Biopsy....update??

So, I know you've all been wondering about the biopsy.  I haven't updated on that because there was really nothing to report.  And once there was something to report, life (as seen in the last post) got a bit busy last week.

Dr. Lorusso, my medical oncologist in Santa Fe (SF), emailed me last Tuesday to say that there had been a delay (I was supposed to have gotten results on Tuesday), and that I would have results on Wednesday.  On Thursday (when I was on the road to Tulsa), she sent the following email message: "Unfortunately results are not available.  Testing failed for technical reasons. Very frustrating; no more insight available as to the suspicious cells.  I will talk with Eric about next steps."  "Eric" is Dr. Bernstein, my Los Alamos (LA) medical oncologist.  I met with him this morning when I went in for the next round of chemo.  

Dr. Bernstein is no happier than Dr. Lorusso about the lack of specificity in the results.  He feels that the suspicious cells in the lymph nodes are cancerous, and he seems to be leaning toward calling this a Stage 4.  He said that he and Dr. L had talked with the pathologist, and that the dye test the path used didn't yield any better results.  He (the path) felt that he was seeing cancerous cells, but couldn't say for certain.  Dr. B has said that he will talk with "Karen Miller" who is a "well-known and respected breast cancer specialist" to see what she thinks.  When we discussed reasons why we would go ahead with a Stage 4 type treatment rather than a Stage 3 type treatment (carrying on with the current plan), he said that if it is Stage 4, this becomes a marathon rather than a sprint, and he doesn't want me "beat up" by the chemo, surgery, and radiation.  When I mentioned that the tumor seems to be responding, and asked about the PET scan at the end of the six cycles - if it would show whether or not the cancer was gone from the lymph nodes - he said he felt sure it would show it was gone at that point, and might even show that now, but he said that it is not a test that gives the kind of definitive specificity we need, that it's like trying to see if you've cleaned up all the grains of sugar you spilled on the kitchen floor this morning - from an airplane.  When I asked about another biopsy, he thought we might could do that, but he also thought it would be potentially good to have one of the lymph nodes in my neck removed to test it.  He kept saying that I am, unfortunately, in lots of gray areas.  

He repeated what Dr. L had said about all the new research, study, and debate about how to treat someone who is getting results like mine (not knowing if the cancer has spread to another area, particularly an area that is "in the neighborhood").  Although he first said that he feels pretty sure the cells in my lymph nodes are cancerous, he also said he doesn't feel it is a new cancer, but that the breast cancer has spread and become metastatic.  He did a manual exam of my neck, and he didn't feel anything - I mentioned that I hadn't been able to feel anything either, although just before the PET scan I had felt a small lump in my neck.  I told him that I'd had pretty bad allergies when the PET scan was done, but he said that usually when you have allergies, the lymph nodes on both sides of the neck fire.  I told him that while I know he's the doc, I also know that my allergies are always worse on the left side (the one that has/had the suspicious cells) of my head.  When we first discussed what would happen if we called this a Stage 4, he said we would be looking at how to keep me alive as long as possible and would treat this like a chronic disease.  When I asked for specifics, he first said that we would take off two of the drugs, and that there would be no surgery and no radiation.  When I expressed concerns about that, particularly since we were doing the chemo to shrink the tumor to do a lumpectomy, he backed off, and said that was a possibility.  But he is concerned about the radiation - he said that he would like to present this to the tumor board, and that he was particularly interested in what the radiation oncologist would have to say since they would be treating such a large area with radiation due to the number of lymph nodes involved (under my arm, center of my chest, and my neck) plus the breast. As we continued to talk, he said that a few years ago, there would have been no question that we would just call this a Stage 4.  But he said that the new drugs they are using for cancer now are so good, and the cancer responds so well, there is reason to think we could potentially continue to treat this like a Stage 3 and expect that I would be cured of cancer.  But he is obviously hesitant to make that call.  

I will be honest and say that I know how fast this tumor grew from the time I found it until we began chemo - in one month, it had more than doubled in size to that 6 x 5 cm.  I also know how quickly and how well it has responded to the chemo.  That makes me afraid to call this a Stage 4 since Dr. B is, at least initially, talking about taking off two of the drugs, no surgery, and no radiation.  Based on what I was told in the beginning and what I experienced in the exponential growth of the tumor, it frankly scares me to take away so much that seems to be doing so much good.  My biggest fear is that if we back off as much as Dr. B is suggesting right now that there won't be a marathon because this tumor will grow and the cells will spread so fast the whole thing will be done quickly.  I know there are legitimate reasons not to "hit it with all we've got," like the fact that they can't use the same drugs again if the cancer comes back, the amount of radiation we're talking about, and the fact that if it is discovered definitively later that this is Stage 4, we have less to work with.  Dr. B said that he wants to cure me if that's possible - but we can't know that for sure right now.

I would ask that you pray for wisdom for the doctors right now.  We are at a critical stage with this.  We continued with the status quo for today, but Dr. B said he will call me this week with some sort of answer as to how we are going to label this - Stage 3 or Stage 4 - and some sort of plan if we call it Stage 4.  

I have prayed from the beginning that God would receive glory through this, and that He would do something so amazing that it would be clear it was He who did it.  Maybe that's the reason for all this grayness - He's trying to bring this to a place where He is the only option for healing.  I would argue that that has always been the case, but maybe His plans extend beyond what I can imagine, as they often do.  All I can do is rest in His care right now, acknowledging again the words of Psalms 139 {italicized gray comments mine, to symbolize the gray areas I'm living in right now}:

O Lord, You have searched me and known me. {all of me, Father...}
² You know when I sit down and when I rise up;
You understand my thought from afar. {even the scary thoughts, Lord}
³ You scrutinize my path and my lying down,
And are intimately acquainted with all my ways. {all the ways the cancer is attacking, all the ways the chemo is attacking back....}
⁴ Even before there is a word on my tongue, {the cries for mercy, the cries for life....}
Behold, O Lord, You know it all.
⁵ You have enclosed me behind and before, {you have placed a hedge around me, and there is a limit to even what cancer can do to me....}
And laid Your hand upon me.
⁶ Such knowledge is too wonderful for me;
It is too high, I cannot attain to it.

⁷ Where can I go from Your Spirit?
Or where can I flee from Your presence?
⁸ If I ascend to heaven, You are there; {thank you, Father}
If I make my bed in Sheol, behold, You are there. {thank you, Father}
⁹ If I take the wings of the dawn,
If I dwell in the remotest part of the sea, {no matter how high or how far, You are there...}
¹⁰ Even there Your hand will lead me, {lead those who will care for me, Father...show them the right path to take with my care}
And Your right hand will lay hold of me. {Your righteous and strong right hand...}
¹¹ If I say, “Surely the darkness will overwhelm me,
And the light around me will be night,” {it feels a little like that right now, Lord}
¹² Even the darkness is not dark to You,
And the night is as bright as the day.
Darkness and light are alike to You. {this isn't at all scary to You, Father....I rest in Your security, in the fact that this gray darkness I see is not darkness to you at all}

¹³ For You formed my inward parts;
You wove me in my mother’s womb.
¹⁴ I will give thanks to You, for I am fearfully and wonderfully made; {even with cancer...}
Wonderful are Your works,
And my soul knows it very well.
¹⁵ My frame was not hidden from You,
When I was made in secret,
And skillfully wrought in the depths of the earth;
¹⁶ Your eyes have seen my unformed substance; {the substance that is giving the doctors such fits right now...You can see it very well}
And in Your book were all written
The days that were ordained for me, {You know how many days I have left - whether that be years and years.... or not...}
When as yet there was not one of them.

¹⁷ How precious also are Your thoughts to me, O God!
How vast is the sum of them! {You have not forgotten me - you continue to remember my plight...}
¹⁸ If I should count them, they would outnumber the sand. {I can rest in the fact that You have me squarely in the middle of Your "radar screen"}
When I awake, I am still with You.

²³ Search me, O God, and know my heart;

Try me and know my anxious thoughts; {for they are many, Father.....}
²⁴ And see if there be any hurtful way in me,
And lead me in the everlasting way. {let nothing I do, and nothing I say, detract from You, oh my Father, my Redeemer, my Savior, my Lord.....this is ALL in Your omnipotent Hands....}

I pray that God has many more years for me here.  I pray that the doctors can come to a place of confidently calling this Stage 3, and that we can continue with the care plan we put in place before these "suspicious cells" that have proved so ornery and difficult to pin down came into the picture.  I feel as if I have so much living left to do...but I am trying not to place God in a box either.  If He is ready to call me Home, I have my house in order.  But I pray it is not time for me to go Home yet, that He will give me more years here to work for Him.  Regardless - I say with Job, "The Lord gave and the Lord has taken away. Blessed be the name of the Lord.” (Job 1:21)

Did someone pray for patience for me????  I think you can stop now....

Seeking Him, finding Him to be faithful and sovereign, good and gracious,
Sherri