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!