First Update: Meeting with Surgeon

Thank you all for your prayer and amazing support. We are eternally grateful for everyone one of you and covet your continued prayer over Julie, her healing, and wisdom and discernment for us as a family throughout this process.

This being our first blog, its a bit long, so I apologize in advance.

Today we spent 2 hours meeting with Julie's surgeon going over her test results, doing a quick exam and talking about the options and decisions we need to make in the near future. It was both fascinating to learn about how the body works, exhausting to process all the information, and emotional as the reality of the road ahead set in.

Lesson 1: The basics of breast cancer

We learned a lot about carcinoma. BIG caveat here. I am not a doctor and likely missed some of this, and if you are a doctor, feel free to correct me here, but this is what I think we heard. There are many kinds of breast cancer, one of them is ductal cancer. There are basically two kinds of ductal breast cancer, ductal carcinoma in situation (DCIS - I think that is what the IS stands for), where the cancer is contained within the duct; and invasive ductal carcinoma (IDC) where the cancer cells have gone beyond the duct itself into the surrounding tissue. Julie has IDC.

There are two "ratings" for breast cancer: Stage and Grade. Grade is determined by a pathologist looking under a microscope and there are basically 3 grades:

1. Grade 1: low grade, highly differentiated (meaning the cells are differentiated from non-breast cells - normal breast cells are fully differentiated)
2. Grade 2: Intermediate grade, moderately differentiated
3. Grade 3: High grade, poorly differentiated.

What's tricky is that the cancer doesn't really move from grade to grade. It is what it is.

Julie has Grade 2 IDC.

Stage - Stage is based on 3 factors: Tumor size, nodes (as in lymph nodes) and if they have cancer cells in them, and mets - meaning is the cancer anywhere else in the body. They won't know the stage until after surgery and they can do more tests.

Lesson 2: Options

There are several options, some based on results of lymph node testing, others based on cosmetic preference. God's design for the body is amazing. there are several lymph nodes near the armpit that are called "sentinel nodes". Sentinel nodes, as the name implies, are the guardians - they pump radioactive fluid into the breast, knowing the sentinel nodes will stop the "bad stuff" from flowing to the rest of the body, then test the sentinel nodes for cancer cells. If these cells are cancerous, is it obviously more serious.

The "old" way was to completely remove all breast tissue, lymph nodes and pectoral muscle. Later, they figured out how to leave the muscle, and now, they have tests to see if they can leave the lymph nodes. The benefit of which is to avoid lymphedema (severe swelling that occur in the arm - the lymph nodes control all the flow of fluids throughout the body), so you don't want to take them out if you don't have to.

I will save you all the details on the options, but suffice it to say there is everything from a simple lumpectomy (removal of the tumor only), to a single mastectomy, to a bilateral mastectomy (double mastectomy). There are also options on reconstruction (including none and using prothesis). Each of these comes with pros and cons, different length of surgery, hospital stays, recovery, etc.

Some of the decisions can't be made until we meet with more doctors (plastic surgeon and oncologist for starters). But here are the next steps:

• We are working on getting appointments set up this week with the plastic surgeon to discuss reconstruction options and the oncologist to discuss post surgery treatment.
• Depending on the results of the lymph node testing (which we won't know until after surgery), we will know what reconstruction options are still available.
• Also, based on results of lymph node testing, we will know if Julie will need chemotherapy and radiation, or just radiation. Right now, the prognosis based on the size of the tumor is that she will need chemotherapy.
• We are trying to get the surgery scheduled the end of next week. There will be about 4 weeks of "down" time, then the post op treatments (chemo and/or radiation).

We have felt the Lord's presence throughout this process. While emotional and scary, we fully put our trust in him and in his plan, and that it all happens in his timing.

Specific Prayer Requests:

1. That the Lord would miraculously remove the cancer from her body
2. Should we need to proceed with surgery, that the lymph nodes have no cancer in them
3. That Julie will NOT need chemotherapy
4. That we will be able to line up all the docs and surgeons required to pull this off in the next 2 weeks.
5. That we will be able to minister to others in the midst of this trial
6. For continued hope and perseverance

Thank you all. We will be updating this blog several times a week as we have more information.

Blessings

Steve, Julie, Sarah and Hannah