The big day

We finally met with the surgeon, Dr. Freeman this morning. Ultimately the purpose of the appointment was to discuss whether or not Roger is a good surgical candidate to have his esophagus removed (esophagectomy). So, unlike our last attempt to meet with Dr. Freeman, we actually made it to the appointment, checked in, and met with the doctor. To cut to the chase, a date has been set for the surgery.... Monday, December 14! Basically, we had two options ~ either the 14th or the 28th. The doctor wanted at least 6-8 weeks between the last radiation treatment and the surgery....which is the week of the 14th. The doctor's schedule is pretty limited because the procedure is estimated to take 6 hours - so a whole day is pretty much blocked out for the procedure on the doctor's schedule. Again, Dec 14 is the day.

One of the first things out of the doctor's mouth today was how pleased he was that Roger was doing really really well in his treatment. Dr. Freeman was genuinely pleased/excited that Roger was sooooo healthy. He said that Roger is an excellent surgical candidate and should do well with the surgery because he is so healthy. Separately, from Dr. Freeman, Lisa (Dr. Freeman's surgical nurse) also expressed the same excitement/enthusiasm with how healthy Roger is and how well he should be able to do with the surgery. Both of them repeated that Roger should come through the surgery well. Both independently said that Roger is much much better off than most people who have the surgery.

Dr. Freeman proceeded to explain the surgical process, the time frame, and the recovery as well as answer our questions. The process: we go in at 6:00 am. Roger will have a serious of tests, blood work, etc to make sure that he is "ok" for surgery. He will then have the surgery wherein they make an incision in his chest approximately 4-5" to free the stomach from the esophagus. Then a second incision, even smaller in size, will be made on his right side under his arm pit. At this second incision site, the doctor will spread Roger's ribs to access the esophagus and free the lower 2/3 of the esophagus to be removed. The stomach is then moved up and rotated. A portion of the stomach that was near the cancerous site in the esophagus is removed to insure a "clear field" from the cancer. A small section of the stomach is then used to create a new small esophagus that is then attached to the remaining 1/3 of the original esophagus. During the operation, a feeding tube is inserted into Roger's small intestines; this will be used to give Roger hydration and nutrition until he is able to drink/eat by mouth. Roger will then spend 2 days in the thoracic intensive care. He is expected to be in the hospital a total of 7-10 days.

The day following surgery, Freeman said that they will have Roger is supposed up and moving. The 7th day after surgery, they will have Roger do a swallow-test to make sure he can swallow and to make sure there is no leakage at the incision areas of the stomach and remaining esophagus. If there is no leakage, they will try to get Roger drinking more and ultimately eating soft foods.

Roger will have an epidural for pain while in the hospital. The greatest pain that he is expected to experience is from his ribs being spread. As explained by Dr. Freeman, the other areas including the incision sites, while painful should be the least of the areas of pain. Dr. Freeman said that the pain is not as intensive as a broken rib, nor as long lasting but is painful nonetheless. He said he was confident that they could help Roger manage the pain.

When Roger is released from the hospital, according to Dr. Freeman, he will be able to move around and function well. Of course he won't be back to "normal" but at the same time he won't be an invalid. Dr. Freeman and Lisa both said Roger will not be released from the hospital until they are comfortable that he can get around. Roger's sister Denise, recently expressed concerns about Roger's recovery (based on her experience from similar surgery 23 months ago) that Roger would not be able to go up/down stairs and thus would have recovery issues in our house. We shared the same with the doctor. He looked at us and said, "No. That should not be an issue for you at all. You should be able to get around just fine ~ you should be able to do stairs. We're not going to let you out of the hospital until we are confident that you can be mobile safely". Roger's surgery is much less invasive (though VERY invasive nonetheless) than Denise's...so the recovery, sounds like it may be slightly/somewhat different. It sounds like, if Roger is able to get his nutrition via mouth, then they will remove the feeding tube early...maybe within a couple weeks after the surgery.

The greatest area of concern for the surgery is potential "leakage" from the site where the stomach is reattached to the remaining 1/3 of the esophagus. Though not expected, if there was leakage then a second surgery would be scheduled to remedy the leakage.

It was a day of mixed emotions: 1) fear of the coming surgery, 2) general anxiety from this whole process, 3) a sense of resolution...we finally have a date... like I said, everything. Its the full gambit of emotions. Its pretty exhausting to run through all of these emotions in the course of a week let alone in a single hour. As with the past several months...one day at a time....breathe in...breathe out.

Now this day would NOT be complete without at least one classic "Roger Moment". Allow me to set the stage: this was during our conversation with Dr. Freeman. We both had been peppering him with questions about the procedure, Roger's recovery, etc. Dr. Freeman had just explained that Roger's stomach would be moved up into Roger's chest area and attached to the remaining portion of the esophagus. We asked how this would affect Roger's eating habits in the future. Dr. F said that Roger would need to eat 5-6 small meals rather than 3 large meals (like bariatric patients go through after bariatric surgery). With a very sincere, very earnest look on his face Roger looked at Freeman and asked, "so, if I eat a large meal and am feeling full....will this make my boobs get larger??" Freeman, in his uber-professional doctor-mode, looked at us quizzically, initially not quite understanding the gist of the question and then the light bulb came on. He realized Roger's line of questioning.... "my stomach has moved up into my chest, when its full, its going to expand...I won't be loosening my belt because the stomach is higher so it must make my boobs grow bigger". Poor doctor. He turned a couple shades of red, started choking, chuckled a couple times, and responded "I'm not going there" . The appointment was pretty much over from that point on. Freeman basically ran out of the room. Roger leaned over to me and whispered..."bet you he'll remember this little conversation and ME when I'm on the operating table." Roger and his lasting impressions!!

You now know everything we know. We'll start thinking more about the logistics of the recovery and how much additional assistance we will need. We may approach additional assistance on an as need basis depending on how Roger is doing. Again, as referenced above, the doctor and his staff repeatedly stated that Roger should be mobile - though in some pain. We feel fortunate in knowing that there are so many family and friends out there ready to help anyway possible. And we promise to let you know when we need help.

More to come in the days to follow. Much love to all. R & A