Cancer Chronicles - March 26, 2010

I met with my oncologist this morning, Friday, March 26. The GREAT news is, all biopsies, scans, and pathology reports show me to be cancer free at the present time! Of course, we are rejoicing in this, praising God, and thanking you for all your prayers.

The bad news is that people with melanoma who have one or more positive lymph nodes are at a high risk to have their melanoma recur. It is believed that 70 to 80% of these individuals will have their melanoma come back within the next three to five years. My tumor, which was removed on February 24, was lymphoid tissue.

For this reason my oncologist is recommending adjuvant interferon treatment (This is the “annoying” treatment, for those who recall a previous blog update). This treatment, its purpose, methodology, and side effects, etc., are very well described at this link, so I’ll not bother with any of it here (With apologies to my Ohio friends – it is a University of Michigan web site). Studies show that interferon treatment lowers that risk by about 20 percent.

Right now, I am planning on moving forward with this treatment. If any of my medical personnel friends care to share your thoughts or experiences, I would be glad to hear them. Also, if anybody else has experience with the adjuvant interferon treatment, I hope you will share your story with me, how you or a loved one coped with it, and so on.

So here’s the plan. Next week, Dr. Smith (surgeon) will implant a Mediport for intravenous delivery. The following Monday, April 5, I will begin the adjuvant interferon treatment. The first phase of the treatment is one hour a day, five days a week, for four weeks. More good news – I will be receiving this treatment about two blocks from where I live.

Several family members were already planning to join me here in Gallatin for Easter weekend. Daughter Rachel, and grandson, Thomas Charles Clay will be here Thursday evening, April 1. Beth and Jonathan and Anna are coming on Friday, April 2. Beth is now planning to be with me for the first week of the treatments, April 5-9.

Finally, I am planning to continue my pastoral duties as I am able through the treatment period. Fatigue is the major side effect of the treatment, so your prayers for extra measures of strength and endurance will be much appreciated!

Thanks again for all your thoughts, prayers, and actions on our behalf! God is good all the time; His people are blessings beyond measure; and life is a precious gift! Live, love, and laugh—lavishly!

Cancer Chronicles - March 22, 2010

My appointment yesterday, Monday, March 22, with surgeon Dr. Smith went very well! First he removed 11 of my 19 stitches. The rest will come out next week.

The pathology report indicates that the nodule on the thyroid has nothing to do with the melanoma. Dr. Smith was not too concerned about it but recommends that it be looked at again with ultrasound in about three months just to see if it has changed at all.

The report on the wide-area excision around the melanoma site came back clear, and again, no cancer in the sentinel lymph node. The report did not reflect all the tissue (the muscle in particular) that Dr. Smith had removed, and he was perplexed about that. He is going to speak with the pathologist concerning the language. I am convinced—by the tightness of my incision, the depression in my chest, and his drawing—that he took enough. The report just needs to reflect that for the rest of the professionals involved in this.

So, all reports seem to indicate I am clear of cancer right now! Praise the Lord! The next step is to see oncologist, Dr. Mathew Joseph this Friday, March 26, 10:45 a.m. Central Time.

If you would, here’s how you can pray for us at this time:

1. Pray for wisdom for our decision regarding the recommended treatment.

2. Pray for our house to sell in Mississippi so Beth can join me without that burden when the school year is over.

3. Pray for Beth to get a teaching position in Tennessee for the next school year.

4. Pray for our son Jonathan as he seeks employment upon graduating from college in May.

I must add a special word of thanks which cannot begin to express my appreciation for Jim Joyce, his wife, Faith, and friends who stepped in and finished my fence project in Mississippi. Jim and Faith, in the dictionary by the words Christ-like servants, there’s a picture of you two!

Thanks to all for your prayers, love, support, and encouragement. You are blessings beyond measure!

God is good—all the time, and His people are something else!

Cancer Chronicles - March 16, 2010

A great deal was accomplished today! It began by rising at 4 a.m. to be at Hendersonville (TN) Medical Center at 6 a.m. About 8 a.m. radioactive material was injected around the site where the tumor had been removed. The idea being that this material flows to the nearest places (specifically lymph nodes) where cancer might spread. In my case it would be toward the left neck or the left armpit—it was the armpit. Then, “pictures” were taken which in a sense draw a map for the surgeon to follow.

Surgery began at approximately 10 a.m. (I have no recollection of even entering the operating room). Dr. Smith’s incision ended up being about six inches from the upper middle left chest toward the left armpit. One concern has arisen from this. Dr. Smith found more than he expected at the original site. At this point he is not sure if this is a result of the cancer growing there, or if it was a hematoma—a collection of blood/dried blood. For this reason he had to go deeper than he had intended at that spot, actually taking some of the chest muscle below it (and I don’t have that much to spare). We will have to wait on the pathology report to find out exactly what was going there.

Next, Dr. Smith removed the sentinel lymph node (the hypothetical first lymph node or group of nodes reached by metastasizing cancer cells from a primary tumor according to Wikipedia). This was the best news of the day! There was NO cancer in that lymph node!

Lastly, Dr. Smith had hoped to do a biopsy of a nodule that had been detected by the PET scan on the left side of my thyroid. Dr. Smith could not find it with his ultrasound, but the radiologist, Dr. Wunder, with more advanced equipment, located it and performed the biopsy. Neither physician seemed too concerned about the nodule, but with metastasizing melanoma it bears further investigation.

We were able to leave the hospital and arrived home about 4 p.m. I am actually feeling next-to-nothing in terms of pain—I hope it lasts! The needle-poking biopsy in my throat has been more irritating than the incision at this point.

I will see Dr. Smith for follow up and pathology results next week, then oncologist, Dr. Mathew Joseph, next Friday, March 26.

Meanwhile, our wonderful church folks are bringing in dinner every night this week. Life is good and God is better! Thanks again for all your prayers and kind words of love, support, and encouragement!

Cancer Chronicles - March 12, 2010

Today was a good day! It began at the oncologist office (Tennessee Oncology) at 7:45 a.m. I learned first of all that I weigh a little more than I should and that I am still as short as I’ve always been. Next we met oncologist, Dr. Mathew Joseph. Beth and I were both very impressed with his kindness, professional thoroughness and gentle manner. Today we are quite thrilled that he is my doctor for this journey.

The big news and good news from today (Friday, March 12) was that the PET and CT scans which took place yesterday (Thursday, March 11) were clear and showed no other “hot spots” for cancer in my body. Of course, we are rejoicing and praising the Lord for this good result. The scans did reveal some small spot within the left thyroid lobe which bears some follow up with ultrasound.

The worst news of the day was just a reconfirmation of the initial diagnosis. The tumor was a metastatic melanoma and that is our working diagnosis. Dr. Joseph performed an examination and he, too, found no primary site. This is unusual but not unheard of. Dr. Joseph explained our next options which I will note below.

We next visited my surgeon, Dr. Peter Smith. He removed my previous stitches, but did not perform the wide-area excision. He felt that it would be too extensive for an in-office procedure. Out-patient surgery has been scheduled for Tuesday morning, March 16, at 9:30 a.m. At that time, Dr. Smith will remove an area about one inch in diameter around the original incision and down to what little chest muscle I have. He will also look at some nearby lymph nodes and if they look suspicious, he will remove several of those. He will also do an ultrasound and a needle biopsy on the thyroid spot.

Dr. Joseph explained that the next options are “treatment” and “treatment.” His recommendation will depend largely on the pathology report from the wide-area excision on Tuesday. If that report indicates an apparently localized tumor, Dr. Joseph said he would most likely recommend what he called an “annoying” treatment. What I know about that so far is that it would involve about an hour of immunotherapy, five days a week, for at least four weeks. The best thing about this would be it would take place at his office about two blocks from where I live.

If the pathology report indicates more cancer in the surrounding tissue, then Dr. Joseph will recommend a treatment which he called high-dose, and a hard treatment. By “hard,” he meant difficult side effects and hospital stays. This treatment would probably take place at Vanderbilt University Medical Center. We will know which direction we’ll be taking no later than Friday, March 26.

Beth will be here in Tennessee through late next week. We are thankful for some very good news, and also to have some clue as to what the next steps are. Thanks to all of you who are praying for us! It is a great encouragement. We are for thankful God’s grace that is so evident through this experience and all of our dear friends.

No matter what, God is good all the time!

How Much Faith is Enough?

I can always count on my father for an interesting observation. Several years ago I had taken a new position on staff at a church that shall remain nameless. As was their custom, my folks came to visit shortly after I began serving there. They attended Sunday morning worship, and met the ministry staff and many others with the usual and customary introductions. Following the service we made our way to a local restaurant for lunch.

At some point in the conversation that early afternoon, my Dad expressed, “That Senior Pastor of yours doesn’t have a lot of faith.” I looked at him rather incredulously and said, “What? Where did that come from?” He restated, “He just doesn’t have a lot of faith!” “Dad,” I implored, “What in the world do you mean?”

He said, “Well, he wears a belt AND suspenders. And besides that, he walks around with his hands in his pants pockets all the time! He just must not have much faith that his pants are going to stay up!”

Dad was only kidding—I think—but it does raise the question of how much faith is enough? A lot of people talk about it these days—having enough faith that God can heal, having enough faith that a miracle can be accomplished. Personally, I’m not so sure it’s a relevant concept. How do you measure “enough” faith anyway? When I read the gospels, I never see Jesus looking for “enough,” or an amount, of faith. In fact, Jesus’ perspective seems to be exactly the opposite. He said it was faith the size of a mustard seed—very small—that could move a mountain.

When Jesus looked up and saw the faith of the four men who had lowered their paralytic friend through the roof they had dug up (Mark 2:1-12), it seems He was not measuring the quantity of their faith so much as recognizing the quality of it. He says nothing about it, but His response to it was forgiveness and healing.

Certainly He saw a faith that had moved the men with compassion for their friend. He saw also a faith that moved them to action. They did something. They brought their friend to the house were Jesus was. Last but not least, He saw a faith that moved them to RADICAL action. They would not be denied. They stepped out of the box; they got their hands dirty. They risked offending the traditionalist, sophisticated church folks below. Mark says, they literally unroofed the roof!

Lord, I don’t know if I have “enough” faith. But give me a faith that will move me with compassion; that will move me to do something, that will move me to radical action. Lord, give me a faith that is willing to unroof the roof!

Cancer - Now Part of the Journey

On Wednesday, February 24, I had a small lump (dime size) removed from my chest just underneath the skin (no visible mark on the skin). Before the doctor went in to get it, he thought it was a cyst. When he opened it up, he thought it was a fatty tumor. I could tell he was a little more concerned when he mentioned that it had a blood supply.

The doctor called me Thursday morning, February 25, and stated that he was not happy with a preliminary report he had heard from the lab. The technician had said, “If I had to say, I’d say it was a melanoma.” So Dr. Smith wanted to see me the very next day, Friday, February 26. On that day he took a look at all my moles and examined some lymph nodes – no signs of anything. He did tell me it was definitely cancer. I had two main questions. Number one: Since you have already talked to an oncologist, are you cautious or alarmed? Answer: Both (I expected that one). Number two: Are we early? Answer: I don’t know (Wrong answer, Doc. Try again. He declined the opportunity).

What makes this complicated—for me—is that I have never had a skin surface melanoma, but that is the typical way melanoma works, and a tumor like mine usually has a primary source—meaning this would be a metastasized tumor. That, of course, is not a good thing, because it could have also spread somewhere else. Dr. Smith did say that about ten percent of the time, they never find the primary source for melanoma.

I got a final report early afternoon, Wednesday, March 3. Dr. Smith’s words were: “It is almost certainly a melanoma” (My interpretation: It looks like a duck, quacks like a duck, smells like a duck. It must be a duck. But it’s kind of a funny-looking duck).

The next step is a PET scan on Thursday afternoon, March 11. I will see the oncologist Friday morning, March 12, then back to my surgeon, Dr. Smith, that same day when he will likely excise a little more tissue around where this tumor was—normal procedure.

As for me, I feel fine. No known physical effects from anything, and I am working as usual. I appreciate your prayers, especially for Beth, since, as many of you know, she is still in Mississippi teaching till the end of the school year, and I am pastoring in Tennessee. All of this medical treatment is taking place in Tennessee—Nashville area. Of course, our dual locations complicate things somewhat. Beth is planning to be with me next week.

For those of you who are interested, this will be my place for updates. Hopefully, there will not need to be many. No matter what, God is good all the time! Thanks again!