More than once I've been accused of having a "fire, ready, aim" personality and while that wasn't exactly the case here, it was close. It also goes to show that having only a little bit of information is not always best.
Our radiological oncologist has been great -- professional, competent, and well reasoned, yet not afraid to laugh with us either. It is her opinion that the best explanation for what the surgeon found during the surgery is that the second tumor was part of the main tumor moving it's way to the lymph nodes. Fortunately, however, it didn't reach any lymph nodes. It was a blessing from the Lord that the second tumor was even found -- it was only 1.5mm in size and the surgeon suspected it was just residual from the nuclear medicine injection. However, he decided to go ahead and remove it for testing -- we're glad he did. Had it not been found during surgery, it would have showed up six months from now and we would have been doing this all over again.
The end result of the pathologist's report was that there were no lymph nodes affected, and the margins were clear on both tumors (how does one respond to answered prayer -- with a grateful heart, of course). Because of the location of the second tumor, near her armpit, the localized, 5-day course of radiation will not work. Thus, Sarah will start the standard course of radiation treatment the first week in January and go 5 days a week for 6 1/2 weeks. Additionally, we'll have an appointment with a medical oncologist to discuss estrogen blocking therapies going forward (the tumor was strongly estrogen positive indicating that the likelihood of recurrence is heightened without the use of estrogen blockers).
We thank you all for your prayers (and your continuing to do so), words of encouragement, and acts of kindness showed to us and to our kids.
Thursday, December 9, 2010
"Behold, I am doing a new thing ..."
A new day; the sun still rose, the boys have to get to school, the dishes need to be washed, and another day to praise God for His goodness, His character, His heart and His provisions for all of our needs.
George Perles, a former Michigan State football coach use to tell his players after a big win that they had one day to celebrate and after a big loss they had one day to feel bad about the loss. While we're not exactly dealing with a game here, the principal is the same -- today is a new day for us to graciously deal with the situation before us. Our prayer is that over the next couple of days, we'll get the information we need to make well informed and wise decisions. We keep reminding ourselves that, even with this unexpected finding during surgery, we're not dealing with a life-threatening cancer, and we'd like to keep it that way.
We have an appointment with the radiological oncologist this morning at 10. Please pray that we'll be level headed, that we'll communicate effectively and that God will be glorified through this interaction.
George Perles, a former Michigan State football coach use to tell his players after a big win that they had one day to celebrate and after a big loss they had one day to feel bad about the loss. While we're not exactly dealing with a game here, the principal is the same -- today is a new day for us to graciously deal with the situation before us. Our prayer is that over the next couple of days, we'll get the information we need to make well informed and wise decisions. We keep reminding ourselves that, even with this unexpected finding during surgery, we're not dealing with a life-threatening cancer, and we'd like to keep it that way.
We have an appointment with the radiological oncologist this morning at 10. Please pray that we'll be level headed, that we'll communicate effectively and that God will be glorified through this interaction.
Wednesday, December 8, 2010
Pathology Report
Kind of a discouraging end to the day. While we don't have all the details yet, it appears that we need to take some time and regroup -- probably get 2nd opinions, at this point.
The day started with an 8am appointment for the CT Scan at the radiological oncologist's office to check the location of the mammosite balloon and everything looked good there. She told us the pathology report hadn't been received and that she would call us when it came in. At 11:30, her office called to say the report probably wouldn't be received until tomorrow.
At 4:30, the surgeon's office assistant called thinking that the oncologist had talked with us about the pathology report, which hadn't happened. The surgeon got on the phone and explained that a small "hot" area (an area to which the nuclear medicine was draining) had showed up unexpectedly during the surgery. After the surgery, he told me he thought it might just have been some residual from the nuclear medicine needle poke. However, the pathology report indicated that it was another tumor about 2mm in size. He also said that it probably shouldn't be treated with the localized radiation and that he might even advise having a mastectomy.
So, we'll get an appointment tomorrow with the oncologist (the surgeon is in the OR all day tomorrow). One big question is why this wasn't caught by the MRI, which is supposed to be the most sensitive test we could get and presumably should have caught this other tumor. One thing I never like to hear is the word "suprise" when it comes to a surgeon discussing a surgery (particularly when it involves my wife).
Our faith is strong, but we are a bit deflated. Everything seemed to be falling into place fairly neatly for a quick resolution to this issue, but it looks like that won't happen. Not sure yet whether the longer course of radiation is a possibility, but I guess we'll get more answers tomorrow. The surgeon suggested getting a late morning appointment with oncologist so that they would have a chance to talk prior to our appointment.
Please continue to pray that we'll gain an understanding of what the medical issues are at this point and that we'll have the wisdom to make the best decisions.
The day started with an 8am appointment for the CT Scan at the radiological oncologist's office to check the location of the mammosite balloon and everything looked good there. She told us the pathology report hadn't been received and that she would call us when it came in. At 11:30, her office called to say the report probably wouldn't be received until tomorrow.
At 4:30, the surgeon's office assistant called thinking that the oncologist had talked with us about the pathology report, which hadn't happened. The surgeon got on the phone and explained that a small "hot" area (an area to which the nuclear medicine was draining) had showed up unexpectedly during the surgery. After the surgery, he told me he thought it might just have been some residual from the nuclear medicine needle poke. However, the pathology report indicated that it was another tumor about 2mm in size. He also said that it probably shouldn't be treated with the localized radiation and that he might even advise having a mastectomy.
So, we'll get an appointment tomorrow with the oncologist (the surgeon is in the OR all day tomorrow). One big question is why this wasn't caught by the MRI, which is supposed to be the most sensitive test we could get and presumably should have caught this other tumor. One thing I never like to hear is the word "suprise" when it comes to a surgeon discussing a surgery (particularly when it involves my wife).
Our faith is strong, but we are a bit deflated. Everything seemed to be falling into place fairly neatly for a quick resolution to this issue, but it looks like that won't happen. Not sure yet whether the longer course of radiation is a possibility, but I guess we'll get more answers tomorrow. The surgeon suggested getting a late morning appointment with oncologist so that they would have a chance to talk prior to our appointment.
Please continue to pray that we'll gain an understanding of what the medical issues are at this point and that we'll have the wisdom to make the best decisions.
Tuesday, December 7, 2010
Surgery Results
I know many of you were praying for us yesterday and probably looking for an update to be posted. As you might imagine, surgery day was filled, not only with much activity, but also some down time waiting for various things to happen. Nevetheless, trying to think about updating my blog wasn't the first thing on my mind. However, the Lord was gracious in providing great doctors and nurses -- a skilled and experienced surgeon, anesthesiologist, radiologist and support staff that provided, not only excellent medical care, but also compassion in trying circumstances.
Our day started with a trip to the radiologist at 7:30 for a procedure to help the surgeon know exactly the location and size of the tumor (if you'd like to know the gorie details please ask, but I'll spare the rest of you). Then to the hospital at 9:00 for check-in, nuclear medicine at 11:30 and then surgery started at 1:30.
The nuclear medicine was interesting -- a doctor injected a small dose of radioactive medicine into the tumor site so that the surgeon could pick up (by a geiger counter) the lymph nodes to which the tumor drained -- between the wire placed by the radiologist and the nuclear medicine, Sarah swears she was picking up NPR on the operating table. :)
The surgeon found two "hot nodes" (meaning that the nuclear medicine drained to those nodes) that were removed for testing, which if found to be cancer free, then no other lymph nodes will need to be removed. The surgeon did say that none of the nodes he removed "looked suspicious", but cautioned that we need to wait for the pathology report (should be Wednesday) to be certain that they're cancer free. Surgery was over by 3:00 and Sarah was in recovery until 4:00 and then to her "room" and discharged at 6:15 -- still a bit groggy at that point, but able to get up long enough to get her home (in the middle of a snow storm).
We both slept much better last night than we did the previous night. We were awake at 5:30 this morning -- Sarah even got up and was washing dishes -- ok, so before you get too provoked and wondering what kind of husband I am, it was only her tea cup; I had done all of the other dishes last night. :)
So, next steps are CT Scan on Wednesday to give the radiological oncologist the information she needs to determine if Sarah is a candidate for the "mammosite balloon" radiation treatment. The purpose of the radiation treatment is to kill off any cancer cells that may have travelled outside of the surgical site. Even if there are clear margins around the tumor, there is still a chance that some cancer cells may have gotten outside of the margin. During the course of the surgery, the surgeon inserted a balloon into the cavity where the tumor was removed. Provided the radiologist finds that there are proper margins from skin and breast bone to allow this type of treatment, this balloon becomes the delivery vehicle for the radiation. The advantages of this treatment over the standard "full-breast" radiation treatment are that this is a 5 day course of treatment, rather than 6 weeks and this treatment is localized to the area surrounding the tumor site. If everything looks good for this treatment, then it will begin on Thursday and she'll be finished by the 15th of December. If not, then the standard radiation will start in January.
Also on Wednesday, we should get the pathologist report back regarding the lymph nodes -- if these are clear, then chemo is likely contra-indicated.
In our prayer time this morning, we acknowledged how the Lord has been showering us with His grace not only for the excellent medical care, but also for friends and family that have prayed for and with us, have provided transportation for our teenagers, have called at just the right moment to encourage Sarah (and me), have written emails of encouragement to both of us, and have brought food to the house (yummie soup, salad and cookies were waiting for us in the kitchen when we got home last night).
A couple of verses that have meant a lot to us during the last few weeks are Isaiah 43:18 and 19 "Remember not the former things, nor consider the things of old. Behold, I am doing a new thing; now it springs forth, do you not perceive it? I will make a way in the widerness and rivers in the desert." Those are God's promises that He is in the business of spiritual renewal and that He is active in, not only showing us the way, but also walking along side of us and providing the resources to get there. The Lord is GOOD.
Please continue to pray that further treatments will be minimized, that the cancer will have been eradicated and that we'll continue to be receptive to the working of the Holy Spirit in our lives as He seeks to eradicate the "spiritual cancers" that have invaded all of us.
Our day started with a trip to the radiologist at 7:30 for a procedure to help the surgeon know exactly the location and size of the tumor (if you'd like to know the gorie details please ask, but I'll spare the rest of you). Then to the hospital at 9:00 for check-in, nuclear medicine at 11:30 and then surgery started at 1:30.
The nuclear medicine was interesting -- a doctor injected a small dose of radioactive medicine into the tumor site so that the surgeon could pick up (by a geiger counter) the lymph nodes to which the tumor drained -- between the wire placed by the radiologist and the nuclear medicine, Sarah swears she was picking up NPR on the operating table. :)
The surgeon found two "hot nodes" (meaning that the nuclear medicine drained to those nodes) that were removed for testing, which if found to be cancer free, then no other lymph nodes will need to be removed. The surgeon did say that none of the nodes he removed "looked suspicious", but cautioned that we need to wait for the pathology report (should be Wednesday) to be certain that they're cancer free. Surgery was over by 3:00 and Sarah was in recovery until 4:00 and then to her "room" and discharged at 6:15 -- still a bit groggy at that point, but able to get up long enough to get her home (in the middle of a snow storm).
We both slept much better last night than we did the previous night. We were awake at 5:30 this morning -- Sarah even got up and was washing dishes -- ok, so before you get too provoked and wondering what kind of husband I am, it was only her tea cup; I had done all of the other dishes last night. :)
So, next steps are CT Scan on Wednesday to give the radiological oncologist the information she needs to determine if Sarah is a candidate for the "mammosite balloon" radiation treatment. The purpose of the radiation treatment is to kill off any cancer cells that may have travelled outside of the surgical site. Even if there are clear margins around the tumor, there is still a chance that some cancer cells may have gotten outside of the margin. During the course of the surgery, the surgeon inserted a balloon into the cavity where the tumor was removed. Provided the radiologist finds that there are proper margins from skin and breast bone to allow this type of treatment, this balloon becomes the delivery vehicle for the radiation. The advantages of this treatment over the standard "full-breast" radiation treatment are that this is a 5 day course of treatment, rather than 6 weeks and this treatment is localized to the area surrounding the tumor site. If everything looks good for this treatment, then it will begin on Thursday and she'll be finished by the 15th of December. If not, then the standard radiation will start in January.
Also on Wednesday, we should get the pathologist report back regarding the lymph nodes -- if these are clear, then chemo is likely contra-indicated.
In our prayer time this morning, we acknowledged how the Lord has been showering us with His grace not only for the excellent medical care, but also for friends and family that have prayed for and with us, have provided transportation for our teenagers, have called at just the right moment to encourage Sarah (and me), have written emails of encouragement to both of us, and have brought food to the house (yummie soup, salad and cookies were waiting for us in the kitchen when we got home last night).
A couple of verses that have meant a lot to us during the last few weeks are Isaiah 43:18 and 19 "Remember not the former things, nor consider the things of old. Behold, I am doing a new thing; now it springs forth, do you not perceive it? I will make a way in the widerness and rivers in the desert." Those are God's promises that He is in the business of spiritual renewal and that He is active in, not only showing us the way, but also walking along side of us and providing the resources to get there. The Lord is GOOD.
Please continue to pray that further treatments will be minimized, that the cancer will have been eradicated and that we'll continue to be receptive to the working of the Holy Spirit in our lives as He seeks to eradicate the "spiritual cancers" that have invaded all of us.
Thursday, November 18, 2010
Humorous Update
Never saw this one coming -- think of something that we haven't done in about 15 years (clue: our youngest child is 14). No, I know what you're thinking, and trust me, IT hasn't been that long.
Sarah's Radialogical Oncologist encouraged her to get an MRI for a couple of reasons: 1) to determine whether there is any cancer in her other breast, and; 2) to give the surgeon a clearer picture of the tumor's extent to potentially reduce the amount of tissue that needs to be removed.
The Radiologist's office called and insisted she get a pregnancy test prior to having the MRI -- HA HA, right. Well, guess what, she's not, but we sure had fun going to the drug store and making a couple of people wonder what these grandparents were doing (if only we'd had Ben with us) :)
So Sarah's surgery is scheduled for Dec 6th (day after the Toby Mac concert -- couldn't do it before, of course). We anticipate that it will be a relatively, uneventful out-patient "lumpectomy". This will likely be followed by a course of radiation treatment (either intense doses twice a day for 5 days or less intense once per day, 5 days a week for 6 weeks). However, from what we know right now, we're not anticipating having to do any chemo -- please pray that that won't be necessary.
The Lord continues to give us good attitudes, thoughtful friends and encouraging family. We had a nice, but too short, visit from Paul and Mary (brother and sister-in-law) who drove over from Jacksonville for a day. We continue to pray that cancer will not have spread to her lymph nodes and that, even now, the tumor will actually be shrinking (let's hear it for brussel sprouts, nature's chemo). Thank you all for your prayers, thoughtful cards and email.
Sarah's Radialogical Oncologist encouraged her to get an MRI for a couple of reasons: 1) to determine whether there is any cancer in her other breast, and; 2) to give the surgeon a clearer picture of the tumor's extent to potentially reduce the amount of tissue that needs to be removed.
The Radiologist's office called and insisted she get a pregnancy test prior to having the MRI -- HA HA, right. Well, guess what, she's not, but we sure had fun going to the drug store and making a couple of people wonder what these grandparents were doing (if only we'd had Ben with us) :)
So Sarah's surgery is scheduled for Dec 6th (day after the Toby Mac concert -- couldn't do it before, of course). We anticipate that it will be a relatively, uneventful out-patient "lumpectomy". This will likely be followed by a course of radiation treatment (either intense doses twice a day for 5 days or less intense once per day, 5 days a week for 6 weeks). However, from what we know right now, we're not anticipating having to do any chemo -- please pray that that won't be necessary.
The Lord continues to give us good attitudes, thoughtful friends and encouraging family. We had a nice, but too short, visit from Paul and Mary (brother and sister-in-law) who drove over from Jacksonville for a day. We continue to pray that cancer will not have spread to her lymph nodes and that, even now, the tumor will actually be shrinking (let's hear it for brussel sprouts, nature's chemo). Thank you all for your prayers, thoughtful cards and email.
Saturday, November 6, 2010
Things We are Rediscovering
1. The power of prayer.
2. Long walks on a cool fall day.
3. Fireside chats with red wine and good music.
4. That even cleaning the refrigerator can be fun when we do it together.
5. In times of trouble, your friends and family come to the rescue in unexpected ways.
6. It's ok to feel like we're dating again, even after 32 years or marriage.
2. Long walks on a cool fall day.
3. Fireside chats with red wine and good music.
4. That even cleaning the refrigerator can be fun when we do it together.
5. In times of trouble, your friends and family come to the rescue in unexpected ways.
6. It's ok to feel like we're dating again, even after 32 years or marriage.
Thursday, November 4, 2010
Discussions with Surgeon
We met with Dr. Johnson on Wed and he was great, although, Sarah wasn't terribly thrilled with his bedside manner, but he seems to be extremely well qualified, competent, experienced and willing to spend as much time as we needed to answer our questions (which were numerous).
Dr. Johnson's assessment is that it is unlikely there has been any lymph node involvement since he found no swelling of the lymph nodes (he pegged it at a 20% chance -- although, that's the same chance given to us that the tumor would be cancerous, so we'll wait and see). We've been praying that there would be no lymph node involvement, so please continue to pray with us that that would in fact be the case. The bottom line is that his initial assessment is that we're dealing with a Stage I tumor and the prognosis is excellent.
We're not "out of the woods" completely -- Dr. Johnson wants Sarah to be genetically tested based on her family history (Sarah has 2 sisters that are breast cancer survivors) to determine if she is carrying a gene that predisposes her to breast cancer (her sisters don't carry the gene). If Sarah is carrying the gene, however, his recommendation will be to do a bi-lateral mastectomy (yes, that means both breasts, yuck!!) However, if she's not carrying the gene, then we're probably looking at just a lumpectomy followed by a short (5 day) course of radiation. We won't have the results from the genetics testing for 2 to 3 weeks, so they'll wait to do surgery until after those results are in (surgery should be end of Nov or 1st week in Dec).
Needless to say, we got much better sleep last night than we have in several weeks. We appreciate all of the prayers and expressions of care from our family and friends -- please continue to pray; Sarah has dramatically altered her diet -- lots more fresh vegetables, fruits and nuts, but no meat, dairy or refined sugars -- we're beginning to feel at home here in Asheville :) She has read that there is some research that indicates such a diet can actually slow or retard the growth of breast cancer. Pray for me, too; in a weak moment, I agreed to join her to show my support and encouragement (although, I must say that cooked greens are becoming a favorite at our house, as long as you don't ask Dan or Pete).
The Lord is good!!!
Dr. Johnson's assessment is that it is unlikely there has been any lymph node involvement since he found no swelling of the lymph nodes (he pegged it at a 20% chance -- although, that's the same chance given to us that the tumor would be cancerous, so we'll wait and see). We've been praying that there would be no lymph node involvement, so please continue to pray with us that that would in fact be the case. The bottom line is that his initial assessment is that we're dealing with a Stage I tumor and the prognosis is excellent.
We're not "out of the woods" completely -- Dr. Johnson wants Sarah to be genetically tested based on her family history (Sarah has 2 sisters that are breast cancer survivors) to determine if she is carrying a gene that predisposes her to breast cancer (her sisters don't carry the gene). If Sarah is carrying the gene, however, his recommendation will be to do a bi-lateral mastectomy (yes, that means both breasts, yuck!!) However, if she's not carrying the gene, then we're probably looking at just a lumpectomy followed by a short (5 day) course of radiation. We won't have the results from the genetics testing for 2 to 3 weeks, so they'll wait to do surgery until after those results are in (surgery should be end of Nov or 1st week in Dec).
Needless to say, we got much better sleep last night than we have in several weeks. We appreciate all of the prayers and expressions of care from our family and friends -- please continue to pray; Sarah has dramatically altered her diet -- lots more fresh vegetables, fruits and nuts, but no meat, dairy or refined sugars -- we're beginning to feel at home here in Asheville :) She has read that there is some research that indicates such a diet can actually slow or retard the growth of breast cancer. Pray for me, too; in a weak moment, I agreed to join her to show my support and encouragement (although, I must say that cooked greens are becoming a favorite at our house, as long as you don't ask Dan or Pete).
The Lord is good!!!
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