They are and they aren't. We do know I am going to have surgery down here and it is looking more and more likely that it will be Dr. Wang performing the surgery. The bad news is that it may not be until the middle of May and there are two reasons for this.
The first reason is that Dr. Wang's schedule simply does not support it right now as he has several conferences at which he is an invited presenter and needs to attend. The second reason is that the FDA is doing a bit of re-evaluation of the the nano knife technology. Nano knife has been used in well over a thousand cases since 2009 but it was somewhat rushed through the FDA approval process because of its similar characteristics to other tissue ablation processes. Dr. Wang believes that this will be completed by the end of April.
From what I have been able to read, it looks like they got approval to use the nano knife device for general surgical ablation of tissue. Their advertisements then seem to sell the technology for treating specific situations which is an error on their part since these capabilities have not been demonstrated in FDA approved tests. Basically, they are claiming something that the FDA does not believe has been proven. There may be a more recent FDA issue with the nano knife but I have not been able to find it.
That said, Dr. Wang seems to be very happy with the performance he is getting out of the nano knife. From what I can understand of the technology and physics, it makes sense that it would perform the way that they are describing.
There is a cool video on the use of nano knife and how it functions. Ablation techniques kill off cells with one of a number of forces, typically heat (Radio Frequency Ablation) or cold (Cryo ablation). The problem you run into with the other techniques is damage to adjoining tissue is ill-defined. This means that RFA cannot be used close to important tissues such as veins, arteries, or ureters and my situation involves at least two of those situations.
Without the nano knife, the surgeons would need to use old fashioned scalpels to remove the tumor and that also is fraught with potential error. Nano knife would give a higher likelihood of better margins without destroying the adjoining tissue. Obviously, this would reduce the likelihood of death, temporary colostomy, or permanent colostomy which is a good thing!
So. What do we do now. I have been on a full liquids diet but started cramping up yesterday so we limited my full liquids somewhat but without any success as I threw up lunch today. Food by mouth was intended as a supplement to the TPN that I have been receiving but TPN has issues. Basically, it is just sugar water with amino acids and electrolites and it is going in through a PICC line (essentially, a super duper IV). This means that TPN is relatively expensive, caries some risk (infection and PICC line maintenance), and can lead to pre-diabetic conditions.
What Dr. Wang is proposing as an alternative is a Gastric-Jejunostomy tube be installed. This will allow insertion of predigested food directly into my small intestine and will allow me to vent any gas that builds up in my stomach. This would be done in two steps. First, a Gastric tube would be installed and, a couple of days later, this would be upgraded to a GJ tube.
This would allow me to 'feed' myself at night and then close it off during the day time. Since the food is predigested, it should not back up in my small intestine and would give me the ability to live a bit more freely. There are fewer side affects to a GJ tube as well so that is a positive result.
So, now we need to decide. GJ tube or TPN. We are leaning towards the G tube installation on 4/13 with the GJ upgrade on 4/16 and then returning home to wait for the surgery with both the nano knife and the neoprobe. The combination of those technologies should lead to the best possible outcome for me. Dr. Wang performs his long surgeries on Wednesdays and Thursdays and my birthday is on a Thursday in May. Finally getting my surgery would be a very nice birthday present!
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