Thursday, February 2, 2017

Latest Medical Update

My wife and I spent Tuesday at Sloan Kettering in NYC.  Most trips to NYC are somewhat fun, at least to some extent.  We normally manage at least a decent meal, or a nice adult beverage somewhere, but no such luck this time.

Unlike most trips, we had a later start to this day, so we were on the 7:00 a.m. train out of Albany (we stayed at a nearby hotel the night before) rather than the 5:00 a.m. train.  We were in the city by 9:30 and we walked quickly to hospital - maybe a 35 minute walk.  From there, it was straight into CT scan prep - drinking the oral contrast liquid.  After half an hour of that, they took me for the scan, which also included an IV contrast.  I will never get used to the warm feeling that the contrast creates.  It's focused at the back of my throat and also my butt.  It almost feels like I've peed in my pants, but that hasn't actually happened yet.

Next, I was scheduled for some lab work while the CT scan was being read.  But, there was some confusion here.  The doctor who had ordered the labs was a medical oncologist who I've only spoken to briefly, and they couldn't even figure out what labs he wanted.  Eventually, they decided to cancel those orders, so I spent the next 90 minutes waiting to see my surgical oncologist.

The first statement he said was that the tumor that was irradiated last month was exactly the same size as when scanned in November.  That made my heart sink a bit, but he explained that this was good.  The tumor density had changed, and the words necrosis and necrotic were in the report.  In summary, the tumor was essentially "killed" by the radiation.  It didn't shrink, but it also didn't grow.

However, it's not safe to leave the mostly dead tumor in place.  If there are viable cells left in the tumor, they will eventually find a way to escape and spread the disease, so the tumor has to come out.

The surgeon explained how he would do the surgery, what the incision would look like, what the risks were (bleeding from the inferior vena cava - a major vein) if he has problems prying the tumor away from the vein.  He said he will need a few units of blood in the OR in case that scenario happens, but he didn't seem overly concerned by it.  He said it's a 3-4 hour procedure, and part of that time is simply getting to the tumor.  They have to make the incisions, get to the liver, essentially flip the liver up and over to get behind it, and then extricate the tumor.

He does think this surgery will be less severe overall than my last surgery, where he had planned to resect a couple organs and cut out a large part of the psoas major muscle.  I will spend 5-7 days in the hospital this time, vs. 7 last time.  The surgery is still an invasive surgery under general anesthesia, and I will be intubated and have a catheter inserted.  So, it's non-trivial, but I'm getting used to these by now.

This time, I can go home for a week after discharge rather than having to stay in the city the entire time.  I will simply have to return to NYC on the 28th to get the staples removed and to get the final pathology report.  Mostly, I will be concerned with the margins on the final report - did they find any cancer cells right at the edge of the tumor, indicating that some might have been left behind.

After the meeting with the surgeon, I was supposed to follow up with the radiation oncologist to discuss my December radiation.  But, they also need to do pre-op testing - lab work, EKG, etc.  Normally, they do a chest X-ray, but after a full body CT scan earlier in the day, an X-ray was unnecessary.  So, we cancelled the appointment with the radiation oncologist, and focused on pre-op testing.

I had to change our reservations to a later train while waiting for the lab work to be done (they took 9 tubes of blood!)  And, we still had to take a cab rather than walk to make it to our train on time.  There was no time at all to even have one drink at the American Whiskey Bar - one of our favorite NYC watering holes.  Next time!

So, Tuesday's news really couldn't have been any better.  To be honest, in the back of my mind I guess I was secretly hoping that the tumor would just be gone - vaporized.  But, there was no real chance of that.

My surgeon is one of the best in the world for this disease and he seems quite optimistic.  He was thrilled that nothing new showed up in the past 3 months.

Now, I'm working on the logistics of travel for the trip.  This is always a challenge, working with train schedules, social workers at Sloan Kettering to help with lodging, and just the overall timing of things.  But, I should get that wrapped up today or tomorrow.

So, on to the next round.

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