NOTE: postings are in reverse chronological order. Newest at the top, earlier ones scroll down to the bottom. To appreciate the full drama of it all, read from the bottom up?
Happy New Year
Today Luanne went in to have the surgical staples removed from her abdomen. Luanne said she was glad to have this done since the staples were starting to feel like jewelry, something she was wearing and would require coordinating with outfits. Remember, the procedure was done laparoscopically, so there were just three small slits to close up. The staples are even less heavy-duty than what you might use to staple papers together, and they are just pulled out by the surgeon with tweezers. Just lie back and pop, pop, pop.
Surgical Staple (pencil tip for size comparison)
The surgeon also said there are no further dietary restrictions and as long as she avoids doing abdominal crunches for another two weeks and does not lift or push anything heavier than 20 pounds in that time period, whatever she feels like doing she can. Oh, and as a bonus at no extra charge, Luanne’s appendix was also removed. This was most likely required because of the location of the colon that was also removed.
The cancer was officially classified as stage 1, and except for a colonoscopy in a year, no further treatment is required.
That’s all folks!
18 Again
Unexpectedly on December 21, just 3 days after the procedure the surgeon calls with the pathology report.
“No chemo. You're done!” he says.
!!!!!!!!!!!!!!!!!!!!!!!!!!!
The details: the colon has 4 layers, Luanne’s mass penetrated only 2 of those. A benign polyp was found and removed, 23 lymph nodes were sampled and all found to be clear.
Life again.
Going Home
Luanne’s bowel behavior, pain and spirits are all good enough so that she is discharged after two days on December 20.
For the next two weeks she must eat a low fiber diet. This does not sound too bad, but it turns out it is almost 180 degrees removed from her normal abstinent meals. Most of her food consists of a ton-and-a-half of raw and cooked fresh vegetables, some fruit, whole grains and protein. Low fiber consists of almost no raw fruits and vegetables; canned or overcooked is preferred. No whole grains, only white rice (or white bread if she ate bread, which she does not).
Luanne says that when you are a food addict in recovery you have given up your drug of choice for at least 90 days. Consequently, 14 days is a piece of cake (figuratively speaking, not literally).
Most of the next two weeks will be spent taking it easy, although the only restrictions other than diet are do not lift or push anything weighing more than 20 pounds. When she feels like it she can drive, and after two weeks she can go in the hot tub.
The end of this month she meets with a doctor to remove the staples that hold together the three incisions. Once again, as always, it is one day at a time.
In Hospital
From the beginning we were told that Luanne would be in the hospital 2-3 days, depending on how long it takes her to fart. Yes, really, although the medical term is “pass gas”. With part of the colon cut out and the two dangling ends stitched together, passing gas indicates that the connection and the new system are working. So does pooping. Luanne has always been pretty good at those two things, so she was satisfying these requirements the very next day.
The first day she was put on a liquid diet. Remember that Luanne is a long-time (16+ continuous years as of this date) food addict in recovery, which means among other things, no flour (not just gluten free), no added sweeteners (not even artificial ones) and she also does minimal dairy. You would think a hospital could adjust to these requirements, given the diabetics, celiacs and lactose-intolerant people they see. Perhaps they can, but the communication between patient and kitchen seems to suffer. One tray Luanne received had custard, milk and sugar packets for her herbal tea. Another had a sandwich and more custard. Fortunately if you speak up there are enough people who can fix the situation and corrections were promptly made.
We are told that the pathology report indicating the degree of spread (if any) will take 7-10 days. When we met with the surgeon he does not offer any hint of how things looked or what the stage might be. Wait for pathology, he says.
Luanne is still in great spirits, tired and pooping.
18
Modern Hebrew uses Arabic numerals (how’s that for peace in the Middle East?!), but older Hebrew used the letters of the alphabet to represent numbers. For example, the Hebrew equivalent of ‘A’ (aleph) is 1, ‘B’ is 2, etc. The symbols for 18 use the Hebrew letters that spell out “life” (“chai”; that’s a guttural ‘ch’, not a type of tea). Because of this positive association of “life” and 18, it is common for monetary gifts between Jews to be multiples of $18 ($36, $54, …) or values that end in 18, like $118. In general, 18 is associated with good luck and long life. Therefore, it was quite propitious that Luanne’s surgery was scheduled for the 18th of the month. Automatically, no reasons for fear nor concern with her upcoming surgery.
It’s not clear why this surgery was so much like going fishing: it is best done in the wee hours of the morning. Luanne’s was scheduled for a check-in time of 6:00 AM on December 18. Of course this was preceded by a day of preparation, similar to that of a colonoscopy—drink this concoction from 8 AM to noon, poop, take this pill at 1 PM, poop, take this pill at 2 PM, poop, take this pill at 11 PM, poop, drink this concoction at 4 AM, poop, show up at 6 AM. Good thing they knock you out for this because you are definitely exhausted. Luanne was not too concerned throughout all of this prep. Here she is waiting to check in:
Before Surgery
Kaiser San Rafael, where the laparoscopic procedure (i.e., no wide open incision, just 3 little slits on the abdomen) was performed, uses an interesting procedure. Each patient is given an ID number (630824 for Luanne) which appears on a large TV monitor in the waiting room. Interested parties can then follow their loved-one through the entire process. Here you can see Luanne’s progress:
Waiting
In Pre-op
In Surgery
In Recovery
We were told the surgery would take 131 minutes (not “about 2 hours”) with an hour for recovery. After 95 minutes we were called and told “all done”. Shortly afterwards we walked with a conscious Luanne while she was rolled to her room. She was in great spirits and looked pretty good, as you can see for yourself:
Post-surgery
Should we have asked for the phone to be surgically removed at the same time?
Smell the Roses
Today Luanne had her pre-op appointment with a Kaiser nurse practitioner. It consisted mostly of taking vitals, giving blood, getting a baseline EKG and informing her of the preparations she would have to do prior to and on the day of surgery. If you have had a colonoscopy (lucky you) this is similar and in some ways easier.
One interesting aspect is that they want Luanne to work on breathing before and after surgery, in an effort to prevent pneumonia. Ira’s sister Sioux, a retired RN, developed and promoted a program to this very purpose many years ago. She called it “Smell the Roses” and patients were taught to breathe deeply, as if smelling roses. Now the hospital gives you a small, take home, plastic “breathe-o-meter”. It seems to easily do the same thing and gives you visual feedback as to how well you are doing. Next there will be an app for that!
Here is the device:
Piece of Cake
Today Luanne had her surgical consult. A little apprehensive going in, but the surgeon was very informative, pleasant and helpful. The surgery is schedule for December 18, with a 2-3 day hospital stay.
Some of the technical details: the mass is in the right side ascending colon, about 4 cm. in size, non-obstructive. But as many of you know, size does not matter! It is the amount of penetration, in this case into the colon wall. Here, less is better and the surgery will tell. Apparently of all the possible variations of colon cancer, this one is best (best cancer, a true oxymoron). Prep is similar to a colonoscopy. Otherwise there are no restrictions prior to the surgery. “Do everything you normally would,” the surgeon said. “Piece of cake,” Luanne said (that was not a request for a slice, but a reflection on the ease of thing going into all of this). After surgery she can’t move anything over 20 pounds for two or three weeks, and must eat a low fiber diet for two weeks. Otherwise, she is up and about and eating the night of surgery.
So for now, business as usual.
FEAR
Today Luanne said: “I am full of FEAR: Face Everything And Recover.”
She also said she feels really good.
What's Going On
In August Luanne had decided that her lack of energy and breath should be medically analyzed. Her doctor ordered blood tests and they came back extremely low in iron and B12. Easy fix—take more of both. She did and her energy, etc. rebounded to her previous normal. As a safety measure her doctor also ordered an endoscopy (down the throat) and a colonoscopy (up the butt) to make sure there was no internal bleeding. These took place in August. However, Luanne reacted to the anesthetic and was too squirmy for the colonoscopy to complete. Consequently another one was ordered under a more general anesthesia, and this took place on November 20. While walking through the parking lot at Kaiser Hospital, Ira and Luanne saw this license plate on a patient’s car:
Wonder how that got by the DMV?
Anyhow, the second colonoscopy was successfully completed. The gastro-enterologist who did both procedures came in to tell us his findings (or lack thereof). When he entered the recovery room he brought a chair with him and sat down. Now you don’t need to have had a lot of medical procedures to know that when the doctor sits down (or tells you to sit down) it’s not good. "I found a mass and it is cancer”, he said. Not even “found a mass and let's wait for the biopsy results. BAM! CANCER!. He did say it was not blocking the colon, it was high up (along the level of the appendix) and a CT scan would be needed to determine more.
Well, the prep for a colonoscopy covers the prep for a CT scan, so we trudge down to radiology (Luanne is actually feeling pretty good) and a scan is done that afternoon. Off we go the next day to Santa Cruz for Thanksgiving with Jeremy, Jessica and Kaia. On the way there the gastro-doc called to tell us that the results of the CT scan show no indications of cancer outside of the location in the colon. YES! Not stage 4 cancer; only possibly stages 1, 2 or 3.
So what does that mean? In these three stages surgery is performed laparoscopically (through small incisions in the abdomen), the mass and any surrounding areas removed and cleaned up, along with lymph nodes if required. At this time the surgeon determines the stage of cancer. If it is stage 1, Luanne recovers, doesn’t lift anything heavier than 10 pounds. for 3-6 weeks (that rules out her purse) and lives happily ever after. If it is stage 2 or 3, Luanne recovers and goes through 3-4 months of chemo and lives happily ever after. Other than having had cancer, neither sounds like too bad a deal.
As you all know Luanne works a strong program of recovery, has an amazing support system and years of practicing one day at a time make living one day at a time so much easier. Both Luanne and Ira are really OK. People in crisis/trauma often say that, but it is true in our case (people in crisis/trauma say that too!). Fortunately an option here does NOT seem to be death, and that really makes things a lot easier. We know if we need anything we can call on all of you, but for now we are good.
A surgical consult is scheduled for November 27. Come back for more info afterwards.