Cancer

Hawaii 2010

Holly and headed off to Hawaii last week. It was a combination Happy-9-Year-Anniversary and Happy-Being-Done-with-All-Things-Cancer Vacation.

What a gift it was! We mostly just camped on different beaches, talked, and read. I didn’t take many photos, but here’s a few:

(If you can’t see the slideshow above, click here)

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Final Reconstructive Surgery

Hiking Jan 2009-46295:30 will come early tomorrow morning. That’s what time we are scheduled to be back at the hospital for the final surgical step in the cancer recovery process.

This final surgery has been hard to decide to go forward with. It’s hard to decide to inflect Holly’s body with more scars when the last ones are just now healing. It’s hard to choose to have a surgery that’s not technically necessary, that just finishes the reconstructive process.

That said — we have peace this is what God has for us. I would have thought this surgery would have been easier, that this would be routine by now.

The truth is it’s never easy to step into pain. We are hard-wired to avoid it, and yet Jesus says things like,

Blessed are the poor in spirit, for theirs is the kingdom of heaven.
Blessed are those who mourn, for they shall be comforted.
Blessed are the meek, for they shall inherit the earth. (Mt 5:3-5)

I keep looking for the verse that says, “Blessed are those that push through,” or “Blessed are those that pretend it doesn’t hurt,” but I can’t find it.  Somehow it is blessed to have our spirits be poor, to mourn and be meek.

These last months we’ve been learning that these places of blessing are not things that happen to us, they are things we choose.  We have to choose to step into — feel — the pain of life and let it crush us a little bit.

It’s in that crushed place where Jesus meets us in new and fresh ways.  It’s there He blesses us with healing from pain, current and old pains all the same.

God has been so very good to us in the pain of cancer and recovery.  He has faithfully met us, healed us, and blessed us.  Please pray we will continue to let the pain break us to continue in the blessing.

How’s Holly Doing?

Don’t you hate it when people ask you to pray for them and then they never update you on what’s going on?  Me too!

I hope we haven’t been those people too bad, but frankly most times someone asks me, “How’s Holly doing?” I have no idea how to answer.

Well she’s making some significant progress worth sharing, so I would take the almost-four-week-anniversary-of-her-surgery to update you…

Progress:

  • She’s much less tired (went last few days without naps)
  • She’s almost completely off medication (just occasional over the counter pain medicine or muscle relaxer )
  • She is got her last drain out today! Wahoo!

Still issues:

  • She is still under a doctor-imposed ban of lifting more than 8 pounds. (A challenge when taking care of kids that weigh more than 8 pounds)
  • She is still tired and “runs out of gas” pretty easily.

We’re about to send Holly’s mom home for the first time since the surgery, so we will have a good idea of how well she really is doing pretty quickly.  She has been a tremendous blessing, and I seriously don’t know what we would have done without help from her and my mom.

So, there’s a quick update for you!  Thanks for all the prayers!

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Plano Breast Cancer Rockstars

I write this post looking back on what was one of the hardest parts of this cancer journey: finding the right partners to run the race with you. What makes me qualified to pick a cancer doctor? Nothing.  Ultimately, I know God led us to just the right people. If you will permit me, I’d love to brag about the team God gave us, in the hopes that someone where we were a couple of months ago may benefit…

Dr. Canavan, Hollys Breast Surgeon

Dr. Lynn Canavan, Holly’s Breast Surgeon

The Breast Surgeon

We found Dr Canavan by literally Googling for “plano breast surgeon.”  We had been referred to a different breast surgeon by Holly’s OB/GYN, and only went to Dr Canavan for what we thought was a routine second opinion.

What we found was that our first surgeon had really dropped the ball, and grossly misjudged the extent of the cancer.  When we switched to Dr. Canavan we found that trips to the doctor went from being full of fear and uncertainty to being full of peace and confidence in the next steps.

She truly has the heart of a teacher and was always available for every question.  She went to great lengths to educate us and would always show us, not just tell us, what was going on.

The other great thing about Dr. Canavan’s office is Gaynelle, her scheduler.  Gaynelle schedules every appointment with every doctor, every testing center, every hospital — she just makes it happen magically.  You can’t imagine how much easier that makes the whole process.

The Plastic/Reconstructive Surgeon

Dr Patty Young, Hollys Reconstructive Surgeon

Dr. Patty Young, Holly’s Reconstructive Surgeon

Once we knew Holly needed a mastectomy we started the process of picking a plastic surgeon.  While you might think that Plano, TX has the highest concentration of Plastic Surgeons per square inch, but it turns out very few do reconstruction.  There’s just not much money in it.

That’s why finding Dr. Young was such a God-send.  Like Dr. Canavan, she actually took the time to teach us all the reconstructive options.  The first time we left her office, we knew we had found the right reconstructive surgeon, we just had to pick the right procedure for us.

Once we decided on the DIEP flap, her scheduler worked to clear a whole day for Dr Young to do the procedure.  That morning we got to pray with and for her, and afterward she told us it was prayer that sustained her through the 13.5 hour surgery.  Where she gets the endurance to push through such a long surgery, I have no idea.

She was always sensitive to Holly and us as her family.  She had the nurse call out every hour or two to give us an update, so we didn’t get too worried.  She did a great job helping to control the pain afterward, including inserting a local pain pump to numb the area.

Oh, did I mention she did b-e-a-u-t-i-f-u-l job with the reconstruction!  She has a gift (and amazing staff like Dr. Canavan).

The Nurses at Baylor Plano

Baylor Plano, our home for five days

Baylor Plano, our home for five days

If you look on US News and World Report or National Cancer Institute there doesn’t seem to be a clear hospital leader for cancer care the Dallas area.  However, I will tell you from our experience, Baylor Plano is the place to be for breast cancer care in Dallas.

First off they have the most advanced diagnostic equipment, and the two rockstar doctors above prefer to do surgery there. That should be enough.  But they never ceased to amaze us at going above and beyond in caring for the patients and their families.

When we showed up for surgery at 5:00 am the most friendly woman named Robin met us at the front door to escort us the surgery floor.  Who does that?

Even the food was pretty good — they call it room service and it’s pretty much whatever you wanted delivered when you wanted it.  They even had free wifi throughout so Holly could make a Skype video call to her brother in Hawaii.

Those are little things, but really nice touches.  The big thing was the staff — specifically the nurses.  We didn’t have one nurse who was not full of compassion, attentive, and just generally great to be around.  They always did there best to control Holly’s pain, teach us to take care of her, and make our stay the best it could be.

Thank you to Dr. Canavan, Dr. Young and all the nurses at Baylor Plano.  God used you to heal my wife and do it better than we ever could have hoped for.

I hope this helps you if you are ever in need of Breast Cancer Care in Dallas.  Of course, feel free to contact us if you have any questions or if we can help in any way.

Post-Surgery Update

I realize we’ve fallen off the grid a little since coming home from the hospital. So, here’s a quick update how Holly is doing a week home from the hospital…

Emotionally, she’s doing amazing. She has never stopped being in good spirits, very thankful for all the love and support being poured her way.

Practically, lots of help is helping keep the wheels on the bus. Our moms are still in town, and amazing meals are coming every day.

Physically, she’s doing pretty good. She’s still in some pain, but that is largely controlled by muscle relaxers. She has to take some pain medicine once or twice a day, but muscle relaxers keep it all largely in check. Of the 8 medicines she was taking when she first got home, she’s down to about 3 and that’s definitely a step in the right direction.

She still has 2 of the 4 drains installed during surgery to prevent swelling from excess fluids. Those are an annoyance and sometimes uncomfortable, but not too bad. They should be out by the end of this week or beginning of next.

Mostly, she’s just tired — very tired. (She woke up this morning and declared she was ready for her first nap.) She’s made it out of the house a few times, like to church on Sunday, but that is about all she has for the day. Her body is working very hard to heal itself and just doesn’t have much energy for much else.

On the cancer front, we got good news yesterday. The pathology report came back with “clean margins” which means not only did they get all the cancer, but also 1cm around it all.

They also found cancer in the same breast in a previously undetected area. This just confirms that taking it all was the right choice. Neither of us realized how much we were holding our breath so-to-speak waiting to hear the news. There were a few tears of joy shed yesterday.

So, can I hear a collective “Woohoo!” for being officially cancer-free?

Thanks for all the prayers and for stepping into our pain. We are blessed!

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Grace

Grace (n): the free and unmerited favor of God

It may seem strange to be talking about the favor of God at a time when we have just gone through radical surgery to remove cancer from Holly’s 33-year old body. But God’s favor is exactly what has been upon us lately.

Grace is not the absence of pain — it’s not an easy life. Grace is God stepping into your pain and showing His goodness by making a way out. Ephesians 2 says it like this:

And you were dead in the trespasses and sins in which you once walked, following the course of this world, following the prince of the power of the air, the spirit that is now at work in the sons of disobedience— among whom we all once lived in the passions of our flesh, carrying out the desires of the body and the mind, and were by nature children of wrath, like the rest of mankind. But God, being rich in mercy, because of the great love with which he loved us, even when we were dead in our trespasses, made us alive together with Christ—by grace you have been saved.

You see, without the death there would be no grace. Without cancer, we would have missed out on so many ways to see His unmerited favor in our lives.

Mary Ida as one of our team members tended to her wounds.

Mary Ida as one of our team members tended to her wounds.

When I was in Uganda, I saw two things that made His grace more clear. One was Mary Ida — an elderly, emaciated woman literally laying in the dirt waiting to die. Everyone in the community simply passed her by without a 2nd thought.

The second thing was visiting a clinic for HIV+ kids. The pediatrician explained that they advised the HIV+ moms to breastfeed their kids, knowing it would almost certainly lead to them contracting HIV as well. They did this because the alternative was the kids dying of malnutrition.

So to me, Grace is…

…living where the community cares if my wife lives or dies.

…having to make choices between reconstruction options, not HIV vs death by malnutrition.

…a free trip to Africa.

…world-class surgeons who work for 13 hours to not just get rid of all the cancer, but go to extremes to make you look the way you did before they started.

…God providing money to pay for it all.

…people we don’t even know bringing us amazing food everyday.

…family who drops everything to be by your side in a time of need.

…an endless stream of friends almost begging to be able to do something for us.

…God providing the strength to fly 25 hours back from Africa and have minimal jetlag so I can be there to care for my wife.

…two amazing kids who are excited Mommy is cancer free so we can start adopting.

…God stepping into our pain, and being more real to us than He ever has before.

There is nothing in me that merits me getting any of these things more than Mary Ida or the kids at the HIV clinic. I have no idea why Jesus would show us such favor — but thank you Jesus.

Surgery Scheduled

Is it strange to say we’re excited to have a surgery day?  After so much waiting and so many decisions, it’s good to have this big step on the schedule.  We’re also glad that we got in earlier that we might have had to wait.

Friday, September 18 is the big day.

We did decide on a reconstruction option, the DIEP Flap.   You can read the details of this surgery, and the truly brave of heart can watch a 1 hour video with play-by-play of it being done (warning: parts are hard to watch).

It will take 8-10 hours at Baylor Regional Medical Center of Plano.  Then she will spend 4-5 days in the hospital.

There’s not a lot to do before then, but Holly is working out hard to do her best to get her body ready for surgery.  School has started and life is busy with welcome distractions from cancer-world for now.

Jamie will be leaving for Uganda Monday and getting back the day before her surgery.  More about that later though…

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Results of MRI-Guided Biopsy

Daniel and Candas Wedding (82 of 96)The doctor called tonight to give us the results of yesterday’s MRI-guided biopsy.   As a reminder, the radiologist took samples in front of and behind where they had previously found the cancer.

The good news is that the sample behind was not cancerous. This lessens the chances that cancer has spread to the lymph nodes.

The bad news is that the sample in front of was cancerous. It’s still DCIS (non-invasive), but it means that a mastectomy is the only reasonable option from here.

The next step is to start meeting with plastic surgeons, to find someone good to do the reconstruction (that will happen at the same time as the mastectomy).

Then after that she will probably have a sentinel-node biopsy.  How many biopsies can she have?  Evidently, she can have one more.   This one will be a little harder ( she’ll be under general anesthesia) and they will check to see if it has spread to the lymph nodes behind the breast.  There’s only about a 5% chance of this, but it seems better to rule it out as a possibility before the surgery.

On the home front, we are kidless.   Holly is very tired but getting lots of rest.  The kids are at Grammy and Paw-Paw’s ranch this week, and we will go join them this weekend.  It will be good to get away for a little bit.

That’s about all we know for now.  Thanks for all the continued prayers.

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More tests, new doctor

On Tuesday, we went to see another breast surgeon for what we thought would be a routine second opinion on Holly’s cancer diagnosis.  It was anything but routine.

From the start, something about this new doctor was different.  First, she put all our test results up and taught us what they meant.  It was during this process we collectively realized something was wrong.

You see, when we first got our MRI results we were told the suspicious area it was confined to just one small area, about 4.5cm long. That was not what we are all looking at on the screen at the MRI results.

It looked pretty obvious to the new surgeon and us that the suspicious area was essentially the length of the whole breast.  This is not good news.

The next step is to have a MRI-Guided Double Biopsy.  That’s a fancy way to say they will use the MRI to guide the needle to take more tissue samples above and below where the cancer was already found.

If the biopsy comes back positive like we are expecting, a mastectomy will be needed to remove all the cancer.

Unfortunately, right now it’s looking like we won’t be able to get this test done until July 29, almost 2 weeks away.  We would obviously want to get it over with quicker, but maybe this will be a nice calm in the midst of the cancer storm.

In the mean time, we have switched to this new doctor.  You see the old surgeon never even looked at the MRI results herself (or any other test results for that matter), she just trusted the radiologist’s report.  It would be kind of hard to trust her after that.

Thanks for all the support and prayers.  Please pray we would has wisdom in the midst of this trial – and with that wisdom the kind of faith that would keep us from being tossed like waves like James 1:2-6 says:

Count it all joy, my brothers,  when you meet trials of various kinds,  for you know that the testing of your faith produces steadfastness. And let steadfastness have its full effect, that you may be perfect and complete, lacking in nothing.

If any of you lacks wisdom, let him ask God, who gives generously to all without reproach, and it will be given him. But let him ask in faith, with no doubting, for the one who doubts is like a wave of the sea that is driven and tossed by the wind.

Terrorist Cells

The picture of exactly what Holly’s cancer looks like is starting to develop more fully.  First, it turns out that fighting Ductal Carcinoma In Situ (DCIS) is trickier than we first thought. If you will allow me the liberty of an analogy here…

Fighting other types of cancer with a large easy to identify tumor is like fighting a traditional war.  The enemy is easy to find, it’s just a matter of picking the right weapon to kill them.

In contrast, fighting DCIS is like fighting terrorists.  The operate in small (ironically named) cells that are hard to identify, and therefore kill.

What does that mean for how we go forward?  It means that even if the alternative medicine methods we are trying work, there’s no way to definitively know it.  The test simply aren’t that sensitive.  The mammogram can detect calcium deposits which sometimes, but not always, hang out with cancer.  The MRI can detect increased blood flow to an area, but by no means detect it at cellular level.

Besides knowing the nature better of what we are fighting, we also learned more details out of the pathology report.  It turns out that the DCIS Holly has is “High Nuclear Grade.”

Here’s how one website explains what that may mean:

There are three grades of DCIS: low, intermediate, and high. The grade relates to how the cells look under the microscope, and gives an idea of how quickly the cells may develop into an invasive cancer (or how likely it is that the DCIS will come back after surgery). Low-grade DCIS has the lowest risk of developing into an invasive cancer, and high-grade carries the greatest risk.

Here’s another one says (it also gives a much more technical explanation of how they determine the grades):

Cancers with a high grade, necrosis, cancers close to the surrounding margin of breast tissue of a lumpectomy sample, or large areas of DCIS are more likely to recur after breast cancer treatment than other breast cancers.

So, obviously neither of these pieces of information are good news.  Stack on the fact that just getting breast cancer so young increase the chances of recurrence substantially.  So, Holly still has the best kind of breast cancer to have — it’s just the worst kind of the best kind.

We’ve been discouraged about this this weekend.  While we have been praying and wondering what this means about how we move forward we have found great comfort in Psalm 147:3-5:

He heals the brokenhearted
and binds up their wounds.
He determines the number of the stars;
he gives to all of them their names.
Great is our Lord, and abundant in power;
his understanding is beyond measure.

Thanks for sticking through a long post.  Continued prayers for wisdom are appreciated.

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