This is a lengthy update after a week of silence. Wednesday, March 25, we had the appointment at Texas Oncology. I anticipated a visit in an exam room or office with a desk. That’s what happened. But not until after Scott had stopped for a blood draw just outside a stark white room filled with 20 or 30 patients in Lazy-boys, hooked up to IV’s receiving chemotherapy. I wasn’t prepared for that. Envisioning what would likely be Scott’s future there, I wanted to cry. And I thought that we needed some kind of ‘tour’ or introduction to this part of the journey. Like, “Here’s where you’ll get your blood drawn each time you come to the office. And here’s where you’ll sit for 4 hours while the medicine drips into your veins.”
Instead, after taking Scott’s vitals (he’s lost about 17 pounds), the nurse ushered us to an exam room and we met again with Dr. Wilfong. He invested lots of time with us. After each little conversation about questions, concerns, symptoms, etc. Dr. Wilfong would ask again, “What else is bothering you?” Later we learned that he told his staff to schedule us before lunch or at the end of the day because he knew we’d need more time. He was right—but how in-tune with us and accommodating. He shared he had connected with Dr. Hurley, the surgeon, to discuss treatment options and they intently considered what would be best for Scott—looking at his diabetes, age, family, etc.. And layering that with what treatment option they would want if they were in his shoes. Both men are in their late 30’s/early 40’s with young children. They get it.
Interestingly he said that if this were a colon cancer, we’d be done with treatment right now. But with rectal cancer, when cancer goes thru the wall, there’s a 20% risk of having it come back in that area. Radiation has shown to reduce the risk of local cancer recurrence to 5%. Dr. Hurley did the right kind of surgery technique (TME) when he removed the tumor (which lessens the risk of cancer coming back and doesn’t ‘spread’ cancer cells in the area). So, Scott probably doesn’t need radiation on the area. But the problem is that no one has studied TME alone, without chemo. It’s kind of challenging to recruit volunteers to not get radiation and see what happens just with the surgery—when the studies show that radiation can help. If the cancer were to return, it would be ‘bad.’ It invades the nerves, bladder, prostate etc. It hurts and causes paralysis.
His recommended treatment plan:
- 5 weeks of Xeloda pills (3 in the morning; 3 in the evening), 5 days a week (M-F off on the weekends)
- 5 weeks of intensity modulated radiation therapy (IMRT) on the cancer site (M-F off on the weekends)
- Likely another 6 months of just the pills (depending upon how Scott tolerates them)
Possible side effects: mouth sores, some nausea, dry skin or blisters on hands and feet, diarrhea, skin sensitive to sun.
He is not recommending the often standard Oxaliplatin IV chemotherapy, which is almost certain to cause some type of neuropathy (nerve damage) in the hands, feet, eyes and affect walking, feeling and sight—pretty severely.
Scott shared that we were confident in his care and personally really like him, but were interested in a second opinion and had reached out to M.D. Anderson. He certainly understood. He asked if we’d like to go ahead and meet with the radiation oncologist. After a quick call, we learned Dr. Barker could squeeze us in. A short drive around the corner landed us at the radiation center and an energetic team. Though Dr. Barker said he had previously worked at M.D. Anderson, I didn’t catch if he’d had a stint in sales—but am sure he must have. Nicknamed the Energizer Bunny, he was really good in working to appropriately ‘sell’ us on the technology and capabilities of the oncology team here in Dallas.
He reassured us that as cancers go, Scott’s situation is really good. Low grade. No lymph nodes. “We can take care of this. Scott’s going to be around a long time.”
My dad researched and found the rectal cancer specialist at M.D. Anderson. He emailed Scott’s situation and recommended treatment plan and asked if the team in Houston would have anything to offer Scott that would not be available to him in Dallas. About 15 minutes later Dr. Eng called Dad and said that the plan seems quite appropriate and no different than they would do at MDA for a patient with Scott’s findings. At the end of the conversation, she mentioned how easy it was for her to respond to the information in Dad’s e-mail since he had provided her with nearly everything she needed, and that didn’t happen very often. No surprise to us, though. Dad has been just one question ahead of us in helping provide what we may need to know next. What a gift he is.
So, Scott starts all of this on Monday, April 6. He wanted a bit of a ‘break’ before facing more side effects. The recommendation is to start treatment within 5-8 weeks of surgery, so we’re well in that window. Tomorrow (March 30) Scott will see Dr. Barker to have ‘lines’ drawn on him so the team knows where to aim the multiple laser beams that will guide the radiation beam(s). He won’t be able to get them wet for 5 weeks and will need to cover the area with a plastic trash bag of sorts when showering. Then ‘sponge bathe’ around the marks. He can’t swim or take a bath while the lines are on him.
The radiation should cause no nausea or hair loss (so, Scott’s started growing a beard!). He just should avoid spicy foods. He can keep working and should be able to drive himself back and forth.
There’s so much more we’re grateful for:
- An oncologist who’s tops in his field and with whom Scott feels comfortable
- A quick response from Dr. Eng and confidence that we have tremendous resources locally
- Pills and no IV treatment for now
- Return to mostly normal life (Scott started back to work mid-week; his appetite’s returned; he’s driving and exercising lightly; boys are doing fine)
- Great health coverage (I know I’ve mentioned that before, but it’s huge)
- Dinners from friends
- 3 free house cleanings thanks to the Buckets and Bows foundation that helps with house cleanings for cancer patients (usually women, but I consulted with an author who knows the owner and he asked if she could help us in this way). It’s called Cleaning for a Reason.
- Incredible support from our family
If you’re praying:
- That Scott would have limited negative side effects. He’s especially concerned about the possibility of blisters on his hands and feet.
- That the medicine and radiation would do their work fully and cancer will not return
- That we would continue to experience God’s presence in remarkable ways