Surgery

We met with Dr. Flores at Memorial Sloan-Kettering yesterday. He started off by stating that there is no way to know whether the nodules in my lungs are actually metastases until they are tested and talked about doing a biopsy. He was then called out of the room to take a phone call. When he returned, he stated that had called Dr. K but wasn't able to reach her. (Apparently, she failed to call him prior to my appointment as she said she would.) He asked what she recommended. I said that she had suggested after my April scans (which showed stability) that he might want to do surgery to remove at least the largest nodule in my right lung, but that she had sounded less confident when I spoke to her after my July scans. I then said that Dr. Healey advocated removing them.

He asked me what I wanted to do, because he wants to know how agressive the patient wants to be. We then discussed the quality of life issue involving my cough, and he agreed with the pulmonologist I saw that the large nodule in my right lung was the likely culprit. Ed mentioned the other option, which was not to do surgery and try a more potent chemotherapy treatment, but Dr. Flores said the end goal of that would be simply to reduce the size of the nodules and then do surgery. Since the goal is to remove them (and find out what they are), he said that he would recommend surgery on my right lung to remove all the nodules he could find and then at some future date, he would do the same surgery on my left lung. We all agreed that this is a better plan than stepping up the chemo, which would damage my immune system and certainly not cure anything.

Since we have a trip to Las Vegas planned and a wedding to go to in mid-September, plus some work timing issues, I asked if the surgery could be put off until mid-October and he agreed. The plan is that I will either continue on Gemzar or be off chemo until mid-September and then have scans again. I will then meet with Dr. Flores again to schedule the surgery. He said that he would perform a wedge resection (where he removes the nodules along with some of the surrounding tissue) using VATS (video assisted thoracic surgery), but if he could not get to the nodules using VATS, he would have to open me up. (I told him that following the surgery I would want to know everything he did, but prior to it, I only wanted the basics. The details would only make me more nervous.) If he can accomplish the job using VATS, I would be in the hospital for about two days (and out of bed on the second day) and home for four weeks. During that time I believe I would be working to regain full use of the lung.

I asked him if there were anything I should be doing to prepare for surgery, and he suggested I "remain active and exercise." Music to Ed's ears! As you all know, I am not an exerciser -- never have been, never enjoyed it, and never will. However, I know that I need to get my lung capacity up prior to surgery in order to make the recovery easier -- which will, of course, involve more exercise. So in addition to all the other ways that cancer has changed my life, it looks like this is another one. Ed's thrilled and I am less so, but there are things one must do whether one wants to or not, and this is one of those things. Why can't eating chocolate be something one must do??

I need to discuss this timetable with the boss, who is away fishing this week, but I believe this is the schedule we will stick with. It allows me to enjoy the rest of the summer, take the two trips we planned, get my major work commitments out of the way, and wrap up some loose ends. In the meantime, I continue to take my pills, which have been reducing the frequency and severity of my cough. The prescription did not come with a refill, so I have contacted the pulmonologist's office to see if I can get a renewal.

I feel somewhat relieved to know this is practically a done deal, although I still have to get through the bone scan and MRIs at the end of this month. We'll keep our fingers crossed that the bone mets are stable and nothing new shows up, and then we can proceed.

I hope your August is going well thus far. It's hard to believe that my time home is almost up. I need to pack a lot of enjoyment into the next two weeks!