Caitlin Whyte (Host): In our last episode of In Their Words, brought to you by UPMC in Central PA and the UPMC Pinnacle Foundation, we heard from Angelique, who was just 28 years old when she was diagnosed with breast cancer. She shared the fear and uncertainty that came with that diagnosis, but also the people who helped carry her through it, including someone she affectionately calls Dr. G.

Today, we hear the other side of that story. Dr. Abby Geletsky is a breast surgeon with UPMC who has spent more than eight years caring for patients through some of the most difficult moments of their lives.

For her, that care goes far beyond surgery. It's about relationships, celebrating milestones, supporting families, and walking alongside patients for years after treatment. In this episode, Dr. G reflects on the first time she met Angelique, the bond they've built, and why caring for someone with cancer means caring for the whole person. This is In Their Words.

Dr. Abby Geletzke: I am Abbey Galetzky, MD, breast surgeon. I've been with UPMC for a little over eight years now.

As far as medicine, I think I had the very typical course of just, in thinking about my life, I wanted to say that I helped people, and it's such a great way to do that. And surgery itself is a really gratifying way to do that, because you get to provide that help right away. But then, as a surgery resident thinking about what field I wanted to go into, it really took me a while to decide. And there were a couple of big factors there.

One was the ability to have a relationship with my patients. So, I see my patients before surgery, during surgery, and then for years after surgery. And I get to know them and their family members and their interests and we get to celebrate milestones together. It's such a gratifying and sometimes humbling thing to have those relationships. I feel so privileged that my patients welcome me into their lives like that.

And the other thing that's incredible about the field of breast surgery is how fast it changes. So back when I was a resident, I went to a talk, and I know I've told this story before on other media forums, but the speaker said, "In no other field are people working so hard to put themselves out of a job." And that just struck me right in the heart because it's true.

Breast cancer is such a well-researched field, thank goodness, that I really think we may have a cure for this sometime during my career. And I find myself out of a job for that reason, it'll be well worth it. I'll find something else to do. But people are working on all fronts to chip away at this disease, and it's changed dramatically since I've started doing it, and I'm so grateful for that.

I live in Manheim Township in Lancaster County, Pennsylvania. But I came out this way for college and then for residency. I was at Penn State Hershey. So, I met my very wonderful partners up in Harrisburg, Dr. Barton and Dr. Wolff. And when the opportunity came up for a job joining them, they were such mentors to me that I was thrilled to take that opportunity.

I will never forget meeting with Angelique. She has such a tremendous personality. So, she said in her podcast that she received her diagnosis on Valentine's Day, which is devastating as a 28-year-old, I simply cannot imagine that. I saw her just a few days later. She had this multifocal aggressive cancer. She was so young. She would have every right to be in tears or just that stony silence of people who can't grasp what's going on or any of the stages of grief would've been more than appropriate. But she was there ready to fight. She was like, "We've got this. We're going to be a team. This isn't going to slow me down." And it never did, not for a single moment.

We are seeing younger diagnoses for a number of cancers, breast included. We're also seeing it for lung cancer and colon cancer, and that's a scary thing. We don't know what's causing this. Is it something in the environment, something we're being exposed to? Which is making screening all the more important. So, for a time there, we were talking about starting screening mammogram for women later, maybe 45 or 50. But the American Society of Breast Surgeons recommends beginning annual screening mammogram at age 40, and they do recommend annual, so once-a-year mammogram throughout those years.

There's some studies going on to determine maybe some women can safely do every other year. But for patients who have a high risk, they might even need to begin younger. We usually recommend 10 years before the earliest breast cancer in a first or second-degree relative. But for someone like Angelique, without a family history of breast cancer, to have this diagnosis in her 20s really takes a level of self-awareness.

I think it would be very appropriate for women in their 20s maybe not to be thinking about that or to be doing a monthly self-breast exam. But not only did she notice that, but she brought it to the attention of her gynecologist. She saw the wonderful Dr. Sharee Livingston who is just a force in this community. And Angelique advocated for herself and that led to her diagnosis, and I think that's an such an important thing for young women to feel like they can do that and to maybe work through some of the fear that might be associated with that.

A breast cancer diagnosis is definitely about more than what's going on in the breast. So when we see patients, of course, the first questions that we're answering are, "What's my prognosis? What does this mean for my life? Do I need surgery? Do I need chemotherapy? Do I need radiation?" But for some patients who have chemotherapy, that can affect their fertility, which can be hugely impactful, so we try to work with local fertility preservation teams to give women options for that. For some women, this can really create a mental health crisis. So thankfully, we're developing some great connections for women's health specific mental health resources that are available through UPMC.

For some women especially and understandably in their 20s, they don't have the savings that people later in their career might have. And even some people well into their career just haven't had the resources to financially support a cancer diagnosis. So, it can be absolutely devastating. And the foundation is just tremendous in supporting those women. If we reach out and say, "What can you do to help us?" They're there to help.

And there's other wonderful local organizations. The one I'll mention is Vickie's Angels, is just tremendous, and I know Angelique worked with them. But to have this cancer diagnosis and know that if a bill comes, there's someone out there to help you with that. It just takes one of those many weights off their shoulders.

When we have a patient with a breast cancer diagnosis, when we see them for that first appointment, we're looking for any signs that they might need help, if that's mental health assistance or financial help, or, you know, maybe that patient is a caregiver for children or parents. What other stresses do they have going on? Our social work team is just phenomenal gathering resources for these things. They're able to provide counseling. They're able to provide resources. I think some of our patients think Jenny Wahler and her coworkers as their best friends, their partners through this treatment. I'm here to get cancer out. But they're there to help with some of those other weights that are on their shoulders to let them focus on their cancer treatment.

When patients come back, they're excited to see us. We're sharing that win. I'm smiling in front of computer right now. That absolutely warms my heart to feel like, you know, we're not just on a team with these people, we become family. And I have been to patients' weddings and, you know, and very sadly, I've been to funerals. But we see patients on their birthdays. We saw Angelique. We try to come with cards. Celebrate the little wins. When I have a patient who quits smoking, we try to throw a little mini party in the office to celebrate that because that's such a win, or to celebrate finishing chemo.

And the really amazing thing is, I think, my patients have that connection with my whole staff, from Kelly who works at the front desk and Jenna who's my nurse navigator. They know my patients when they call on the phone, and I think sometimes my patients call just to talk to them to catch up, because we feel that closeness. And what better environment to be fighting a disease like cancer to be moving forward from that diagnosis and that treatment survivors afterwards. I just feel such immense privilege and joy in being able to do this

I think patients will come see me for their initial appointment with a cancer diagnosis with any number of feelings associated with that. Fear is an obvious big one. But some patients, they're angry about it oryou have that sense of it being unfair because they did everything right through their lives, or they feel really guilty. Maybe they missed their mammogram the last year, or they've never had one, and they think this is somehow their fault, which it absolutely is not, or they're worried about, "How am I going to care for children?" Maybe they're a single parent. Or how they're going to care for their spouse or parents, or how they're going to pay the bills or will this be disfiguring through their treatment or, you know, will they lose their hair? There's just so many concerns and worries.

So, I think just to meet patients where they are, that maybe there's good days and bad days, maybe there's days of not being able to get out of bed or raging or crying. I'll tell my patients once in a while, pity parties are okay. My office is like Las Vegas. I know they're strong women. They don't have to be strong every moment, though, and those other feelings are valid.

And the one other thing I sometimes check on is the support person who comes with my patient, who might be a mother or a daughter or sister or a spouse. Those people really go through it sometimes, too, and sometimes they get a little bit ignored. To have a spouse or a loved one with breast cancer, everyone's asking, "How is that person? How are they doing?" But maybe they're not asking about how the caregiver's doing, and maybe they're the ones who are shouldering the burden other household needs or bills or not sleeping at night or not eating well. So, I think it's worth checking in on the caregivers also.

The foundation is wonderful. They help get things like mammograms covered, some of the more expensive breast imaging treatments. But they will help patients with other bills, patients who maybe after a mastectomy might need breast prosthetics or bras, rides. They're just really good at saying yes if we're reaching out and asking for help.

Some wonderful women in our office are associated with the UPMC Women's Mobile Health Unit, which travels throughout Pennsylvania, reaching out to underserved communities. They're helping to practice street medicine for people who don't have resources, because maybe there is someone out there who's checking blood pressure or diabetes. To have that resource specifically for women and for women's health, some of these things that can be missed on a breast exam or gynecologic exam, I think is a tremendous resource, and I'm so glad that UPMC is investing in that.

Angelique, you are a light in the world. Keep being you. The world needs more people like you in it, and I want you to know if I ever won the lottery, I would take you on the cruise with me too in a heartbeat.

The most important thing that I can say is to get screened. If you're worried, act on it. We really do think mammograms save lives. But for some women like Angelique who might not be old enough, if you feel something that you're worried about, we're here for you. and we're not going to judge whether you missed a mammogram or if you've shaved your armpits or if you're kind of sweaty. We here to help. My entire staff is incredible. My goal is that you feel welcomed and safe. And we really hope there is never a cancer diagnosis. But if there is one, we're here to help.

Caitlin Whyte (Host): For Dr. G, the relationship between a physician and patient doesn't end when surgery is over. It continues through follow-up appointments and milestones, good days and difficult ones. And sometimes, as she puts it, patients and their care teams become family.

Angelique's story is also an important reminder to pay attention to your body. Advocate for yourself when something doesn't feel right, and seek care when you have a concern. And for patients navigating a cancer diagnosis, support can extend far beyond medical treatment, from social workers and nurse navigators to resources made possible through the UPMC Pinnacle Foundation.

And if you enjoyed this episode, please be sure to follow, rate, and review the show, and share it with someone who might connect with this story. Thank you for listening to In Their Words.