Plans becoming more firm again

We have been in Louisiana for about 24hrs now and things are becoming a bit more firm.  We spoke with Dr. Boudreaux at the emergency room last night for a few minutes along with Dr. Rau who is a surgical resident, working with the carcinoid group.  Dr. Boudreaux scheduled yet another CT scan (that is three in about three weeks) which I did last night.

Late this morning, we spoke with Dr. Boudreaux again but for about 30 minutes this time.  He had Dr. Rau in tow along with a couple of (third year?) med students and we got a lot of more definitive information.  Nothing completely solid but it is solidifying.  At work, we often talk about a software freeze where no changes are allowed.  This is sort of a software slushy.

The CT shows that I do have significant tumors in the messentary and in the pelvis.  The tumors are starting to impinge on the main artery that leads to the messentary and the decreased blood flow certainly is not helping with the health of my intestines.  Dr. Boudreaux and Dr. Rau seem to believe that my recent (prior to the more critical obstruction) bowel behavior is more likely obstructive in nature rather than decreased blood flow in nature.

What this all leads to is that he believes surgery is an option and is necessary at this point.  The intent is that I will receive an octreoscan on Thursday the 12th.  This is a standard scan for carcinoid patients and gives a picture of where the tumors are based on their affinity for octreotide.  I have had a couple of these in the past and I did show up on the scans which is a good thing.

This scan will give a better picture of what is tumor and what is scar tissue.  Furthermore, it can be used during surgery to actually guide the surgeon's scalpel to find the tumors amidst the good and scar tissue.  This is done using what is called a neoprobe.  Neoprobes are, essentially, mini geiger counters that can be used to identify tumor from other.  They do need to wait a week after the original injection to perform the surgery (needed to let the body excrete the excess octreotide) which gives us a potential surgery date of 4/19.

This is going to be a VERY long surgery, perhaps as long as 15hrs to perform.  In the end, I should be as tumor free as is possible from surgery, leaving behind only the liver tumors or tumors too small to be identified by the neoprobe.

Of course, there are downsides.  The length of the surgery and the amount of bowel/rectum that may be resected leads to a higher chance of complications.  These include

• Death.  Of course, this is a possible complication of any surgery
• Abdominal infection.  This would certainly prolong my hospital stay and could lead to further rounds of surgery
• Temporary colostomy.  This would be required if the rectum required time to heal or if other work required that there be a bypass.  Not something I would like and it would require another surgery to remove the temporary bypass.
• Permanent colostomy.  Another bad outcome but people can still be active with colostomy bags although I don't want to think of taking an 80mph slapshot in a colostomy bag...

Recovery time would be about a week at the hospital (release around 4/26) with a couple of days in New Orleans to ensure that I am healthy enough to return home.  Overall, this schedule has us back home by the end of April which means we won't miss all of the rest of the kids' soccer season.

So, things are looking up at this point.  Dr. Wang may do the surgery rather than Dr. Boudreaux but they are both patient, methodical surgeons which is exactly what is required.  We may also get out of the hospital for a time between now and the surgery but that remains to be seen at this point.  I will continue to update this blog but my wife is updating her caring bridge site as well with less of the cold analytical side I am accused of having.

Thoughts and emails are always appreciated as well as contributions to my iPad beowulf cluster!