After rectal cancer diagnosis, horse trainer is back in the saddle again
As a horse trainer, Trey Bullinger spends hours in the saddle every day. That’s why he blamed hemorrhoids when he noticed blood in his stool.
“Moving up and down on a horse can do that to you,” he says.
But Trey would soon learn that the bleeding was caused by rectal cancer, not hemorrhoids.
Rectal cancer symptoms provide a wake-up call
Trey’s story starts like that of many rectal cancer survivors. He had no family history of the disease, and initially thought it was nothing serious.
“I’ve always been athletic and healthy,” says Trey, who played minor league baseball for the Kansas City Royals two decades ago before he began training horses. “A little blood was no big deal. I figured it would eventually go away.”
But after two months of bleeding, Trey visited the nurse practitioner in his hometown of Kentwood, Louisiana. She performed a digital rectal exam and immediately felt a mass.
“That was a wake-up call,” Trey recalls. “For the first time, it dawned on me that my problem might be more serious than hemorrhoids.”
A rectal cancer diagnosis
The nurse practitioner sent Trey to a gastroenterologist, who ordered a colonoscopy.
“I knew by the look on his face that I was in trouble,” Trey says.
The colonoscopy revealed an egg-sized tumor near the lower end of his rectum. A biopsy confirmed it was cancerous.
Trey called MD Anderson.
“My father-in-law was treated at MD Anderson for a rare, smooth-muscle cancer called leiomyosarcoma,” he explains. “Because he received such excellent care, there was never a question that I would go anywhere else. The doctors there are the best in the world.”
Before beginning the five-hour drive to Houston, Trey and his wife, Anna, broke the news to their sons, George and Lawson, who were 8 and 6 at the time.
“That was the hardest thing I’ve ever had to do,” Trey recalls. “I promised them that I would always be their daddy, and that God and MD Anderson were going to help us get through this.”
Rectal cancer treatment: Chemotherapy and radiation
At MD Anderson, Trey underwent more testing. A special type of MRI revealed the cancer was stage III. The images provided doctors with detailed information to help plan Trey’s treatment.
First, he would undergo six weeks of chemoradiation, which combines chemotherapy and radiation at the same time.
“Chemotherapy drugs make cancer cells more receptive to radiation,” explains Van Morris, M.D., Trey’s oncologist. “The two therapies work well together to reduce the risk of the tumor spreading and to shrink the tumor tissue before surgery.”
Trey took an oral chemotherapy called capecitabine each morning and evening. While taking the drug, he completed 26 radiation therapy sessions.
During each treatment, he visualized the radiation beams dissolving his tumor. “It gave me a feeling of control over the cancer,” Trey says.
Robotic surgery for rectal cancer treatment
With chemoradiation done, Trey underwent surgery. Colorectal surgeon George Chang, M.D., removed the entire rectum, along with 17 nearby lymph nodes. He then reconnected the colon to the anal canal so that bowel function could be restored after Trey healed from the surgery.
To create a temporary solution and give the bowel time to recover, Chang rerouted a loop of Trey’s small intestine through a surgically created opening in the abdominal wall. Waste would pass through this opening into an ostomy bag for the next seven months.
Chang performed the entire operation with a robot. Sitting at a computerized console, he used specialized controls to move four robotic arms that maneuvered a miniature 3D video camera and small-scale surgical instruments inserted through tiny keyhole incisions in Trey’s abdomen.
“Robotic surgical instruments have joints that provide a range of motion similar to the human hand, but their movements are much more precise and steady,” Chang explains. “The video camera provides the surgeon with a magnified, 3D view of the area being operated on.”
Chemotherapy close to home
Three of the 17 lymph nodes Chang removed were positive for cancer. This required Trey to undergo eight rounds of chemotherapy after surgery. He received three drugs – folinic acid, fluorouracil and oxaliplatin, together known as FOLFOX, into his bloodstream through an IV drip.
His MD Anderson team collaborated closely with a cancer center in Baton Rouge so Trey could receive chemotherapy close to home.
“I wanted to be near my boys,” Trey says, “so they could see I was OK.”
Throughout treatment, he remained active. He coached his sons’ Little League teams, worked on his 25-acre farm, and bought a quarter horse named Blazer Lena Rey.
When his chemotherapy was done, Trey returned to MD Anderson, where Chang removed the ostomy bag in one final surgery. Three months later, Chang told Trey that all evidence of cancer was gone.
Making up for lost time
With Trey’s treatment complete, Chang urged him to get back in the saddle.
“Keep doing what you love,” he said. “Your life took a temporary detour. Now you can make up for lost time.”
Trey took that advice. Each day, he spent hours training Blazer Lena Rey to become a cutting horse.
“Cutting is an equestrian competition requiring a horse and rider to separate a single cow from a herd of cattle and prevent it from getting back to the herd,” Trey explains. “Ranchers do this to single out a sick cow for treatment by a veterinarian, or to take a cow to market for sale.”
Training a horse to cut takes patience, knowledge and years of experience.
“I wasn’t always a patient person, but training horses helped me become one,” Trey says. “I used that patience to get through cancer treatment.”
A cancer recurrence
Blazer Lena Rey proved to be a champion. She earned high scores in local and regional cutting horse competitions, and Trey was looking forward to competing with her nationally.
“But a year after my treatment ended, the bottom fell out of my world,” he says.
During a checkup at MD Anderson, a scan detected a cancerous spot on Trey’s left lung. Two more spots appeared soon afterward. Cancer cells had broken away from the rectal tumor and travelled through the lymph system to Trey’s lungs. Over time, they grew into tumors large enough to appear on a scan.
Lung surgeon Mara Antonoff, M.D., removed them, and Trey underwent six more rounds of chemotherapy to help prevent another recurrence.
Today, he shows no visible signs of cancer. He returns to MD Anderson every three months for scans and checkups.
“Waiting to hear if a scan detected a tumor can be stressful,” he says. “But my checkups are so frequent that if the cancer does come back, we’ll catch it early. So far, so good.”
Lessons learned from cancer treatment
Blazer Lena Rey recently fulfilled one of Trey’s dreams when the 4-year-old mare was awarded for her performance at the National Cutting Horse Association’s Super Stakes competition in Fort Worth.
“The entire time I was training her during cancer treatment, I envisioned myself competing at the national level,” Trey says.
He’s looking forward to future competitions, but cancer has taught him that winning isn’t everything.
“It’s much more important to be a good role model, appreciate your blessings, and don’t sweat the small stuff,” he says. “I know that God is running the show. I’m just along for the ride.”