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Archive for the ‘Cancer Journey’ Category

Summer Lessons

So here we are, where we honestly never expected to be. We’ve gone from a more than 60% chance of incurable cancer that could have taken Mark in less than five years to a roughly 70% to 80% chance that he’s completely cured. The radiation oncologist says it’s not in Mark’s best interest to do radiation right now, and the risk involved in waiting until there’s a definite reason to radiate is minimal. Every three months we will get his blood drawn for a PSA check, pray, hold our breath, and wait. Waiting. In many ways that’s a word that very well describes a journey through cancer. You’re always waiting.

So what have I learned through this summer of cancer? I’d say it wasn’t so much new things as reminders and reinforcement of things the Lord has already taught me. First of all, regardless of what the doctors say, our future is determined by the Lord. Time and time again the odds were against a cure. Time and time again, Mark beat the odds. Just goes to show that while doctors can give you odds, it’s the Great Physician who gives the outcome. He may still choose to use prostate cancer to bring Mark home, but if so He isn’t going to do it anytime soon. For the time being anyway, it appears He wants Mark healthy.

He also reminded me that He meets us in the moment. He knew all along what was going to happen, but He also knew I didn’t know. When I was weak, He was my strength. When I grieved over the thought of losing my beloved husband, He was my comfort. What a blessing to cry out that I didn’t have the strength to get through the day, knowing that at the day’s end, He will have given me the strength and I would be OK. Tomorrow is in His hands. We live in the moment, and in the moment He gives us what we need. Not necessary what we think we need, but always what we really need. When the future looked dark and uncertain, what a blessing to know I could trust the One who has written out every day of my life before any of them came to be. I could rest in the moment knowing that whatever ‘moments’ might be ahead, He’d meet me in those as well.

I learned once again that there is joy even in the darkest of times. I watched Mark on the tractor, brush-hogging the grass in the pastures (cutting it down, for all you non-farmers out there). It was a beautiful sunny day with the warmth of Spring soaking into our winter-chilled skin. It was a moment of joy. I watched chicks break their way through their shells and blink in the light of a new life. It was a moment of joy. I took Akira down to the river, built myself a little altar of river rocks, and surrendered everything to the Lord once again. The depression that hung over me that day evaporated like mist, replaced by peace. It was a moment of joy. True joy doesn’t come from our circumstances, it comes from the Lord. And He is there regardless the circumstances.

For the believer, God has promised to work all things together for good. That oft-quoted passage in Romans (Romans 8:28) can sometimes seem trite. Believe me, in the trenches of life’s trials, there’s nothing trite about it. I can see already some good He’s worked in our lives through this summer of cancer. The future may show us more. I’m sure I won’t see it all until I’m actually with Him. For now, we go on, knowing as ever that we are in the Lord’s hands, regardless of what tomorrow brings. There’s no better place to be.

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OK, this is a little complicated, so I’ll do my best. First, much to everyone’s delight, Mark has no detectable PSA. In theory, this means there is nothing in him producing PSA, neither a prostate nor prostate cancer. Under normal circumstances we’d be dancing around and shouting, “Let the ten year countdown begin!” But this is where it gets a little complicated. Mark had positive margins. This means there was cancer all the way to the edge of the tissue that was removed during surgery. Positive margins mean either the surgeon cut right at the very edge of the tumor, or there were cancerous cells beyond where he cut. That’s why men with positive margins have such a high recurrance rate. Normally, detectable PSA is the indicator that there is still cancer present.

In Mark’s case, he had a very aggressive, very extensive tumor but a relatively low PSA. This tells us that his cancer wasn’t producing a lot of PSA to begin with. So for him, undetectable PSA is not necessarily a good early indicator that cancer is still present. It could be that there is cancer present, but not enough to produce enough PSA to be detected. Thus, we have a choice. Do we watch and wait to see if the PSA begins rising, or do we proceed with radiation treatment to be on the safe side. There are pros and cons on both sides. Radiation should never be treated lightly, and in Mark’s case the risk is higher because he’s on Coumadin. That might argue for at least waiting until he’s off the Coumadin, either in November or in February, and then testing the PSA again. On the other hand, because we know Mark’s cancer is not one that produces a lot of PSA, the chances are higher that by the time PSA is detectable (if cancer is present) it will have already gone distant and hence become terminal.

We will meet with a raditation oncologist within two weeks, after which Mark will make his decision. Prayers for wisdom would be greatly appreciated. 🙂

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Vertical Perspective

Well before we knew Mark had cancer, we decided to use Livestock Guardian Dogs to protect our herd of goats. Mark, in shining Mark style, researched the options, decided on a breed (Anatolian Shepherd), and found some breeders. We put a deposit down on Akis and a younger male puppy from another breeder. Mark’s diagnosis didn’t change our plans. One week before his surgery, we went to pick up Akis. The younger puppy would be ready a couple of weeks after Mark’s surgery. Alas, despite a very large litter (eleven puppies, six of them male), all of the puppies were sold to people who had sent in deposits earlier than us. She referrred us to another litter that had a male available and offered to transfer our deposit to that breeder. We agreed and got in contact with the other breeder. I planned to make a very long drive to Northern California and back to pick up the pup once I was convinced Mark would be well enough to be home alone all day.

As the time approached, I began to dread the drive. I felt overwhelmed and exhausted. One morning I woke up early and decided to pray until it was time to get up. Among other things, I prayed for the energy I needed to make the long drive. Instead, I got the very clear thought that we should wait on getting another puppy. I’m not 100% sure, but I think it was Friday morning. Later that day, we would learn that Mark will likely need radiation treatment. I told Mark of the thought that had come to mind when I was praying. We talked about it, and he said he would think about it. I left it there, confident that if the thought had come from the Lord, He would confirm it for Mark, the head of our household. He sent an email off to get some more information about the puppy. We got a reply saying that the puppy was no longer available.

Looking at things from a strictly horizontal perspective, the fact that a male puppy was suddenly unavailable not once but twice could have been a big disappointment. Instead, I sat at my computer, reading the email, awed at the way the Lord was obviously guiding and directing us. I think He started directing us with the reluctance I felt to make a long drive, and confirmed it for both of us when the second puppy fell through. For whatever reason, God is keeping us from getting the second dog. Instead of feeling deprived of what I need, I feel so cared for and protected. Eventually, from our perspective anyway, we feel we do need two guardian dogs. God obviously knows that right now is not the time to have two of them. Maybe next year we’ll be in a better position to add a second puppy. Akis will be more mature, and we’ll have a better idea of Mark’s prognosis. Maybe it has nothing to do with Mark’s prognosis and God is keeping the second puppy from us for reasons that at this point are hidden. It doesn’t really matter. The important thing is to keep our perspective vertical, knowing that God is in control, guiding, directing, caring for, and protecting us.

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The Road Ahead

Mark had his post-operative appointment with his doctor this afternoon. He removed the catheter (hooray!!!) and went over the final pathology report with us. We wanted to hear that the lymph nodes were negative for cancer. We heard that. We wanted to hear that Mark had negative margins. We didn’t hear that. The cancer had broken through the prostate wall and had begun to invade the bladder. What the doctor meant when he said he “cut wide” was that he removed part of Mark’s bladder and then reconstructed it. Did he get all of the cancer out by doing that? Probably not. He said he felt there was less than a 30% chance that he got it all out.

So what next? We wait until late in September to let all of the residual PSA exit Mark’s system, then do a PSA test. If that comes back with detectable PSA, Mark has radiation treatment. There is a 50% chance that radiation treatment would be successful and we’d still have a chance at a cure. If radiation doesn’t work, that means the cancer has left the immediate area and we begin treatment to slow the cancer, which at that point would be incurable. So, roughly speaking we have a 60% chance of a cure. If it isn’t curable? The doctor is confident he would have at least another 10 years, maybe 15 to 20. Statistics are nice to give you a general idea of how things might go, but we are ultimately where we were at the beginning of this process – in God’s hands. He’s known from the start what would happen with this. We just have to wait to find out what that will be.

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Mixed Results

Mark’s final pathology was not yet back last Friday, probably due to the fact that the previous Monday was a holiday. The doctor called us yesterday with the results. Thankfully, the lymph nodes still showed negative. However, the cancer did break through the prostate wall. This doesn’t mean the doctor did not get all of the cancer out, although it does mean that possibility exists. He told me at the time of the surgery that due to the size of the tumor, he “cut wide.” While we will find out more details at his appointment this Friday, we know right now that a PSA test will be done as soon as it would be reliable, and the results of that test will determine if we proceed with radiation treatment. So, once again we wait. Waiting will simply be a part of our “new normal.” After all, even if the PSA levels are undetectable (indicating no cancer), we need ten years of undectable PSA levels before we can consider him cured.

Mark is recovering well following his surgery. He grows stronger every day. He is able to care for himself well enough that I’m comfortable leaving him for four hours tomorrow while I drive to pick up a couple of Mottled Java Roosters for my hens. 🙂 I could have picked them up last week, but there was nothing that could entice me to leave him for that long at that point. He has a great attitude (not to imply we haven’t both had moments of crabbiness :D), but is very eager for his appointment this Friday after which he’ll be less restricted. We are daily amazed at how faithfully God has sustained and blessed us.

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Mark’s surgery went very well. He stayed in the hospital two days and came home on Sunday. He’s obviously very sore, but getting better every day. During surgery, they do a quick check of the lymph nodes. That quick check came back negative. So, we’ve crossed two of the four hurdles in order to have a chance at a cure. The third comes this Friday, when we get the final pathology report. In order to clear this hurdle, we need negative margins (no cancer on the outside edges of the tissue removed during surgery) and negative lymph node involvement. The final hurdle won’t come until he gets his first PSA test done. According to what I’ve read, that will take place anywhere from 6 weeks to 3 months post-op. We’ll probably find out for sure when that will happen at his appointment this Friday.

During the surgery, I was blessed by a dear sister in Christ who stayed with me the entire time, and brought me a delicious lunch too! The next day good friends from Seattle came down to see Mark and take me out for lunch to make sure I wasn’t neglecting myself while taking care of Mark. Friends and family from all over have been covering us in prayer. I tell you, I will never again take it lightly when some says they are praying for me. It has been such a blessing to know many people our taking our needs to our Lord, petitioning Him on our behalf.

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We’ve been here before, we’ll be here again. Tomorrow is Mark’s surgery. What will the doctor find when he gets in there? Will he be able to get all of the cancer out? Will the lymph node dissection show microscopic spread? We just don’t know. Once again, we must rest in the hands of the One who does know. Soon enough, the facts will be known and we’ll go on from there.

It’s funny the thoughts that have been on my mind today, the day before our life changes. And change it will, even if they do get all of the cancer out. The surgery itself, even if successful, will have long term, possibly permanent consequences. One of the most surprising things I’ve been thinking about is the absolute certainly of no more children for Mark and I. I haven’t thought about having more kids for years. I’m almost 46, Mark is 57, we have two grandchildren. Why this mourning over a dream I gave up years ago? Maybe it’s just the finality of it. I don’t know. All I know is that I need to open up my hands, lift what I thought was a long ago dream to the Lord once again, and say “Yes, I accept Your decision to not give us any more children.”

What a joy to know that whatever tomorrow brings, we can rest confident knowing our Lord knows best, knowing He will never call us to go through that which He will not also equip us to go through. I don’t fully understand the heaviness of my heart today, but I do understand who has my heart in His hands. It’s enough.

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