind of questions were focusing on were: Assuming we take the radical approach of Sternum resection: Where is the best place to perform it? What hospital and what surgeon performed most of these operations? How does one check that this is a leading surgeon in his field? What kind of integration is necessary between the Oncologists, Plastic Surgeon, Thoracic surgeon and Oncologist surgeon? Who has experience in performing a frozen section biopsy during operation in order to verify the clean margins of the tumor? Is the construction technique state of the art? What kind of permanent disability is involved following the operation? What happens if there are surprises and other tumors are identified whilst in the OR? After doing our research we were aware that this is a complicated Cancer case, not popular, with the Cancer tumor sitting in a very nasty place, with big question mark if the tumor is just in bone or also in surrounding tissues etc? After conducting our research, we found that the leading centers for assisting with Cancer were the following: Memorial Sloan Kettering Cancer Center, New York University of Texas M.D Anderson Cancer Center, Houston Texas John Hopkins Hospital, Baltimore Mayo Clinic, Rochester Minnesota Dana Farber Cancer Institute, Boston Our Insurance Champion Mr. Eli Vikelman and wonderful wife, had the most impact on convincing us and providing us with the courage to proceed with an operation overseas. Eli is a very experienced person and after having lunch with Eli and Nava, there was no doubt in my mind that having a Sternum resection operation at an experienced institute is a doable mission, even though we had no clue as of yet what the leading institute is and what the lead surgeons name would turn out to be. This meeting took place on September 11th 2007. At that point additional wonderful people from our Insurance team of Clal and David Shields came in to the picture. Michal Ben Ami Overseas Surgery Coordinator and Ran Mizrahi General Manager of David Shields immediately started locating the suitable location.Ultimately we were connected to Rabi Eliezer Goldwasser a unique individual with a splendid international medical assistance Network. So this was our team and this team accompanied us closely during 5 intensive weeks, as you will see. It wasn't more than hours before we started the ball rolling with the assistance of my Friend from Boston Elinoar at the Dana Farber Cancer Center, via their International desk. After a few suspicious questions regarding our capability to use Insurance and pay, we were told that the minute we pass on the information and Pathology slides it would take 2-3 weeks to schedule a first appointment with an Oncologist and Surgeon. It wasn't more than a couple of days till the entire team decided that Memorial Sloan Kettering in New York would be the institute with the most experience. (Memorial Sloan Kettering Cancer Center on 1275 York Ave New York has some 9000 employees and huge research funds and is considered the leading institute in the world). So, on September 13th Rosh Hashana, we passed on the Dana Farber option and hours after we decided on Sloan Kettering, my husband and I got on a plane to New York to get organized for the appropriate meetings in Memorial Sloan Kettering. We arrived on Thursday afternoon, and it was the following day on Friday when we were told that we were shooting to meet with a leading oncologist Dr. Hudis and a leading Thoracic surgeon Dr. Manjit Bains. We were about to embark on a 40 or so day mission abroad, leaving our three kids alone in Israel but surrounded by a very supportive family, and a some close friends all making sure the kids were doing fine, whilst we concentrated on the task ahead. Dr. Bains is a leading thoracic surgeon who is internationally recognized for his innovative surgical techniques. He is an authority on surgical treatment of malignancies involving the lungs, pleura, mediastinum, esophagus, and chest wall. He has led studies in the treatment of esophageal tumors that involve shrinking the tumor before surgery in an effort to improve resectability and survival in these patients. An approach he developed allows resection of an esophageal cancer in some patients through an abdominal incision alone, which saves patients from a disabling chest incision. Technology developed by Dr. Bains allows successful replacement of the ribs and breast bone after resection of tumors, an approach that is both functional and cosmetically pleasing. On Monday, in the lobby of Memorial Sloan Kettering Cancer Center, we met the wonderful person doing the coordination for David Shields. This was Rabbi Lazer Goldwasser, who for many years has been coordinating various treatments for operations. Rabbi Goldwasser is an orthodox Hassidic Jew from the court of Rabbi Gur who was from Beni Brak and has been in the States for many years. Mean while in our hotel we started our research regarding who Dr. Cliff Hudis and Dr. Manjit Bains were, and with the assistance of Prof. Eran Lietersdorf the head of Internal Medicine Dept in Haddasa had access to some Thoracic surgery publications which looked like the following: We understood that Dr.Bains and Dr. Hudis where exactly the team we were looking for radical Sternum resection operation. We were lucky that with the aid of Rabbi Goldwasser to have a meeting with Dr. Bains Thursday, a week after we had arrived to the States and with Dr. Hudis the following Wednesday. Dr. Bains carefully reviewed the situation, and said he could and should perform the operation, and a tentative date would be Monday Oct 1st, pending our meeting with Dr. Hudis, to make sure he didn't want to do anything with the tumor prior to resection. Even though Chemo can't eliminate such a tumor, Dr. Bains thought there is a chance that the oncologist Dr. Hudis might want to give it some Chemo to see what potentially works on it. Dr. Bains explained to us how he would resect the bone, what he will do if he finds malignant soft tissues around the bone, and how he will re-construct the bone a mesh of Gortex and bone cement. Dr. Bains then sent us to a series of preadmission tests at the Memorial Sloan Kettering Cancer Center outpatients facility. Sitting there during those tests, we felt our first sign of victory. At that moment we knew every thing in this trip is going to be all right. We had traveled a week ago from Israel, to an unfamiliar destiny and with the fantastic aid of people like Eli Vikelman, Michal Ben-Ami, Rabbi Lazer Goldwasser, Ran Mizrahi, and probably other people behind the scene, we had located, the expert, who has done many of these kind of operations, at the best Cancer Center in the world, and we had a tentatively scheduled operation pending the meeting with Dr. Hudis. The struggle with cancer is associated with many small victories. This was no small victory. This was a huge victory. Yom Kipur was coming up, I had done what ever tests the hospital required prior to surgery, so we decided to head up to Boston to stay with our close friends. The distraction from what now quite a few weeks a continuous ongoing focus on how to treat this stage IV cancer was just the thing we needed. The following week I met the oncologist Dr. Hudis, whos bio in MSKCC reads as follows: "I am a medical oncologist with research interests in all areas of care related to breast cancer. My clinical practice is solely devoted to the treatment of patients with breast cancer, and my research is focused on prevention of the disease, prevention of recurrence after surgery, and treatment of recurrences. Working with a broad team of experts at MSKCC and throughout the world, I am involved in clinical and translational studies that aim to develop better hormone therapies, improved chemotherapy drugs, more effective and less toxic methods of drug delivery, and newer highly specific agents. This work is conducted both at MSKCC, through the Breast Cancer Disease Management Team and the Breast Cancer Medicine Service, and also through my role as the Breast Committee Co-Chair of the Cancer and Leukemia Group B (a national clinical research group sponsored by the National Cancer Institute). In addition, I am fortunate to serve on the editorial boards of several leading cancer journals and in several capacities with the American Society of Clinical Oncology (ASCO)." Dr. Hudis explained that we need to understand that Stage IV cancer is not like a cold. It is not curable. Most likely cancer cells are hiding in other parts of the body and at some stage we will most likely need to face that. He mentioned that hence, the treatment we were offered of Xeloda plus Avastin was the conventional treatment. The theory being today that when cancer is in the bone it is still breast cancer, its not bone cancer, or sarcoma etc etc and hence start off with a mild treatment (Xeloda taken orally, with out the side effects such as loosing hair) and when that doesn’t' help move on to more toxic chemo etc. However, Dr. Hudis emphasized that I am in a unique situation, because normally when Stage IV Metastasis happens it is located in several places and my scans indicate a one deposit in the Sternum alone therefore as Dr. Hudis put it, "if it were me, I would definitely perform the radical Sternum resection operation", if only to potentially delay potential Chemo treatments (or meeting the Oncologist as he phrased it) for a long time. We talked some more of the physiological benefits of taking this tumor out, we talked a little of the Dr's opinion of Maitake mushroom food supplements. Therefore Dr. Hudis finalized by saying he would recommend to Dr. Bains to go forward with the surgery and hence there we were all geared up for the operation.The night before surgery our friends Elinoar and Eyal from Boston, traveled from Europe via New York to meet me and encourage me which was great. So I was all geared up for the big operation. October 1st the big day of surgery. My husband and I checked in to the hospital at 9 am, my operation was scheduled for 12 noon. At about 10 am I was in the pre-surgery room starting on the anesthesia procedures. My operation lasted from around 1 pm till 5 pm, e.g. 4 hours. A little after 5 pm , Dr. Bains met with my husband and described that the operation was successful. That the sternum had been resected and reconstructed and that the soft tissue we were debating about between rib 1 and 2 was in fact a cancer tumor and it had been removed with safe margins. Dr. Bains mentioned that because of this he would want us to meet the oncologist Dr. Hudis to see if he wanted to recommend chemo for me as follow-up for the operation. Dr. Bains mentioned that he was happy that we did the operation with him. Given all he knows now, he is confident the radical sternum resection was the right way to go, and that even for him, this operation, the location of the breast cancer, the soft tissue, the construction was not a regular task, but the patient had undergone it well and is now recovering. I spent 5 days in the hospital in the Thoracic dept recovering with the aid and supervision of a great group of doctors and nurses who did everything to ensure I am recovering whilst minimizing my pain cycle, until finaly after 5 days, of very close care in the Thoracic Dept of MSKCC, and significant progress, I was released home to our apt in NY, and was told to recover 2 weeks prior to traveling to Israel. I started to walk a mile every day and made significant progress, however after some 4 days or so, I started having significant pain in my right shoulder and neck, until on Friday night I had no option but to return to the Urgent Care desk of MSKCC. To expand on this story, I will mention , that, prior to my operation, I had purchased a book named "Crazy sexy Cancer tips" written by Kris Carr with an inspiring story about Kris and how she chose to deal, by changing life style, with her unique Cancer. When I was released from hospital the health discovery channel, screened a 2 hour movie edited by Kris on her story, and a few days later, I saw that Kris was giving a lecture in New York on Friday night. So my husband and I traveled down town to hear this lecture, but I was in such pain, that in the middle of the movie screening I told my husband we need to rush to hospital urgent care center. On the way out we saw Kris, and apologized that we were leaving not because lack of interest , but because of this emergency, so she quickly endorsed my copy of the book with: " Vered, Bless you my beautiful soulful amazing Survivor sister. Peace and Veggies! Kris Carr." We arrived at the hospital, and luckily for me one of the wonderful surgeons from Dr. Bains team was on duty. He hospitalized me, updated Dr. Bains, and for some 4 days I had undergone intensive tests such as a neck MRI, a shoulder MRI, a Pet CT scan, and with the close involvement of some wonderful people such as Dr. Zekaria and Dr. Anthony Daniels, it was established that this unfortunate pain was not a result of any new tumors, or problems with the operation, but rather, the body getting used to this new construction and specific pressures on muscles and muscle flaps should be dealt with gentle physical therapy. I had suffered enormously, I exhibited some form of allergy to most Morpheme based pain killers, and I can't say I enjoyed the MRI or Pet tests, but the devotion of the team to get down to the bottom of this, and the fact I had gone through extensive tests a two weeks after the operation and had a baseline conclusion that all was fine, was some form of compensation. On Wednesday October 17th 2007, 5 weeks after leaving for the operation in the USA I finally returned home. Its so good to be home. Some useful contact Info I acquired along the journey Dr. Noa Efrat ( Ben-Baruch) Head of the Oncology Center Kaplan Medical Center 972-8-9441083 972-54-4641070 noa_b@clalit.org.il Eli Vikelman C.L.U Insurance Advisors 11 Haodem St. Kiryat Matalon Petach-Tikva, Zip code 49517 P.O.Box 9211 Zip 49192, ISRAEL Tel: 00-972-3-9193999 Fax: 00-972-3-9192999 Mobile: 00-972-50-5200200 eli@vikelman.co.il Prof. Corradino Campisi Prof. of Microsurgery for Lympadema via Assarotti 46/1-Genoa Tel 010-8393755 Fax 010-8461057 campisicorradino@tin.it Prof. Moshe Inbar Oncology Division Manager Sourasky Medical Center Tel Aviv Tel 03-6973407 Inbr-nc@tasmc.health.gov.il Private Clinic 03-5444413 Prof. Tamar Peretz Oncology Manager Haddassa 02-6776725 02-6778899 tamari@hadassah.org.il Prof Eyal Fenig Head of Radiology Belinson Hospital Petah Tikva 03-9377308 Head of Pathology Labs Assaf Ha-Roffe medical center Dr. Sandbank 08-9778030 (via Zipi administration assistant) Prof. Joseph M. Klausner MD Professor and Chairman of Surgery Surgical Oncologist Sourasky Medical Center 03- 6974711 josephk@tasmc.health.gov.il Dana Farber Cancer Institute Boston MA International new patients 1- 617-7325777 Simona Shuster sshuster@partners.org Memorial Sloan Kettering Cancer Center International Center 160 East 53rd St, 11th floor New York, NY 10021 USA 212- 639-4900 1-888-675-7722 Fax – 212-639-4938 International@mskcc.org Memorial Sloan Kettering Cancer Center International Center Karina Marmolejos Guest Services Coordinator 212- 610-0869 Roberto Moya Guest Services Coordinator 212- 610-0870 Dr. Manjit Bains Thoracic Surgeon Memorial Sloan Kettering Cancer Center 1275 York St Manhattan New York 212- 6394938 (assistant Camila) Clifford Hudis Medical Oncologist Memorial Sloan Kettering Cancer Center 1275 York St Manhattan New York USA Appointment for new patients 212- 4979064 212- 6395449 (assistant Iris) International Medical Assistance Network Refua V'Chessed Rabbi Eliezer Goldwasswer International Director Tel: 718-972-4500/ 718-705-7484 24 hour assistance 646-220-2720 nymedical@gmail.com Leasing an Apartment in the Mid town/Upper East side in Manhaatan Estee JakuelApartment Resources Inc. 340 East 57th StreetSuite 1ANew York, NY Tel: 212.421.5615 x201 Fax: 212.644.0809 Email: estee@aptresources.comhttp://www.aptresources.com