Erik MH:

blog entry

24 months later, there’s great news and bad news

original date2019-12-07 23:59 utc
republished2024-06-11 15:09 utc
topicshealth; orig. on PostHope
noteThis post was ori­gin­ally pub­lished on Pos­tHope, where it’s still avail­able, along with sev­er­al pub­lic comments.

The good news — and we need to remem­ber that it’s very good news! — is that (on more-or-less the second anniversary of the big sur­gery) I just had my fifth fol­low-up CT-scan and there is no sign of any return of the can­cer. Hooray!

And anoth­er bit of good news is that, while at the hos­pit­al, I met with a new nutri­tion­ist. After she grilled me closely about my post-eso­phag­us diet and diges­tion, she told me that in her exper­i­ence deal­ing with people who have had my sur­gery, they fre­quently exhib­it symp­toms that patients with pan­cre­at­itis, pan­cre­at­ic can­cer, and oth­er troubles of the pan­creas do: since, because of the new, stretched shape of the stom­ach and upper intest­ine, much of the food ends up entirely miss­ing the digest­ive enzyme bath the pan­creas pro­duces, fat, pro­tein, and even car­bo­hydrates end up passing right through one’s digest­ive sys­tem without their nutri­ents get­ting pro­cessed — caus­ing gen­er­al dis­com­fort, weight loss, and under-nutri­tion. And in fact, my only real com­plaints over the last couple of years have indeed been try­ing to keep my weight up — and gen­er­al dis­com­fort after basic­ally every meal. So, she’s try­ing me on some pan­cre­at­ic enzyme sup­ple­ments, which so far really seem to be helping.

But. … But. … But. When he walked into the room and shook my hand, Dr. Fin­ley asked me how I was.

“Great!” I said.

“No, you’re not,” he said.

“No, really. I feel great!” I repeated. “I had a bad week in Oxford, but things are good!”

“No, they aren’t,” he assured me. And then he went on to explain how (pre­sum­ably dur­ing that bad week in Oxford), a sec­tion of my colon had man­aged to squeeze itself up through the eso­pha­geal hiatus in my dia­phragm (along­side the por­tion of the stom­ach that replaced my eso­phag­us) and into the left side of my chest cav­ity. This doesn’t hap­pen among the gen­er­al pop­u­la­tion, but it does hap­pen to about 10% of patients who have had eso­phagec­tom­ies, thanks to their smal­ler, stretched-out stomachs.

Though this is not gen­er­ally a ten­able loc­a­tion for one’s colon, it’s not usu­ally caus­ing any dif­fi­culty oth­er than some occa­sion­al pain and some sur­prise at the sounds eman­at­ing from my chest — sounds that are usu­ally asso­ci­ated with one’s abdo­men. But, thanks to some­thing that may or may not be kin­et­ic fric­tion caused by the colon’s peri­stalt­ic move­ment against the rim of the hiatus, there would be a con­stantly increas­ing pro­por­tion of the colon on the wrong side of the dia­phragm — and soon­er or later it would become quite dangerous.

And so, without fur­ther ado, I’ll be back at the hos­pit­al for a two-hour sur­gery on Decem­ber 20th. It will again be a robot­ic­ally-con­trolled lap­aro­scop­ic affair, with sev­er­al small incisions in my lower chest / upper abdo­men. Dr. Fin­ley will snake the colon back down where it’s sup­posed to be, and cinch up the eso­pha­geal hiatus with sutures so that it’ll be much nar­row­er. Finally, he’ll suture my stom­ach into place such that it will also help block the eso­pha­geal hiatus — hope­fully keep­ing the colon from get­ting any big ideas about a return vis­it to my chest.

This is a much smal­ler sur­gery than the big one — more on a par with hav­ing your gall blad­der removed, although with this one they keep you overnight and give you a bari­um swal­low the next morn­ing to make sure you aren’t leak­ing. Depend­ing on the res­ults, I’ll get to go home on Sat­urday the 21st or Sunday the 22nd.

I heard dif­fer­ing opin­ions from the sur­geon (“no”) and the nurse (“yes”) as to wheth­er I would then be on a liquid → puréed → soft food three-week pro­gres­sion. Hope­fully, we under­stood the sur­geon correctly!

We could have delayed this, but the insur­ance works bet­ter for us in 2019. And hav­ing Karen’s folks and Timothy and Camer­on all in res­id­ence (for vary­ing time­frames) begin­ning that week­end will be very pleas­ant. And dear Kar­en will hardly have to work from the 20th through New Year’s (and will be able to be present with me for much of my hos­pit­al vis­it). So this seemed to be a good option. And I’m already lin­ing up phys­ic­al ther­apy appoint­ments such that I’ll be ready for reg­u­lar lift­ing and haul­ing and push­ing come garden­ing season.

I won’t lie: this sucks. But try to remem­ber the good news with me: No can­cer! And hap­pi­er eat­ing and digesting!