Ablated updated

I've been through all the good drugs today keeping me sleepy, silly, itchy and pain-free. They're not letting me have solid foods yet so I have been cycling through all the hospital's clear liquid offerings; broth, jello, Popsicles, repeat. I had to ask, "Why no solid foods?" Apparently they don't want to risk my nausea causing me to puke. That would not be a good thing to be retching when you have a liver that's in a sensitive condition. But I really do feel great. Not much pain and good spirits.

I had a doctor whom I had not met before, slip into my room earlier and spent about 30 seconds telling me that the surgery went "beautifully". Her word. It is nice to know that the mass is now toasted, and therefore an impotent mass.

My job now is to relax for about a week. I think I can handle that.

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I wrote the above entry the evening of my surgery while sitting in a hospital bed.  I just realized that I forgot to hit the "publish" button, which explains all my family members checking in to see how things went. That was yesterday and today I am resting in the comfort of my home, falling asleep while watching documentaries on Netflix.

Right after I wrote that, Dr. Pimiento popped in and gave me a more detailed account (and also updated my chart to include solid foods).  He was a bit more reserved in his analysis about how things went.  He said the mass was a bit oblong and so he blasted it with two intersecting orbs of tissue death.  He also said that one of the wires did not heat up, probably due to the heat sink properties of a local artery.  He said we would check it in a month to see if another treatment would be required. 

Dr. Pimiento reappeared first thing in the morning to prepare my discharge papers.  When does that guy sleep?

One thing I forgot about surgeries and hospital stays is all the poking that happens... and bad poking.  They needed redundant IVs plus an arterial line and for some reason could not use my port.  The Nurse assigned to poke me before surgery failed in her first two attempts.  Thankfully, she called in someone else who managed a successful tap in the other arm and at that point the Anesthesiologist with a cool Russian accent stepped in and said she would do the other one after I was asleep.  At Lacks, you get regular heperin injections plus an early morning (as in 5:00 a.m.) visit from the hospital vampire charged with gathering blood samples.

Right before leaving, I had a surprise visit from Amy, the Lacks nutritionist who was making her rounds with an intern in tow.  She introduced me as her "fastest healing patient ever" and added that it was not an exaggeration.  She has never seen anyone respond better following major surgery and major chemo.  At least that is what she said.

Everyone was incredibly nice at the hospital and took care of all my little needs but it is good to be home.

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.