Home Sweet Home
After a series of hospitalizations, I’ve finally returned to Phoenix and am on the road to recovery. The past month has been grueling, to say the least, but it’s nice to be in the comfort of home.
Despite the interruptions, overall things have are good. The surgery was generally successful and while we obviously don’t yet know the long-term impacts of it, things went quite well.
As I’d mentioned earlier, the first step of the procedure was a diagnostic laparoscopic procedure, which was intended to confirm that there was no extra-abdominal spread of the disease. (In essence, if things have metastasized beyond the abdominal cavity, then HIPEC is no longer a good option.) The diagnostic also provided a detailed accounting of just where the tumors were and how much of my abdominal region was affected. The CT and PET scans don’t do a good job of imaging these smaller tumors, so until the surgeon went in laparoscopically, the only indication we had of the extent to which my abdomen was infested with tumors was from what the surgeon who conducted the colon resection in February saw.
On the first count, the surgeon determined that things were still contained to the abdominal cavity. On the second count, the diagnostic laparoscopic procedure showed that the spread of the tumors throughout my abdomen was rather far-reaching. Before deciding whether or not to go forth with the cytoreductive surgery and heated chemo treatment, surgeons will assess the spread of cancer throughout the peritoneum using something called the Peritoneal Cancer Index (PCI). Each patient is scored on the PCI, which ranges from a low of 0 (no tumors) to a high of 39. Anything above 20 is considered to be “extensive carcinomatosis,” and most surgeons who undertake the HIPEC procedure use a cut-off somewhere in the mid-to-high 20s to determine patients who are or are not appropriate for the procedure. I scored in the mid-20s, keeping me on the right side of the cut-off and the surgeon decided to go ahead with the procedure.
Given the extent of the disease, the procedure went as well as could be hoped. I spent approximately 12 hours in surgery — a bit longer than we had initially expected, but it took some time to try to cut out as much of the diseased peritoneum as possible. The surgeon estimated he’d been able to remove some 60-70% of all the visible tumors, and essentially removed the entirety of my peritoneum.
The goal, of course, is complete cytoreduction — that is, complete surgical removal of tumorous tissue. While this wasn’t possible in my case, what he left were the tumors that, if removed, would’ve entailed removing various portions of organs or other material that would have significantly reduced my quality of life. This was something we had discussed with him during the pre-operative consultation; while I want to receive very aggressive treatment, the goal is to make sure that the procedures used to extend my life do not make life less enjoyable. It can be a somewhat imprecise trade-off, but I was comfortable leaving my surgeon to decide when he was operating on me what was worth doing and what wasn’t. So, in the end, I lost my gallbladder, lost a small portion of my diaphragm, and my peritoneum, but kept most all else (including my spleen, which, going into surgery, I’d expected would also be removed).
After such a long, intensive procedure, my in-hospital recovery went surprisingly quickly. I spent less than a day in the ICU (where one of the nurses told me I looked far too healthy to be), and then headed into the general ward, where I stayed for a little more than one week. It was a shorter stay than expected and was surprisingly pleasant. I had a room to myself, had my parents, brother, sister-in-law, and, of course, Heather, and had an excellent team of doctors and nurses constantly checking up on me. (Let me take just a moment to recognize the excellent nursing staff of University Medical Center. They were consistently wonderful.)
Strangely, I felt less pain following this procedure than I did following my much smaller surgery in February. (February: 2-inch incision, August: 12-inch incision.) Indeed, I was rarely even requesting pain-killers by the end of my initial hospitalization. So, overall, the initial stages of recovery were quite positive.
Upon discharge, I ran into a couple issues. First, I had to be re-admitted because I was running fevers and having some abdominal pain and vomiting. Turns out I had a staph infection, a not-at-all surprising outcome when you’ve got a giant incision and you’re spending time around sick people. It was nothing that some antibiotics couldn’t treat. Then after returning to Phoenix for a second time, I started having issues with my GI tract once more and the surgeon was concerned that I might have a bowel obstruction. It turns out that it was more an issue of dehydration and the fact that my bowels, after being pushed around, poked, prodded, and heated up, were still getting back to normal function. So with that out of the way, we returned from Tucson to Phoenix once more.
I’ve now been back for a week and a half and I’m doing much better. It’ll take a while for my energy to completely return and to regain the 15 or so pounds I lost, as well as for my GI tract to completely return to normal. At the moment, I still get cramps whenever I eat and my stomach capacity just doesn’t seem to be the same as it was before, but these are things that should hopefully change with time.
The next step in the recovery comes tomorrow, as I go back down to Tucson to get my staples (37 in total) removed from my incision site, and also meet with my oncologist about my future treatment plan. As fun as it’s been to have a stomach glistening with shiny metal staples, I’ll be quite glad to see them removed.