Saturday, 2 June 2012

Surgery + the first few days following....

WARNING: Blogger substitute, as it's me, Tanya substituting in for Stephen give the update that currently he is unable to give. I have tried to put together most of the emails that were sent out over the course of Stephen's surgery and the first few days afterwards while at Roswell Park Cancer Institute in Buffalo N.Y., so hear it goes....

They had some delays the morning of the surgery at the hospital, and were only able to make Stephen's initial incision at 10:30 am Wednesday morning (planned for 9 am to 9:30 am).  They first reviewed the cancer in the peritoneum and it was in such a way that they could proceed. Then they went onto the liver, where they needed to have an ultrasound performed in the operating room. This was done, and it was then determined that it was okay to proceed based on location and size of the liver tumors, the ultrasound confirmed that the 2 liver tumors were as the doctor had expected them to be and no bigger, or not to close to the main hepatic artery.

I got the news from Dr. Kane's nurse, Anne, at around noon Wednesday that they had a green light to proceed, and that the liver specialist, would begin with removing the 2 liver tumors, then Dr. Kane would work on removing his entire right colon, then resecting the left colon in 2 sections, and then final application of heated chemotherapy drugs for 2 hours, and then seal Stephen back up and send him to I.C.U. Anne (the nurse) said she would give me another update in a couple of hours, but that Stephen was holding up very well in the Operating Room.
We found out at around 3 pm Wednesday afternoon that the liver specialist had just finished with removing the 2 tumors from Stephen's liver and he was just about to have the colon work done and then the heated chemotherapy.

By around 8 pm on Wednesday evening, Stephen was in the final 2 to 3 hours of surgery. All the visible  tumors in the peritoneum, liver, and colon are removed and he was about to  receive the application of the heated chemotherapy drugs. The nurse informed me  that Stephen held up extremely well throughout the surgery all day  so far with no issues.

Final update of the night, although it was already May 31st, so technically it was the first update of Thursday morning.

I had gotten off the phone with Stephen's doctor, Dr. Kane, just at 1:00 am. He sounded quite tired. Stephen was out of surgery as of 12:30 am and moved into I.C.U. and remained sedated with the breathing tube in, as we had been told in advance would be the likely scenario.

As Dr. Kane stated, everything went very well, and they were able to get all the visible tumors out, of the peritoneum, liver and colon as well as apply heated chemotherapy. Stephen did not require a blood transfusion during surgery, as he lost only the equivalent of "2 cans of coke" of blood (according to Dr. Kane's analogy) and all of his levels and counts remained fine, and remain okay once he was moved to I.C.U. He said that I.C.U. will be pumping Stephen full of IV fluids overnight, and keep a close monitor on him.

Dr. Kane mentioned that all of the tumors were concentrated and there appeared to be little spread of the disease in small pockets throughout his body, which is a good sign going forwarded. One of the liver tumors was a bit tricky, which took some extra time by the liver specialist' as it was located close to an artery within the liver. He also mentioned that it didn't appear that any of the tumors had started to grow again during the interim period between stopping chemotherapy and Wednesday's surgery, which is also a good sign.

I thanked Dr. Kane extensively, to which he responded, very humbly, "don't thank me yet, as this is just step 1, thank me once I return Stephen back to your family healthy". I cannot but feel that this is the first step to that outcome, and without Dr. Kane's willingness to take Stephen on as a patient, we would not even be at this first step.

Stephen was moved to a room in  I.M.C.U, on Thursday, which I found out stands for Intermediate Care Unit, a level less critical than I.C.U. which is good, but still more closely monitored than a regular hospital room. The nurse, Sue, informed me that he will remain there all day Thursday and possibly all day Friday, until Dr. Kane can see him and determine that he is ready to move to a regular hospital room.

Stephen is in and out of sleep, but can talk, and says that his throat hurts quite a bit. He can self-medicate himself with a combo of Morphine and Novocain, every 10 minutes. All his levels are good, he was just a bit low on his magnesium count this morning, so they added that to his IV. He is doing really well, from everyone's perspective.

By Thursday after dinner,  Stephen was sitting up in a reclining chair beside the bed. He was talking, and still going in and out of sleep. The nurse came over to tell us that based on all of his readings he will definitely be moved to a regular hospital room tomorrow, and that he should know that the nurse on tomorrow's day shift will actually make him get up and walk, even if just for a couple of steps, so to be prepared. The tough love begins tomorrow he was informed. He seemed in good spirits and was watching CNN Anderson Cooper 360 on the TV in his room.

 Stephen spent most of the day Friday still in and out of sleep. He did however get moved a single regular hospital room today, and walked the length of a long corridor to get himself there. He will remain in this private room, on the 7th Floor West, room 7406 until he is discharged in 2 weeks to go back home to Toronto. Hard to believe, actually. He also got permission to have 1/4 glass of ice chips every 4 hours which is great. All his levels and output is very good. I will spend the rest of this evening with him in his room, and then check on him tomorrow morning at around 7 am, and then drive back home to Toronto. I won't see him again until next weekend, unless obviously something goes wrong.

For those who plan to come to see Stephen, visiting hours are from 11 am to 8:30 pm, 7 days a week, and they recommend 2 visitors at a time, although most nurses haven't been picky about this with me. He cannot eat or drink anything, and currently has trouble to focus, so really isn't reading or watching TV very much. He is able to sit up and really enjoys you talking to him to pass the time, as he cannot really talk because his throat is so sore. They gave him special spray for his throat today to help with the pain. I spent time this afternoon reading to him all the emails he received, as well as the emails I sent, and he seemed to like that quite a bit.

Thanks again for all the kind thoughts and prayers. Greatly appreciated.


Tuesday, 29 May 2012

May 29 pre-surgery

So, it’s been a seven months since my last update. In many ways not much has changed. The major decision was whether to go for surgery in North Carolina or not. Glad that I waited. During this time I’ve stayed on Chemo and it has been working well and looked into other surgery options.

Turns out the Ontario Ministry of Health works with Dr John Kane III out of Roswell Park Cancer hospital in Buffalo. Dr Kane comes very highly recommended by my doctors at Mt Sinai as well as the team from Sunnybrook. This is also covered by OHIP, which is very nice. Over the past four months I’ve been meeting with Dr Kane to discuss surgery options. Things have been going very well. My tumors have been getting smaller and Dr Kane has been getting more confident on surgery.

Doing surgery on stage four cancer patients is new. The goal is to get as much as possible out and to reset the clock. Since the tumors have spread they know that getting everything with surgery is not possible. Some cancer cells will still be in the blood stream or other organs. As Dr Kane described, the best analogy is weeding a garden. The initial surgery will take everything that he can see. After this I’ll go back on chemo to catch some stuff. If anything starts to grow they will go in again with smaller surgery to take it out. This is a new direction, just over two years, so they don’t have much in the way of stats but so far things look good.
On May 30th (tomorrow) I go in for surgery. They will do a smaller incision first to look at my liver. If it is just  the two or max three growths on the liver they will continue; if not they will sew me back up. Dr Kane puts the chances of this at 10%. The next potential road block is the spread of cancer in my small intestine. If there are too many small growths this will also be a point where he stops the plans and sews me back up. He feels the chances of either case is small but still a real chance that they may occur.
After the liver and bowel work is completed then onto the next phase of the surgery. If all goes well I will get 120 min of HiPEC. This will give Dr Kane a bit of a break during the 12hrs surgery. Expectations for post-surgery are that I’ll be in the hospital for two weeks. Personally I’m a huge suck and not looking forward to any of this at all but the upsides are worth it.

Dr Kane has been clear that I will not be disease free after this, small chance that I would be but it would be like winning the lottery twice. He is going to address everything that he can see (bowls, liver, peritoneum). Once I’ve recovered from the operation I’ll need to go back on chemo and have regular CT scans. If they see something else they can hopefully take it out with a minor operation.

As for my health I’m doing fine, other than gaining more weight back. The boys and I are going to Taekwondo five or more times a week. Three weeks ago, we all got our Yellow belts and I can for the first time since grade school that I can touch my toes without bending my legs. Personally I’m more proud of the touching my toes than the Yellow Belt, not a small task for man of my age. Hopefully this will help with a faster recovery and lower risks during surgery.

Over the past week I’ve spent a lot of time with the boys. Went to Wonder Land a few times and took them out of school to see The Avengers and MIB III. It will be good for them to have a few weeks of school without dad pulling them out for fun. Had my last blowout on Friday. Went to the Munk Debates with Mike Stubbs who I first meet in grade nine. After we went to the Rex and a few other bars, didn’t make it home till late. After several request from the east coast, on Sunday we all went to church and I was blessed by the priest.

Tanya will be providing short updates over the next two weeks. My plan is to start more regular updates again in a few weeks. Thank you all for your support, prayers and kind wishes.