Diagnosis - Lung Cancer

Hope this finds you well. We so appreciate all the kind emails, prayers, and love on our behalf. Certainly makes it easier to go through this sort of thing. We feel very much upheld by God's grace on our behalf. 

Things are moving forward for us. We had lots of doctors appointments today. Long story short - James has been diagnosed with non small cell lung cancer (squamous cell, poorly differentiated, for all you medical people! =) ). It is a little unusual, as this is not the type of cancer you usually find in young, male, non-smokers. This type of cancer is somewhat aggressive, but not as bad as some others. 

The amazing thing is that because of the location of the tumor - in his bronchi, which resulted in a cough and a collapsed lung - we were able to get this diagnosed while the tumor is still small. Many times, this kind of cancer would be on the lung tissue, growing for years before symptoms materialize. (And then, obviously, prognosis is not as good.)

The plan is for James to have a full body PET/CT scan, an MRI of his brain, and a pulmonary function test. This morning he had a bone marrow biopsy as well. (Thankfully a lot less freaky than that one they did on House a few years ago!) This is all the doctors being proactive, making sure that James is a good candidate for surgery and that the cancer has not spread. The doctors are hoping that everything will be clear, and are believing that we caught it early. It is possible, though, that the tumor metastasized to his brain or other organs. (It would be very rare for an endobronchial tumor to be metastasized from somewhere else though.)  Obviously we can pray that the cancer is contained!

James will be getting tests over the next 3 days and will be getting results by next Wednesday or Thursday. Our team of doctors want to operate as soon as possible, performing a lobectomy. (The pulmonologist said "For you, I choose the best surgeon." I asked if he was sure he didn't want to find someone off the street, just for fun. He stopped smiling and said, "No, no, we must have good one. I choose the best.") (Sorry, couldn't help myself.) They will remove James's right middle lobe (FYI the best lobe to lose, if you ever have to choose). 

After surgery, James will be hospitalized for about a week and then he'll be able to return home a few days later. (Assuming everything is clean & contained.) The hospital is helping James extend his visa (Chinese only get 2 weeks on arrival; Americans get a month). The visa extension will not be a problem. We are looking into the possibility of living at a mission organization's guest house. And our insurance is working beautifully. James has been able to communicate with his family and miraculously, even though he told them he has cancer, they are doing OK. ("Cancer" is a death sentence in China, so extreme anxiety would be normal.)

Currently our most pressing need is that we need wisdom to know what to do with our girls. I don't yet know enough to feel comfortable leaving James here on his own. But being away from our girls for 3 weeks seems a bit insane/intense for us, our girls, and our friends/family taking care of them. Please pray for us, our girls, and our help as we sort this out. Lydia starts school Monday.

Sorry for a somewhat boring update - a lot of details. But we are so thankful. God's protection, provision, and kindness can be clearly seen through every circumstance of this ordeal. We are amazed. 

"Prognosis is Excellent"

Made it back to the hotel after an afternoon spent at the hospital. 

After yesterday's good news, here's impetus to keep praying. 

James has a lung tumor. There is a 90% chance it is malignant. (Whew, that is tough to write; I am sure it is not easy to read either. Sorry!)

Dr Yongyudh, the pulmonogist who did the bronchoscopy, has sent the biopsy to pathology. He called me to his office to show me pictures from the bronchoscopy and to tell me the diagnosis & treatment. I asked, "So, the prognosis is...good?"  He said, "The prognosis is excellent. EXCELLENT. Do NOT worry." Then he asked me about James and I, and told me about how much time he had spent in America to reassure me of his skill, I guess. He later found me in recovery to reassure me again that everything is going to be OK and to please not worry. (Such a kind doctor.) 

He is recommending that James's right lobe be removed. He is also recommending a PET scan and MRI to ensure that the tumor is contained, which he believes it is. (Why prognosis looks so good; cut it out and move on, apparently.)  James's lungs will expand over time to regain capacity. 

He says treatment will be 2-3 weeks. Not so bad, but I told James this was really poor planning on his part. It would have been much better if he had gotten sick last year when we didn't have much going on. =)

Oh, for trivia's sake - I asked whether this was normal, Dr Yongyudh says this kind of problem is not to be unexpected given the pollution/second hand smoke James has been around his whole life. Jeepers. 

We will meet with the doctors on Saturday and will have a lot more information on what the exact course of treatment is. 

Again, thank you all for praying, especially as we sort out what to do with our lives for the next few weeks! 

Reasons for Optimism

First, thank you all for your prayers, they have truly strengthened and encouraged us during this time. We are doing well; we understand the girls and the restaurant are also good. :)

We met with Dr. Theera this morning for some good news. First, he had been very concerned about James's x-ray bc it looked like lymph nodes were already affected. Great news - all clear on the latest x-ray. Awesome news.

Additionally, James's blood work is clear - no cancer markers present. Fabulous.

Finally, pathology says nothing to indicate cancer from the first biopsy. Sweet. All they can see is chronic inflammation.

Dr. Theera was so happy to see James's work come back looking so good. If possible, he was smiling even more than the first time we saw him.

We just saw a pulmonologist (who incidentally escaped from Ch!na in 1950, fascinating story, and spent 30 years in Cincinnati, less fascinating, LOL). He has James scheduled for a bronchoscopy tomorrow where he says, "this time we won't miss it. We will get a great sample." 

We asked what the possibilities are. He said we have no way to know until they get in there. Cancer remains a possibility, and our old friend TB is back on the table bc of where we life. Then he said, "Whatever it is, we can treat it for sure. It is so small." (Dr. Pulmonology shares Dr. Theera's buoyant optimism.) It does sound like surgery is most likely in James's near future - Dr. P wants to cut out whatever it is. Fun times. 

James will have the bronchoscopy on Thursday 3pm Thai time. Pray that they really do get a great sample for pathology to work with.. The bronchoscopy will most likely make James's coughing worse. It's very hard for James to get over his back pain with the cough. Ask that it doesn't make his coughing/back pain too severe.

We will return to Dr. Theera on Friday at 9am. Let's continue to ask that this is something weird and simple to treat - either with drugs or a knife. Let's continue to ask that it's not cancer. 

And, just because God can handle our selfish requests, I would like to be back in Dali on Sunday night at the latest; Lydia will start first grade on Monday morning at a local school. If our other prayers are answered, this one doesn't seem that outlandish. :)

Thanks so much, everyone. We so appreciate each and every one of you!

Towards a Diagnosis

I am sitting in Bangkok, having just left Bumrungrad Hospital with James. We visited today with Dr. Theera Umsawasdi, a thoracic oncologist.  He is a lovely man, quite upbeat for someone who deals with cancer patients for a living. (Maybe they are all that way?  But I would be sooo depressed.  =)  ) 

James has not been diagnosed with cancer, though there are a few things that make Dr. Theera suspicious. James has RMLS (which is a partially collapsed lung). He also has a small growth in his lungs (less than 1cm).  And his X-ray has a bit of cloudiness that makes him concerned.  (He was more concerned with the Xray than the CT scan.)  He has has had a persistent cough for 8 months.  

Given James's age, gender, and non-smoking history/health, there are lots of things that don't add up to cancer. So, as Dr. Theera says, "It is still quite early" (with a beaming smile).  

So, we are doing some additional tests.  Today James had blood work done and urinalysis.  He also had a chest X-ray.  Dr. Theera sent James's biopsy slide (which he had done in Kunming) to pathology.  He would like to see if they can get a definite positive or negative read for cancer based on the slide.  If not, James will have another bronchoscopy. 

James will see Dr. Theera on Wednesday at 10am Thai time and we'll go from there. 

In the meantime, please pray for us!  Pray for a quick diagnosis.  And golly, we would love if it was not cancer, so you can pray for that too.  =)  Pray for our girls, they are all in the care of friends/relatives back in Dali.  And pray for our staff, that they will all work together well in our absence.