Trip to Tulsa (Jan. 30-31, 2006)

Early Monday morning on Jan. 30 found Jim and Laurie winging their way to Tulsa, Oklahoma, to visit the Cancer Treatment Centers of America. We anticipated a three-day visit for consultations and testing. Our purpose in going was to get a second opinion on Laurie's medical treatment. We also were interested in exploring more natural approaches to helping Laurie fight her cancer. CTCA is known for their integrative approach that complements the medical treatments with nutritional and naturopathic methods of cancer treatment. We felt this was an important step, having observed for years the value of such an approach in the health of Laurie's parents.

We spent the first day getting settled in and then in meetings with a radiation oncologist and medical oncologist. Both basically confirmed the course of treatment that had been prescribed by Laurie's team in Dallas. Interestingly, we discovered that Dr. O'Shaughnessy, Laurie's medical oncologist at Baylor, is very well known indeed. The oncologist in Tulsa had not only heard of her, but indicated that Dr. O. had an international reputation and produced much of the research on which medical oncologists across the country based their decisions. In fact the oncologist in Tulsa was pleased that her recommendations were very similar to Dr. O's! This gave us another opportunity to praise God for leading us to some of the best breast cancer doctors in the U.S.

Tuesday morning we met with the nutritionist and the naturopatic doctors. Our meeting with the nutritionist was phenomenal. She walked us through many of the things that Laurie could do to support her body during and after her treatment. She also gave us some good recommendations of things to avoid because of the characteristics of Laurie's cancer. One of the things Laurie needs to avoid is soy. You would be amazed at how many food products contain soy--besides soy sauce that is! :-) She also gave us some suggestions on how to prepare meals and where to buy inexpensive natural and organic foods. We almost felt that the meeting with the nutritionist was worth the trip to Tulsa.

The naturopathic doctors were also very helpful in giving us information on certain foods and supplements to avoid as well as things we could take to support the medical treatments. Their recommendations also confirmed recommendations from Dr. O'Shaughnessy in Dallas, especially in regard to taking natural alternative herbal supplements. Basically they affirmed that avoiding a lot of supplements during chemotherapy was a safe course of action. The rational was to not create an environment in Laurie's body that might make the chemotherapy less effective. They affirmed that Laurie could begin a naturopathic regimen subsequent to her medical treatments that would help her rebuild her body's health and strengthen her immune system to help ward off a return of her cancer in the future.

As it turned out, our consultation with the naturopathic doctors was the last appointment of our visit to CTCA. Since most of Laurie's medical tests from Dallas were so current, we were not required to stay the extra day, and in fact, were allowed to go home early, much to Jim's delight, since he preferred to spend his birthday with Steffi and Abby in Dallas!

In retrospect, we were very glad to have made the trip to Tulsa. To have the medical options for Laurie's treatment confirmed was encouraging, and to get a good handle on the natural things Laurie could do to support herself through those treatments and rebuild her body's defenses after the chemo and radiation was very helpful. With the trip behind us, we were more confident of the next steps Laurie would face in Dallas in the treatment of her cancer.

First Consult with Dr. O'Shaughnessy (Jan 24, 2006)

Today was the long awaited (and somewhat dreaded) day to meet with Dr. Joyce O'Shaughnessy, our medical oncologist (Jim refers to her as the drug doctor). Our hope all along has been that Laurie might be able to avoid chemotherapy, recent pathology reports not-with-standing. So we were not anticipating the best of news in that regard. Actually the appointment went very well. Dr. O'Shaughnessy was very attentive and patient and spent over 2-1/2 hours with us answering our questions. The bottom line is that she considers Laurie to be in the best of all situations considering the fact that she has cancer. When all the treatments are added together, along with certain life-style changes (low-fat, healthy diet and exercise), she has every confidence that Laurie has a 98 to 99 percent chance of being totally cured. In fact, she came just short of guaranteeing that Laurie would beat this cancer! We certainly couldn't fault her for her optimism or encouragement! :-)

On a positive note, Laurie's cancer is extremely hormone receptive, which makes her an excellent candidate for oral hormonal therapies. Hormonal therapies, it turns out, give her the best chance of curing her particular type of cancer. We were also encouraged by Dr. O'Shaugnessy's affirmation of some complementary approaches to Laurie's treatment, including a focus on eating healthy foods, good nutrition, vitamins, and exercise. The downside is that in Dr. O'Shaughnessy's medical opinion, Laurie will also need some chemotherapy to get the best percentages.

We spent at least an hour talking about the various chemo drugs, combinations, and side effects. When the dust cleared, Dr. O'Shaughnessy recommended the shortest, least toxic combination of drugs we could have hoped for, with the confidence that they would accomplish the same positive results as the stronger and longer regimen. Of course, chemo is chemo, and that prospect is not pleasant, especially the losing-your-hair part, but the long-term, permanent side-effects appear to be minimal to nonexistent with the proposed regimen. In a case like this, we are happy to take the bitter with the sweet.

Now it's down to decision time. We will consider all the factors, ask a few more questions, and make a decision. If we decide to go the chemo route as recommended, the regimen would be four treatments three weeks apart (about 12 weeks total). Three weeks following that, we would begin Laurie's six weeks of radiation treatments. Lord willing, the process would be completely done by early summer.

We cannot express adequately our appreciation for all the support, encouragement, and especially prayer we have received from so many of you. Our hope is in the Lord, but it is much easier to walk this path with so many of you walking with us, encouraging us on the journey. Please keep praying, especially in the next few days as we rehash all we have heard and make our final decisions. We will keep you posted as those decisions are made.

Laurie's Second Surgery (Jan. 20, 2006)

Laurie's second surgery to remove additional tissue surrounding the tumor site began at 7:20 a.m. She was finished by 8:00 a.m. Dr. Knox said the procedure went well. Laurie was not fully anesthetized this morning. Instead she was put in "twilight sleep". Her recovery from the procedure was much quicker, and she followed her trip home with a take-out breakfast from Cracker Barrel provided by her parents. Laurie is feeling much better and appears eager to take on the day, although Jim is probably going to require a nap. :-)

The next step in the process takes place on Tuesday afternoon, Jan. 24, when Laurie and Jim will meet with her medical oncologist (drug doctor), Dr. Joyce O'Shaughnesy. That's when more information will be presented on the possibilities of chemotherapy.

Surgery Follow-Up and Pathology Report (Jan. 18, 2006)

This was the day that Jim and Laurie went back to meet with Dr. Knox for Laurie's follow-up visit. It was also the day we got the pathology report from Monday's surgery.

Up to this point we had been praying, as were many others, that the tumor would have been completely removed with clear margins and that none of the lymph nodes would be involved. The hope was that such a result would minimize the chances that Laurie would have to go through chemotherapy, something we did not want to do. The results were not exactly what we'd hoped for, but Dr. Knox assured us that the report was a good one. The pathology report revealed that a very small, almost microscopic tumor had started growing a few millimeters away from the first. This tumor did not show up on any of the tests to that point. Fortunately Dr. Knox removed it in the first excision, but because it wasn't visible, it was closer to the edge of the incision than expected. The result is that a few cancer cells were close to the edge of the removed tissue, indicating the possibility that additional cancer cells still remained in the breast. Dr. Knox informed us that a re-excision would be needed to get the remaining cells and get clear margins.

The pathology of the lymph nodes was also a mixed bag. The sentinel node revealed two small clusters of cancer cells in the node, one of 10 cells the other of 40, these were not visible to the naked eye. They were very lowgrade with an extremely low rate of mitosis (cell division). The second node was completely clear. Dr. Knox said this was almost as good as having no nodes involved. The cancer was trapped in the first node and had not migrated further. That node was no longer in her body and those cells weren't going anywhere.

The report, however, did make the possibility of chemotherapy more of a reality. That decision will come later in meetings with the medical oncologist next week.

Because of the small secondary tumor, a second re-excision surgery was scheduled for early Friday morning to remove the additional tissue.

This was probably the gloomiest day of the journey so far. We have a great deal of confidence in God's goodness and sovereignty, but we had prayed so hard for a clear report that the news was a little discouraging. At the same time, we know whose Hand holds ours and He will give the strength to get through each step of the process.

Laurie's First Surgery (Jan. 16, 2006)

The Sunday evening before Laurie's surgery to remove her tumor, the elders from their church, North Highlands Bible Church in Dallas, met with Laurie and Jim for a special time of prayer on Sunday evening before surgery. Several friends from their Life Group also came. The time of prayer was sweet and very encouraging for Laurie as she anticipated the next day's surgery.

Early Monday morning, January 16, Laurie and Jim headed down to Baylor University Medical Center near downtown Dallas. Her first stop was in the Breast Imaging Center where a wire was inserted into the tumor site to guide the surgeon. That was followed by a visit to the nuclear medicine department for a Sentinel Node Injection. This injection of a radioactive dye was designed to create a map of the lymph nodes and indicate which node was the sentinel node (the first node that drains the breast). This information allowed Dr. Knox to remove for testing only the first few lymph nodes that might be involved.

Laurie actually went in to surgery at the Texas Surgery Center at 11:15 a.m. for her breast "excisional biopsy" (i.e., lumpectomy). Jim, along with 32 of her family and close friends pretty well overwhelmed the surgery center waiting area. We almost felt guilty. . . . but not quite. :-)

The surgery lasted for about 90 minutes. Dr. Knox was pleased with the outcome and wasn't surprised by anything, nor did she see anything that would give her cause for concern.

Laurie was at home by 4:00 p.m. that same day. The only side effect was some groginess from the anesthesia and some tenderness. Laurie's biggest emotional day was over.

The First Doctor's Appointment (Jan. 3, 2006)

Laurie and husband, Jim, met with surgical oncologist, Dr. Sally Knox, on Monday, January 3, for their first consultation. Dr. Knox is highly regarded in the Dallas area. She is not only an excellent surgeon, but knows and loves the Lord, and has served in medical missions as well as developing a foundation to provide breast cancer care for women otherwise unable to afford the costs.

When we went in, we had no idea what to expect from the process. The pathologist who had called us with the initial diagnosis before Christmas had indicated that Laurie would likely need only a lumpectomy, probably with chemo, and that her prognosis was extremely good. That certainly had eased some of the stress over the holidays. This appointment with Dr. Knox, however, would provide the detail that we would need to move forward.

Dr. Knox affirmed that Laurie's tumor was very treatable, requiring only a lumpectomy and sentinel node biopsy. A mastectomy was not necessary. However, a lumpectomy does require radiation treatments.

Two types of radiation were presented as possibilities for Laurie's treatment. The standard radiation treatment protocal requires 33 days of external-beam radiation once a day over a six-and-a-half week period. A new procedure, called Mammosite, required only five days of treatment twice a day. This procedure would irradiate the tumor cavity from within the breast with a more intensely radioactive pellet. This procedures delivers the radiation only to the immediate vicinity of the tumor cavity, which is less invasive. This treatment is preferred if no nodes are involved and if the tumor cavity is small and not close to the surface.

The hope was that the tumor would be completely contained and no lymph nodes would be involved, because the Mammosite procedure seemed to be the preferrable option for us. We wouldn't have all the answers until after the lumpectomy and the pathology report.

Laurie's first surgery was scheduled for Monday, Jan. 16.