Recovering From Surgery

Recovering From Surgery

It has been a little over 7 weeks since surgery.  I would say my recovery is going pretty well since I last posted on September 29.

We met with Dr. Dunst, my surgeon, about 4 weeks after surgery.  The weekend before that meeting I started drinking and eating different liquids and soft foods, the first I'd had through my mouth since surgery.  We reported the results to her and she gave me the green light to eat anything, but to be really cautious with each new food - little bites, chew a lot.  The only foods she warned me off of were steak and carbonated beverages.  She also reduced my time on the food pump from 18 hours a day to 8 hours a day.  I'm getting about 1000 calories from the food pump and the rest through eating.  I've held my weight steady at around 228, which is at least 23 pounds overweight.

I've been working at the office for three full weeks, starting just after I was reduced to 8 hours a day on the food pump.  Prior to that I was working full time from home for a couple of weeks.  My total down time from work was about 2-1/2 weeks.  I did not work at all for the two weeks starting on my surgery date and I worked 1/2 time for the 3rd week.  Sitting in front of a computer monitor and working is not very much more taxing physically than watching TV.  I was paid the entire time.  I had a week of vacation and the rest was covered by disability insurance that Symantec had.  What a great way to spend my vacation.

I've been walking for exercise.  For the last 3 weeks I've been walking with Steve Zeigler and Steve Scalpone during lunch at work.  We have a loop mostly through parks and on trails that is about 2-1/2 miles.  My brother Powell joins us on Friday sometimes. On the weekends I walk with family.  Here's a picture of Martha and I on a walk last Sunday (10/27) taken by Caroline:

I'm still kind of tender in my abdomen.  I feel some pain in two specific places, one is at the biggest scar, when I move in certain ways, mainly picking something up with my right arm or pushing with my right arm.  It is repeatable.  But interestingly, it goes away while I'm walking.  So it may be more a stiffness pain.  But it is real when it happens and it hurts a little.  I definitely adjust what I'm doing to avoid it.  Getting in and out of the car is always adventure.  I used to grab my laptop and get out with it in my hand.  Now I just get out then walk over to the passenger side door and grab the laptop.

Oct 30: Chemo Round Two Begins

Oct 30: Chemo Round Two Begins

I just finished my first round of chemo.  My schedule is to go 4 times, once every 3 weeks, so I'll be done with treatment 9 weeks from today if all goes as expected.  As I well know, done with treatment does not mean it gets better.  The 3-4 weeks after my last chemo session will be when I'll feel the worst.  Also, I will definitely lose my hair this time.  

I had chemo and radiation over a six week period prior to surgery.  Why am I having a second round of chemo?  When my surgeon, Dr. Dunst, removed most of my esophagus she sent all the tissue to pathology to be examined.  The report came back that I had six lymph nodes and three contained live cancer cells.  The original tumor had shrunk, but had not been totally "killed".

Only six lymph nodes?  Dr. Dunst said this number is unusually small, she said the pathology lab knew she'd be calling back so they double checked.  Yes, only 6.  She expected the number to be in the 15-22 range.  She does not know why there were only 6.

Three of six lymph nodes have live cancer cells in them.  This fact is why I'm in chemo for a second time.  The cancer cells have proven they can "travel" since they've moved to different lymph nodes.  Have any live cancer cells gotten out of the lymph system and traveled to other parts of my body?  There is no data to know this right now.  I've talked with three doctors about this, my surgeon, my original oncologist (chemo guy), and an oncologist Dr. Dunst really respects at her hospital.  All three said "we do not know if cancer cells have traveled."  All three seemed to say either "it is likely" or "why take a chance?"  That is, you should have another round of chemo.  So I am.

I've been dreading this day for weeks, ever since Martha and I decided it was the best course.  The chemo drugs I'm taking are quite different than last time and being given at full strength.  In the original six week chemo-plus-radiation, the purpose of the chemo was more to enhance radiation than as chemo by itself.  Also, the fact that I was taking chemo every week meant (I think) that they had to give me a less powerful dose.  I believe my Oncologist said "50% strength".  Now I have a 3 week interval between treatment in which to recover so I'm getting full strength.

Sep 29: Healing, Tethered to the Feeding Tube

It has been 10 days since I got home from the hospital.  For 18 hours a day I am tethered to the feeding pump.  This is roughly 6pm to 12 noon.  Then from noon till 6pm I am free.  I do mostly the same stuff when I'm free as when I'm tethered.  Martha and I go to the track at Southridge HS so I can get some exercise.  I walk at least 1/2 mile, sometimes 3/4 at a session.  One day Martha and I went twice, once right after I unhooked and once before I hooked back up to the pump.  Powell came over and walked with me on Friday.  It was raining and a little windy.  Yesterday the rain was so bad I did not go.  Today may also be a too-rainy day, we'll see.

I spend 99% of each day just hanging around the house reading, browsing the internet, watching TV etc.  I am working 1/2 time (since Wednesday) and I start working full time this coming Wednesday.

I have had nothing to eat or drink through my mouth since the surgery, which will be 3 weeks ago this Wednesday.  We meet with Dr. Dunst (my surgeon) a week from Tuesday.  She wants me to have tried some liquids (including a milk shake) before we meet with her.  I'm going to start the liquids on Saturday.  Slowly, water first.

I have had no serious problems.  When I first got home I could not sleep on either side - my abdomen hurt too much when I tried.  Now I can sleep on both.  This makes a big difference and I'm sleeping ok.  Not great, just ok.  The problem is I'm getting water automatically and have to get up to go to the bathroom a few times a night.  I have to haul the pole (see below) along with me, so it wakes me up.  The only two problems I have are:  my breathing is shallow and my lower back muscles hurt if I stand for very long, almost like they are getting ready to cramp.  The shallow breathing must have been an expected consequence of surgery since they gave me a device to measure how much breath I could take in and told me to work on increasing it.  Why the back muscles seem to be cramping, I do not know.

The Pole, the Pump, and the Feeding Tube
The formula,"Jevity 1.5", and water are pumped directly into my upper intestine.  The formula is pumped at a rate of 90ml/hour.  90 ml is not that much.  The formula and water are hanging in bags off a 5-1/2 foot pole.  The pump is a little blue box, "the Kangaroo Joey", that is also attached to the pole:

If you look carefully you'll see a small tube dropping down out of the middle of my sweatshirt.  You cannot see the entire tube, but the other end comes back up and into the pump, between the black power cord and the pole.

Martha is the expert on setting up the pump each day.  She has been my hero. She learned it how to operate the pump at the hospital from one of the nurses who was really helpful (Sabra).  Martha sets the pump on totally automatic - it switches back and forth between food and water.  All we have to do is make sure the bags do not get empty.  Martha does all of that also, except in the early morning I top off the bags.

The tube from the pump connects to the feeding tube which was surgically placed in my abdomen:

My hand is holding near the end of the tube from the pump.  That purple thing at is kind of like a nozzle that fits into the feeding tube.  The feeding tube is the sort-of-Y-shaped gizmo that says "JEJUNAL" on the side.  For the 6 hours or so when I'm detached from the pump, I just tuck that small tube including the Y-shaped gizmo in my shirt.

Going Home Tomorrow

Wednesday Evening.

I am leaving the hospital and going home tomorrow.  We're outta here at 12:00 noon.  There is a lot of anxiety about what feeding tube/pump we'll have at home.  The home-care company that my insurance company contracts with does not supply the same exact pump that we've learned on here.  My doctor has prescribed 18 hours on the pump and 6 hours off every day.  I'll be receiving 92 ml of food an hour for a total of 2300 calories per day.  The Jejunostomy feeding tube is very narrow, I'm guessing about ~3/16" diameter on the outside and at least half of that diameter is tube wall.

We've been getting contact info so if anything goes wrong at home we have people to call.  We have to worry about all meds we're getting because nothing can be taken through the mouth for 3-1/2 weeks, everything have to go through the feeding tube.  If available, we get elixers (like Children's Tylenol), if not we have to get pills we can grind down into very small powders, then dissolve in water, then manually push it with a big syringe into the tube.

As I said: 3-1/2 weeks.  I hope I can make it.

The nurses and the doctors (and Powell) have all said I am doing great.  I walk at least 5 or 6 times a day around the loop on this floor.  Today I started walking up stairs.  The first time I did 1-1/2 flights and was getting winded.  My nurse stopped me as she got nervous.  The second time I made it up 2 flights of stairs and was definitely panting.  We took the elevator down.

Powell has been in every morning this week to visit.  Lori came with him yesterday.  It is good having visitors.  Julia (my niece, Powell and Lori's oldest daughter) came by for a while today.  She got here about about 5 min. after her Dad left.  Julia was really dressed up because she was going to an interview when she left.  Every night my family comes by.  Martha's friend Stephanie Quirk came by one night and Caroline's friend Devon came by.

Some Visitors

Martha, Steph, Paul and Amy

Dave and Veda

Surgery: day 4 post op

Written by powell

Sam is in good spirits.  He was reading stuff on the internet when I walked in.  He self administered pain meds 3 times today.  He could be taking 4/hour so he seems to be doing well.
o 6:30am to get out of bed
o 9:00am before the walk (was not in pain just anticipating it)
o 11:30am after getting back into bed, sore back.

Sam took three laps.  No problem, no pain.

The Dr. said best case, absolute best everything goes perfect, could be three more days in the hospital (anticipating longer).  Food tube is delivering 15cc/hour and just got upped to 30cc/hour.   Hard to tell how well the food consumption is going, no diarrhea - good,  no poop - bad.

Sam is hungry.  Not even a drink of water is allowed.


Go Shockers:

Surgery Recovery, Day 3 - Evening

This is Caroline.

Dad obviously posted the earlier post, and gave you a clear overview of the morning and early afternoon.

He had his first guests this afternoon.
He has been talking more (than yesterday) to my mom, Kevin and I, and watching college football.

He walked around the floor a few more times than yesterday, and is actually getting ready to go on another walk with the evening nurse (whom has been his nurse for the past two nights). Real Time: They just made one loop and he passed the room saying he wanted to make a second loop, and they are off...This is the first time he has completed two loops of the floor. The nurse claims the floor loop is 1/15 of a mile.

He is still commenting on his breath and noticing the difference of breathing post surgery than before surgery when he did not think about breathing. Dad has now returned and he and the nurse are talking about breathing...He especially notices it when he gets in and out of bed and when he sits down in the chair or gets back in bed after walking. He is also on the same drug that he can dispense himself, and it sounds like the nurse might give him some Tylenol to help with how he feels at certain times when he is breathing.

Not that dad has paid attention, but I think the view could be worse...The image below is looking west.

Surgery Recovery, Day 3

I've been moved to room 740 in the Cancer Tower at Portland Providence.  Exit 3 off of I-84 then head back west on Glisan to 47th.  The easy access is from 47th, just south if I-84.

I am alert enough to sit at a computer and type in my blog for a while.  The picture that Caroline posted yesterday shows Dr. Christy Dunst, my primary surgeon, and Dr. Radu Peskaro who is a fellow under Dr. Dunst's tutelage.  He can write orders.   He came by this morning and said it is time to get onto the feeding tube.  We begin with 15 ml /hour.  If everything goes well, it will ramp up over time to 100ml/hour.  So far, the only "feeding" I've had is from saline IV's.

I took a walk last night around 12:30a when I woke up with a headache and was feeling kind of lousy.  That walk was very short, after about 40 feet we turned around and came back.  I felt worse.  This morning at 8:00a I walked around a loop that might have been 60-80 yards total.  I'm feeling better and planning on doing that again in about 20 minutes.  Then a sponge bath.  Then I'll get back in bed and hope that I haven't over done it.  I know that if I've done too much I'll feel bad.  On the other hand, when a slow walk of 80 yards is overdoing it you realize how much much further you have to go.

The doctors have thankfully removed a lot of tubes that were connected when I came out of ICU.  There was a tube through my nose into my stomach to suction out any stomach contents.  That really irritated my throat, which was incredibly sore for two additional reasons: (1) the breathing tube and ventilator and (2) the main incision through which the operation was performed was high up on my throat.   Here is the incision in my throat, you may have to blow it up:

They removed the bladder catheter.  They like to remove those as soon as possible because they are primary source of infection.  I was under anesthesia when they put it in.  It felt really weird coming out like it kind of hurt, but when it was out I felt fine.  I was very nervous about the first time I urinated without the catheter, but had no burning.  Since it is difficult for me to get in and out of bed, they give me a "urinal" (which is kind of like an empty plastic milk bottle) which I use while in bed.  Guys have it a lot easier then girls.

They removed two IVs from my right wrist, one was arterial. I'm getting all IV stuff through the one in my neck, which everyone refers to as "a main line".

Finally they gave me this breath quantity measuring device to help me improve my lung capacity.  As I breath in, beyond a certain point it really hurts, due to the surgery.  Here's a picture:

Surgery: Status Update - 7:45 PM PT / 9.13.13

This is Caroline.

It is 7:00 which means the nurse change is currently happening in the room. The new nurse is his same nurse as last night. She is very friendly. In the midst of the change, the surgeon stopped by for about 15 minutes to check on Dad. Both times, I have seen her, she has been quite upbeat and friendly. The photo below is the of the surgeon and the man is on a fellowship with the doctor. This was the most upbeat and talkative Dad was all day, today.

He took another walk, which is encouraging. The doctor wants him to walk and breathe into a small box (where when you breathe a small ball moves. The object is to get the ball as high as possible).

Otherwise, not much has happened since a few hours ago...

Surgery: Status Update - 5:45 PM PT / 9.13.13

This is Caroline.

Not much knew has happened or changed since I last wrote, except my dad appears to be sound asleep. We are hoping he can sleep for a while, or at least until the next nurse arrives...

They did up the medicine he can dispense himself to double the amount (since he was not taking it enough as he should have been the past 24 hours), so I am convinced that is making him extra drowsy and sleepy.

I will post a final update later...In the meantime, it's Friday, and past 5:00 PM everywhere in the US (except Hawaii), so if you happen to be enjoying a beer or cocktail, I encourage you to have an extra for my dad...

Surgery: Status Update - 1:45 PM PT / 9.13.13

This is Caroline.

Pain is still quite high and he seems a bit out of it today. Per the picture I posted last night, that smile is definitely not on his face today. He did sleep somewhere between 2 - 4 hours last night; however, the nurses do not document this piece of data, so we do not know for sure the exact number of hours. I am in the room and he is napping at the moment.

Earlier, he was very slowly walking around with the nurse. They are trying to make him walk every so often. He also used the bathroom.

They have been encouraging him to take the medicine in which he can dispense; yet, he is hesitant at times because it makes him feel drowsy. He is taking the medicine. Per what the nurses are saying, he could probably be taking more.

He would like to have glass of water, but he cannot swallow anything until, tomorrow (Saturday). The only thing "food wise" going into his body is something with salt through an IV that has zero calories.

Surgery: Status Update - 10:30 PM PT / 9.12.13

This is Caroline.

A few updates:

• Pain was a word we heard several times from my dad. Per my earlier post, he is now hooked up to some powerful drug in which he is able to dispense to himself once every ten minutes (if needed). The amount is programmed into a machine and when he needs the medicine he clicks a button. The nurse assured him that there is no way he could overdose. The epidural that I also mentioned today, did not take, in which allowed him to feel much pain in his abdomen this morning. The anesthesiologist that was with him during surgery, stopped by this afternoon and confirmed that in fact the epidural did not take.

His surgeon also stopped by this afternoon and removed a few items...

• The catheter - An item that has been known to cause infections (specifically staph infections). They were going to give him a bucket type thing to pee in later tonight, so he would not have to walk to the bathroom the next few hours.
• The tube in his noise that was bothering him last night, was removed - He was quite pleased about this going away.

Additionally...

• His throat is still quite bothersome (despite some items having been removed)...the three main items causing the pain: nose tube (which was removed), breathing tube ventilator (in which was placed in his throat during the surgery), and a mini tube that is running through his neck (still in place).
• They helped him get out of bed (the first time since before surgery) and he sat in a big, La-Z-Boy-like chair that is next to the bed. He also spent approximately 4 hours total walking around the nurses station. He said it felt good to walk around for a few minutes at a time.
• Dad is very, very tired. Since post-surgery, he has received only 40 minutes of sleep. We left around 8:30 this evening, and he was hoping to get some sleep, tonight.

To lighten things up a bit, the nurse this evening mentioned, "I am glad he is making jokes, despite being uncomfortable and in pain!"

*Still, no visitors are allowed. Once I get confirmation that people can visit and that my dad is OK with people visiting, I will post a quick post, as I know a few of you have been asking when you can visit (I would be the same way). I have a hunch it will be late this weekend. Yesterday was the surgery and today/tomorrow the nurses want to ensure he does not get an infection. On top of that, dad is hoping to sleep most of tomorrow and perhaps Saturday.

Surgery: Status Update - 3:00 PM PT / 9.12.13

This is Caroline.

Dad is still in the CICU and the pain is in full affect.

The epidural is no longer working, so around 2:00 PM they gave him a new drug to help ease the pain. They were also going to let him get out of the bed for a few minutes, as he has been lying flat since the surgery started yesterday morning.

He is talking, but his throat hurts like 'heck.'  It sounds like there is one drug that after he takes it, it helps ease the pain associated with the sore throat.

We are trying to not make him talk too much, as talking makes it worse.

He also mentioned pain in his abdomen area, due to the movement of so many body parts and the overall surgery.

He is also very sleep deprived and has not slept since before the surgery, or I suppose during the surgery. The nurse comes in to check on him approximately every 45 minutes, and there are a lot of people (nurses and doctors) and noises, in the CICU area, and also the fact that he is on his back. He never sleeps on his back, so being on his back, alone is not comforting. He is looking forward to when he can move into a more permanent, quieter room. It sounds like within the next day or two the move will take place.

On a more encouraging note, one of the doctors stopped by this morning and told him the surgery went very well.

Will post another update this evening...

Surgery: Status Update - 9:45 PM PT / 9.11.13

This is Caroline.

We heard the doctor say CCU, it is actually the CICU where my dad will be until at least through tomorrow. 

After I wrote the last post, Paul, Martha, and I were able to see Sam/Dad.

He was awake, knew who we all were, and seemed very literate. We had been informed a while back that he would be completely out of it and would not be speaking. He showed us where he was in pain – The nurse was in the midst of getting an epidural ready. He has a lot of IV's in him (as expected) including a catheter to pee and feeding tube, to feed him. There is a tube in his noise that he said was quite annoying. 

He did not look swollen (as we had previously been informed) and much different, aside from several tubes, IV's, and about a 4-inch incision on the left-hand side of his neck. His face is a bit pale in color. The other incisions are not visible when simply looking at him. The nurse could not believe at how alert he was after this specific surgery. She said patients are rarely smiling, and talking a few hours later. 

Typical Quiring male, they needed to increase the length of his bed, as it was a bit short.

We stayed in the room for about 30 minutes, and then it was a shift change, so we went to the cafeteria in the basement and came back up around 8:00 and said good night. Martha stayed a bit longer than Paul and I.

So far, he is recovering well.

Surgery: Status Update - 5:30 PM PT / 9.11.13

This is Caroline.

The surgery was complete about 45 minutes ago 4:45 PM PT.

Paul, Martha, and I just met with the surgeon.
She seemed very upbeat and said everything went well, and that his body is responding well to the surgery.

He will be transferred to CCU within the next hour. He will be in the CCU for at least one day.
*No visitors are allowed at this time. We will let everyone know when people can visit. It sounds like it will be a few days before people can visit (they do not want to risk an infection).

We cannot thank everyone enough for your thoughts and prayers the past few months, weeks, today, and the next several days...

Surgery: Status Update - 3:30 PM PT / 9.11.13

This is Caroline -

The surgery began at 9:15/9:30 AM PT.
Mom just received an update from the operating room saying that everything is progressing nicely.

I believe there is around 2 - 3 more hours left.

Paul or I will post an update later this evening.

The Night Before Surgery

Sept. 10, 2013.

According to the instruction sheet in the mail, I am scheduled for: Laparoscopic Transhiatal Esophagectomy and Feeding Jejunostomy Tube Placement.  Say that five times really fast.  I just double-checked and all those words are spelled exactly like the instruction sheet.

Before going any further, I want to thank everyone who has wished me well, sent me email, called, sent a card, and told me that Martha and I are in their prayers.  I am humbled that so many good people are thinking about us.

The anesthesiologist just called me at 9:00 pm to go over what's going to happen tomorrow.  I could have used a lot less detail.  I'm going to get an epidural high up on my back that will provide good pain relief.  It will be in place for a few days.  I'll have many other wires and tubes, including a catheter through the urethra into the bladder.  I'll have an IV in my neck.  He went on and on.  Every time he used the words "discomfort", "some discomfort", etc. I chuckled and so did he.  I don't think I'll be chuckling when I am experiencing the discomfort.

We have to be at the hospital at 6:00 am.  I'll be put under a general anesthetic around 8:30.  Martha will have to endure the waiting room without the help of medication.  She will be joined by Caroline, Paul, and Kevin as the day progresses.  I hope they can keep each other in good spirits.  I am guessing surgery will take until 5:00 pm then an hour in the recovery room, then they wheel me into the ICU for the night.  Emphasis on "guess".

The anesthesiologist said that I will have a breathing tube (ventilator) during surgery.  They hope to remove it at the end of surgery, but there can be many factors that would make it better to leave it in until the next morning.  He emphasized that my family should not be alarmed if this happens.  As long as the ventilator is in, I'll be under full anesthesia.

For the last three to four weeks I have felt great.  I have gained enough weight that I've had to start watching what I eat.  Everything tastes great.  Well almost. I've started eating my usual breakfast of Fiber One cereal.  It doesn't taste that great.  Barbecue Rigs?  Great. Pizza?  Great.  Chips and salsa?  Great.  And finally beer has started tasting normal again, which is great.

I maxed out with worry and stress over the surgery about three weeks ago.  I think that numbed my brain so I'm not very anxious any more.  The human brain is amazing.  Talking to the Anesthesiologist made me a little anxious (I felt some discomfort) but even that faded quickly.  I hope I adapt as well to the actual circumstances.

Feeling Good, but Dreading Surgery

It has been 4 weeks and 3 days since my last radiation treatment.  I've really started to feel better.  I can eat almost anything, but some stuff (beer, pop) still do not taste right.  I split a beer with Caroline last night before the Timber's game that tasted good.  I was very optimistic, so I grabbed another at half time -- it did not taste so good.  Oh well.  There were six of us a dinner at Thai Orchid on Burnside (Zeiglers and Steinfelds).  We ordered a variety of dishes and they all tasted very good to me.

Last week Steve Z and I did our normal 2.5 mile walk at lunch every day.  It is getting easier, but I'm still pretty tired and sweaty when we get done.  I do get much hotter than I used to and way hotter than Steve.  I have not started swimming yet, hopefully next week -- I put the towels and swim gear into my car yesterday.

My brother Sherwood visited last weekend.  It was a great weekend, I was really glad he came.  Sherwood, Powel (my other brother), and I toured the Columbia River Gorge on Friday 8/9 and as part of that we drove up to Larch Mountain and hiked to Sherrard point, about 3/8 mile uphill from the parking lot.  I had to rest twice on the way and felt a little light-headed at the sun-drenched lookout area.  I think if I did the same walk today I would do much better.  Here we are at Sherrard Point (left to right: Powell, Sherwood, Sam).

Every day  surgery draws closer and I get more nervous about life after surgery.  I try not to think about it too much.

July 29 - Aug 2: Improvements, finally

I'm starting to improve.  It is incremental improvement, not dramatic improvement, but I can eat more foods without serious pain.  I rarely experience nausea.

There are still a lot of foods which hurt after I swallow until I swallow some water, room-temperature water. I'm still pretty sensitive to temperature.  Cold foods like ice-cream, ice water, etc., hurt to eat or drink.  One of the most bothersome problems is taste.  Beer just doesn't taste good.  I think the more complicated something tastes, the less likely I am to like it.  Fritos taste great.

Strength is slow coming back.  I walked at lunch with Steve Z every day at work last week (Steve S. joined us a few times).  The walk was about a mile.  It was hard and did not seem to get easier by the end of the week.  When I wake up I still feel really weak when I'm brushing my teeth, almost like I might keel over.

I've started to get more regular.  I think the constipation and abdominal cramp issues are over, thankfully.

Every week surgery looms a little closer (Sept. 11) and becomes more real.  Martha shares with me some of the stuff that's going to happen after surgery, different "stages" of eating from "nothing through the mouth", i.e., feeding tube, for the first 4 weeks, then pure liquids only (Ensure, Boost), then pureed "a little bit of texture", etc.  At each stage I have to gain some weight to get to the next sage.  I'm dreading it.

July 22-26, The Week After Treatment

As the doctors predicted, this has been the worst week, by far.  Monday (July 22) I woke to a profound sense of fatighue and exhaustion.  Much more intense and real than what had come before.  But this was minor compared to other difficulties.

My last radiation was Thursday, July 18.  My esophagus continued to get more painful every day after that.  I went into work on Monday and Tuesday morning, but had to leave around 11:30a Tuesday, as the pain was dominating my thinking.  My radiation doctor had prescribed a general pain medication which I began taking as soon as I got home (Lortab).  This made me pleasantly drowsy so I slept through the afternoon.

As the esophagus pain got worse, it seemed to make me more queasy and eating became impossible.  I would only force down enough calories in the evening so I would not have a headache.

Wednesday morning I had an appointment with my medical oncologist (chemo doctor).  As I drove over, I started having abdominal cramps.  He told me to take a liter of IV saline right then.  I also mentioned to him that I had not had a bowel movement since Friday.  So he had me get a stronger laxative, Miralax.  The nurse administering the saline IV told me you take Miralax every 3 hours until something happens.  I took it at 3:30p, 6:30p, and 9:30p and nothing happened, except I had intense abdominal cramps the entire time.  I finally called the office around midnight.  The doctor sleepily said to stop taking Miralax, rest, come in for saline IV Thursday.  I did not sleep very much Wed. night.

Thursday I went in for another IV and they told me to get a suppository and if that did not work, a bottle of Magnesium Citrate.  The suppository did not work.  Magnesium Citrate comes in a 10oz bottle and is a very strong laxative.  I was supposed to take 5oz and if nothing happened within an hour take the other 5.  I took both and about an hour after the second dose I one diarrhea BM and an hour later one more.  Then nothing till Thursday night, when I had 3 or so more diarrhea BMs.  I may not have slept at all Thursday night.

The nurse who explained the dosage of Magnesium Citrate also told me that constipation and abdominal cramping seemed to be the two most severe effects of chemo.

Cramping Explained?

Most of Wednesday, Wednesday night, Thursday, and especially Thursday night were dominated by abdominal cramps. These are very uncomfortable.  Add in esophagus pain and queasiness, and I am hardly eating or drinking anything.  I think around 4:00am Thursday night, as I lie there in pain, one fact hit me.  Both on Wednesday and Thursday, before getting the saline IV I had abdominal cramps, but after the IV, the cramps were gone.  Maybe a big contributor to the cramping was dehydration.  I got up right then and forced down a big glass of water.  I think the cramping subsided a little soon after.

Friday morning the diarrhea subsided and there were no abdominal cramps and I was drinking lots of water.  My esophagus still hurt and queasiness was still there.  I started making sure I was getting more nutrients.  A nutritionist had given me a bottle of Boost and Ensure, two high-calorie, high-protein drinks.  I drank one Thursday night and another Friday.  Martha bought me some more on Friday.

I tried to work from home on Friday, but after sitting in front of my monitor for about an hour, I got this bad pain in both my lower front ribs that made me stop.  I have no idea what that was, but it was not the first time it had happened.  I'd had it last Sunday also.

It has been a difficult week for me.  I think I may be turning the corner now.  I'm still weak and light headed and my esophagus hurts, but it doesn't hurt quite as bad.  I'm able to eat more normally.  Hopefully this next week will see a big rebound.

July 15-19, treatment done, effects in full force

The good news is treatment is finished.  No more chemo and no more radiation.

However, all the doctors have said that the 7-10 days after my last treatment will be the worst of the entire treatment time because all treatments are cumulative.  So far this is proving true.  Muscle fatigue, esophagus discomfort, queasiness are all worse this weekend than any before.  So far no cramping since my last chemo.  Knock on wood.

Muscle fatigue is an effect of chemo therapy.  Imagine a simple activity like picking up the newspaper off the driveway.  On Saturday morning when I did this, my stomach muscles felt as if on Friday night I had put a fifty pound weight on the driveway and then reached down and picked it up fifty times.  When I do anything physical, the fatigue feels like I exercised the involved muscles to exhaustion the night before.

All I think about is that around this coming Thursday I should start to turn the corner.  The effects of chemo should start to wear off and I should start healing. Same for the effects of radiation.

Of course there is still esophagectomy surgery looming on the horizon.  It is scheduled for September 11.  It is a major, major surgery and I am expecting the recovery from surgery to make chemo and radiation seem like a walk in the park.  One of my doctors gave me a link to a paper on Esophagectomy and Quality of Life, which gives a glimmer of optimism about life after surgery.

Getting Radiation (picture and movie)

I only have two more radiation treatments.  About 1-1/2 weeks ago I had one of the nurses, Melanie, take a picture and a video of the radiation machine with my phone.  Above is the picture.  That big round thing aimed at my left side is the X-ray source.  It rotates around me and stops 4 times to radiate my esophagus, a little bit of my stomach, and the surrounding lymph nodes.  The movie below shows it rotating -- be patient, it may take a few seconds for the video to load.

I wish I knew how to make the video bigger, but I do not.  I also posted it to You Tube, where it is bigger and better: http://youtu.be/mnsrAtCRuak

July 8-12: 4th full week: fatigue

I've completed 21 out of 25 radiation treatments and 5 out of 6 chemotherapy treatments.  All treatments finish up this coming week.

The fatigue that we chemo patients have been warned about hit me like a ton of bricks.  I felt ok Thursday and Friday, so I decided to swim Friday evening.  My goal was 25 laps, normally I do 45 laps (each lap is 50 yards).  I did 45 laps on both Sunday and Monday.  But on Friday, I was only able to get 20 laps in.  My arm muscles just felt too tired.  I was not out of breath or anything, just tired muscles.

Saturday morning when I woke, my arms felt like I'd just swam a huge workout, like 80 laps.  They were really tired.  This was from swimming.  Every little physical activity I did just wore me out.  In the morning I get the paper, fill a plastic watering can and water a corner of the grass that the sprinkler doesn't hit.  Carrying that water can felt like I was carrying a huge weight.  Walking up the stairs from the driveway back into the house with the paper made me feel tired.

Since I have one more chemo treatment, I am wondering how bad I'll feel next weekend?  I will definitely not exacerbate the situation by swimming!  Until I start to recover, my exercising is over.

Speaking of recovery.  My last radiation is Thursday.  My Radiation Oncologist says that 7 to 10 days after that last day, I will really turn the corner and start to feel better.  I can't wait!  My last chemo is Wednesday, but since the effects of chemo seem to be most intense Thursday evening - Sunday evening for me, I won't count chemo as being finished until next Monday.

On the cramps and constipation front, this week was not bad.  My doctor was quizzing me on my symptoms and what I was taking.  I had started taking a stool softener and stopped taking a laxative.  He said I should not have stopped the laxative.  Sure enough, I took the laxative Wed., Thurs, and Friday mornings and I had almost no cramping issues.  I did have a fair amount of mild nausea, but they'd given us anti-nausea pills when we started chemo and those did the trick.

7-10 days from this Thursday is July 25-28.  I am looking forward to turning that corner.

July 1-5, Third full week

Treatment so far: 4 out of 6 chemotherapy treatments, 16 of 25 radiation treatments.  I am pretty sure Dr. Hanson said the swallowing pain will max out after treatment 20, on Thursday.  Next weekend ought to be really pleasant.

This week is the similar to last week, most symptoms get a little worse.  Last week's worst symptom was cramping, which I attributed to constipation, a side effect of chemo.  This week, the day before chemo I started taking Durolax, an over the counter stool softener.  The cramping was way more subdued, so maybe it helped.

Swallowing food down my esophagus is getting more painful.  It feels like there's a tender open sore about 1/2 way down to my stomach and right at that point there is also an obstacle, something that makes the food linger on its way down.  I chase down many swallows with room-temperature water.

Eating is Not Much Fun

The queasiness, starting for me on the evening of day 2 after chemo, seems slightly worse this week.  Like last week I have this bad combo:  it hurts to swallow food, I'm queasy a few days each week, food doesn't taste as good.  What I want to do is not eat as much.

Three Pounds Lost: Concern

I met with Dr. Hanson (radiation) on Tuesday.  He was concerned that I'd lost 3 pound from the previous week.  Every Monday when I go in for radiation they weigh me.  This weigh-in is not very precise. I'm fully dressed with shoes on, etc.  I weighed 242 last Monday, which by the way is at least 35 pounds overweight.  He had me meet with the nutritionist again.  They both told me to eat.  The nutritionist said if I lost too much weight there's a surgically-installed feeding tube with my name on it.  She gave me (for the second time) a list of high-calorie recipes.  The focus is supposed to be high-fat, not so much carbs, but since the only measure is weight...  The "mac and cheese" recipe includes 1/2 cup mayonnaise and 2 cups grated cheddar.

I think they're making way too big of a deal over 3 pounds out of 245 pounds.  Maybe they're just being cautious.  I have been trying to eat more since Tuesday.  It is hard given all the effects of the radiation and chemo treatment (see above, Eating is not much fun).  I've stocked the pantry with my favorite snack foods, dry-roasted peanuts, potato chips, and ice cream in the fridge.  On the weekends we have a box of Cinnabons.  It must be hard to imagine, but I have to gently force myself to eat any of this, although sometimes the ice cream is soothing, for a while.  I was able to eat 4 or 5 pieces of my favorite pizza (Round Table) last night.  Normally I love the smell and the taste, but both were slightly off.  Fortunately, not so off that it was horrible.  Last night, I wanted to stop after the first piece, but given the pressure, I kept eating.

I am going to be upset if I loose my taste for these "foods" in a permanent way because of this treatment.  Normally I try, not always successfully, to avoid all the above.  But just knowing that if I have a pizza or some ice cream it is going to taste sooo good, makes the broccoli and Fiber One bearable.  Right now, broccoli and Fiber One are not edible.

June 24-28, second full week

I've had 3/6 chemo and 12/25 radiation treatments.  As I write this on Sunday June 30, I'm almost exactly 1/2 way through the treatment by all measures.

This week was fairly uneventful, but these symptoms have gotten worse:  fatigue, cramping, queasiness, taste, and swallowing pain.

Fatigue.  The tiredness that I've been hearing about from chemo is worse.  I noticed it this morning as I walked up the 14 steps from getting the newspaper.  My muscles all over just felt tired.  The thought of going swimming this evening (Sunday) makes me feel tired.

Cramping.  I had cramping on Thursday evening and again on Friday evening.  It was pretty uncomfortable, but I was able to get to sleep ok.  Both times, when I woke up the next morning the cramping was gone, but I felt a little queasy.  I am pretty sure the cramping is related to constipation, which was more intense this week than the previous 1-1/2 weeks.

Queasiness.  Since Friday I've had a constant, but minor, feeling of queasiness.

Taste. Starting yesterday I noticed that food isn't tasting the same and the change is not for the better.  So unless I'm hungry, the thought of the taste of different foods is not appealing.

Swallowing pain.  The swallowing seems to be transitioning from "there seems to be a small obstacle in the way" to "a slight burning sensation along with the small obstacle".  The burning sensation is more uncomfortable.

Add together the queasiness and the taste changes and I'm a lot less hungry.

Summary.  All along I've been told "the effects of chemo and radiation are cumulative".  So all these symptoms will get worse.  These symptoms are all making me uncomfortable now, with the cramping being the worst.  When I think about each of these symptoms getting worse over the next 2-1/2 weeks, wow.

PS: I met with a nutritionist this week.  She told me to start focusing on high calorie and high protein foods.  She said if I lose 10% of my body weight they'll put in a feeding tube.  I think my Radiation doctor said the same thing.  Basically, you have to eat, even though you don't feel like it (queasy, taste) and it's really going to hurt to swallow.

June 17-21, First full week

This week was fairly uneventful.  I had five radiation treatments and a chemotherapy treatment.  I feel a little weaker than I did last week, but not much.

I have finished 7 out of 25 radiation treatments and 2 out of 6 chemotherapy treatments.

This is me getting chemo.  One of the IV bags on the pole is part of my chemotherapy.  The other is just a saline solution.  If you look carefully you can see the IV tube going under my shirt under my chin - that's why the shirt is open so wide.  The chemo port is high up on the left side of my chest, not visible here.  They connect the chemo directly to the port without having to puncture a vein each week.

I'm starting to have swallowing issues.  Not horrible issues, but it's getting a little worse.  Kevin joined Martha and I for happy hour at The Stockpot on Friday.  I was hungry and ate too much too fast and suffered some for a couple of hours in the evening.  The rest of the weekend I was careful to eat more smaller meals.  That is working much better.  I am nervous about next weekend after five more radiation treatments and my esophagus is in a lot worse shape.

Recovering from chemo was just a bit harder this week.  I have chemo on Wednesday and so Friday is my "day 3", which is usually the worst day.  I woke up Friday and thought "I don't feel different at all."  I got ready for work,  ate breakfast, drove in, everything was normal.  The office is on the second floor, up two flights of 12 steps.  As I walked up those steps I could feel a small buzz through my muscles, arm and leg, that I did not remember ever feeling before.  Then I felt a little weird for a while.  But even so, Steve Z. and I did our normal 2-1/2 mile walk for lunch and I felt fine.  I think Steve is walking a little slower than normal to help me.

After I wrote the blog entry about anxiety I had crystalized a bunch of questions for my radiation oncologist on Tuesday.    I met with Dr. Sueng, who was filling in for Dr. Hansen who is on vacation.  Dr. Sueng was really friendly and pleasant.  I told him my concerns.  

I asked him, "how many Esophageal patients do you have per year, ballpark?"

He said "It is not a common cancer, six to eight patients a year."

I asked do they all lose weight because it gets painful to eat?

He said, "Yes, between 5% to 10% of their body weight during treatment."

This rocked me back on my heels.

I said, "treatment is only 6 weeks, right?  Losing 10% of your body weight in 6 weeks is not easy.  You basically have to stop eating."

He kind of nodded.

I told him I really did not want a feeding tube.

He said, "I do not like feeding tubes.  I'll try to help my patients so they do not need one."

But then he added, "but some patients develop a total aversion to eating, so what can you do?"

Obviously it is going to get really painful.  All I could think of is wow, this is going to be really bad.

Dr. Sueng basically agreed that it's going to be painful.  He told me about lydocain and pain medication.  He said for some of his patients they may stop treatment for a few days during week 4 and then continue on.  That can help some to make the last couple of weeks go better.  I just thought that would prolong the agony, but what do I know?

He told me, "try not to worry about 2-3 weeks from now.  Take it a day at a time."

Easy to say.

He also told me, about five times, "eat up."

Treatment Anxiety: Fear of pain

On Thursday (June 13) afternoon Martha and I went to a "What to expect during Chemo" class.  The nurse told us about symptoms such as fatigue, hair loss, fluid loss, and others. I had not slept well last week so I was tired and more susceptible to suggestion.  As she mentioned some of the symptoms I thought "I think I have that right now!" (not hair loss yet, of course).  When the class finished I felt bad enough that I was going to skip my daily swim.  But she had also strongly recommended moderate aerobic exercise during chemo, so I decided to swim a few laps and see how I felt.  Turns out I felt great so I swam a whole workout and really glad I had not skipped.

That night around 2:45a I woke up to go to the bathroom and that's when the anxiety hit.  The chemo-expectation class had 7 or 8 cancer patients with some family members.  I am pretty sure the guy sitting next to Martha had the same diagnosis as me: esophageal cancer.  The nurse kind of said that and asked if we'd had feeding tubes?  He had one installed.  I had not.  At the time I figured that was good for me, "my cancer is not as advanced as his," I thought.  The previous week I talked to a swimming buddy who has had the same treatment I've begun.  His cancer was definitely more advanced than mine.  He talked about needing a feeding tube installed part way through chemo/radiation and how bad things got.  When Martha and I met with Dr. Dunst a few weeks ago, she also talked about a feeding tube, but at 2:45a all I could remember was "that a feeding tube might be necessary."  Earlier this same Thursday I met with a radiation oncologist and he had said that about 1-1/2 weeks into radiation I was going to start feeling pain when I ate/swallowed.  They would  manage the pain with "lydocain" (I think) which I will swallow to numb my esophagus so I can eat, but he also said after a while I'll need real pain medication.

At 2:45a my subconscious had assembled all this data and presented it to my conscious.  I began thinking about how bad it might really be and tried to figure how long the "really bad" period might be.  I've already been told that the worst period will be the two weeks after chemo and radiation are finished.  So I'm guessing the pain starts at week 1-1/2, ramps up day by day until it hits a maximum, then stays constant for the rest of treatment plus two weeks.  Treatment is about 6 weeks, so worst case of max pain is the final 4 weeks of treatment + 2 week after =  6 weeks.  Whoa!  This is when the anxiety, actually fear, set in.  How bad will this pain be?  Could it get so bad that I'll actually want a feeding tube installed?  Then it hit me that some doctors may automatically install feeding tubes in their esophageal cancer patients -- it must be necessary most of the time.

At this point other memories started popping up.  My chemo nurse, Rob, noticed that I'd lost 7-8 pounds over the previous 10-12 weeks.  That's good, right?  I've been dieting and exercising extra since January.  He strongly suggested that now was not the time to try and lose weight.  Some of the nurses at radiation told me "You look in great health for esophageal cancer treatment."

I pointed at the spare tire around my waste and said, "I feel in pretty good shape, except for this."

The both replied, "No, that's a good thing."

So at 3:00a my brain factors those comments into the mix and now I feel like I am finally realizing that I have a really bad stretch ahead of me.  I couldn't stop thinking about this.  Sleep went out the window.  Finally at 3:45a I got up, set up my laptop, and started working (at my job, I can work from home as easily as from the office).  I was able to successfully get my mind temporarily off the worry about this treatment, but it haunted me all day and all this weekend.  This (the haunting) was exacerbated Friday because I was pretty tired all day from lack of sleep.

Martha had a "grads and dads" dinner Friday night.  Our kids were there, except Zachary who is in Spokane working for the summer, also Martha's Dad and Amy, Paul's girlfriend.  I was glad they were there and I had a few hours where I did not think about this.  After they left I was pretty tired and slept well Friday night.

Saturday the anxiety came up again.  I talked about it with Martha -- it is good to have someone close at your side.  The anxiety levels have come down quite a bit from Thursday night.  But I would be lying if I said I'm not pretty concerned about how this is going to go.

June 13 - First Radiation Treatment

First Radiation Treatment

Radiation treatment  (for me) involves laying on my back on a table that slides in and out of a big ring.  The way I understand it, the ring contains five low intensity X-ray beams.  These beams are focused on the area on my esophagus and stomach around where the tumor is located.  Here's a picture of a picture they gave me of where they are aiming:

The purpose of radiation is to burn the tumor and surrounding tissue so they kill all the cancer cells.  We met with the radiation doctor, Dr. Hansen, last week.  He said that the cancer was barely visible on the CT Scan.    I took that to mean "it is a very small tumor" right now.  Yet look at the size of the area they are treating, drawn on my chest and belly.  That does not look small to me!  This includes the tumor as well as much tissue around the tumor and also lymph nodes around all this tissue.

My understanding is that for a cancer growth to be visible on the most precise CT scan or PET scan, it must have about 200,000 to 250,000 cells.  Any cancer growth that is smaller cannot be detected.  So they treat (i.e., burn) a big area around what they can detect, hoping to kill all the cancer cells they can't see.  Better safe than sorry.

Today I was on the table for about 20 minutes.  Some of this time was positioning me exactly according to the tattoos that they gave me a week ago:

From now on they said I'd be on the table about 10 minutes.

The actual radiation treatment is painless.  However, since they are burning my esophagus, around week 3 of the treatment, it will start hurting to eat.  They can give me something to swallow that will numb my esophagus so I can eat, but then that will not be enough and they'll prescribe pain medication so I can eat.  I can't wait.

June 12 - First Chemotherapy session

I've been dreading this for a while.  I feel like once I start down this path I'm committed.

There is a lot more to chemo than I thought.  The main chemo drugs I'm getting today are Taxol and Carboplatin.  The evening before they prescribed 20 mg of steroids and 20mg more this morning immediately after breakfast.  One hour before I was given a cream to apply to my chemo port to numb it.  That worked very well.

You have to wonder how they learned about all the extra drugs they give you to help with chemo.  Did the first chemo patients go through hell before they came up the helper drugs?

The chemo session was painless.  It lasted about 3hr 15 min.  The nurse said it would go faster next time since I did not show any problems with the two main drugs - they will pump it into me faster.  They have WiFi and I was working and browsing the internet the entire time.  It went pretty quickly.  During the time I was there I saw about 14 people also getting chemo.

Below the drug list is the side effects I may see.  Oh boy.

Symptoms, What to expect the next few days

Days 3-4-5 are the worst after each session. Example I'm getting chemo on Wed, which is day 1. 3-4-5, are Fri. Sat, Sun.

Day 2, feel pretty normal, little tired, not nausea. Friday start looking for symptoms:

1. Nausea
2. Constipation or diarrhea
3. Fatigue
4. Blood dripping out my eyeballs
5. Farts that stink so bad metal nearby begins to melt

Hair loss (Alopecia) begins soon, but slowly. They told me to use a softer brush. What's softer than "nothing"?

My Chemotherapy Drugs (June, 6, 2013)

Here are all the drugs they gave me through my port today.  You may be more interested in the drugs below the blue text than the ones above.

Title of the drug list

Carboplatin + Paclitaxel + XRT (Esophageal)

C1D1 Cycle Day Approved by Gruenberg, Daniel R., MD

Paclitaxel, inj: 120 mg (50Mg/M2) as directed by IVPB, Rate: over 1 hour

Instructions: Mix in 250-500mL NS. Administer using Non-DEHP-containing equipment and through an in-line 0.22 micron filter. Paclitxel is a vascular irritant (sbq: good to see that the substance they're injecting directly into my vein is a vein irritant\).  Aka, Taxol

Carboplatin, inj: 290 mg (2 target AUC) as directed IVPB, Rate:over 30-60 minutes

Instructions: Mix in 100-150 mL D5W or NS. Carboplatin is an irritant.

The two drugs above are the chemo therapy.  The drugs below help me handle the drugs above.  The helper drugs only last a short time (e.g., anti-nausea), which is why they also prescribed pills -- to take up the slack.

Palonosetron hcl, inj: 25 mg as directed I.V. (anti-nausea, Aloxi is the brand name) My nurse shot this into the drip line.

Dexamethasone sod phosphate, inj: (steroid) 10 mg as directed I.V. - calms down immune, so body received gives me energy, 3

Diphenhydramine hcl, inj: 50 mg as directed I.V. (generic equiv to Benadryl, anti-histamine). 2

Rantidine hcl, inj: 50 mg as directed I.V. (antiacid) Note: today we are substituting Famotidine, a generic equivalent)

Typically the Diphenhydramine and Famotidine are combined into one. Dripped at a rate — there's a pump.

Cancer Treatment Summary

Summary (as of July 7, 2013)

I've been diagnosed with esophageal cancer.  More precisely:

On my radiation chart:  T2N1 Stage IIB adenocarcinoma of the distal esophagus
As summarized by Dr. Grunkemeier:  esophageal adenocarcinoma in setting of Barrett's, preoperative stage T2 N0-1 M0, clinical stage IIA- B (where T=tumor, N=Nodes, M=Metastasis).

I believe the N0-1 and the stage IIA-B both represent approximate best guesses, that is, it is either N0 or N1.  These are guesses since surgery has not been performed followed by an detailed examination of tissue. I think Nodes means "lymph nodes".

The current best treatment is the trifecta of chemotherapy and radiation, followed by surgery to remove most of my esophagus.

I've been diagnosed pretty early as a result of periodic endoscopy's and some luck.  Most people are diagnosed when they exhibit symptoms, usually a tumor grows in the esophagus to the point where it interferes with eating.  I have no symptoms.  I have been on a schedule of getting an endoscopy every other year after I was diagnosed with Barrett's Esophagus in 2007.  It was a biopsy in my February 2013 endoscopy that found suspicious cells.  The doctor performing these endoscopies had me come back in May 2013. Biopsies from the May endoscopy showed cancer. There was also some bad luck.  Normally this cancer starts on the interior surface of the esophagus, where the food passes.  Mine apparently started a little further into the esophagus wall, so the biopsies taken during the February endoscopy did not catch it.

Timeline

Future

July 8, radiation #17/25 3:24p
July 9, radiation #18/25 3:24p
July 10, chemo #5/6 9:30a
July 10, radiation #19/25 3:24p
July 11, radiation #20/25 3:24p
July 12, radiation #21/25 3:24p

There will be 25 radiation treatments.  One every weekday starting June 13

There will be about 6 chemo treatments.

After chemo and radiation are finished there's a four week recovery period and then I'll have the surgery.  The surgery is major.  I am guessing the recovery from surgery will be long and difficult.

Past

2007

December: first endoscopy by Dr. David Grunkemeier - I am diagnosed with Barrett's Esophagus.  He prescribes Nexium which dramatically reduces acid reflux for me.

2011

January: second endocsopy (Dr. Grunkemeier) - looking better

2013

Feb 6:  third semi-annual endoscopy to check on Barretts, "suspicious findings that require close supervision"

May 9, Thursday:  follow up endoscopy, more biopsies in and around suspicious area. 

May 13, Monday: Dr. Grunkemeir calls to say "pathologist reports cancer", schedules EUS

May 22, Wednesday:  Endoscopic Ultrasound (EUS) by Dr. Douglas Shumaker.  Cancer confirmed.  Tumor too deep into esophagus wall to perform an endoscopic resection.  Referred for surgery, chemo, and radiation.

May 23, Thursday: CT Scan (had to swallow barium)

May 24, Friday: PET Scan, injected with radioactive sugar

May 28, Tuesday:  Met with Dr. Christy Dunst, surgeon, esophagectomy specialist.

May 29, Wednesday: Met with Dr. Dan Gruenberg, Medical Oncologist (chemo)

May 29, Wednesday: surgery (by Dr. Dunst) to have chemo port installed

June 3, Monday: Met with Dr. Eric Hansen, Radiation Oncologist

June 5, Wednesday: Radiation CT Simulation (more barium), small targeting tattoos.

June 12, Wednesday: first chemo

June 13, Thursday: first radiation (of approx 25)
June 13, "Chemo class" - what to expect.
June 14 - July 5: radiations and chemo on schedule.