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[Cancer]

[cancer] Pre-operative appointments

Yesterday I had two pre-operative appointments. One was with my surgical oncologist, the other was with a nurse-practitioner in the Pre-Operative Medicine clinic.

My surgical oncologist discussed possible alternatives to the surgery on 1/22, which mostly consisted of going off chemo and waiting a few months to see if the suspected new tumor developed into something more substantial. Given my doubling rates last summer, this seemed to all of us like a poor idea. We talked about the genetic testing, and they are prepared to fully support that, and will be working with Surgical Pathology to make sure the samples are correctly prepared and shipped to the lab where we’re sourcing the work. We also talked about freezing additional tumor tissue should further testing be warranted. My surgical oncologist cannot guarantee that will happen, but they thought it perfectly reasonable and will talk to Surgical Pathology about that as well.

We reviewed my idiosyncratic issues, specifically my extreme digestive reaction to opiates, as well as my recently developed severe contact allergies to virtually all medical adhesives. I asked that the OR team use Duoderm for dressings, and coban where possible. They will work on an anesthesia and pain management plan that minimizes my opiate exposure, as we did on the last surgery. (Otherwise what happens is pathological constipation, which means I do a ‘bounce back’ hospital readmission, and have another one of the most unpleasant nights of my life.)

I was also provided with pre-operative instructions.

The only surprise to me in the consultation was the surgical oncologist’s comment that my
liver had adhesions, and was stuck to both my colon and my stomach. This will lengthen the surgery, possibly by hours, as they work to trim away that scar tissue and free my liver so it can be extracted and examined. They will then work with the surgical pathologist to inspect my liver both visually and with an ultrasound scanner looking for any identifiable lesions. They plan to excise the two biggest tumors, and presumably the third one, though radiofrequency ablation may be used there. They will also be examining the fourth site for evidence of metastatic disease and taking whatever steps are required there. The goal is to eliminate all known disease sites and return me to NED (No Evidence of Disease) status.

My surgical oncologist spoke of the possibility that the fourth site was a testing artifact or some other interpretive error, but they didn’t sound like even they believed that. I asked if it was possible this was a newly emerging tumor which was below the resolution of the MRI, on which there is no evidence. They acknowledged that could be the case. In other words, we’re still where we have been since the test, and won’t know more until after the surgery.

I should receive a call from the hospital schedulers on Friday with an arrival time for Tuesday. Given the probable length of the surgery (7 hours, perhaps, based on prior experience), I assume this will be another 5 am check-in or some such on the surgery date, 1/22.

Two hours after my consult with the surgical oncologist, I saw a nurse-practitioner in the Pre-Operative Medicine clinic. Nothing surprising happened there, and they have cleared me for surgery. They also provided pre-operative instructions, as well as a pair of informative brochures for my review. (My treating hospital has been on a big quality and customer service kick lately.) Amusingly, the two sets of pre-op instructions are slightly contradictory.

So that’s all the print that’s fit for new, for now. I don’t expect any further information or action until we know the surgical outcomes, and I won’t be in a position to comment on that for days after. I am planning to give the keys to both blogs to Lisa Costello, who will provide any significant updates while I’m incapacitated. Be nice to her in comments.

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