It’s been a year now… and I want to post about God’s answered prayers

First Published on November 7, 2024 on my blog

I have recently realized that I haven’t updated this blog much. The main reason for that is because my treatments and complications were so onerous (chemo, then surgery, with complications, then radiation, and then complications, etc). I have been too fatigued to update anything aside from the prayer request emails that Sunny wrote for us to others for the whole last year. We also could not meet up or zoom anyone given how tired and busy with so many more appointments than regular cancer patients I have had to do.

I haven’t felt better until the last 1-2 months where I have regained my ability to drive, to type on a keyboard (all email correspondence prior were dictated with software), and have a little more energy to spare. I am still on adjuvant chemotherapy, which causes me to be fatigued, more so as my doses are being titrated upwards too. However, I also have to deal with lymphedema in my arm now with lots of PT and chasing down government forms to fill out for the sleeves, or titrating (but failing still) at biPAP for my severe OSA. I have just discovered that I am actually claustrophobic to the mask, and now need to work on that. I also need further surgery for prevention reasons. I was quoted a lifetime risk of 37% for ovarian cancer, so I am going about getting preventative surgery in the coming months as well.

The Lord has answered our prayers:

It was about a year ago that I started treatment for stage 3 triple negative breast cancer (TNBC). Oct 25, 2023 to be exact. Treatment with neoadjuvant chemotherapy is standard, and about 50% will respond well to this. I had two doses of immunotherapy before getting a life threatening skin reaction, rending me allergic to the new leading edge mortality benefiting treatment for triple negative breast cancer. Treatment for the skin condition was pulse steroids and prolonged steroids over 7 months to taper and wean off of.

As a physician, I know the literature, statistics, and odds of my type of illness better than lay patients. I was personally super disappointed that I was allergic to the new amazing immunotherapy that was supposed to help me live longer and gave hope to those with TNBC. But given what things were, and what God had said to me – that He would save me from my cancer – I chose to continue to pray and believe that even with only conventional chemo, known to be <50% effective, that I would be okay enough no matter what. God will make it okay because He said that he would – no matter the odds. So we kept on and persevered through the treatments.

I chose the most aggressive surgical and radiation treatment course. Part of the reason is that I knew that I had no immunotherapy – neoadjuvant or adjuvant – to have. I chose to have a complete axillary lymph node dissection – which was more than the recommended sentinel node biopsy given that my imaging could not see the primary tumour or any active LNs in repeat MRI after completion of chemotherapy. I also chose 5 weeks rather than 3 weeks course of radiation therapy – the treatment I had was old school conventional treatment course for TNBC. I had a >25% risk of chronic lymphedema in my arm. I took this risk. I could live with being disabled from it if need be.

The truth is, no one knows what is best in our situation with very limited data, much of it extrapolated from the non-TNBC population. I read all the relevant studies myself. But I could not live with myself if I didn’t try to get everything out because my kids are so young. Especially if the neoadjuvant chemo wasn’t effective enough, which is >50% of the time for TNBC. Even with the mass gone by the middle of chemo treatment, there was no guarantee that it wasn’t actually only shrunken to the point that you can’t feel it.

Prior to surgery and the pathology report, we have no idea how effective or not neoadjuvant chemo would be. Even if you can’t see the cancer on imaging anymore, there could still be residual cancer burden on a micro level, if not in the primary lesion, then in the lymph nodes (which is a different metastatic tumour environment). My back up plan (and I always have one, this is how I practice medicine too) was that if there was any residual cancer burden, I would private pay the thousands of dollars needed for genomic testing to guide any adjuvant chemo options. Part of that was driven by fear of 5-FU and the fatal genetic polymorphisms for Asians – this killed a prominent urologist in our centre. But aside from that, there are no other treatment options available aside from the one for BRCA that I could have.

I chose to take everything out – all at once. No reconstruction needed. I went flat. I only wanted good wound healing, where possible. As it turned out, it was the right decision. I was on such high dose steroids that I had really abnormal would healing post op and I am still living with the seroma issues.

In hindsight, all of the choices that I made were the best, and smart ones. As complications came, I didn’t get more than that. I tell my husband often that, as difficult as some stuff happened, I actually know that it could have been a lot worse because I am a doctor and have seen worse.

The pathology report from the surgery was the best that it could ever be given how aggressive and extensive my cancer was. I achieved pathologic complete response (PCR) to neoadjuvant chemotherapy. I am very moved every time I think about when I saw the path report through the mychart portal in March of this year. God had answered our prayers, and this was the confirmation of it. My cancer with all the poor prognostic markers on biopsy 5 months prior was entirely dead on all the tissue taken out from the bilateral mastectomy and axillary lymph node dissection. I had 9 lymph nodes where they took out everything, and 6/9 LNs had dead cancer cells inside of them. Sentinel node biopsy would not have been enough and would have left some of these behind. There was no way for us to know this prior to surgical resection because my imaging appeared normal.

PCR in TNBC means that my longer term prognosis was not just good, but very good. PCR means a median 5 year overall survival of 92% vs 66% for those without for TNBC. It doesn’t mean that I won’t get a recurrence, but that the risk is much much lower given PCR on my surgical pathology.

To me, this is God’s answer and confirmation to me that I will be okay. He has saved me from my breast cancer even without the help of the new fancy immunotherapy on the market. All I had was conventional chemotherapy, which was not known to be that effective for all comers.

After that, I had a few minor but annoying surgical complications and 5 weeks of radiation therapy. Radiation was the easiest thing to do, but I got cellulitis from it, and that pushed me into febrile neutropenia with my adjuvant chemo that got me hospitalized in June. I feel like these were just some bumps on the road to recovery.

I am now on a parp inhibitor for adjuvant chemotherapy given my BRCA status. I will continue that for one year. This drug technically costs $10K per month at full dose, but has massive mortality benefit in BRCA related breast cancers. I thank God for private drug coverage from my work that covers this completely. Apparently, no one can access this drug easily (not funded in Ontario – exceptional access only), and aren’t being put on it when they can be on IV immunotherapy instead. I am the first one in my centre taking it for breast cancer. Studies show that the mortality benefit from the parp inhibitor in BRCA breast Ca actually is independent from achievement of PCR. So, I am glad to be on this drug, even if it makes me very tired and have to sleep 3 hrs naps every day and gave me febrile neutropenia. I only have to be on this for a year. It is only for a season.

The other complications from my cancer treatment included right arm lymphedema which I expected, cushings from steroids, massive weight gain which is multifactorial, generalized painful inflammatory arthritis, and painful neuropathies. I am still working on recovering from these in addition to the cognitive brain fog from IV chemo that gave me so many side effects. I get incrementally better with each passing week. There are some good days and some bad days still. I am still not well enough to return to work yet with the fatigue and cognitive brain fog while I am on active chemotherapy until next year. But, compared to 3 months ago, I feel and look a lot better already.

I am technically in remission and cancer-free for now since the complete resection – and it is the Lord, through use of conventional modern medicine, who has saved me. We thank Him for answered prayers. The only infection that I had for the last year was the radiation induced cellulitis causing febrile neutropenia that got me hospitalized for a weekend. I never caught a virus or covid, and it is because God has kept my family and I safe this whole last year (we also didn’t accept visitors much and didn’t go anywhere). We continue to pray that I don’t get infections while on my current chemo still. We came back from a trip to the USA more than a week ago, and none of us caught any viruses – because we wore N95s everywhere, brought portable hepafilters to the hotel, and God has kept us safe with our best efforts.

God has been here with us, which is why we feel okay in so many ways – not lonely and not feel too much suffering despite some circumstances. I think the topic of cancer is triggering for many people. They don’t know how to handle it for lack of experience for some, or that they have lots of family traumatic experience and presume that we have been going through fiery trials of a season or that we suffered in the same ways that they did. I will not say that it was physically easy at all – chemo is one of the worse things to go through. However, I have to say that our family did not feel fiery or especially difficult or scary – not in the way that some people presumed. This is not to tempt God to trial us more. But that because Jesus was with us, that it wasn’t so bad because He provided us the help that we needed when we needed it through everyone who supported us and pulled in favours for us, especially at the beginning with the speed to get me diagnosed and into the cancer centre. It is because of Christ that we felt okay through it all. Perhaps we were like Daniel’s friends in the furnace, and we were okay.

It is the Lord who will continue to walk with us. I feel cured completely of my cancer by the Lord. I am so thankful that it was found early enough before it could spread to stage 4 given how aggressive it truly was. It is the Lord who saved me, and who signalled to me to find the cancer on myself that fateful day after clinic. As my close physician friend points out, “Betty, you found and diagnosed the cancer on yourself,” and I shared with her that I truly believe that it was God by His own means, who pointed it out to me, otherwise, I would never have bothered to try to check and found it on my own at the time.

I believe that I am going to live cancer-free and have overcomed this. I put my trust not on medicine (which can only give you so much in stark reality especially when prognosis is guarded, stats only mean so much, and leading edge treatment is what I am allergic to). But instead, I trust in the Lord, our God – maker of heaven and earth; Lord of life and death. Even if conventional medicine is what God uses to heal me of my cancer, it is the Lord’s personal reassurance to us that allows us to live anxiety-free about the cancer, cancer treatment complications, and about my longer term prognosis.

I believe and trust in the faithfulness of the Lord. I would be very surprised if I ended up dying in the next few years, because then that would mean that I have been mistaken/misinterpreted what God had told me – that He would save me from my cancer. If I die in the shorter term (of cancer or complications), then the Lord has not really visited us at all, and all we got in our lived reality is what normal conventional medicine delivers and expects (by the stats) and part of that is the natural history of having TNBC – something that does not require a God, nor my God to show up for.

I don’t believe this, and have enough faith and courage to state that God has visited me when I prayed, and that is why we believe in His salvation which is both spiritual, and in this particular instance, physical in its healing. I am cancer-free, and I get to live, because it is the Lord who has saved me from my cancer. It is because He said that I get to live, so that is why I have lived this way for the past year, not caring about death, nor expecting it nor preparing for it more.

For my children’s knowledge, I will also disclose that I even had to audacity to ask God for XX numbers of years of life in my lifespan during my prayers about my breast cancer because He told me that He would save me; that I get to live. I truly believe that I will survive this to achieve that – just like when Goong Goong (my father) asked for XX number of years when he was dying of liver failure in his 20’s and the doctors told him to ready for palliation. God even told him that it was his time to go home to Christ, but my father argued with Him in prayer, and got a different outcome instead because he asked to stay/work/live for God because of me. This happened when I was 2 years old in Hong Kong. God answered my father’s prayers clearly, and within 24 hrs, his fulminant liver failure miraculously got better and he was discharged from hospital. My father tells me that he knew in an instant the Lord changed his mind and granted his request in prayer, even before the doctors saw changes in his clinical status. Even recently, with other diagnoses, Goong Goong received reassurance from the Lord that he will live a long normal life span, and we rejoice and believe. Just like when uncle John, my middle brother, was so sick with life threatening SLE as a child with very few treatments then (heart failure, kidney failure, frequently in hospital at Sick Kids, etc), and my parents received reassurance from God that he would grow up and reach adulthood and live a normal lifespan when such a thing was unknown at the time. John is an adult now, and doing okay. God has healed us for real more than a few times in the past, and we are humbled and blessed to know from Him some of these discerned things as they happened in real time. These are not just miraculous healings and fulfilled promises from the Lord, but these are part of our very real God stories within our family. To bear witness to the work of the Lord when He has shown up for us in tangible and real ways in real life. This is part of the spiritual heritage of lived faith in our family to show our children which is why I want to write some of these down.

All glory to God in the highest, for He is God and He is king, and He is real, and He most certainly is with us.