Doctor Paul, MD

A small-town doctor working to preserve the art of old-fashioned primary care.

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Surgery

August 14, 2016 by Paul Williams 9 Comments

Thank you Father for watching over Theresa this week, for answered prayer, for your many promises, and that as your children, we can be confident that all that comes into our lives first comes through You.

Again, thank you all for walking with us in this journey. Thank you for your continued prayers and thoughts.

Theresa had surgery Wednesday morning. Based upon the PET scan and MRI, we agreed that the best step forward would be a large lumpectomy and an axillary lymph node dissection – with the dissection extent determined by what was found. As you can guess the night before the surgery, Theresa couldn’t sleep. She had moved up her Herceptin treatment to Tuesday, since she knew she wouldn’t be able to do it the day after surgery. Her port was accessed on Tuesday and she asked them to keep it accessed so it could be used Wednesday, which made the preparation for surgery much easier on her, as they drew blood and used it for all the IV meds and fluids. Her surgery was about 1.5 hours. She had a bit of post operative pain and side effects from the medications, but we got home by 4pm.

She had a needle localization of the breast mass before surgery. When she had her biopsy in January, the radiologist left a metal clip at the site of the biopsy. This clip helped in the localization process. They localized the mass and clip with a mammogram and were able to put a hooked wire right at the spot. In surgery about a 1 inch section was removed from the breast that showed margins free of tumor on frozen section at the time of surgery. He found matted lymph nodes in the arm pit and had to do a complete level 1 and partial level 2 lymph node removal. She came home with a drain with a vacuum bulb attached. This will come out in a week.

Friday we received the pathology results. Theresa took the call from the surgeon that morning and I talked with her at lunch. Theresa heard “cancer” and misunderstood what was said next. So when I talked with her, she was pretty distraught. She had heard that all the lymph nodes still had cancer in them. I talked with the Oncologist and also received a copy of the pathology report. The news was much better than what she heard. The lump removed from the breast showed multifocal residual carcinoma about 1/4 of an inch in size (about 3 places in that 1/4 inch area with cancer). The lymph nodes showed 9 that were completely clean, though scarred, and one (which was the lymph node that was 2 inches in size completely filled with cancer in January) that was now 1/2 inch in size and about 1/8 inch of the same cancer.

What bothered Theresa is that there was still cancer present, as we had hoped that the only thing found was scar tissue. We though are very thankful that God answered our prayers, and yours, and gave us wisdom from above to go forward this way. We are also thankful for the skill of the surgeon and the removal of all the residual cancer. The cancer removed was in the two areas of slightly increased uptake in the PET scan. From our Oncologist point of view this is a huge success, and he is pleased that the residual was so small compared to the huge pretreatment tumor burden. Because there was cancer still present, he thinks he will recommend radiation, and we will talk about another treatment (Kadcyla) that uses Herceptin with chemo attached (sort of a smart bomb), that goes into the cell and destroys it verses Herceptin alone for the next year.

So how is Theresa doing? Actually, she is doing better than I expected, and for that I am very pleased. She has pain, but not taking any pain meds and is up helping out some, exercising a little, and mainly sitting in her recliner watching movies or reading a book. She is determined. Some days are better than others, but nothing like it was in January.

She wishes this was all over. She was hoping the pathology would have shown no residual and that other than Herceptin for a year, she was done. But that is not what our Father had in mind. We know what we want, not knowing what our loving Father has allowed. As this was a long post, I’ll end it with a poem from Streams in the Desert (August 9th). “I have been through the valley of weeping, the valley of sorrow and pain; but the “God of all comfort” was with me, at hand to uphold and sustain. As the earth needs the clouds and sunshine, our souls need both sorrow and joy; so He places us oft in the furnace, the dross from the gold to destroy. When he leads through some valley of trouble, His omnipotent hand we trace; for the trials and sorrows He sends us, are part of His lessons in grace. Oft we run from the purging and pruning, forgetting the Gardener knows that the deeper the cutting and trimming, the richer the cluster that grows. Well He knows that affliction is needed; He has a wise purpose in view, and in the dark valley He whispers, “Soon you’ll understand what I do.” As we travel through life’s shadowed valley, fresh springs of His love ever rise; and we learn that our sorrows and losses, are blessings just sent in disguise. So we’ll follow wherever He leads us, let the path be dreary or bright; for we’ve proved that our God can give comfort; Our God can give songs in the night.”

“Though the fig tree does not bud and there are no grapes on the vines, though the olive crop fails and the fields produce no food, though there are no sheep in the pen and no cattle in the stalls, yet I will rejoice in the LORD, I will be joyful in God my Savior (Habakkuk 3:17-18). Heroic confidence! Glorious faith! Unconquerable love! Philip Doddridge.

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Filed Under: Breast Cancer - our new normal

Comments

  1. Hoa DeBruler says

    August 14, 2016 at 3:56 pm

    We continue to hold you in our prayers

    Reply
  2. Carol & Marcus Johns says

    August 15, 2016 at 1:03 pm

    We still pray for you and Theresa each day without fail. Your faith and continued gratitude helps us to put our own troubles into perspective and to realize our fortunes in the mist of our battles.

    Reply
  3. Lori Spencer says

    August 15, 2016 at 3:04 pm

    Thank you for the update Paul, we’re keeping you all in our prayers!

    Reply
  4. Glenn Palmer says

    August 15, 2016 at 4:15 pm

    Standing with you daily in prayer.

    Reply
  5. Judith and Hector Aguilar says

    August 15, 2016 at 10:30 pm

    Our prayers are with you. God is good…Your journey is inspiring to all of us. Thank you for sharing your family’s faith during this journey.

    Reply
  6. Donna Rao says

    August 16, 2016 at 4:42 pm

    Good news that the cancer has diminished in size and that treatment now has a defined enemy area. Hugs & kisses. Auntie Donna

    Reply
  7. Julie Wilber Gamewell says

    August 18, 2016 at 11:04 pm

    Thank you for the updates and inspirational messages. I am so sorry that Theresa has to go through so much, but I’m so thankful for the the Lord’s work being accomplished. I pray for her comfort and strength and healing. Faith, Hope, and Love in Christ.

    Reply
  8. Rose Weed says

    August 19, 2016 at 11:23 am

    Keeping Teresa in my prayers.

    Reply
  9. Margie Briscoe says

    September 22, 2016 at 2:43 pm

    So grateful for every good report, and the many small victories along the way! May the Life-giving breath of our Heavenly Father continue to flow through every nerve. fiber and tissue of Theresa’s being. May His face shine upon you and give you peace. May our Lord Jesus, the Good Shepherd continue to guide and sustain you through this difficult, steep and dark path. May the Holy Spirit continue to pour the soothing oil of His comfort upon you both, bathing you in the oil of gladness as you put on the garments of praise in place of the spirit of heaviness. This is my prayer for you! Be blessed. Margie Briscoe

    Reply

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About Doctor Paul

Dr. Paul Williams, MD is a small-town family practice doctor working in Centralia, Washington. He works from the same office where his primary care practice was established by his father over 38 years ago. He believes strongly that the art of the old-fashioned primary care doctor is an important feature of our medical system that should be preserved and protected from excess interference from insurance companies and government regulation alike.

Due to changes in the health care industry and regulations affecting it, and in an effort to preserve the art of old-fashioned primary care, Dr. Paul has shifted his practice to a Direct Care model, meaning that patients pay an affordable monthly fee to purchase primary care health care services directly, rather than having their services billed through an insurance company.

This blog is intended to help Dr. Paul's patients (and anyone else!) understand the changes the medical industry is going through, and to provide information about the Direct Care model of primary care.

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