New Year's, A Birthday, A Diagnosis (Oh My!)...

Today has been quite the long, emotional day and since I can't sleep, I figured I would update you all as to what we found out, while my darling husband sleeps like a baby in the other room. All jokes aside, since he didn't sleep well last night, I'm glad he is getting good rest now.

First, a little catch up since our last entry. New Year's Eve was a great time with our friends Chad and Cathy despite the fact that Brad was still feeling crummy. We rang in the new year and then quickly came home with Avery and his friend Zach, who spent the night. The boys had a great time staying up until nearly 2:00am, which was WAY past my bedtime! Brad and his twin brother Chad celebrated their 36th birthday together last night and it was really great having family and friends over for cake and ice cream. When I asked Brad when the last time he and Chad celebrated their birthday together, he said it was when he was about 12. Not sure if that was a joke, but the pic you see at the top of today's entry is them blowing out the candles on their cake.

Today was the much anticipated, first meeting with Dr. Fintel, Brad's Oncologist. It is evident upon first meeting Dr. Fintel, despite his very youthful appearance, that this is a man who knows his stuff and is really dedicated to the wellness and connections he makes with his patients. We immediately liked him and his joking attitude. He was worth the wait of the extra week and we'll be sure to get a picture of him to share with you all soon!

When Dr. Fintel first came in, he didn't realize we had not been given any information other than the fact that Brad does in fact have lymphoma, so he was throwing out big words and our heads were immediately spinning. When we asked a couple of clarification questions he quickly realized he needed to start from ground zero.

I took quite a few copious notes while we were there and told Dr. Fintel that I was Brad's "personal secretary". He began by stating that what Brad had was "highly treatable, in some cases curable, low grade, non-Hodgkin's lymphoma with a follicular B-cell derivation." Yep, this is where the head spinning begins, but I'll provide an explanation shortly.

Initially, when I heard the term "low grade", I was thrilled thinking along the lines of a low grade fever = not dangerous. We quickly found out that is not what this type of cancer is. With Brad's specific lymphoma, the term "low grade" actually refers to the fact that there is a high incidence of relapse, but that the cancer can be treated with a variety of treatment options. It appears that Brad will become quite the "stud" among patients with this type of lymphoma. Why is that you ask? Let me tell you...

Apparently, the median age for most patients with this type of cancer typically falls between the ages of 60-70. The fact that Brad is only 36 and in such good health makes him a bit of an anomaly. The fact that he has a twin, makes him even more of an anomaly that may be helpful in the future, but I'll get to that soon. Yes, Dr. Fintel's eyes lit up like a Christmas tree, as it appears that they have stumbled upon an ideal research patient. If they are going to use Brad as a guinea pig, we hope this means they cut us a deal on the treatment options, so keep your fingers crossed on that one!

So, some specifics about Brad's lymphoma and what it all means...
The type of follicular cancer that Brad has, affects about 1 in 5 non-Hodgkin's patients in the U.S. There are two types of lymphocytes (a type of white blood cell) in our bodies (T cell and B cell). The B cell normally helps protect the body against germs, viruses, etc... by producing antibodies that typically attach themselves to the unhealthy germs and helps kill them off. In Brad's specific case, his B cells are "monoclonal B cells", meaning they just keep making copies of themselves, but since they are not healthy B cells, they are starting to take over his lymphatic system and are not protecting him against illness the way they do in healthy people. Light bulb side comment: this is why Brad has been so sick lately and also the reason he was sent for chest x-rays today when Dr. Fintel thought he may have pneumonia. While the test came back negative, Brad does have a severe infection in his lungs and is now taking a new antibiotic and has been prescribed an inhaler so he can breathe more easily. Please pray for a positive reaction to these new meds.

The PET scan that was completed a couple of weeks ago revealed that Brad has about 5 times more than normal cell activity throughout his entire body than most of us. The information that came next literally was like a punch in the stomach...

Dr. Fintel started talking about the need for a bone marrow biopsy. Apparently, the way this specific cancer works is that it occurs in many lymph node sites throughout the entire body, which is true in Brad's case. In addition to the lymph nodes, the lymphoma will also in most cases make a "home" in the bone marrow, requiring a bone marrow transplant in order to be "cured".

While we do not know 100% at this point in time that Brad will require a bone marrow transplant, all current road signs are leading us to Duke University. While we were at the Blue Ridge Cancer Care Center today (where Brad received his "free" season parking permit for the close spots), Brad had to identify a transplant center that he would like to work with during the long journey ahead. After several regionally close options were discussed, he chose Duke University Medical Center. Brad will have his bone marrow test completed next Tuesday here in Roanoke and appointments are already being made for us to visit the medical team in Durham, NC which is about a 2 hour drive one way.

The lymph node that was removed just two weeks ago is being shipped to Duke for additional testing and research. Because it is likely that Brad will need the transplant, resulting in him being hospitalized at Duke for 1-2 months, Brad's brothers are already being looked at as possible marrow matches for him. This is where the "stud" stuff really kicks in...

So even though Brad and Chad are not identical twins, the fact that they are twins really increases the chances that Brad may already have his match and testing will begin soon not only on Chad, but Brad's brothers Kevin and Todd as well. The ONLY way for Brad to be "cured" is through a bone marrow transplant, should they find that the lymphoma has spread to his bone marrow. Although we are hopeful that the marrow test will come back negative, with all the other arrangements that started being made today, in addition to the information Dr. Fintel shared, there is the uncomfortable knowledge and likelihood that the lymphoma is present in Brad's bone marrow.

The good news is that Brad's lymphoma is a very slow moving cancer (which is why it's classified as non-Hodgkin's) and Dr. Fintel estimates that Brad was probably at stage 1, 4 years ago or so. If the lymphoma is found in his bone marrow, Brad will be classified as stage 4, if it is not in his bone marrow, he will be classified as stage 3.

We ask that you continue to keep us in your thoughts and prayers. We weren't mentally prepared for the information we received today, but still have confidence that Brad will make a full recovery. Thanks again to each of you for continued support and encouragement - we hope you can sustain it through Brad's treatment as it certainly helps lift our spirits and that of our family members. We'll continue to keep you updated through the blog.

Many hugs of thankfulness,

Sandy (& Brad)