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[cancer] Excising the nacho; or; the surgical plan - Lakeshore — LiveJournal
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Jay Lake
Date: 2009-11-05 20:29
Subject: [cancer] Excising the nacho; or; the surgical plan
Security: Public
Tags:calendula, cancer, conventions, health, personal, work
Went to see the thoracic surgeon today. ginastonge drove me, as I was extremely stressed out. The thoracic surgeon is young, capable and has an excellent chairside manner. This is much like my colorectal surgeon, frankly, though you'd never confuse the two of them.

He started by asking me a few questions about my medical and surgical history, and then drew a diagram of my lungs.

Tumor Position in my Lungs

Illustration of tumor position in lungs

He discussed the rationale behind surgical addressing of the tumor — more than 12 months since the original tumor, and five or fewer lung lesions, is the most optimal combination, and I fit that profile. He showed me the actual size of the tumor, its site in my left lung, and discussed the surgical plan.

Actual Size Tumor, May and October

Actual size of my tumor, from the May scan to the October scan

They are going to use remote instruments with video camera through an incision beneath my arm and another between two of my lower ribs. He says in this type of surgery, there's about a 10% chance of needing to go to open incision if he cannot get a good enough view of the tumor site, but that my location is very "easy", and he does not expect that. If an open incision is needed, it will be about five inches long, and involve using a rib spreader. The surgeon characterized this process as an order of magnitude less invasive and difficult than my colon surgery of last year.

He will take out a chunk of lung about the size of a Dorito, centered around the tumor. It looks like a nacho chip with a jalapeno sitting on it.

The Nacho

Dorito-sized chunk of lung, actual size, with tumor

This will represent approximately 1% loss of lung capacity for me, post-op. That piece will go off to be biopsied, I will have a chest drain temporarily installed, and can expect about three days of in-hospital post-operative recovery before I'm released to go home. Release criteria are the drain clearing (and then being removed), and my general recovery from pain management to a point of oral medication in lieu of IV. We do not expect the GI issues associated with last year's surgery.

Complications include bleeding, sepsis, and chronic pain syndrome, each with about a 1% incidence. Some chronic pain sufferers also experience a phantom sensation of shortness of breath. All of these complications are at least partially treatable. There is also a 0.1% risk of death due to heart attack, adverse response to anesthesia, etc.

Post-operatively, I can expect the chest drain and an epidural for pain management, along with the usual fun with catheters and IVs. I will be heavily medicated the first few days, and can expect about two weeks of bed rest when I get home. I think he's being a bit conservative, even last year's surgery had me up and about on a limited basis by three weeks, and this is much less of an insult to the body. I will initially plan to take that Wednesday off from work, all of the following week, and then play it by ear from there. The surgeon estimates six weeks to full recovery.

His assessment of the likelihood of the tumor being metastatic colon cancer varied widely from my oncologist's. The surgeon felt it was 70% likely to be metastatic colon cancer, 10% likely to be a primary lung cancer, and 20% likely to be a lesion from some other source such as infection. (By contrast, the oncologist quoted 97% as the likelihood of this being metastatic colon cancer; a number which an epidemiologist friend also arrived at through independent number crunching from published medical data.) Note that the tumor had a SUV (standard uptake value) of 2.9 on the PET scan, which is indicative of cancer.

Once the tumor is biopsied, I will meet with the oncologist to plan chemo and otherwise evaluate options going forward. I am querying her as to when she'd like to meet, but I can't imagine that will be prior to 12/7. Given the surgical healing times cited by The surgeon, I don't expect chemo prior to Christmas/New Year's.

We have scheduled surgery for Wednesday, November 25th. I will be in the hospital at least through the 28th in post-operative recovery. (For those of you keeping track of such things, this means I will miss OryCon. I am contemplating a virtual panel in my hospital room for those of you willing to trek across town to see me.) Surgery is set for 7:30 am, with me having a 6:00 am checkin time. I do not currently know the expected duration of the surgery, nor the expected recovery room time prior to being able to receive visitors.

Summary of important dates:
  • Pre-op appointment 11/20

  • calendula_witch arrives 11/22

  • Surgery 11/25

  • Probable release date 11/28

  • Earliest possible return to work 12/7

What does this all tell me? Well, it reinforces that medicine is an art as much as a science. It confirms that this sucker is a problem, and is being addressed. But most of all, this tells me once again that when I have a course of action, no matter how dreadful things are, they are much more manageable than when I have only uncertainty before me. I expect the Fear will be a regular friend to me in these next few weeks, and I have a long-time horror of anaesthesia, but I will pass over these, too.

In the mean time, I believe I shall refer to my impending dip into surgery as a "nacho-ectomy".

Post A Comment | 25 Comments | | Link

Kelly Green
User: saycestsay
Date: 2009-11-06 04:36 (UTC)
Subject: (no subject)
Nacho-ectomy, huh? Now I know what to get you for Christmas :).
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User: etcet
Date: 2009-11-06 04:45 (UTC)
Subject: (no subject)
They keep taking out meat, and you keep turning it into carbs. :-)

We're pulling for you, even those of us who don't say so much.
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Elizabeth Coleman
User: criada
Date: 2009-11-06 05:01 (UTC)
Subject: (no subject)
I'd visit you, since I am officially going to OryCon, and I'll try to have Doritos and macaroni on Thanksgiving, in honor of your losttumors.
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Michael Curry: alton
User: mcurry
Date: 2009-11-06 05:03 (UTC)
Subject: (no subject)
I'd say "Mmmmm....nacho," but that would be wrong.


I'm glad you seem to have had a good consult, even if the timing of the actual surgery could be better. Sounds like you're in capable hands.
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User: deborahjross
Date: 2009-11-06 05:16 (UTC)
Subject: (no subject)
Keyword:teddy bears
My friend with ovarian cancer had surgery followed as soon as possible by chemo. She had 6 rounds of chemo, and I took care of her for #2 and #5. What a difference -- the first time, she was still majorly wiped out from the surgery; the second, she was able to go back to work (desk job) the week after the chemo. Her onc team did a great job of minimizing the chemo ickies. The worst for her was the 2nd day, but once she was past that, it was all in the direction of better. She's about 6 months post-chemo now, hiking and camping and talking about a trip to Turkey.

May your passage be as easy and results as successful.
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Peter Hollo
User: frogworth
Date: 2009-11-06 05:17 (UTC)
Subject: (no subject)
Yummy! ...not.

Emailing you to see if you'd really like to meet up the day before your pre-op! Would love to if you think you'll be up to it.
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User: crystalrmartin
Date: 2009-11-06 05:45 (UTC)
Subject: (no subject)
Big hugs! Thinking of you, even if I'm much quieter lately. College has the ability to steal all of your time... ;)
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User: triskelmoon
Date: 2009-11-06 06:08 (UTC)
Subject: (no subject)
While I see through your entries that you have a good support network in place, and am just a lurking fan (*waves*): I work at OHSU (and have 10 years experience with them), so I am on site if any of you need anything. Please feel free to ask. I can send you my cell number and email via pm if you would like.

I hope that everything goes well. Thank you for sharing this difficult time.
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Camille Picott
User: camillemulan
Date: 2009-11-06 06:13 (UTC)
Subject: (no subject)
Sending good thoughts your way!
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Kate Schaefer
User: kate_schaefer
Date: 2009-11-06 06:47 (UTC)
Subject: (no subject)
May the surgery go as planned, so we'll all have something to be guardedly thankful for come Thanksgiving.
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Grant Kruger
User: thirdworld
Date: 2009-11-06 07:20 (UTC)
Subject: (no subject)
Sooo, will there be another stuffed toy, this time Dorito-shaped, with a blob... or hole?

More seriously, the dates do not seem to align for the hospital, but let us know if you want a writers' Tuesday at your house, or at the hospital.
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Cliff: Mordred armor
User: obadiah
Date: 2009-11-06 07:30 (UTC)
Subject: (no subject)
Keyword:Mordred armor
I hope the surgery and recovery go as smoothly as is possible.
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User: jaborwhalky
Date: 2009-11-06 07:46 (UTC)
Subject: (no subject)
So they take the Dorito of doom out of your lung and you will be ok?

Good and I hope it turns out to be a infection if not your still going to be ok cuz you have all of us.
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User: jaborwhalky
Date: 2009-11-06 08:01 (UTC)
Subject: You need a LJ icon with your new battle cry on it I think

Use it if you like.
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Lisa Deutsch Harrigan: Girl Genius Done
User: lisa_marli
Date: 2009-11-06 10:03 (UTC)
Subject: (no subject)
Keyword:Girl Genius Done
*hugs* You remain in my Reiki Box so you can get some healing energy. Prayers to an easy surgery and quick recovery.
Let's get this stuff OUT of your system once and for all.
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Kari Sperring
User: la_marquise_de_
Date: 2009-11-06 12:29 (UTC)
Subject: (no subject)
I am thinking of you and will be lighting candles. May it all go beautifully.
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Lawrence M. Schoen
User: klingonguy
Date: 2009-11-06 13:05 (UTC)
Subject: (no subject)
It is wrong, but there're voices in my head that sound a lot like the Village People singing Nacho, Nacho Man
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Wendy S. Delmater
User: safewrite
Date: 2009-11-08 07:34 (UTC)
Subject: (no subject)
Oh, good. I thought I was the only one.
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Stone of stumbling and rock of offense
User: wordweaverlynn
Date: 2009-11-06 13:08 (UTC)
Subject: (no subject)
I love the idea of the nacho-ectomy. Beating cancer with humor is a great tactic. Good luck, and heal fast.
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The NewroticGirl
User: newroticgirl
Date: 2009-11-06 15:40 (UTC)
Subject: (no subject)
I'm down with hospitalcon!

And if you need extra hands around the house afterwards, I'm more than happy to help out. You can ask the Scholes girls for a reference. ;)
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cathschaffstump: needlebone
User: cathschaffstump
Date: 2009-11-06 17:56 (UTC)
Subject: (no subject)
Nacho-ectomy it is.

Best of luck. No salsa!

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User: yourbob
Date: 2009-11-06 18:03 (UTC)
Subject: (no subject)
Just be sure they don't take your macho instead of your nacho.
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User: kmckiernan
Date: 2009-11-06 23:42 (UTC)
Subject: (no subject)
Once again, I'd like to thank you, Jay, for sharing this incredible and scary journey. I continue to be humbled and awed by your raw honesty and amazing courage. You, your family, and friends are in my thoughts and I'll be sending positive, healing energy your way via the universe. Be well, dear one.
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User: shaolingrrl
Date: 2009-11-07 04:59 (UTC)
Subject: (no subject)
Just don't let them take the cheese!
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Leah Cutter: Blue ornament
User: lrcutter
Date: 2009-11-07 19:05 (UTC)
Subject: (no subject)
Keyword:Blue ornament
Cancer sucks, big time.

You are in my thoughts and I wish you the best, fastest, easiest recovery. As well as the best possible outcome for the biopsy.

::massive hugs::
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