Provision doctor diagnosed with cancer, chooses proton therapy for his own treatment

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This story starts the way a lot of cancer stories start. A visit to the doctor for an unrelated issue. A few tests. And then, while trying to solve one problem, the doctor discovers another – a red flag.

That discovery sparks a journey down a road far too many have traveled. First, more trips to the doctor. Then more tests. And then the waiting. Waiting with fear and uncertainty – hoping for the best, but preparing for the worst. Until eventually, the wait is over and the news is in…

It’s cancer.

And from there, this story continues down a common path. Mulling over questions like “How bad is it?” and “How do I deal with this?” Determining the options and choosing a treatment. And of course, fighting the cancer.

There’s something uncommon about this story, though – the person making the journey. Because he’s literally been down this road hundreds of times before. He knows the roadmap better than most, because he’s guided people through it for decades.

The only difference this time? He’s no longer the guide. This is his journey.

FROM DOCTOR TO PATIENT

James Gray, MD, FACRO, Medical Director at Provision CARES Proton Therapy NashvilleDr. James Gray is a board-certified Radiation Oncologist and the Medical Director at Provision CARES Proton Therapy Nashville. His career includes work with the National Naval Medical Center and the National Cancer Institute. He began practicing radiation oncology in Nashville in the mid-1990s, including membership in Tennessee Oncology, one of the largest privately-held physician groups in the country. He has established his reputation as a pioneer in the industry, performing many advanced procedures never-before-seen in the region.

Accomplishments and accolades, aside, it’s Dr. Gray’s passion and commitment to his patients that define him. He’s spent 30 years studying cancer and helping patients navigate the difficult path of fighting it.

“I get to work with patients in a time of dire need for them. They undergo a diagnosis of cancer, and this is terribly frightening for most people to accept and move forward,” says Dr. Gray. “Helping someone move through that. Counseling them. Making them understand their disease. That’s what brings joy to me – the actual effort of bringing this understanding to those patients and then bringing the best possible care to them. That drives me every day.”

Then, in 2019, he visited a physician to check out a minor health issue. During that visit, Dr. Gray underwent a PSA level screening. Much to his surprise, the levels came back slightly elevated – a possible indication of prostate cancer.

“I realized with that PSA level, I needed to pursue this, and I went to see another physician – an outstanding urologist – and he proceeded with a diagnostic work up. That led to some other lab tests, an examination and then a biopsy.”

Dr. Gray recalled the anxiety he felt during the days following the biopsy. “You’ve got to wait maybe 3 or 4 days to get the pathology results back. I got to live firsthand that trepidation – that worry of, ‘Oh gosh. I hope it’s not cancer.’”

Unfortunately, though, it was cancer. Prostate cancer.

“It put me in a unique position where I’ve actually counseled patients who’ve just gotten this news. I’ve counseled probably more patients in this setting than anybody else in the area. All of a sudden, I’m counseling myself. Now, I’m the patient.”

WEIGHING THE OPTIONS

After receiving the news of his cancer diagnosis, Dr. Gray says he had a 30-year head start on the typical patient. As an established Nashville oncologist, he already had a strong grasp on the answers to questions like, “What does this mean for my life?” and “Am I going to die from this?” However, it was still important for him to remain objective, gather information about the severity of his cancer, then step back and make a clear treatment decision.

The initial decision for most prostate cancer patients is to determine whether the cancer is actually worthy of treatment, or if it would be more appropriate to observe it through active surveillance. In Dr. Gray’s case, he felt the cancer was threatening enough to treat immediately.

The next big divide – the “fork in the road,” as Dr. Gray calls it – is to decide whether to remove the prostate surgically or treat the tumor with radiation therapy.

“For me, that was not a difficult decision,” he says. “Knowing what I know about the likelihood of getting rid of the disease and the likelihood of having any kind of consequences from the treatment itself, I knew pretty quickly that I wanted to have radiation.”

That led to his next decision – choosing a radiation therapy method. There are many options for prostate cancer patients, including traditional x-ray radiation, radioactive seed implants (brachytherapy) and proton therapy.

For Dr. Gray, this was another easy decision. “One of the key advantages of proton therapy is that we’re putting (radiation) into the tumor with as little unnecessary dose to other tissues as possible. That inherently reduces the possibility of side effects – fatigue, difficulty with urination or bowels in my circumstance. So statistically, I am convinced. I’ve seen the data. I know what I consider to be the best treatment for prostate cancer, in my particular setting, was a proton therapy treatment system.”

“And fortunately, I happen to work at a proton system.”

WORK-LIFE BALANCE

They say it’s important to have a good work-life balance in your career. In Dr. Gray’s case, those two worlds collided as soon as the radiation oncologist began his proton therapy treatment in Nashville.

“I could actually go to work every day and receive a treatment – close to six weeks of treatment – but I was just going to work. And for 20 or 30 minutes, I stepped into the patient role, had my treatment, then went back into the doctor role.”

Dr. Gray remembers the transition from doctor to patient being fairly easy, mainly because of the trust he had in the treatment itself, as well as the Provision CARES team performing the treatment.

“For a lot of patients, they have to slowly gain the trust in me as their physician. They have to gain the trust in the people that are going to do their treatment. They have to gain the trust in the technology,” notes Dr. Gray. “I didn’t have those misgivings. I knew that when I was being treated, very bright people were watching over the treatment and making sure it was done right. I know how competent, outstanding and professional those people are, so I didn’t have any qualms about that.”

In fact, Dr. Gray’s positive attitude during his treatment actually helped the other staff members deal with a situation in which their colleague, friend and mentor was battling cancer – and they happened to be the ones treating it.

“I’ve never been in that situation before where you’re treating someone that you know so closely,” remembers Justin Pigg, Radiation Therapy Manager at Provision Nashville. “But to Dr. Gray, he just wanted to be treated like any other patient. He wanted the patient experience.”

“He was really calm and really strong through it, and I think that helped everybody else be calm, as well,” says Valerie Bohannon, the proton center’s Patient Concierge.

That sense of calm among the team was critical, as just about everyone at Provision Nashville had some role in Dr. Gray’s treatment.

“It’s all the way from the top to the bottom,” Dr. Gray says. “Every member of this staff had something to do with making sure my treatment went well. They all wished me well. They all asked me how I was doing. They were genuinely concerned about this.”

And that concern – that culture of care – is what Provision is all about. Dr. Gray hears it from his patients all the time.

“They will tell me how impressed they are from the moment they walk in the door to the time they’re leaving the center. They felt like they’ve been enveloped in care. And I felt the exact same way. It was obvious to me that I was brought into that care – that love – that people wanted me to do well.”

WALKING IN THE PATIENT’S SHOES

Dr. Gray, a Nashville oncologist, completing his proton therapy treatment at Provision CARES NashvilleDr. Gray successfully completed proton therapy in January 2020, placing him in a rare category of radiation oncologists who’ve actually been through the very cancer treatment in which they specialize. He says the entire experience impacted the way he’ll approach his role as a doctor going forward.

“It was enlightening. Going through the treatment myself gave me quite a bit of a different perspective. It’s important for me to understand that my personal experience can be translated only some degree to my patients, but at least having a taste of it allowed me to understand a bit more how they see it – how they experience the whole treatment process.”

That “taste” of proton therapy, as he calls it, will now be another tool for a Nashville oncologist who is passionate about making this effective and successful treatment available to as many people as possible.

“Some people suggested I had to choose proton therapy because I work at a proton therapy center. No, not necessarily. I’m not going to compromise my own good health just to make a point in my professional career. I wanted to have the best outcome, and I genuinely believe my best outcome would be achieved through the use of proton therapy.”

And with 36 operating proton centers across the country, why did he choose to be treated at Provision CARES Proton Therapy Nashville? He says that was another easy decision.

“Why would I leave here when I know I’ve got great people here to treat me. I can get world class treatment by world class people just downstairs from my office. Why wouldn’t I take advantage of that?”

Casey rings the victory bell after completing cancer treatment at Provision CARES Proton Therapy Knoxville

Surviving Breast Cancer (Part 4)

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Casey’s Story: Ringing the Bell

Casey is a two-time breast cancer survivor who is sharing her experience during her proton therapy treatments at Provision CARES Proton Therapy Knoxville. Catch up on her story first by reading parts one, two and three of her blog series.


There is something about ringing that bell at Provision CARES Proton Therapy Center.

After my final radiation therapy treatment, my friends, family and co-workers gathered around me  as I rang the bell three times, symbolizing an end to treatment and a new beginning to a cancer-free life.

Victory.  Celebration.  Gratefulness.

It takes time to actually realize that the most difficult journey in my life is really going to be over soon and it will be time to be well again.  I remember my brother Pete telling me at this exact time last year, “Winter never lasts forever and Spring never skips its turn.”  I thought about his words every single day.

Something very valuable I learned during my journey:  choose your providers very carefully.  Do your research in every way possible.  As a Care Coordinator, I would always tell a prospective patient that they owed it to themselves to learn about and evaluate several  treatment facilities before choosing where they would receive their care.  This thought process served me well during every step of my journey.

Without the care of Dr. Brig and his amazing staff at Brig Center for Cancer Care, my surgeon Dr. Danielle Duchini and the entire staff at Provision CARES Proton Therapy, I would not be where I am today.  I am well on my way to health and wellness and beating breast cancer.

I will be forever grateful to so many people and hope to pay it forward for as long as I can.


Provision CARES Proton Therapy would like to thank Casey for sharing her story. Please visit our website to learn more about the benefits of proton therapy for breast cancer and read other patient success stories.

Surviving Breast Cancer (Part 3)

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Casey’s Story: Starting Treatment

Casey is a two time breast cancer survivor who is sharing her experience during her proton therapy treatments at Provision CARES Proton Therapy Knoxville. Catch up on her story first by reading part one and part two of her blog series. As a Care Coordinator for Provision CARES Proton Therapy Knoxville and going through radiation therapy for the first time for recurring breast cancer, I can absolutely say that radiation therapists are gems…each and every one of them.

After initial office visits, CT Simulation, and treatment planning are finished it is time to start radiation therapy and these folks, the radiation therapists, are right there in the trenches with you. For the next 7 weeks I will see these wonderful people day in and day out to “finish off” this breast cancer.

Working at Provision gave me a sense of calm about the end result but to be candid, I was still nervous about the process.  Would I know what to do and say?  Is it weird to just lay on the table and be alone while radiation is being delivered?  What does it feel like?  Will I be self-conscious being exposed from the waist up?

Trust me when I tell you these therapists are experts at what they do. Zane, who manages the radiation therapists, was present for my first day.  He explained everything to me as it was happening which was particularly helpful to me. A quick example:  Zane explained body positioning, and how important it was to relax while being still. Proton therapy is very individualized which means no two plans are alike.  Your plan is specific to your tumor size and site, your physical body size and contours and believe it or not, your breathing!  These radiation oncologists and physicists think of everything.  

After putting on a gown you are escorted to the treatment room and use a step stool to get on to a slightly raised table.  In my case, radiation was going to be delivered with my arms above my head while I was lying flat with my knees slightly bent and supported.  There is a mold for my arms to rest in that was made specifically for me.  I remained covered up with a sheet until it was time for the actual treatment which was important to me.  The next and maybe most appreciated step for me:  MUSIC! It was calming and an immediate source of comfort for me.  The therapists will ask you each day what you feel like listening to that day.  This was a godsend to me as the music eased my nerves and passed the time.  

I was unprepared for, but very impressed by, the perfection in positioning the therapists strive for.  This is of utmost importance as the precise delivery (within a millimeter) of the proton beam depends on it.  Before your actual treatment, one of our Radiation Oncologists will check the position of the patient and give the okay for proton delivery.  The therapists leave the room and you are alone for about 90 seconds during treatment.  You are never truly alone as you are being watched remotely, and after a few treatments you become very accustomed to the whole process.  

Truthfully, it is a very quiet and calm time in the treatment room.  There were no smells or sounds to really get used to and I did not “feel” the radiation delivery.  For me, it was a time of reflection…a time to really think and appreciate what these fine folks do day in and day out.  I never got the feeling that it wasjust a job for them.  I always felt like I was the only patient there that day when in reality, there were up to 80 patients being treated in three treatment rooms.

Weekly visits with the clinical team are also part of your radiation therapy treatment.  This is an important step in monitoring your skin and any other changes you may be going through such as fatigue.   As I proceeded through treatment my only symptom was a significant “sunburn” to the areas treated.  I was prepared for this and used creams and lotions that were suggested by my doctor.  It was an easily forgotten side effect for me, though uncomfortable for a short period of time.  

Every Friday I was given a treatment schedule for the next week.  Wait, no weekends?.. a whole two days without radiation treatment?  I wondered “What will I do without the conversations and encouragement from Amos, Chris, Jamie and Jennifer?  They were my people.  My lifesavers. My friends.  I can do this, and I will do this with the help of these compassionate, kind and relatable therapists.

To follow Casey’s story, please follow us on Facebook.

Surviving Breast Cancer (Part 2)

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Casey’s Story: Preparing for Treatment

Casey is a two time breast cancer survivor and care coordinator at Provision CARES Proton Therapy Knoxville.  She answers phone calls and helps answer the questions of cancer patients every day, but with her experience on both sides of the phone, Casey is offering readers a unique perspective as someone who has been both a patient and someone who helps patients.  To meet Casey, you can read part one of her blog series, Casey’s Story: Learning she has cancer for a second time

After all my tests and scans were complete, it was definite.  Dr. Brig, my medical oncologist, told me I would have radiation therapy as part of my treatment protocol to make sure I never see this breast cancer again.  My doctor knew that I know how important of a role proton therapy will play in my life with left sided breast cancer.  Was I excited to undergo 34 radiation treatments? Not at all.  Was I anxious about the possible side effects and time involved?  I knew I would be tethered to Knoxville for the next 6.5 weeks, with only weekends off in between treatments.  I mean, several months ago, I actually had a life!  I regrouped and breathed a sigh of relief because I knew I would be in good hands at Provision.

A consult with one of our radiation oncologists is always the first step.  A care coordinator that I have worked with for the past 2 years quickly gathered all my medical records and set me up to see Dr. Ben Wilkinson who spent time with me explaining how many fractions (treatments) of radiation I needed and how it may affect  the skin around my left breast and axilla area, as well as my fatigue levels throughout treatment.  He reassured me that he would be checking me weekly, right after one of my treatment days.  Brittany, one of our awesome nurse practitioners, would also check my skin regularly.  No stone would be unturned.  If I needed anything, I knew who to ask.

Very shortly after consult I had what is called a CT Simulation.  This is essentially a scan of your body to provide the contours needed for treatment planning.  It took about an hour which was a bit longer than I expected in a slightly uncomfortable position with my arms above my head and lying flat on the table.  Kerry, one of our incredible radiation therapists, made this procedure seamless for me.  Not only is she an expert at what she does but she cares…and shows it in her disposition and heart-warming smile.  A physicist, Sammie, was also present to help with body positioning and placement.  We all know Sammie to be brilliant, energetic, beautiful and funny.  She was one of many who would be making sure I never see breast cancer again.

After CT Simulation, I waited.  I waited for these committed, hardworking, all knowing people behind closed doors of Provision Cares Proton Therapy to plan my treatment.  They are a team of radiation oncologists, dosimetrists, physicists and radiation therapists.  Not your average run of the mill people, but exceptionally trained and smart folks.  All of whom are working on a treatment plan for me to be able to continue living my best life.  It is truly humbling to me to be surrounded by such intelligence and excellence.  It is fun too…. we laugh a lot at work and we appreciate each other.  Not a bad gig for this girl.  I love coming to work.

In the meantime, I patiently waited for my start date and appreciated all the hard work that brought me to this point in my interaction with Provision from a patient’s viewpoint.  Many, many people got me to this point.  The Finance/Insurance teams who work tirelessly to verify insurance benefits and fight for coverage….the Concierge team who coordinate countless appointments and make sure you as a patient are up to date on where you are supposed to be and what time….and our fabulous Hospitality team who treat you and your family members like guests in their home.  What we call our “Culture of Care” is experienced in all facets of care at Provision.  We know it is a hard time…a scary and challenging time, for many patients and their loved ones.  We want our patients and their families to feel respected and cared for.  I always smile when I peek downstairs at our lobby and see patients having coffee and chatting…after their treatment is finished.  It is a beautiful thing. The next step for me? Starting my treatments.

To continue to follow my journey and read updated blog posts, please follow Provision on Facebook.

 

Surviving Breast Cancer (Part 1)

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Casey’s Story: Learning She Has Cancer for a Second Time

I have always considered myself a normal girl with a fairly normal life.  Married to a great guy. I am healthy and active with 3 kids and a precious granddaughter who, along with my husband, are the loves of my life.   We have lived in Knoxville for the past 18 years and feel blessed to have found this great part of East Tennessee to work, raise our kids and find wonderful friends.  I have been working at Provision for two years now as a Care Coordinator, a position that I feel very comfortable with since I am a breast cancer survivor and can easily empathize with the patients. Recently, after two years at this job I love, I was again diagnosed with breast cancer.  Although I have never blogged a day in my life, when presented with the opportunity to share my journey and my point of view from both sides of treatment, I thought it would be another way to help others facing cancer and radiation therapy – and for that reason, I was all in.

In 2012, while busy raising my then young teenagers, I was diagnosed with early stage breast cancer. My particular diagnosis required a bilateral mastectomy and reconstruction, and subsequent  chemotherapy and immunotherapy.  Relatively straightforward and at times challenging, but doable.

As a Care Coordinator, we are often the first person an individual who has been newly diagnosed with cancer or a concerned family member or friend speaks with when they call Provision CARES Proton Therapy for information.  Almost always, this person is anxious, scared and uninformed about their illness.  We do our very best here at Provision to provide a compassionate ear while collecting patient records and facilitating a consult date so that our radiation oncologists, clinical nursing and radiation therapy teams can address the patient’s treatment needs in a timely manner.

To hear for the second time in 6 years, “you have breast cancer” is enough to rock anyone’s world.  I heard this news in the fall of 2018. Now, this mom of 3 children and one beautiful 6-year-old grandchild, was full of shock, fear and dread of what was in my immediate future: a whole lot of treatment that would NOT BE FUN and would cause me to again, lose my hair and my energy.  And then maybe eventually… my life.  We knew nothing at this point only that here we were AGAIN.  It was a very dark time for my family.  And for me.

Once the shock wore off, the Care Coordinator part of me began to surface. I knew immediately what I had to do to combat this disease for the second time.  After a bilateral mastectomy and reconstruction in 2012, along with chemotherapy, I realized that radiation therapy would be in my immediate future.  Recurrent breast cancer requires and arsenal of incredibly bright practitioners, along with state-of-the-art drugs and treatment.  I knew right away that with left sided breast cancer, Proton Therapy is the recommended treatment in order to spare the heart and lungs from unnecessary radiation exposure.  I knew that we (Provision) had a brilliant clinical team and a caring and conscientious support staff, state of the art technology and extensively trained radiation therapists.

This was not going to be a sprint…. but more of a marathon.  As a former triathlete of 30+ years, I tend to think of things in segments or parts.  Chemotherapy was the swim portion of the race.  I hated getting in the pool, but knew I had to put the time in.  Biking is fast and deliberate, and I related that to my surgery.  Let the surgery be seamless and without complications  (no bike wrecks).  Get that cancer outta there!   The last part of a triathlon is the running segment and I compare that to my upcoming radiation treatments.  At this point you are tired and simply want a cold drink and some shade. But one must push on at this point and finish strong.  Just like you surround yourself with training partners you trust and who make you feel good about your efforts, the same is true for your radiation treatment team.

I knew, without a doubt, that I would be well taken care of at Provision from start to finish.  With all of this in mind, I also feel that everyone’s cancer journey is different.  In this series of blogs, I’m sharing a little peek into my journey which I hope will give you or a loved one faced with a cancer diagnosis some peace of mind and maybe a smile along the way.

To continue to follow my journey and read updated blog posts, please follow Provision on Facebook.

 

Dale C. Prostate Cancer

Proton Stories: Why Dale Chose Proton Therapy

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Dale C. first heard about Provision CARES Proton Therapy through a TV commercial. Not knowing he had cancer, he tucked the words “proton therapy” in the back of his mind, hoping that he would never have to remember them. It was February 2015 when he learned he had prostate cancer. Dale had always been proactive when it came to his health. He said, “my mom always taught me to be proactive.” He went in for regular checkups, yearly physicals, and was well aware of his PSA and gleason score. At his appointment in 2015, all test scores came back normal, but he insisted on a biopsy, just to be sure. Both the doctor and Clayton were shocked, his biopsy came back positive. Dale was diagnosed with low risk, non-aggressive prostate cancer and decided on active surveillance.

Two and a half years later, things started to change. His PSA remained normal but his biopsy showed the cancer had doubled in size. “It’s a miracle we found it,” said Dale. “I believe God placed the right doctors, urologists, and friends around me to help me make an informed treatment decision.” He researched prostate cancer and treatment options, from surgery to brachytherapy to protons, and there were two things that were very significant to his treatment decision process: Cure Rate and Quality of Life.

(more…)

Whether a career change or cancer treatment, Bill Raffield is the kind of man who goes for what he wants.

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That included treatment for prostate cancer.

Raffleld started out with a B.S. in physics and a career in the Air Force where he planned and evaluated instructional systems for the military’s intercontinental ballistic missiles program during the Vietnam War. He became a captain, serving as combat crew commander and wing instructor and discovered he enjoyed “arranging resources to accomplish the mission,” he said. “At the time, I didn’t know what that was called, but in business, that’s operations.”

After his military career ended, Raffield didn’t settle into the field he had chosen but embarked in a new direction, starting out as a territory sales manager for Michelin Tire and ending up management and operations for Truckstops of America and Universal Tire.

“I tended to say, ‘I’m going to do what fits me,” he said. (more…)

Provision patients report on life after treatment

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For the past three and a half years, patients have been coming to Provision Cares Proton Therapy Center seeking the best treatment and care for the cancer diagnosis. Many of them have shared their stories with us. Today, we celebrate these survivors by checking in with some of the Provision alumni whose stories we have featured in the past. Click the links to find out more about them on our website, protonstories.com (more…)