I hope this works.

Hello All,

I am finally going to get this communication thing under control, I hope. We are desperately wanting to keep in touch with all of you and wish that there were enough hours in the day to talk to everyone. Even with the help spreading the word, I fear that we are failing miserably in our efforts to keep everyone updated.

First of all, there are some who still may not know of our recent news. This Monday Mark went for a colonoscopy and was diagnosed with cancer. Mark has had ulcerative colitis for approx. 14 1/2 years. This condition is one of the leading causes of colon cancer. We have known this and for this reason he has had numerous colonoscopies over the years. Both Mark and I anticipated this kind of news would come one day, but had no idea it would be so soon. It has been a whirlwind of emotion and activity since the moment we were told. Initially we had little information and a whole lot of questions. Our visit to the oncologist and the gastrointerologist have cleared up many of our questions. I apologize for the wait. I know everyone is as anxious as we are to get information. I am going to start with some of the most frequently asked questions to try and cover all this.

Q. How big is it?
A. We initially were told that the tumor was "not small." Today we learned that actual dimensions. It is 5cm (2 inches) in length and is half of the circumference of the lumen. Think of it as if you were looking into a cylinder. On the left hand side this tumor extends from 12 o'clock to 6 o'clock and down the cylinder for 2 inches. This is classified as medium size. The depth of the tumor into the wall is uncertain. The doctor's speculation is that it has infiltrated the full thickness of the wall of the rectum. They will know for certain after surgery.

Q. What stage is it?
A. There has been no staging. Typically this is done after surgery when the depth into the wall is determined and the lymph nodes have been tested. There are new techniques for staging prior to surgery by way of endoscopic ultrasound. We will ask the surgeon about this.

Q. Where is it?
A. In the rectum.

Q. Will he have to have surgery?
A. Most definitely. Initially we were told within a week. Then it went to two weeks. Now I think we are looking at six weeks out. Why so long?, See next question.

Q. Will he have to have Radiation or Chemotherapy?
A. This is the reason the surgery will not be immediate. He will receive 5 weeks of chemotherapy and radiation. Then have a recovery period and then have surgery. I have questioned this repeatedly as our first inclination is to want it out. Here is the explanation we have received. 15 to 20 years ago, the treatment for all cancer was to cut it out. Through research and advanced technology, they have learned things that are applicable to rectal cancer. Many rectal cancers are infiltrative and spread rapidly lending to recurrence of cancer in other places in the pelvis, even when the tumor is removed. Treating with chemo and radiation prior to surgery shrinks the tumor, slows lymph node infiltration and reduces recurrence of cancer in the pelvis. In other words the old "just get it out" has been slightly modified for rectal cancer. Chemotherapy used preoperatively has the purpose of making the tumor more sensitive to the radiation thereby making the radiation more effective. The chemotherapy is taken in pill form. It is taken concurrently with the radiation. Radiation is scheduled to start Oct 23rd, or possibly sooner. Radiation is everyday, five days a week for five weeks.

Q. Where will he have to have surgery?
A. He will go to the Dallas area to have surgery. There are no colo-rectal surgeons in Wichita Falls. While we have some very good general surgeons, cancers of the rectum are often referred to a specialist as they can be slightly more complicated. We will be seeing the surgeon on Monday the 20th. His name is Dr. Randall Crim in Irving. The surgery will be at Baylor Medical Center at Irving.

Q. What kind of surgery will he have?
A. Unfortunately, Mark will lose his entire colon. This is not only a result of the tumor, but of the ulcerative colitis as well. The probability of recurrence is too great to take any chances with the rest of the colon, as the ulcerative colitis affects his entire colon. We have repeatedly been told we have no option but to do it this way.

Q. Has it spread anywhere else?
A. In the morning we are going to have a CT scan. (He is loving the prep as I am writing!) We know that the liver and lungs are primary sites of metastasis, and we will anxiously await those results. Please pray, pray, pray. We certainly don't want anymore bad news.

Q. Have you told the kids?
A. We have done so. They are doing as well as anyone. Such inquisitive minds, and definitely good medicine for us. As you might guess. The church hill and school are the center of our grapevine here in these parts. It only takes three kids praying for their dad at school to spread news like wildfire. You definitely don't need billboards around here!. No complaints for that for sure. We are so grateful for this community and our friends, family and support here. We just wouldn't trade it. The only regret is that I am told that news might have spread so fast that it got to family second hand. We are very sorry to all of those we haven't gotten to.

Q. How are ya'll doing this?
A. We have no idea!. God is good!

Q. How is Mark?
A. Mark is Mark. I am having the most trouble answering this one I think. I am not sure either of us really know how we are doing. He is such a wonderful person and so strong, but human too. We can work, work, work and occupy our time, but when that free minute comes, you might actually lose it. He has told me he has those moments too. Like I said, human. He is positive, and very witty, and yet realistic. We both agree that this is not going to get the best of any of us, but it is real and it is in God's hands. He has taken care of Mark before and he will do it again.

Q. What can we do?
A. You are doing it. Your caring and concern is evident by your phone calls, cards, e-mails and your taking the time to read such a lengthy e-mail. Even the independent side of me is well aware of the needs that will arise during this time. No doubt we will have to rely on family and friends for help over the next several months. Everyone can rest assured that I will suck it up and ask for help! (Even those who know I sometimes just say that) Just ask around. It has already started. More importantly, you can pray, pray, pray. We can't get through this without our faith. Bad things can happen to good people, and good people know where to turn when they do. We both know that these tests of faith can drag you down and we are counting on everyone's prayers to lift us up. "There is nothing that I do today that God and I can't handle"

OK, I am about done. I've never been known to be real wordy, but??????? (He, He, He)

This was the best start I have to keeping everyone informed. These are all of the e-mails that I have. Please forward to anyone who we might be leaving out. We do not intend to do so. I have never created a web page, or blog, but I am going to try to work on that. Then when people ask, maybe they can be referred to a link. That way you can access from anywhere, and I can have help with updates from friends and family. Lord knows I am the worst at checking my e-mail. I will work on that soon. Until then I will do my best to update by e-mail. If you have any questions, don't hesitate to drop a note, I will do my best.

One more thing, Since I know there are a lot of prayer lists going around, throw in an extra for Grandma and Grandpa Berend. God has blessed us with such great grandparents and we pray for continued good health.

Love to all, the Brown's