No, I’m not just sitting around waiting for Armageddon – there are still lots of things to do between now and the surgery. The main thing is to obsessively, endlessly troll the Internet reading every last word ever written about esophageal cancer, staging, treatment, and prognosis. Yes, it’s cancer porn and in many ways its effect on me is remarkably similar to that of real online porn. My pulse races, my breath comes faster, I get a little sweaty, and then when I’m done all I want to do is eat and go to sleep. The problem is that cancer porn results in extended hysterical anxiety and trust me, it lasts longer than four hours.
Other than that, this week I’m meeting with (hopefully) two other surgical oncology specialists for second and third opinions about all of this. The one that is set is on Thursday is with a doctor at USC Norris, which is one of the preeminent cancer facilities in the world. How do I know this? Because in their instructions on how to get there, it indicates that they have free valet parking for all outpatient services. Yes, it’s just like a Vegas casino. Hope I win!
The one that is still pending is with a doctor at UCLA’s gastroenterology department. This place is ranked the 6th best such gastro-program in the world behind the likes of The Mayo Clinic, Duke, and Johns Hopkins. The first problem with this place is that they don’t have free valet parking. Once it has been offered to me, it became important to me for some reason. The second is that they don’t take my insurance so I’ll definitely be coming out of this place with a lighter wallet, but hopefully with more clarity.
The first question I will be asking is whether or not I should have the surgery at all. Everything I have read (and everything I’ve been told) indicates the answer is yes because chemo and radiation won’t do the job on their own. But, who knows… maybe one of these docs knows more than the Internet.
The second question I will be asking is whether or not the way Dr. Frenchy and Dr. James Earl Jones will be doing the surgery is the correct approach.
Regarding the latter, according to what I’ve read, there are several ways to do this surgery. The old way is where they flay you open like a sea bass getting ready to go on the grill. They don’t really do this much anymore unless there is something tricky about where the cancer is located and/or if there are complications during surgery.
The newer way is most often referred to as a minimally invasive esophagectomy (MIE) and there are two ways to do that, which basically add up to minimally invasive (MIE) and really minimally invasive (RMIE – ™ Rick Garman Productions).
RMIE is done entirely with laparoscopic tools. Four 5-10mm holes are made in the right side between the ribs, long thin tubes with cameras and lights go into the holes, and the surgeon disconnects the stomach and cuts out the cancerous part while watching on a monitor instead of looking directly at your insides. Then six more small holes are cut in the stomach and another in the neck to reconnect everything and remove the part they took out.
MIE is pretty much the same only with the addition of a 3-inch incision made just below the ribs on the right side. This is to allow the surgeon to be able to take a hands-on approach (literally) to the hooking things back up part.
Dr. Frenchy and Dr. James Earl Jones are planning the MIE approach, although I haven’t been able to get real clarity as to why other than “that’s the way we do it” kind of answers, which never sit well with me.
I haven’t read or been told that there is a significant difference in risks and complications between MIE and RMIE nor is there a big difference in recovery, so I don’t know why it’s important to me, but it is.
I also want a dispassionate third part to tell me the straight skinny on what I have to look forward to after the surgery, because here’s where the cancer porn really starts getting exciting.
Five year survival on stage 1 is 90% unless it’s 80% or 60% or 45%. It depends on which particular bit of cancer porn you are looking at and the wild variations are mostly because true stage 1 is so rare. Plus, most people who get this are usually older and that could skew the results as well.
The one thing that most of the cancer porn agrees on is this: even with the surgery and even if it is truly stage 1, it cannot be cured. There is a better chance that it will come back and kill me at some point than not.
Stupid Internet.
Anyway, after the consultations, presuming I’m really going to do this (which is my presumption but not my final decision yet), I go for a pre-surgery physical on Monday the 13th, a pre-surgery screening on the hospital on Thursday the 16th, and then at the hospital by 6am for the surgery itself, which is scheduled to begin at 7:15am.
Oh, and I have to stop eating on Wednesday afternoon, so my last real meal will be Tuesday night. Haven’t decided what I’m having yet. I figure it should be something insanely caloric and artery clogging, because it won’t be with me for long. Why? Because Thursday starts the two most dreaded words in the English language: bowel prep.
I’m going to go look at porn now. The real stuff. Why? Because….
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