By DALE GRAHAM
“Back in June, when I got back from vacation, I’d been having some pain in my stomach”, Cheatham County Mayor David McCullough explained when we sat down in his home this week. He had seen his doctor about it, tests had been run, but no “red flags” had been raised. They were sharp pains in the lower belly, and they had gone on for a while. “6 months, 9 months I had been complaining about it”, he said, but since a colonoscopy 3 years previous showed no sign or problems, the doctor first tried different medicines to try and get him some relief. “I did all the right stuff”, McCullough said, like not ignoring the problem like so many of us do.
Then later in June the pain became very sharp and was located more toward his right side. Of course by then the County was in the middle of finalizing a budget, and “I didn’t have time” for another appointment right away. He called the people at Centennial Hospital in Ashland City, telling them that he might be having appendicitis and could he run up there and see someone. They advised that he definitely needed to get more attention, and ran a CT Scan which showed “multiple places of cancer, mainly in the colon and in the abdominal area.”
By the end of that day he was sent to Nashville for further tests and a biopsy. “They didn’t mess around”, he had an abdominal biopsy, followed later in the week by a colonoscopy, a PET and CT scan. Then he met with an oncologist. “He told us the bad news. He said ‘you have Stage 4 colon cancer’”. The doctor told us, “without treatment you’ve got 6 – 9 months to live, with treatment you’ve got 30 months, that’s the median”, not the average, the median. “I was torn up”, David said. Megan said they sat in the car, stunned that day. “He [David] just kept saying, ‘Wow. Wow.’”
What he didn’t know at the time is that the cancer was in the peritoneum, or the thin layer of tissue that lines the abdomen. “It’s a death sentence”, McCullough said.
He and Megan started asking questions, and taking notes. There were too many words being used that neither of them had ever heard before. “I spent the next 72 hours absorbing, researching, and researching”, Megan said.
David made phone calls. “I got on the phone and I called the president of TN Oncology and I said, ‘I don’t like this diagnosis. You’ve got to get me a different doctor because I’m going to fix this”.
“We really had a rough night that night”, he said. They decided pretty quickly that because of their family, and because of the nature of David’s job, they would just be “transparent” about what was happening to David, rather than trying to keep it within the family alone. They gathered their daughters and sat down together and “we just said ‘girls, this is what it is’”, Megan explained, and then added, “but then there’s God”. She said, “and we sobbed, and we sobbed and we sobbed.” Megan sat on the floor with her head on David’s knee and sobbed so deeply that it “racked my body”.
And then they finished, and said “ok, now what are going to do, where are we going from here”, Megan said.
David slept that night, and when he woke up he felt like he had his “senses back”. “I thought, I’ve got faith, I’ve got family, I’ve got friends, and I’ve got to fight, so I’m going to beat this”. By “beat”, he meant that his goals were for a lot more than 30 months.
More research. Much more research followed. Peritoneal cancer is rare, particularly in men. The prospects are bleak, so they started chemo immediately. In July there was surgery to install a port for the chemo, and then on July 11th, hundreds of Cheatham County residents came out and endured extreme heat to pray for the healing of Mayor McCullough. There were hugs and prayers and tears, and more hugs.
Chemo started after that, 3 days a week for 4 weeks of chemo, 1 week on and 1 week of rest in between. During those 8 weeks Megan’s researching skills were improving to the point where she even knew what procedure might save David’s life.
It’s called HIPEC Treatment [Hyperthermic Intraperitoneal Chemoperfusion]. “We noticed that all the top hospitals did this procedure”, and one name kept popping up in the medical journals that Megan was pouring through, one doctor who really stood out as being on the cutting edge of this form of treatment. Dr. Paul Sugarbaker in D. C., where Megan’s brother and his family had recently moved. Tiffany and John Spruill moved to D. C. a year ago and their home and help were a godsend for Megan and the family.
David contacted him and immediately Doctor Sugarbaker asked to see his records and decided that David would indeed be a candidate for the treatment that he “perfected”. After a visit to meet Dr. Sugarbaker, David was chosen for the potentially lifesaving treatment.
Here are the words to remember: Cyto Reduction surgery, and HIPEC. Cyto reduction simply means surgically removing as much of the cancer as possible from multiple sites in the abdomen, and may include, (did include in David’s case) removal of part or all of several organs. HIPEC means, “basically they’re giving your insides a bath with chemo”, Megan boiled down the heavy medical jargon into a simple sentence. The chemo is heated, (cancer hates heat) to between 105 and 107.6 degrees, it is then pumped into the abdominal cavity where it can ‘wash’ out the cancer.
Dr. Sugarbaker was speaking the language David wanted to hear. “He said, ‘I look at this as a curative surgery’”, a word no one had used yet with David. They had used the word “palliative”, which is more about making the patient comfortable in the time they have left, rather than healing the patient. In fact he handed David and Megan a sheet of paper where they saw the words, “50% possibility of complete cure, 80% chance of much extended life”.
Surgery was scheduled for September 29th. The extensive surgery basically involved opening David up from sternum to lower belly, removing the gall bladder, 2 portions of colon, the greater and lesser omentum (a layer of fatty tissue that covers and supports stuff inside the abdomen, like intestines and organs, also a great place for cancer to hide and grow), and the appendix (or what was left of it). The gall bladder was clean and cancer free, but not the appendix. “The appendix was completely eaten up with cancer, there was no real appendix left”, David explained.
After that cyto reduction was done, the HIPEC begins. Dr. Sugarbaker goes further than most, once the chemo is poured into the abdomen, he takes the chemo, puts his hands in and gently moves the organs and colon and intestines, making sure that the cancer killing chemo can get to everything where cancer could be lurking. There are tubes inserted into the cavity to reheat and circulate the chemo, McCullough was then stapled shut, and the “shake and bake” begins, where he was physically shaken to circulate the chemo to assure that it goes everywhere in the cavity. 9 hours in surgery, very tough for the human body to endure.
After surgery, Dr. Sugarbaker told Megan, “I got everything, I got all the cancer. As far as I’m concerned he’s in remission”. That wasn’t the only good news. The doctor said, “if my guess is right, the pathology report is going to come back that the cancer originated in the appendix, and spread to the peritoneum and the colon, that will change things”.
The good doctor was correct. He sent David home with a 70% chance of total cure, 100% chance of a greatly extended life. “Cure,” David said, “I mean that’s a strange word to hear after you’ve been told ‘hey this is not curable, there’s nothing we can do for you’”, except keep you comfortable and try to extend your time. Also, in spite of there being some great doctors in the state, David and Megan basically had to come up with a plan on their own.
Now there is healing. It will indeed take time for David to heal from his MOAS, [Mother of All Surgeries]. He wouldn’t have even been a candidate except that he was and will be again, physically fit and healthy. “It’s basically like 5 surgeries in 1”, Megan explained. When we met this week, David was at 7 weeks post op. He looks like he is recovering from a near death experience, “The option was either die, or live a shorter life, or go through this hell to get extra years. My prognosis is great!”
So the “beautiful news is”, as Doctor Sugarbaker explained to the couple, “I did a complete cyto reduction, which means I got all of the cancer”, he got everything that could be seen, and washed away everything that couldn’t be seen. “Your surgery was completely successful”, he added. Of course no one can ever say 100% that it will never return, but it will have to take on the McCulloughs again, if it does. In order to complete the “standard of care” that David’s healing plan calls for, he will return to his oncologist on November 30th, and then will begin another round of chemo, at least 4 more weeks (over an 8 week period), possibly 8 more weeks of chemo. There was no systemic cancer, there was none that had spread, none in the lymph nodes, nothing in his liver, no evidence that it had spread outside of the abdomen.
David and Megan have always known about the power of prayer, and love, and family. These things got them through some VERY difficult times. Neighbors and friends who looked after their home were so important. And the overwhelming prayers and love and support of the community kept them strong, positive, and pushing forward. They have also learned the importance of choosing your doctor and doing your research. Sometimes the early answers are not the ONLY answers.
David has been working any way he can since this began, and the county business has not suffered, thanks in large part to the flexible and hardworking Amber Locke, Director of Administration. He plans to be back for the December County Commission meeting, and is taking every day as it comes, healing slowly, but steadily. This is a rare cancer, even more rare for a man, and surviving it is even rarer, but with a little teamwork by the McCulloughs and a great and visionary doctor, David McCullough will live to serve his community for many years to come.
“We fully believe that we will live every day and we will accept nothing less than every day that God has designed for us to live”, Megan said. “We trust this”, David added, and that knowledge helped them during the process. “I wanted to live life, as long as I had life”.
David gives due credit to the woman who put him in Dr. Sugarbaker’s hands. “The most important person in this whole process is Megan! She has been by my side the whole time, and secondly she helped save my life through her research. She is the best person in the world and I’m married to her!”
Looking at them today, it’s evident that the feeling is mutual.