A new doctor and a new approach

On Friday, Mary joined me for a consult with the Lacks Center's new surgeon, Dr. Pimiento (who replaced Dr. McCahill, the surgeon who relieved me of my esophagus).  His nurse went over my medications and it is clear they were picking up from Dr. McCahill's records because all the medications were what I was taking after my big surgery a year and a half ago. She got them up to date and shortly Dr. Pimiento whisked into the room.

Dr. Pimiento is a highly engaged, good-looking, young, Latino with a heavy accent and expressive manner.  He launched right into everything he knew about my case, summarizing medical events from the beginning up to what had happened last Tuesday. He then asked if I had seen the x-rays.  I had not but I was glad he asked because I always want to see pictures.  He quickly pulled in a cart with a monitor, called up my CT scan and navigated from the neck down to the spot on the liver.

It was rather a disappointment as I was expecting an ominous, dark, ugly blotch, but it was more like a shadow.  (In the picture to the left you can see it in the yellow crosshairs measuring its size as 23mm x 19mm.) He showed how it was fairly deep into the liver and reiterated how difficult it was for Dr. Skrtic to see with his ultrasound on the outside and the ribs blocking the best views.

He agreed that the ablation was still the best alternative but that it was fairly experimental because my case was unusual and there was very little data on metastasized esophageal cancer in the liver.  If it was colon cancer, there was lots of data showing that liver resection was the most successful approach resulting in longer survival periods.  But so far, all my cancer activity has been limited to this very small area for a fairly long stretch of time and this minimally evasive procedure with a short recovery period and low risk seemed to make good sense.

He then went on to talk about how much he loved doing a liver resection and how it was a beautiful operation. Mary thought that the way he talked about the liver was pretty sexy.

The surgury involves inflating the gut with CO2 to give him room to work and poking a couple of holes for instruments, including an ultrasound wand placed inside this time. The ablation catheter must be plaed exactly in the center of the tumor because it kills tissue within a sphere and all the cancerous cells must be on the inside of that sphere.  It takes 3 months before you will know if you were successful.

 He said that he could do the surgery on Monday but since he wanted to have a radiologist on hand, it was too late to arrange this for this coming Monday so he put me down for the first surgery of the day a week from Monday on the 11th. There would be one night in the hospital required and week staying home from work.

I'm a bit anxious to have this done but I can wait a week.