Time in Japan...

The past few weeks have been GREAT! We were welcomed back to Misawa by a group of friends waiting at the airport. We felt like celebrities as we walked out of the baggage claim area to a round of applause. Why is it that we never seem to enjoy things to their maximum potential until they are about to be taken away?!? We both feel like we have "done life to the fullest" while stationed at Misawa, but I think we took some of the enjoyable day to day things for granted.

Sara has spent much of her time at lunches and coffee shops with her friends. The afternoon nap has also become a scheduled portion of her day. Apparently, it takes large amounts of energy to make a baby in your belly. She has also made it to the gym (her old "home away from home") to tell her aerobics/yoga students goodbye.

Sara and her Yoga Friends

I have been busy trying to tie up loose ends and get out-processed from the base. I also got to fly an F-16 over to Korea for a few days to tell my squadron farewell (the jets were already scheduled to go, I just happened to fly one of them). It was very therapeutic for me to "do my own thing" for a few days. The past month has been focused on all of life's changes, but to wake up early, drive in to work, get in the jet, and go flying made me feel like all was back to normal. I am so grateful for the opportunity to tell my friends good bye and to get to fly an F-16 one last time (for now, at least).

Fini-Flight

We have airline tickets to Hawaii booked and will be departing Misawa on Wednesday, April 1.

For those of you in Misawa... Some of our friends are organizing a "Sayonara to the Sullivans" Farewell Reception at the Mokuteki Community Center on Monday, March 30 from 6 - 9 PM. Please stop by if you are able.

Headed Home...

I have never been "ready" to leave the beach, but I am excited to leave the sunny shores of Hawaii for the snowy shores of Northern Japan.

Sunset Beach on the North Shore of Hawaii

Snow Festival on the North Island of Japan

It causes me pain to realize that Misawa will no longer be "home." However, we are grateful for the opportunity to come back and bring closure to this chapter in our lives, even if only for a short time.

We are leaving Honolulu on Saturday afternoon and will arrive back in Misawa on Monday afternoon (the overnight in Tokyo and the International Date Line crossing make this a LONG trip). I tried talking Sara into the bullet train on Sunday night, but she says she has had enough of the Shinkansen. Who doesn't enjoy 4 hours of HOT train with a transfer at Tokyo Station...during rush hour...with HUGE luggage?

Anyways, this will probably be the last post for a few weeks. We are planning on arriving back in Honolulu on April 1 for a few more appointments before the surgery. Sara's surgery is scheduled for April 6.

Until next time, THANK YOU again for your continued prayers and support!

I thank my God upon every remembrance of you. --Phillipians 1:3

DNA test results

Today was supposed to be a day of rest, but to no avail. While en route to the mall (Sara said she needed some "retail therapy"), we got a call from the hospital requesting our presence. The genetic testing results had come back early, so we busted a U-turn and were Tripler-bound, towards our new home away from home.

Tripler Army Medical Center

On the way to the hospital, I asked Sara what she thought the results were going to be. We had both succumbed to the fact that she MUST have the gene mutation. There could be no other explanations to her early aged cancer diagnosis.

The genetic counselor, Susan, walked in and said, "I have good news." She handed us the paperwork faxed in from the lab, and across the top it said "NO MUTATIONS DETECTED." We were shocked.

This is great news for us. It means that she will be able to keep her right boob and we won't have to worry about the increased ovarian cancer risk that is caused by the BRCA mutation. They were recommending an oophorectomy if she was BRCA positive. For those of you not up on your medical lingo, an oophorectomy is a surgery where they remove the ovaries.

They drew some more blood for one more genetic test. Now, they are going to test her DNA for p53 mutations. Susan says she is pretty sure this test will come back negative, but she wants to be able to rule it out completely. Following is an excerpt from wikipedia.

p53 is important in multicellular organisms, where it regulates the cell cycle and thus functions as a tumor suppresor that is involved in preventing cancer. As such, p53 has been described as "the guardian of the genome," "the guardian angel gene," and the "master watchman," referring to its role in conserving stability by preventing genome mutation.

p53

Random fact of the day - In 1993, p53 was voted molecule of the year by Science magazine.

After Sara had her blood drawn, we had a nice conversation with Susan. We were discussing the developments in chemotherapy and the benefits that have come from breast cancer patients in the past participating in clinical studies. In the past there has been some confusion as to when a lady was considered a "breast cancer survivor." Does it take 5 years, 10 years, or longer post recovery? She gave Sara a pin of an angel wearing a pink ribbon and said, "Sara, you are a breast cancer survivor!" Breast cancer is now considered a chronic illness, and is not a terminal diagnosis. As soon as a person is diagnosed, they are considered a survivor. How encouraging?!?

On our way out of the hospital, we met Indy.

Indy, a Certified Therapy Dog

Indiana Jones (aka Indy) is a 4-year old retired show dog who visits Tripler a few times each week. His handler gave me his business card and told us to email them to set up a canine therapy appointment after Sara has surgery. This dog is AWESOME, and I have a new best friend in Hawaii.

Rejoice in the LORD always. I will say it again: REJOICE! --Phillipians 4:4

Another day in the hospital...

Today was spent with different oncologists at Tripler Medical Center. This morning we sat down and discussed treatment options with the Medical Oncologist (Chemotherapy Doctor). We left the appointment well informed and feeling better about the chemo treatments during pregnancy.

We've been told that chemo can be safely administered (with some risk) during pregnancy, but I was having a hard time understanding how that could be possible.

Drink alcohol while pregnant = Baby born with Fetal Alcohol Syndrome
Chemo (poison) while pregnant = Baby born normal

It just does not make sense! But, the doctor here has personally treated 12 pregnant woman with chemo, and all 12 have delivered healthy babies. THAT IS PROMISING!

As I've found myself doing lately, I will cling to God's word.

Trust in the LORD with all your heart and lean not on your own understanding. --Proverbs 3:5

It looks like Sara will start chemo soon after our arrival in San Antonio (probably mid-April). It will be up to the oncologist at Wilford Hall as to what regimen of therapy Sara is treated with, but they will time it so she is done 3 weeks prior to the baby's scheduled due date. They want Sara to be "STRONG and HEALTHY" for the delivery.

Chemo will consist of visiting the hospital once every 3 weeks for drug administration. She will get 2 or 3 different drugs through IV for a few hours each time. Each 3-week time period is 1 cycle and she will most likely have 6 cycles.

Then the baby arrives...and then it's time for radiation therapy.

This afternoon we sat down with the Radiation Oncologist and got more questions answered. We were told initially that if she got a mastectomy, rather than a lumpectomy, that radiation would not be required. However, the oncologist recommends that she receive a round of radiation therapy regardless of the operation performed. As previously stated, we're going aggressive with her treatment. A round of radiation will increase her chances of a cure (to kill any leftover cancer cells that survive the surgery and chemo). The doc said that with her being young and healthy that the benefit is worth the risk.

Radiation treatment will require DAILY VISITS (Monday - Friday) to the hospital for 6 - 7 weeks. Each treatment will last approximately 10 minutes. They will focus 3 beams at different sections of her body (one at breast level, one at axillary lymph node (armpit) level, and one at clavicle lymph node level). They will "tron" her with powerful X-rays to kill the cells in those areas. Side effects will include "sunburn" and general fatigue. The doc said that based on recovery from chemo, most patients are elated with the way they feel during radiation. She'll still be fatigued due to a newborn at home.

Our next appointments are on Thursday when we will be meeting with the OB/GYN to discuss our "high-risk" pregnancy. We will find out the DNA test results to see if she has the BRCA gene mutations, and then we will have our final consult with the surgeon. If all goes well, we could be back in Misawa by Sunday (tentative).

Sara's mom, sister, and nieces flew out this evening and we're looking forward to a few days of doing NOTHING (including blog updates)! Thanks for your genuine concern and know that we appreciate all the prayers, emails, and cards.

Sheryl, Sara, and Angie

In the midst of TRIALS...

As you know, most of Sara's tests have yielded predominantly bad news. However, one of her tests recently showed a little bundle of HOPE!

Baby Sullivan

That's right! We are expecting a baby on October 22, 2009.

We found out 2 days prior to the mammogram (back in Misawa) that Sara was pregnant. The doctors are hopeful and think that she will be able to carry this baby to term. Surgery is being delayed a few weeks to allow for the baby to develop all of his vital organs (I think it's a boy). Sara will be through her first trimester by the time she is put under anesthesia for surgery.

The doctors have assured us that delaying surgery a few weeks will have no ill effect on Sara. The oncologist told us that, based on the size of the tumor, she has "had cancer for years." We were shocked when he told us that.

So, the upcoming surgery is going to be as simple as possible. We have opted for a single mastectomy with no reconstruction for the time being. They tell us that the shorter the amount of time she is on the operating table, the better the chances are for the baby. We will deal with reconstruction at a later date. There are TONS of risks associated with this and there are not too many case studies of pregnant women with cancer. We are going to treat Sara aggressively and trust that the LORD will take care of the little one. The docs have told us that the placenta will protect the baby from the chemotherapy, and that our primary concern is going to be a low birth weight.

I'm having a hard time contemplating how there can be destructive cancerous cells less than 12" away from a new life inside of Sara. It is as if there is a battle going on within her. We hope and pray and trust that the new life forming in her belly will overpower those which are attempting to destroy.

So, in the midst of trials...there is JOY!

Please add this to your prayers. Hopefully, this will be the last "shock" that we drop on you for some time.

Consider it pure joy, my brothers, whenever you face trials of many kinds, because you know that the testing if your faith develops perseverance. Perseverance must finish its work so that you may be mature and complete, not lacking anything. --James 1:2-4

Let the FIGHTING begin...

We just got home from the hospital. Our concerns were confirmed today...Sara has Stage IIB Infiltrating Ductal Breast Cancer. The lymph node biopsy also came back positive, meaning that there are cancer cells in her lymph nodes. We had mentally prepared ourselves for this, and the discussions with the doctors were "emotionally stable".

Sara will undergo surgery at Tripler (here in Hawaii), followed by chemotherapy and follow on treatment at Wilford Hall Medical Center in San Antonio, TX. We're happy that we will be close to home, but the fact that we are leaving Japan early is VERY difficult on both of us.

The LORD is my STRENGTH and my SHIELD. My heart TRUSTS in HIM and I am helped. My heart leaps for JOY and I will give THANKS to him in song.
--Psalms 28:7

Biopsy & Genetic Testing

Hello all,

Tuesday was another day full of pokes and prods for Sara. The doctors allowed me to stay in the room for the entire procedure. I've often said that if I was unable to fly that I would want to be a doctor. My experience in the hospital on Tuesday confirmed that fact.

Here is the info on the biopsies. The doctors had Sara lay face down on a table with a hole cut in it (at breast level). Once situated and in the correct position, her boob was compressed and X-rays were taken of the mass. Then the X-ray machine was rotated +15 degrees and -15 degrees from center and more pics were taken. Once the location of the tumor was derived, the largest needle I have ever seen was positioned for entry. I had to look away when the doc scalpeled her where the "needle" was going to penetrate. They numbed her up and started the countdown. "3...2...1...Deploy the probe." A large blast of air released and the pencil sized needle was jabbed into the lump. There was some cutting noises and then suction as the sampled tissue was removed. They dumped the tissue (6 pieces about pencil eraser sized) onto a tray and then took that for X-ray (to ensure the calcifications were in the sample). Biopsy # 1 complete.

Then, it was over to the other table for the lymph node biopsy. Sara was positioned on her right side with her left arm up over her head. With the ultrasound, they found the largest lymph node and got 4 syringes ready for the FNA (fine needle aspiration). They numbed her armpit and inserted the needle into the lymph node. Once it was in the middle of the node, they pulsed it back and forth to get some cells in the needle. The needle was removed and the sample was extracted onto a glass slide for viewing under a microscope. The cytologist (lady who studies cells) was there with her high powered microscope to ensure a valid sample was taken. I got to look through the microscope at all the lymphocytes (it looked like 100s of tiny tadpoles). Once all the samples were taken, the pathologist came upstairs and looked at the samples to confirm that there were enough cells for a diagnosis. Biopsy # 2 complete.

On Wednesday afternoon, we went in for genetic counseling and decided to have her blood sent away to a lab in Salt Lake City for DNA testing. Here is what they are going to be looking for...

Location of BRCA gene

BRCA1


BRCA2

For those of you interested in Abstract Art, I think a large painting of BRCA2 would look good on the wall in your living room.

Following is a paragraph from the pamphlet we received from the genetic counselor...

"Two specific genes called BRCA1 and BRCA2 play a big role in preventing breast and ovarian cancers. Normally, these genes act like brakes that help stop abnormal cell growth. However, ALTERATIONS, or MUTATIONS, can occur in these BRCA genes. When this happens, the genes do not work as they should, and there is a loss of control on cell growth. Certain groups of cells can grow at an abnormally fast rate, and cancer may develop."

We found out yesterday, that surgery is NOT going to occur on Friday. On Friday, we will find out the pathologist's findings from the biopsies and develop a plan with the surgical oncologist. We need to wait to get the results back from the DNA test prior to surgery (if she has the gene mutation, she is probably going to get a double mastectomy). The genetic counselor put a "rush" on this sample and we are meeting with her next Thursday.

I promise to update the blog on Friday, once we get the results back from pathology. Our hope and prayer is that the mass is contained within the breast and that the lymph nodes are clean.

Keep praying! Thanks, B & S

More Tests

Hello there...
After a fun weekend exploring Hawaii with Sara's family, it is time to figure out what "the lump" consists of. Sara is having a biopsy tomorrow morning. The surgeon is going to use an ultrasound machine to find the densest portion of the mass and take a "plug of tissue" out. He is also going to take a needle biopsy of the lymph nodes in her left armpit. Then on Wednesday, we are meeting with a genetic counselor. They are going to "sample her DNA" to see if she inherited a gene mutation called BRCA 1 or BRCA 2. Basically, the BRCA mutation increases the likelihood that breast cancer cells will form at some point (in Dr. Brad terms).

At this point, we know that there will be surgery (the operating room is scheduled for Friday morning), but the extent of the surgery depends on the outcome of the biopsy results. Here are the options.

1) The entire mass is contained within the breast tissue...Sara gets a mastectomy (normally, they would do a lumpectomy, but based on the size of the mass relative to the breast, she has opted for a mastectomy).

2) The lymph nodes show some cancer cells...Sara gets a radical mastectomy (entire breast and lymph nodes) followed by chemo (more details later if this is the case). PRAY THAT THIS IS NOT THE CASE!!!

3) If genetic testing shows that she has the BRCA mutation...Sara gets a double mastectomy. We have decided that we would rather them take both boobs now, rather than go through this again in the future. The docs will "reconstruct" during the same surgery.

So, this week, we should finally have most of our questions answered. We are ready to get past the UNKNOWN portion of this journey.

THANK YOU for all your love, support, and prayers. We are still feeling a complete peace about this entire ordeal.

We have not had internet access during the past few days, thus the delay in updating the blog. I'll update it once we hear back from the docs in the middle of the week. Take care and THANK YOU!

Love, The Sullivans