Richard Cramer

If you have been to Central Care Cancer Center in Great Bend, then you might know Richard Cramer.  He has unfortunately been a fixture of the clinic since the clinic’s beginning, and has battled a variety of cancers including colon, prostate, and two rounds of lung cancer. Through it all, the 82 year old father of three and grandfather to seven, remains upbeat, full of life and a bit ornery.

It started near the year 2000, when Richard thought he had hemorrhoids, but his referring provider thought differently and ordered a colonoscopy, which showed colon cancer.  Richard had a colectomy in 2001 and started seeing Dr. Mark Fesen with Central Care Cancer Center.

In the United States, colorectal cancer is the third leading cause of cancer-related deaths in men and women with the majority of them being preventable.  Early detection is key to success, such as getting a colonoscopy.  Richard’s most recent colonoscopy in 2019 came back negative.

On top of the colon cancer, it was discovered that Richard hadn’t had a recent PSA test. The PSA test is a blood test used primarily to screen for prostate cancer. The test measures the amount of prostate-specific antigen (PSA) in your blood.  According to Richard, “they checked mine and it was higher than a kite. I mean it was out of sight.”  Richard received treatment and his PSA is now at a normal level.

Dr. Fesen encouraged Richard to go through a series of tests and scans. That’s when cancer showed up in his right lung: non-small cell lung cancer.  Richard’s right upper lobe was resected in 2003.  He underwent an intense schedule of radiation therapy and chemo for over a month.

However, a few months later, cancer had metastasized to Richard’s right adrenal gland and surgery was performed to resect the gland.  On top of that, Richard developed a hernia on the right side of his body. “The family was in Salina at a hotel and my young granddaughter at the time was sitting on a chair playing a game.  She about fell off and I went to grab her, causing the hernia. I got that repaired, but I had it sticking out there pretty good.  I could rest my arm on it,” chuckled Richard.

“So, I’m getting over the hernia and recovering from the right adrenal gland resection, when it was discovered I was losing my vision.” By now its 2004 and Richard underwent cataract surgery.  It would seem though Richard would not be done seeing the inside of a hospital, as shortly after this surgery, he was sitting on a stool, shaving with an electric razor in his bathroom. He got up, but went down hard and broke his left leg in two different places.  “After that, I was in pretty good shape for a long while,” said Richard.

It wasn’t until January of 2020 when cancer appeared in Richard’s left lung. Again, non-small cell carcinoma.  “Currently it’s in remission, but I continue to take IVIg’s,” said Richard.  Intravenous immune globulin (IVIG) is a product made up of antibodies that can be given intravenously.  Antibodies are proteins that your body makes to help you fight infections.  With cancer, the body’s immune system can be depleted and not make antibodies on its own.

Throughout this whole time, Richard has worked with Dr. Fesen at Central Care.  Richard jokes, “I’m kind of the boss there. When I’m there to do my IVIg’s, I just go there, and pretty much know what I’m doing.  I mean, everybody knows me and if they don’t me, the will in short order (laughing). Nobody really tries to boss me around. I’ve been here since the clinic opened!”

This Army veteran not only battled colon and prostate cancer, but lung cancer twice.  “When I first started, I was scared to death. I didn’t know what was going on.  Dr. Fesen had written a book (Surviving the Cancer System: An Empowering Guide to Taking Control of Your Care) and that book probably helped me more than anything else. But when he told me I had lung cancer, that kind of kicked me in the butt. I just felt well what the heck is going on here. It’s not just the treatments, but its everything else – preventive medicines, additional appointments and doctors. I guess after the lung cancer, I just kind of got strong and I believed a little bit more in the Lord maybe. I got to the point where you are not going to kick me. You are not going to kick me, because I’m already down. I’ve got to kick this.”

Mary, Richard’s wife of 59 years agrees. “He is such a strong person and he takes care of himself, all of his medications and doctor’s appointments. It’s amazing how he has come through all of this. He has had setback after setback with these numerous cancers, but he always comes through. It’s amazing.”

Despite it all, when asked how he’s doing now, Richard responds, “I feel all right. Hell, when you’re over 80 years old, how are you supposed to feel really? I would say that I don’t feel like I’m 40, and I can’t do things like I used to, but I feel all right.”

Karla Garcia

It’s been seven years and Karla (Dunn) Garcia continues to remain upbeat and positive in her fight with what started as breast cancer.  The Great Bend resident first was diagnosed with left sided ductal carcinoma in situ in April of 2013.  A very small lump was found during her regular mammogram.

Karla’s primary care physician referred her to Central Care Cancer Center in Great Bend where she met up with Medical Oncologists Dr. Greg Nanney and Dr. Mark Fesen. “Everybody there is so knowledgeable, genuine and nice.  I can’t say enough about how good everyone is, and so caring.” Karla underwent a few radiation treatments and had a lumpectomy.

However, the cancer came back two years later in the same breast.  This time, the cancer was a little larger and had metastasized to surrounding lymph nodes. “I've always been a pretty positive thinking person, so through this journey, I have not once said I wasn't going to survive this. Because, I just can't think like that,” said Karla.

That positive mentality has carried Karla a long way, as a second lumpectomy was performed.  She also started chemotherapy. During treatments, sometimes she would get dehydrated and she lost over 60 pounds.  Of course, there was nausea and hair loss too.  Karla said, “I couldn’t eat, because nothing tasted good. The only thing I could eat that tasted good to me was mandarin oranges!”

As Karla struggled with her own reoccurring breast cancer fight, she ended up having a bilateral mastectomy in June of 2016.  Through all of this, she continued chemotherapy treatments. However, it took a friend saying ‘Karla, you have to let go and let God’, for everything to click.  “That’s what I finally did. I’m one that likes to be in control of my life. I’ve been independent, living on my own until I got married five years ago at age 58 to my love, Jerry (Vic) Garcia.  I liked being in control of what was happening to me, but this….I was not in control of. I finally let go, and that was the most comforting thing that I could have done for myself.”  Karla added, “Just let go.  Do what you have to do whether you want to do it or not.  Yeah, it sucks and you don’t want to have to go to all these appointments and have all these tests, but you’ll get through and move on to the next step.”

Karla chose not to do reconstruction surgery, but has prosthesis and recommends the services of Knitted Knockers. They are knitted breast prosthesis that are fiber filled, and fit right inside the bra cup.

In August of 2017, the cancer reoccurred in her left axillary lymph nodes and in October 2019, a lymph node in her neck was positive for the same cancer that was initially in her left breast. A whole body bone scan in September of this year showed that the cancer metastasized to her hip, rib and clavicle area; metastatic bone disease.  “Right now there is not a time as to when I’ll be off chemo. I feel like it’s probably going to be long-term, but hey, as long as it keeps me here, that’s ok with me.”

Karla is thankful for all the people that have prayed for her or sent positive thoughts for healing. The outpouring of support has been uplifting and inspiring.  However, Karla is a genuine inspiration to other cancer patients at Central Care Cancer Center.  “I'm so blessed to still be here after seven years of battling cancer. I just never had it in my head that I wasn't going to survive it.  I’m in no position to give up now.  Some people have the doldrums and are negative with what they're going through. I understand that it's a hard time, but that brings your whole soul down. I feel like if you are upbeat and positive, it nourishes your soul.”

October is National Breast Cancer Awareness Month.  The pink you see around you in your daily life is a reminder to get yourself checked.  Breast cancer statistics show that monthly self-exams are important as well as getting an annual mammogram after the age of 40. 1 in 8 women and 10 percent of men will develop breast cancer.

Brenda Rojas

It was the middle of August in 2018, just another normal morning for Brenda Rojas.  The Garden City paraprofessional was getting ready for work when she happened to feel a lump in her left breast. Brenda had an upcoming appointment scheduled with her primary care provider, who suggested she go ahead and get her yearly mammogram and a biopsy at the Breast Center at St. Catherine Hospital.

What came back was the diagnosis of triple-negative breast cancer. “I just started crying. I was at work, during lunch and just broke down and cried.  I left and went to my sister’s work, and we cried. I was thinking holy crud, this really didn’t happen to me, did it? Basically I was kind of numb. My doctor told me that Heartland Cancer Center will be calling and sure enough within two hours, I got a call. That day I started praying heavy.  And I truly, truly believe that helped too. I’ve had some rough times, but honestly by that night I was like you know what, I'm going to try to remain positive, deal with whatever this is, and I'm going to be strong about it.  I've got to.”

Triple-negative breast cancer is cancer that tests negative for estrogen and progesterone receptors, and excess HER2 protein, meaning the growth of the cancer is not fueled by hormones. This type of breast cancer occurs in about 10 to 20 percent of diagnosed breast cancers and can be more aggressive and difficult to treat.

Brenda, however, is no stranger to handling setbacks and tragedies in life.  From losing her husband at a young age from a massive heart attack, watching her mother battle lung cancer, only to go into remission for a few years, before passing away, to her granddaughter being born 11 weeks early. Brenda understood the fight that was about to begin.

Brenda saw Dr. Anis Toumeh from Heartland Cancer Center to start the discussion of treatment options.  They decided to try to shrink the tumor ahead of surgery.  She was set up to have 16 chemotherapy treatments, 12 weekly, with the last four every other week.

“Dr. Toumeh was really reassuring. Everybody at Heartland – the nurses, even the receptionists, all were so supportive and encouraging,” said Brenda.  She started her first chemotherapy treatment right away. “And, by the second one, believe it or not, in a short week, you could see the lump protruding through my shirt. It grew.  Dr. Toumeh looked at it and said, I don’t think we’re going to do chemo today.  I think we’re going to have to have that removed.”

Brenda had a mastectomy of her left breast in October of 2018. After recovering, she was back at it with her chemotherapy treatments and all was going well, until she got to the last four treatments. “It was really harsh. I had some nausea, bad sores in my mouth, lost my hair, and I hurt.  I had to have fentanyl for what seemed like the last two months of treatment because I hurt so bad.  I’d wake up, I couldn’t roll over on my left side, it was just harsh.”  At times, opioids are used to help treat moderate to severe pain. They are often a necessary part of a pain relief plan for cancer patients.

Brenda waited until after her treatments were complete to have her right breast removed.  She chose not to have reconstructive surgery. “It just wasn’t important to me to have reconstructive surgery. I’m not saying a person is wrong for wanting breasts, I just personally elected not to. I don’t feel like not having them takes anything away from who I am. I was more concerned about getting healthy and not having to worry about healing and recovering from surgery or treatment,” said Brenda.

A year later from her last chemotherapy treatment, Brenda sees Dr. Toumeh every six months.  Her latest scan looked great, her hair has grown back and she feels good. “I tell people to think positive and try to keep a positive attitude. Those last four treatment were about to do me in, because I felt so bad, but I kept trying to focus on the positive. It’s ok to be sad and to be down, but don’t let it keep you there. Remaining positive and early detection are so key. It’s so important to get your regular mammogram and do the breast self-checks at home.”

Brenda added, “having my treatments here at Heartland Cancer Center, close to home, was great. You don’t have the wear and tear on your body by traveling far and you can come home to your own bed. Plus, I had the support of my family and they would lift my spirits. I had a real good support system and that really helped.” Evidence has proven that going through cancer treatments near loved ones and close to home have improved outcomes.  Heartland Cancer Center offers complete cancer care that includes chemotherapy, radiation therapy, financial counseling and other supportive services, all at a state of the art facility.

October is National Breast Cancer Awareness Month.  The pink you see around you in your daily life is a reminder to get yourself checked.  Breast cancer statistics show that monthly self-exams are important as well as getting an annual mammogram after the age of 40. 1 in 8 women and 10 percent of men will develop breast cancer.

Bill Miller

“You never know how strong you are, until strong is the only option you have.” Words to live by for Bill Miller of Claflin, Kansas.  The fourth generation owner of Millers of Claflin was recently diagnosed with non-small cell lung cancer, adenocarcinoma, RET mutation positive, Stage 4.  It's a mouthful and it’s been quite a fight.

It started with a lingering cough that Bill had for a few weeks.  During a routine physical back on May 19 at Clara Barton Medical Clinic, PA Philip Barnes listened to Bill’s chest, heard a little wheezing, and ordered a chest x-ray. The cough and the wheezing was a little out of the ordinary for Bill, as he typically is in excellent health and very active.  He’s not a smoker and makes a point to avoid smoke. A call later in the day confirmed that there was something. So the next day, Bill went in for a CT scan of his lungs.  Bill’s wife of 38 years, Tami, who kept a journal through this ordeal, says, “There were two masses in the lower left lobe and then hundreds of little nodules in both lungs.  When I look at his CT scan, it looks like a snowstorm in there compared to a normal lung.”  A needle biopsy showed cancer cells, but they didn’t know what kind.

Bill and Tami called their dear friend Dr. Robin Durrett, who practices at Ellinwood Hospital and Clinic. Dr. Durrett set them up to see Dr. Mark Fesen, Medical Oncologist at Central Care Cancer Center in Great Bend the next morning.  Bill’s first CT scan also shown something on his thyroid. An ultrasound and a biopsy showed cancer cells there as well.

A second opinion, and bronchoscopy was performed in Overland Park to test the hundreds of little nodules in his lungs.  All those nodules turned out to be the same type of cancer as the two masses in his one lung.  At that time, it was determined to be Stage 4 lung cancer, due to the cancer metastasizing to the thyroid.  However, it was still to be determined what the mutation of the cancer was, so genetic blood tests were ordered.

On June 11, Dr. Fesen told Bill he had non-small cell lung cancer, adenocarcinoma, with RET mutation, Stage 4.  Non-small cell lung cancer is a pretty common cancer for non-smokers, versus small cell lung cancer.  Dr. Fesen says, “Only one or two percent of all non-small cell are RET mutation positive.”

RET is an abbreviation for ‘rearranged during transfection’.  “About a third of lung cancers have mutations that are driving the growth of the cancer and that’s one of about ten different mutations that we could search for during testing. These are mutations that when you find out what DNA mutation occurs, in reality, that’s what is driving the growth of malignancy.  Bill’s was a RET mutation positive malignancy.  It’s only a mutation in the genes of the malignancy. It’s not in the rest of his body.  The mutation is in the cancer cells,” said Dr. Fesen.

Bill was Dr. Fesen’s first patient with this RET mutation. “We’ve seen other mutations out there, but this was a first.  There’s a new drug that just came out to help treat this mutation.”  And that new oral drug, Retevmo from Lilly Pharmaceuticals, was just approved by the FDA on May 8.

“The first couple of appointments, I’ll be honest, it was just difficult.  It just was bad news, after bad news, and just difficult.  But then, once we knew what we were dealing with, everybody took on a game face and you could just see it.  And I don’t mean just me, but Dr. Fesen and the whole staff sprang into action. The fight started right then and there,” said Bill.  Tami added, “I can’t say enough about all of them at Central Care Cancer Center. They are amazing.”

Since there was a new drug, to help fight a fairly new cancer mutation, and not too many people in the area, if any, have been diagnosed with this RET mutation, Bill chose to wait on receiving any treatment until after he visited a specialist at MD Anderson.  There have been a couple of other patients seen at MD Anderson with this similar RET mutation to Bill’s.

While Bill and Tami waited to drive to Houston, they understood that there might be a problem in securing this new FDA approved drug, Retevmo, and whether their insurance, Blue Cross Blue Shield of Kansas, would even cover it.  Dr. Fesen and his staff reached out to Lilly Pharmaceuticals. Tami went online to Lilly’s website to try to get a savings coupon for the drug.  Bill and Tami did receive a letter from BCBS saying ‘it’s not in our formulary and we don’t have to review this case for six months’. That meant, Retevmo was not included on the insurance company’s ‘formulary’ or list of covered medications.  A medication may not be on the formulary because there is an alternative proven just as effective and safe, but is less costly.  There was no other alternative to Retevmo.

“According to them, what they wanted him to do was what they called the standard of care. Well the new standard of care was to use Retevmo. The old standard of care was to put a port in and do a combination of three chemo drugs and immunotherapy. Whereas with the Retevmo, we were looking at an oral medication with a possible 85% success rate, “said Tami.

The level of frustration was mounting as Bill’s health was declining. Bill and Tami wondered how did this happen, and could it have been prevented?  Typically, an avid smoker should be screened regularly, but as Bill was a non-smoker, there weren’t any immediate symptoms to warrant a screening. “We had our water checked because we're out in the country and we have well water.  We did a radon test in our house and that all came back fine. So, we didn't know what else to check at that point,” said Tami.

Tami and Bill pulled out all the stops in trying to get Retevmo approved through their insurance.  Tami filed a complaint with the state insurance commission, who then got involved in their case. They made calls, Dr. Fesen made calls, friends made calls.  They were doing a full-court press. “At this point the insurance company was denying the Retevmo. So there I was, not knowing what kind of medicine I was going to get, insurance company was saying we're not going to pay for it, and I was waiting to get into MD Anderson.  We were literally in a hold pattern,” said Bill.

Bill and Tami’s insurance agent they have had for 30 plus years explained it this way to them; in order for the medicine to get on the formulary, it’s got to be reviewed by the company and then a commission at the management group before it’s brought in.  That commission meets every six months, which is why they said they didn’t have to review the case.

However, Lilly Pharmaceutical came through first. Bill was able to obtain Retevmo through them.  “They had a patient care portal person that reached out to us. They have 24-hour pharmacists that we can call if we had questions, they were amazing,” said Tami.  Dr. Fesen added, “they were very cooperative and helpful in getting access to the drug so Bill could start treatment.”

Bill had to wait to see a specialist at MD Anderson until June 29, due to taking his fourth COVID-19 test.  Every time he went to see a new physician, he took a COVID test.  So, on top of fighting Stage 4 non-small cell lung cancer with a RET mutation, Bill was trying to avoid contracting coronavirus. That meant, after going to work almost every day of his life, he stayed home, away from the retail public, limiting contact with friends and family.  Some cancer patients might be at increased risk of serious illness from an infection, such as coronavirus, because their immune systems are weakened by cancer and its treatments.

The MD Anderson specialist confirmed Bill’s diagnosis and encouraged him to start taking Retevmo immediately. Bill and Tami had driven to Houston for this visit, to try to eliminate their exposure due to COVID-19.  Tami said, “We went to the really bad gas stations that nobody was at, just to avoid people.  We had rubber gloves, we sprayed ourselves with Lysol, had masks.” Bill added, “I looked like a hazmat guy when I'd go to the restroom.  That's how scared I was and I guess rightfully so, because at this point in time, my lungs were so compromised that it would have not turned out well at all.”

Bill had taken two Retevmo pills twice a day for about three and a half weeks when he developed what appeared to be nodules on the back of his neck. Dr. Fesen ordered a CT scan of his chest and neck, out of caution.

Bill had the CT scan in the morning, and a weekly appointment with Dr. Fesen that afternoon.  Bill mentally prepared himself for bad news regarding the new nodules.  At the time of Bill’s weekly appointment, the results from the CT scan weren’t in, but while Bill and Tami were meeting with Dr. Fesen the results arrived. Dr. Fesen glanced at the results, said the nodules on his neck and head were not cancer, then kept on reading aloud with the most shocking, but amazing news ever.  Bill’s scan showed that the thyroid nodule and the one in the lymph node next to the thyroid were no longer there.  The two masses in his lung were almost gone and the hundreds of nodules in both lungs were disappearing. “I’ve cried twice during this whole thing. The first time was when Blue Cross Blue Shield called and said they were going to cover Retevmo, and the second time was when we got this news,” said Tami.

You might wonder how is this possible and why did it happen so soon?  It was the right oral medication to fight this type of cancer. Plus, you have the strength of a patient and his family and friends to put up a fight. “I simply tell the ones that ask, you know when you have as many friends praying for you as I do, you never underestimate the power of prayer, and that was and still is my answer for this success,” said Bill.

As far as side effects, there hasn’t been much, maybe some fatigue and few a sores in his mouth, but overall, his appetite is good and he’s getting out more. “He’s doing great! Bill will continue his treatment of Retevmo indefinitely, as long as it doesn’t bother him, as long as it’s useful, he’ll stay on it,” said Dr. Fesen.

And if any issues arise? “I can call Dr. Fesen. I've got his cell number,” said Bill. “We were uncomfortable at first calling because we don't want to bother him with a stupid question.  But he wants to know what's going on. And I was so impressed with that. Not many doctors are going to be there for their patients like that,” said Tami.  Dr. Fesen said that by giving out his personal cell number, it’s his way of reassuring patients and their families that he’s there to help them.

So what’s next for Bill and Tami?  “We both have worked together for 30 some years and now we're both kind of at home together so it's been a challenge. Work is different than home,” said Tami.

“She's still alive.”

“He still won't run the sweeper.”

“I have cancer, I can't do that,” Bill says chuckling.

“I feel like I've asked him for six weeks to run the sweeper and every time, he goes- I have cancer. I'm like, really?  You're going to use that now?” After months of fighting various battles of unknowns, sometimes a laugh over who is going to sweep is needed.

Bill also stresses the importance of reaching out to others when you find out that they might be fighting an illness, or have been diagnosed with a form of cancer. “Everybody should make a point of saying hey, I'm thinking of you. Praying for you. It's so important. It gives you so much encouragement and motivation to get through the day.  When fighting cancer, there is hope. Developments in drugs are coming fast and furious, and what used to be a death sentence, now has so many possibilities of being treated and possibly being cured, so you just simply cannot give up.”

Central Care Cancer Center is dedicated to keeping cancer care close to home. They have facilities throughout Kansas, mostly in rural settings, including Great Bend.  Central Care Cancer Center offers comprehensive cancer care including chemotherapy, radiation therapy, financial counseling and other supportive services all under one roof.

“We try and advocate for all our patients, whatever their needs are,” said Dr. Fesen. “I encourage everyone to limit their occupational exposures, get all screening and preventive tests done once a year (pap, mammograms, colonoscopy, family doctor visit).  And don't smoke, don't chew (tobacco), limit the alcohol, stay healthy, keep your weight good, keep exercising. All those things are very important for everybody.”

“You know, his job drove him crazy at times, but now that he’s not there daily, he’s really missing it,” said Tami.  Bill added, “My job right now is to beat cancer.”  Bill is on his way!

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