Update Xth...

After a few weeks of waiting around, this week has been a rush of physician consultations and decisions. Let me offer up the issues and treatment plan, and then move on to the “how am I doing” part of it all.

Before my recent trip, I got a call that Dr. Mike Pf, wouldn’t feel comfortable doing the microwave zapping we’d originally planned. The lesion is: a) too close to the divide between the left and right lobes, and b) on the outside quite close to the diaphragm. He might damage that muscle.

The best thing good doctors can do is know their limits. I’d hoped that the procedure that was least invasive would be the solution. This week, after my travels, I met with Mike and he went through all the imaging studies, explained the challenges for the technique he might have used, and apologized for not being able to meet my personal needs. He probably felt worse about it than I did.

The referral, then, was to Paul Hansen, MD. Dr. Hansen works specifically with hepatic surgery, meaning he basically only opens people up to work on their bile ducts or livers. In meeting with him today, he described laparoscopic surgery and the remedy he’ll use to quash the life from the liver tumor. It will cost me a day or two in the hospital, some recuperation time following..

Using a video camera and ultra-sound device, Dr. Hansen will isolate the tumor on the outer edge of my liver and utilize (this means “microwave” like we’ve said before, but here’s the formal name) radiofrequency ablation…or “RFA” to kill the offending cancer cells.

I’ve learned a lot in the last 48 hours. First, the reason an older technique, cryogenically freezing the tissue, is not indicated is that the liver has lots of blood flow. Freezing doesn’t cauterize any blood vessels, it simply turns the offending cancer cells into blocks of ice. If bleeding results, it can be quite a complication and would require additional surgery.

RFA, on the other hand, uses a “burning” technique that cauterizes as it goes. Offending areas are cut off from the other, healthier cells, and when the technique is accomplished complications are rare. In both procedures, the important step is to reach beyond the tumor cells to what we call “clear margins” when healthy tissue is alive and well…but not too far into the healthy areas to damage the rest of the liver.

I’ve scheduled this procedure to take place in a couple of weeks. I can cover some important work functions next week, and then ready both my mind and body for the challenge that awaits this next surgical adventure. The doc will use a video-guided tool, with very small surgical entrances to find the tumor on my liver and lift the diaphragm out of the way. It will self-cauterize, no bleeding is anticipated.

After lying around for a weekend watching fancy HD football, I should be fine to return to work. There are chances that I’ll be more sore than anticipated, because my liver has been impaired by chemotherapy in the past. The good news is that livers rejuvenate themselves, and are the only organ known to do so. Mine may rejuvenate on a different schedule than most, in that is has seen some pretty powerful poisons over the past two years.

For the most part, though, I was delighted with the approach and suggestions of the new doc. It was nice of Jillian to come along today, to hear the many different options and learn from the docs. Both of the doctors with whom I met today look about Nate’s age. Dr. Hansen has done several hundred of these procedures, and has specialized in the work related to the liver since he got his medical degree. I hate sitting in an exam room and being reminded that “metastatic disease changes what we have on our plate.” I’d prefer to be a hobbyist, barely knowledgeable of the challenges and prognosis facing me. Now, I’ve become more than an amateur, almost a professional, at cancerous diseases of the colon and liver.

I’m sorry that everyone has to watch this journey with me, and certainly appreciate the care and concern than you all express. Trust me, if I could make it simply go away, I would. We’ll get this handled in the next couple of weeks, and then we’ll move on to the next scan, hope for the best, and look ahead to Winter.

I’ll whip out another update on the eve of surgery, and keep everyone informed as we go. Thanks so much for your prayers, thoughtful cards, and fun phone calls. As Billy Schlager says, TCTFO….we’re taking it one scan at a time and one procedure in step with the next. If you have questions, or want to know than I’ve posted here, just zap me a note and I’ll answer as best I can.