Physician to Patient

Life and Test Results

/ Dr. Lee Bryant / 15 Comments

I was diagnosed with malignant melanoma under my thumbnail on July 21, 2021. For those of you who have been tracking my cancer journey, you know that I am a surgeon. I then became a patient and began documenting my journey in this blog. After undergoing surgery, I completed a yearlong treatment plan of chemoimmunotherapy infusions. I had my last infusion on June 29, 2022. This blog recounts my story with a focus on a surgeon who became a patient. It also highlights melanoma awareness. Additionally, it explores the intersection of medicine and faith.

The great news is that my scans this past November (right hand and arm, chest, abdomen, pelvis) revealed no evidence of any recurrent cancer! My next round of scans and bloodwork is in May, 2025. I am blessed to have survived 3 years, having been told my 3 year survival rate was as low as 40 percent! I still remain high risk until year 5, when my prognosis will improve.

I was remiss in waiting so long to update my blog. This past Fall, the busyness of life seemed to take over. I had several trips to medical meetings, some vacation, a wedding of which I was the officiant in Dallas, and then the holidays. Reflecting back on this past year, I realized that it is very easy to fall back into the busyness of life and slip away from work, life, and health balance.

Let me go back to the summer of 2021 before my cancer diagnosis. The absolute craziness of the life of a busy surgeon was taking its toll. I was in the peak of my career, performing as many operations as ever. My hands were so overworked from operating and typing that I started getting trigger fingers and had multiple hand surgeries to repair them. In addition to being President of our large medical practice, I was also Chairman of the Board of Trustees of my medical center; a consultant for a large medical device company lecturing and traveling all over the country; Chairman of the Deacon Body at Brook Hollow Baptist Church in Nashville, Tennessee; singing in the church choir; leading a young adult small group at our house on Sunday nights; helping my father manage our horse farm; and lastly training for a triathlon! Whoa! And why? Was I getting greedy? Was I happy? Was I spending enough time listening to God and His plan for my life? I stopped…reflected….and actually prayed about it. Let me tell you something…be careful for what you pray! I prayed God would somehow slow me down and help me find some balance in my life. If you go back and read or have read the very first couple of my blogs in 2021, you know what happened. God did answer my prayers to slow down! He did it …His way…not mine! I was diagnosed with a deadly melanoma under my thumbnail that resulted in a partial thumb amputation, a year of chemo, and the process of learning how to operate again! Be careful for what you pray!

That very day that I got the depressing call from my pathologist about my diagnosis, something else happened, likely providential. Pastor Jack Foster is my dear friend, neighbor, and one of my spiritual mentors. Unbeknownst to me, he also had been worried that I had been going too hard in life. That very day, as he was driving by my house, he felt something tug at his heart strings; he slowed his vehicle down; and he almost pulled into my driveway to confront me. He felt called by the Lord to intervene. Interestingly enough, I called him shortly thereafter with my devastating medical diagnosis. He now has walked with me on this cancer journey. Together, we have felt the process of genuine sanctification taking place in my life. God has also given me a testimony and maybe this platform to encourage others.

As I reflect on 2024, I realize that the busyness of life is creeping back in. I am now a national officer in the American Academy of Otolaryngology. I am again one of the Deacons at Brook Hollow Baptist Church. My work load is closer to the busy old days. All of these are good activities in and of themselves. As I get further removed from that year of treatment, I feel myself gaining confidence in my prognosis. In turn, I feel myself losing that sense of humility and selflessness that weighed upon me heavily going through treatment. In 2025, I am challenging myself to strive for a healthy diet, exercise, and sleep. I plan to read more and try to spend more time in prayer. I have always made time and will continue to do so for my wife, kids, and 4 beautiful grandchildren. If you are in the same situation, I ask you to re-assess your life and schedule. Prioritize your Heavenly Father, your family, your friends, and your health! Life can change quickly. Be content with today. And don’t waste another day!

Melanoma Update

/ Dr. Lee Bryant / 24 Comments

I was diagnosed with malignant melanoma under my thumbnail on July 21, 2021.  For those of you who have been following my cancer journey, you know that I am a surgeon who became at patient and then documented my journey in this blog.  After undergoing surgery, I completed a yearlong treatment plan of chemoimmunotherapy infusions, having completed my last infusion on June 29, 2022. This blog recounts my story with a focus on a surgeon who became a patient, melanoma awareness, and the intersection of medicine and faith.

This blog was started to keep my patients informed of my progress. As I have continued to feel better, my surgical practice has ramped back up to normal. And I have taken on some additional work responsibilities. I was elected as the Secretary of the Private Practice Section of the American Academy of Otolaryngology/Head & Neck Surgery.

But as is typical of any major health crisis or really any major life crisis that effects behavioral changes for the better in our lives, it is easy to get busy with work and fall back into old habits. I have not been updating my blog lately, but plan to keep it more updated. Also, when one feels better physically and spiritually, it is easy to drift into old habits. I teach a young adult group in our home on Sunday nights. I always tell my group that you never drift into good habits, only bad ones. Anything you do to improve yourself is intentional, not something into which you drift. So in this new year of 2024, I have tried to refocus on wellness to help my body continue to battle this melanoma. I have been intentional on getting enough sleep. I have been working out more regularly and giving up sweets. Lastly, during the Lenten season, I have tried to refocus spiritually.

Things we can control such as our sleep pattern, our diet, our exercise pattern, our stress level, and our spirituality can work together to reduce chronic inflammation in our bodies. As I have mentioned in earlier blogs, science has shown that chronic inflammation in the body aids and abets tumor biology, helping tumors either develop or progress more rapidly. Some of the inflammation caused by tumors is from genetic mutations and intrinsic factors of the tumors beyond our control. But a lot of extrinsic factors can also cause chronic inflammation such as chronic infections, an inflammatory diet high in sugar, autoimmune diseases, obesity, tobacco use, and excessive alcohol consumption.

My last two rounds of laboratory work up and extensive imaging were in May and November of 2023. They revealed that I continue to have no evidence of recurrent melanoma cancer. Because of the stage of my melanoma and the tumor biology (acral type with high mitosis and ulceration), I remain at very high risk for recurrence. My type of melanoma tends to be very aggressive and many do not survive the first three years. However, the risk for this type of melanoma is more “front loaded,” meaning that as time goes on, my risk starts to drop. I have another round of imaging on May 2, 2024. I am praying for continued good news, because that is near the three year mark, when my risk begins to drop some, and my prognosis improves.

I am planning a big celebration that weekend if all is good…more on that later. I pledge to keep all those who are following more informed! And let’s all focus on wellness. Let me know if you want me to start writing about more specifics.

Lastly, for those in the Nashville, Tennessee, area and beyond, feel free to tune in to Morningline with Nick Beres on Monday, March 18, as we do a one hour live show discussing Springtime allergies and impact on our health. (https://www.newschannel5.com/plus/morningline)

I appreciate all the love and support!

My First Infusion

/ Dr. Lee Bryant / 10 Comments

As we left off, I was recovering from my partial right thumb amputation and sentinel node biopsy. And Kellee and I got the great news, in a providential type of moment, that my sentinel lymph nodes were negative for any cancer cells. I was found to have Stage II disease. Considering that my original lesion presented 5 years earlier, it seemed almost miraculous that my metastatic workup was negative. I took the liberty to assume that my age, lack of any other medical problems, healthy diet (no red meat or dairy), and exercise level (training for triathlon) maybe was keeping my immune system strong enough to battle. And now I did not regret my crazy decision to biopsy my own nailbed!

Almost 2 weeks after my surgery, I sought a second Oncology opinion, which is often a wise idea. As a matter of fact, for every single patient to whom I recommend an operation, I offer a second opinion because I want them to feel completely comfortable both with me and their decision. I got the exact same treatment recommendations, so I kept my original team of physicians where my care would be under the same umbrella. Because of the depth of my melanoma and some other histologic factors, such as ulceration and high mitotic activity, it was felt that I would need further therapy to reduce the risk of recurrence. There are new promising drugs, that are called PD-1 receptor blockers, which help restore the T cells of our own immune system, prevent deactivation of our T cells by tumor cells, and thus restore our body’s ability to combat and destroy tumor cells. These drugs are in a class called biologics, and the treatment is a form of chemotherapy called immunotherapy, administered by intravenous infusion.

My First Infusion:

Exactly 3 weeks after my surgery, I was scheduled for my first IV infusion. I would be scheduled for a full year of treatment, with the first 5 treatments being 3 weeks apart, and then the last 5 treatments being 6 weeks apart, as long as I could tolerate the therapy. This type of drug has common side of effects of nausea, fatigue, muscle pain, bone pain, brain fog, and others. More serious side effects include conditions such has liver toxicity, pneumonitis (pulmonary toxicity), renal toxicity, and others. The drug is intended to enhance one’s immune system against tumor cells, but also can cause the body to attack itself. Naturally, there was some anxiety about how well I would tolerate the treatments. A typical infusion day involves a check-in process, going to a lab to have an IV inserted, and having extensive labs drawn. I decided to try being infused with peripheral IVs to avoid a portacath placement if my veins would hold up. After the labs are returned and evaluated, there is an appointment with my Oncologist, after which I head to the IV infusion center for IV saline fluid, followed by my cancer drug infusion, followed my more saline fluids. It is quite the process and somewhat exhausting at times.

My Mistake:

That first infusion day, I had a gap between my Oncology appt and my infusion. Therefore, Kellee and I decided to grab some lunch at the hospital cafeteria, with the IV already in my arm and all covered up by coban wrap. I also happened to be a patient at the academic medical center where I trained as a medical student and resident physician. As we entered the cafeteria, it brought back memories of late dinners alone before a long night on call in the hospital, and memories of early morning coffee and breakfast after operating all night long. It also brought back memories of my nervous stomach and GI distress, memories that were soon to become reality again! I apologize but this is about to get personal! I had been eating so healthy (anti-cancer diet to be explained in another blog), and I thought I may want some comfort food. So, I skipped all the healthy stuff and went straight for the stir fry Asian food…spicy chicken over some fried rice and maybe a fried roll also. After I consumed all of my own plate, I proceeded to eat about half of Kellee’s plate as it was just too much for her. We then checked in at the infusion center. As we entered the private room, one of the nurses asked if I had eaten a light lunch because the infusions can make one very nauseated…bahahahahahaha. I did not have the heart to tell her I was already nauseated, bloated, and flatulent….well before the infusion ever started. Lesson learned! Thank goodness for nausea medication.

My Nurse:

In all seriousness, I want to close this episode sharing about the most wonderful nurse I had. I want to share with you how nurses make such a difference in the lives of patients. I also want to thank all the nurses that have ever worked for me in my office or with me in the hospital, operating room, ER, or surgery centers. I am just going to use her initial “M.” Although we had seen a lot of care providers, it had all been about my workup, diagnosis, prognosis, percentages, and treatment. As a physician turned patient, I soon realized that sometimes we have so much schedule pressure that we do not always embrace the emotional needs of our patients: their anxiety, their fears, their worries about their jobs, their concern for finances and medical bills, their concern about their families, their spiritual health and search for truth, etc. Here I was, a right handed surgeon with an amputated right thumb, currently unable to work, and worried if I would ever work again or when, worried about my family, worried about innumerable issues. So when M came out and called me and Kellee back, she made eye contact, the kind of eye contact that says “I see you and I know you are scared.” She asked, “How are you doing?” as she reached out and tenderly touched my shoulder, in a comforting manner. As we arrived in the infusion room, she asked if this was our first time, and we said yes. She asked a little bit about my story, and heard some of the craziness of my diagnosis, how I biopsied my own thumb, and my career as a surgeon. She connected with me and Kellee, and the first thing she did was to comfort us and tell us everything to expect. I shared some of my faith journey and the wooden cross that I kept in my pocket that had not left my side since it was gifted to me by some of my OR nurses. We talked about God and faith. And then, the most amazing moment happened. She dropped down on her knees between me and Kels. She took Kellee’s hand in her left hand and she placed her right hand on top my bandaged thumb and then proceeded to pray over us, asking God to comfort us and give us peace and strength, and to trust in Him. Tears were being shed! We greatly needed that emotional connection. My infusion then went flawlessly, with the exception of the GI distress which more than likely was related to my overindulgence of stir fry at lunch!!!

Moving forward, I plan to share how I spent my time recovering from surgery, regaining strength, preparing to return to work, and most importantly, how I embraced a new lifestyle with more balance and a deeper relationship with God.

Surgery Day

/ Dr. Lee Bryant / 8 Comments

As we left off, my pre-operative workup was complete for the malignant melanoma under my right thumbnail; Kels and I had contracts on our new home, which would be a downsize, and our current home; and I took a day of rest in preparation for my surgery, pleasantly surprised by a visit from my 3 life-long relatives/friends, Lee Randolph, James Sutton, and Ronnie Carter, who prayed over me in my living room the night before.

My surgery date was exactly 2 weeks after I was operating on my own patients and received the call from my Pathologist between operations, revealing the diagnosis of malignant melanoma. I will say that I am extremely grateful that had I have access to such stellar and speedy healthcare. In under two weeks, I had seen 4 physicians in consultation, undergone plain x-rays, undergone MRI scans of my brain and upper extremity, undergone a whole-body PET/CT scan, and was on the operating room table! Once the diagnosis of malignant melanoma was made, it was hard to keep it out of my mind since it was so readily visible right there on my right hand. I was extremely grateful for my health care providers and was ready to move on with what we surgeons call surgical extirpation of the tumor.

For my surgery day, the plan involved partial amputation of my right thumb, clearing the margins of the tumor, reconstruction of the thumb, and sentinel node biopsy of my lymph nodes, likely being in the region of my right axilla. I was to report to the medical center around 6:30 am to be checked in by 7:00 am in the Nuclear Medicine Department. For the sentinel node biopsy, the Surgical Oncologist would identify and sample the lymph node (or two) that was the most likely to receive any tumor cells if they had spread beyond my primary tumor. The nodes would be removed and evaluated by the Pathologist to see if there had been any microscopic spread of tumor cells that would not have yet been identified on imaging studies. Localization of the sentinel node or nodes involved two aspects: 1. Lymphoscintigraphy in which a radioactive tracer, Technetium-99m, would be injected in and around the tumor prior to surgery so that it would be taken up by the sentinel nodes and could be detected with a gamma counter probe during surgery, and 2. Injection of lymphazurin blue dye around the tumor during surgery which will stain the lymph vessels and lymph nodes blue to help with visualization and mapping.

I did have some topical anesthetic cream to be placed on my thumb to help tolerate the injections of the radiotracer in the Nuclear Medicine department. Either it did not work very well, or I erred in the timing of the placement of it, but those 4 injections in and around my fingernail were painful!  After that, I checked into the pre-operative area for surgery, was prepared for the procedure, kissed Kellee, and was on my way to the operating room. For obvious reasons, I had very little recall of the rest of the day. All the surgeons told Kellee that everything went well, and the Surgical Oncologist felt confident that they were able localize the sentinel lymph nodes, the first representing most of the radioactivity, followed by a second one that had the remainder of the activity. The team felt good about the surgical margins and had to amputate the thumb back to the first joint or knuckle, but preserving enough of it that I would have the ability to use it and oppose other fingers to it.

Over the next few days, I had a large bandage on my right thumb and a healing incision in my right armpit. Basically, I had to adapt to performing activities of daily living all left-handed. I had to eat left-handed, brush my teeth left-handed, and try to bathe myself left-handed. Fortunately, although I am right-hand dominant, I am also ambidextrous to some degree. I naturally have much more upper body strength on my left side, so in my youth I taught myself to play ball with either hand. I played baseball left-handed, but I could hit both ways. I can shoot a basketball with either hand. In my adult life as a surgeon, I typically remove the right tonsil with my right hand and the left tonsil with my left hand. So, I did not find this immediate situation to be very inconvenient.

As I rested and recovered from surgery, we were anxiously awaiting the pathology on the lymph nodes. Whether or not they were positive for cancer cells would determine my final stage. How this information was revealed to us is quite the story, and I will tell it in my next blog.

More Answered Prayer and Ready for Surgery

/ Dr. Lee Bryant / 7 Comments

As we left off, Kellee and I had received some good news about the MRI of my brain that was clear and about the whole-body PET/CT scan which also came back clear. The very next day after the PET scan, I met with yet another surgeon, a Surgical Oncologist, who prepared me for additional surgery that would be needed. In addition to the partial amputation and reconstruction of my right thumb to clear the margins of the malignant melanoma, I would need to undergo a sentinel node biopsy. I will explain more about the details of this part of the procedure later, but the procedure allows the surgeon to determine the lymph nodes to which tumor cells most likely would travel if it spread via the lymphatic system.  Next the most representative of those nodes is removed and sampled to assess for the presence of tumor and to help with staging. I also met with my Medical Oncologist that same day, who was encouraged about my imaging results, but also said that my staging and thus prognosis would be determined more once the pathology of the sentinel node or nodes is back. The very next day I reached back out to my Orthopedic Oncologist, and my surgery was set to be performed the following week, with a team of 3 surgeons. Everyone was ready to go.

Next, Kellee and I were discussing all the possibilities of how to move forward, receiving healthcare, and how to manage our finances if I would be limited in my ability to work or not be able to return to work at all. In our mid-50s, our only debt was really the mortgage on our house. Everyone says not to make major life decisions under duress, but we had talked about downsizing in the past. We had 3 bedrooms and 3 baths upstairs with an additional bonus room….and we hardly ever went up there. So, we were considering a change, but we love our neighborhood with lots of yard space. We went to an open house that night less than 2 miles from our house, but smaller than our house, more of a ranch style. We loved the house and decided to make an offer. The very next day on a Friday, the sellers countered, and we accepted. We had a deal! Another answered prayer! After we got the contract, Kels and I worked until the wee hours of the morning cleaning out our den in preparation to put our house on the market. There was so much uncertainty at this time regarding my health status, work status, and now we had a contract on a house before selling ours. Kels and I were both anxious but trusting in God.

On Saturday morning, we frantically worked on the house all day to get ready to place it on the market. I placed new pine straw in the beds out front and sold several items on Facebook Marketplace. Kellee worked tirelessly cleaning out and staging the house. My daughter Alex, our realtor, and our son-in-law, Brad, came over that evening to help us start the process of listing our house. Time was of the essence, since we had a contract on the new house, and needed to sell ours to make it all work. We had planned to do a lot of painting, book a professional photographer, do professional staging, and have an open house. On a whim, I took a few pictures, and we listed the house that night. Within 24 hours, we had several showings, an offer on the spot, and a contract! Another answered prayer! Over the next few weeks, we began to reflect on how so many things were working out for us. And we began to anticipate a future with less financial liability, less dependency on material things, and more happiness and joy in glorifying God and spending more time with Him rather than the everyday business of life.

So, by this time, I had one day to rest on a Tuesday before my anticipated surgery date on Wednesday, August 4. I had continued my training for my triathlon, even though I knew I would not be able to compete in it.  I needed some rest after a hard cycle workout that morning and a hard swim workout just 2 days before.  But I had a pleasant surprise coming…….

I got a surprise visit from my cousin, Lee Randolph, and two of my closest friends since childhood: Ronnie Carter and James Sutton. Kellee knew they were coming, but I had no idea. I want to share just a little bit about the days of our youth in Goodlettsville, TN, and then share a little bit about that evening. Lee Randolph, along with another Lee with the last name Harris, grew up with me almost like brothers. Our parents took us to Goodlettsville First Baptist Church, taught us to love God, and taught us right from wrong. Now I know that the community in which we grew up in the 70s and 80s was a much different time and place than now, but we grew up with little to no rules, at least for me personally, and freedom to learn from our mistakes (lots of them). Lee Randolph and I spent many hours together working and playing on my parent’s farm. We imagined ourselves as cowboys around 9 and 10 years old, except that we rode real horses and shot real pellet guns. We rode 4 wheelers, mopeds, motorcycles, and bicycles and never had a helmet. One favorite activity was to head our bicycles down the steep road, Draper Drive, in front of Randolph’s house, take a sharp turn onto his gravel driveway, then hit a homemade ramp in his front yard and see how far we could fly. We did not always stick the landing, and I remember when Randolph broke his femur. I had to help carry him in the house when he came home from the hospital in a full body cast in the back of my parent’s station wagon. We had to turn him sideways to get him in the door and almost dropped him! He will not find this funny! Later, I competed in horse shows, learned to start horses, and learned to always get back on when bucked off. I was driving tractors by age 10 and had an actual driver’s license at age 14, the age at which I got my first two speeding tickets! I never had a curfew growing up and took full advantage of that! The 3 “Lees,” Ronnie, and James all played a lot of ball together, and James’ father was one of our coaches for years. One of our favorite pastimes was to put on actual boxing gloves and fight each other; yes, there were technical knockouts and real knockouts. We were all a little crazy. People could call us a lot of things, but one thing they could not say is that we were not tough (apology for the double negative). My toughness and my ability to fight this cancer come from those days, from working with horses, and from all the team sports in which I participated in high school.

So Lee Randolph, Ronnie, and James all showed up at my house, the evening before surgery, and spent time. We had been “brothers” since we were in diapers in the Goodlettsville First Baptist Church nursery. We always show up for each other in time of need or crisis, and there is no doubt that we would take a bullet for each other. As a matter of fact, Ronnie is an Ivy league educated long standing officer in the Marines and is one of those guys who would sacrifice for all of our freedoms. The boys just sat around and reminisced about the “good ole days.”  James always keeps us laughing, and continued to command the room like he always does, our ring leader. And then I got in the middle of the room as they all gathered around me. They laid their hands on me and we all hugged as they prayed over me. They asked for Father God to give me peace and strength and prayed for my healing if it be God’s will. I love those guys, and they know it. I was ready for surgery, which will be the next episode.