Post Surgery Scan

I have been avoiding doing another blog post until I had good news. Now I am happy to report that my first post treatment/surgery scan and blood work has come back with no evidence of cancer. During the past few weeks I have felt better than I have in a year and a half. I am running again and have resumed a mostly normal life of work and family. 

After my last post, I struggled until around mid-June with urinary tract infections brought on by the catheter I had in until 5/29 and the uretal stents I had in until 6/20. Originally I was given an ineffective antibiotic before being switched to something stronger. Once the stents came out I felt an almost immediate relief and return of energy. I then peed all over my procedure chair which was also relieving. Ever since I've had a daily internal debate about what I hate more; the NG tube insertion I had in the hospital or the cystoscopy with the stent removal (look these up on youtube if you are unfamiliar). I think I've decided but won't say. I don't want to influence anyone's opinion. 

There are still of course concerns. My oncologist says he will watch me like a hawk this first year or two since that is when recurrence is mostly likely to occur. The scan also showed some abnormalities related to the surgery. There are still some abormalities in my urinary tract. The right side the system is showing some hydronephrosis. The left side is showing diffuse hydroureteronephrosis. Yeah I know, fun medical terms! My understanding is that these involves the backing up of fluid. The fact that my right side is involved is interesting since that side was not involved with my cancer but I have noticed a little pain there this past week when using the restroom. However, my oncologists thinks this may be a result of the bladder being reshaped during surgery. He will consult with my urologist but I am already scheduled to have renal study in September. During this they will basically image my urinary tract and determine how it is flowing. 

I also have some pockets of fluid in my abdomen that may resolve themselves but my surgeon at Mayo is going to be consulted regarding this. Nothing may come of either of these issues and the issues may mend on their own but we will keep an eye on them. Finally, my oncologist seemed to really think after a year of being cancer free I should push to have my ostomy taken down. I would likely return to the surgeon at Mayo for that surgery. 

As long as I am feeling healthy I will likely post less on this blog. If you don't here anything for awhile it is likely good or maybe the hydroureteronephrosis took me down. It is a condition with a lot of letters after all. I will post again in a couple months, after I have my next round of bloodwork and scans. Once again I can't thank everyone enough for you love and support. Thanks so much. 

The Surgery

Carrie and I awoke in the Minnesota dark at 430 am on Friday May 4th after a rough night for me of bowel prep. We gathered our belongings and made the 15 minute walk to the Methodist hospital on the cool spring morning. At the front desk I was given my inpatient hospital band and sent upstairs for the first step of surgical prep. My vitals were taken and after going through many questions a couple different times I was sent to another floor for more prep and Carrie was sent to a waiting area. In the second prep area I was given a bed and a curtain separated me from the many other patients preparing for their operations. My chest port was accessed which always involves a saline flush which can be tasted as it is injected. Another nurse came in and shaved my belly.  I was visited by one of the surgeon's resident, one of the urologist and by the anesthesiologist. Throughout it all there was a lot of small talk regarding Colorado and my family.

Eventually an operating nurse came in to wheel me away. I was taken to the largest operating room I have yet seen. It seemed to me there were at least twenty different people buzzing around the room preparing for who knows what. There was a large machine on one side of the room similar to the radiation machine I had encountered during treatment. Someone began to talk to me again about Colorado and about hiking and then a breathing mask was put over my mouth and I was out.

I awoke somewhere around 12 hours later being lifted by several people and a ceiling sling into my hospital bed. I was very out of it but reached down to my abdomen. I still had an ostomy bag right where it had been that morning. Uncertain about what was done to me I managed to get a nurse to give me a phone and called Carrie. She had gone home after a very long day of waiting and being told that I might not even really be awake that night. She didn't know much more than me but they had left my ostomy due to having to remove more of the rectal portion of my colon than expected.

The next morning my surgeon came in and I was given some clarity about the surgical proceedings. The tumor had been slightly larger than scans had shown. They took more colon than planned and decided is was best to have a year or two of monitoring before my ostomy could be taken down. The tumor did not have issues with any major arteries or veins so the vascular surgeons did not have to be involved. Unfortunately both of my left-sided ureters were involved. Large pieces had to be removed. The urologists then stretched my bladder up to meet the remaining ureters. A small piece of small intestine was also removed. The surgeon was confident that all cancer was removed.

The surgeon did give me a piece of information that I am still chewing on. He told me that there was an area of blood vessels (the area that had been my positive margin after the first surgery) that should have been removed during my first surgery. He said it was a fairly standard part of the procedure and didn't understand why it was not done at the time.

I have much more to write about my hospitalization and recovery which I'm still in the midst of. Things still aren't functioning normally and I had a few rough days mentally and physically in the hospital. I will document all of that in the near future but for now will leave you with this. I received my pathology report last week before leaving the hospital. All margins negative for cancer. Urerters negative for cancer. Small bowel negative for cancer. To the best of my current knowledge I am negative for cancer.

Rainbows, Norse Gods, and surgery

Carrie and I arrived in Minneapolis on Tuesday evening. As we drove south to Rochester, home of the Mayo Clinic, the skies grew dark until we eventually were in the midst of a downpour. The storm continued across the Minnesota countryside until our destination came into view and we could see a rainbow arching above the Mayo buildings in downtown Rochester. Surely that was a sign that all would go well with my surgery and that my cancer would get it's buttocks thoroughly  whooped by my world class medical team. Then a lightening bolt crackled across the rainbow above the city. Surely that was a sign that Thor, god of lightening, was prepared to smite this terrible disease. I don't know. I'm not particularly superstitious but it's nice to pretend.

Tomorrow morning I will go into the hospital around 530 am for surgery. In preparation I have had eight different appointments over the last two days including blood work, urine tests, CT scan,   urology consultation, surgical consultation, oncology consultation, and vascular surgeon consultation. There are many unknowns with the surgery. I may require some removal/reconstruction of a ureters and an artery. I will likely receive a blood transfusion. Tonight I must do some bowel prep and in case you don't know it's going to be a blast. Tomorrow when I go in there will be a couple hours of prep. The surgery itself could take around 5 hours. I will be in recovery for a couple hours before getting moved to a hospital room.

At this point the process is out of our hands and we must wait and see. So much depends on the positioning of such a small mass of cells. I will know nothing until I awake from the anesthesia. Carrie will spend a long day waiting for updates and keeping others updated. May rainbows, lightening, Thor and all of our loved ones be throwing their support behind us. I love you all and will be posting sometime soon on the other side of this surgery.

A brief stint with a stent

Around 5 weeks have passed since my curd-filled trip to the Mayo clinic and in four weeks I will return for more curds (plus a major surgery). During March I kept active with some running and always getting my 10000 steps in. Cale will be running the Bolder Boulder again this year so I'm trying to make sure he is sticking to his training plan. We've been staying  busy with work, school, extracurriculars, soccer and relaxation  I've started building our garden area and will hopefully finish before traveling to Minnesota. I had many normal days where cancer did not dominate but unfortunately the beast has crept back.

Shortly after returning from Mayo I was contacted by a urologist there advising me to get a stent in my left ureter prior to surgery. There were concerns that if the tumor started to grow again the ureters could be further constricted and my kidney could be damaged. So on Monday of this week I returned to my favorite Denver hospital so my urologist could insert a small plastic tube up my urinary tract. Luckily, I was put out for the procedure. If you recall from my early post I am one of the lucky 1% with a double ureter setup on one of my kidneys. The urologist decided that only the upper left ureter needed the stent. I felt fairly normal after the procedure with the exception of some colorful urine. On Tuesday I began to experience sharp pain while urinating. It has since gotten better but is still there. Almost a year ago the cancer took all  the fun out of #2 and now it has taken the fun out of #1.

Now if my only concern was the stent I probably wouldn't complain but over the last two weeks I have started to experience pain similar to what occurred back in December before radiation. I have a cabinet full of various pain medications and for the most part can manage to function normally. Nighttime is the worst and my sleep is impacted. The doctors seem to believe it is inflammation from tissue healing after all the radiation.

The plan at this point in time is to push through this month, maintain a positive outlook, and
hopefully four weeks from now the beast will be destroyed and I will have a greater appreciation for #2, #1, and just about everything life has to offer.

Curds and Mayo

On Sunday my sister and I traveled to Minnesota for my consultation at the Mayo Clinic. The hospital is just over an hours drive from Minneapolis and we both got our first taste of Minnesota. There was plenty of blowing snow but a clerk at the gas station pointed out what a nice day it was compared to the rest of February (and probably the previous few months). I pointed out some gas station cheese curds and bought them. It seemed only appropriate given our upper midwest location. We arrived at our rental house in Rochester full on curds and ready for a new chapter to my medical adventures. My brother arrived from Maine later in the evening.

Rochester is a city of about 100000 people and well over half of them work for the Mayo Clinic. The city has a small downtown area packed full of tall building that are all part of the hospital. There is a underground level that connects the various buildings. In a strange way it is sort of the Disneyland of hospitals. The first stop on Monday was to get some blood drawn for tests. My second appointment was with the MRI machine. I got a bit of a scare when one nurse could not get blood to flow through my chest port. It had been seven weeks since it had been accessed which is the longest I had gone since it was installed. Clots can form in the tubes if it isn't flushed regularly. Luckily another nurse was able to get the blood flowing. MRI machines are very loud and they gave me ear plugs and headphones. Sometimes I got instructions to hold my breath but mostly I just laid in the machine for around 40 minutes. Next was  a CT scan. I think I'm a pro at these now. The contrast they inject gives you a 'oops-I-wet-my-pants feeling' but it didn't even phase me this time. Nice try CT scan!

After some lunch, where we may or may not have eaten some fried brie cheese curds, we had a meeting with a GI medical oncologist. First we met with a nurse practitioner who seemed to be the one responsible for coordinating all the different doctors on my care team. Then we met with the oncologist. He showed us the results of the CT scan. My tumor was pretty much the same size as my last scan in December. This is a good sign that my radiation treatment had worked and there was no growth. My tumor marker blood test (CEA) had dropped to 4.9 which was down from 40 something at the start of radiation treatment. This was another good sign. My original oncologist in Fort Collins had told me back in December that I was likely stage 4 now. The Mayo onc told me this wasn't the case and my current tumor is just a continuation of the tumor that was removed so I am still stage 2. The surgeons back in April likely didn't even see anything since the cancer may have just been some cells in this area of colon.

This doctor didn't have much specific info regarding my planned surgery but we did discuss some more general topics like why he thought there was an increase in colon cancer in younger people (a change in the gut biome likely caused by our wonderful American diets). He also mentioned new studies showing the dangers of mayonnaise which seemed oddly specific. Just for the record I don't eat mayonnaise. We left that appointment thankful he didn't say anything about cheese curds. However, at that evening's dinner we did skip the curds (and yes they were on the menu everywhere) and opted for a chicken sandwich with asparagus on the side.

The next day we first met with a couple of radiation oncologists. They were better equipped to talk about my surgery and what exactly they would be doing. The main reason I traveled to the Mayo Clinic was for inter-operative radiation, an option unavailable to me in Colorado. They basically move all your healthy organs out the way while you are opened up and give any nasty spots an extra high dosage of radiation.

My final appointment of the day was with the GI surgeon. He seemed very well prepared for me and very confident in his proposed courses of action. Basically, what I already knew was my tumor is doing some awkward stuff with my Iliac artery, some nerves, and my ureter. What I didn't know if it is also touching my small intestine. This means during the surgery not only will they remove the piece of my colon that the tumor is sitting on but they will also remove a little piece of my small intestine. Supposedly this should not be noticeable to me and my digestion in any way. The situation seems a little more questionable when it comes to the artery and ureter. A vascular surgeon will be involved with the surgery and they may have to resect/reroute the artery. A urologist will be involved and they may have resect the ureter then reattach it to the bladder. Regardless of all that he thinks the surgery is very much curative and I will only be in the hospital 3 to 5 days. The great news regarding the surgery is that he thinks they can also reattach my colon and I can lose the bag. The surgery is scheduled for May 4th. I still have some questions I am trying to resolve but overall feel good about the doctors and hospital.

We left that appointment hoping to meet with the vascular surgeon and urologist before we left town on Wednesday afternoon but unfortunately it did not happen. My brother left for the airport Wednesday morning. My sister and I went for a hike at a local natural area then drove up to Minneapolis where we took a good gander at the mighty Mississippi then enjoyed a brewpub before heading to the airport and yes we did order the cheese curds.

No Bells For Now

Yesterday was the 25th and final day of my radiation treatments as well as my last dose of chemo pills. When asked by one of the radiation techs if  I had any celebration plans I replied that I am celebrating with cautious optimism. When I finished my initial chemo treatment back on November 1st I rang the bell in the clinic and the staff recited an inspirational verse. I appreciated the ceremony of it all but yesterday I decided not to ring the clinic bell.

Since my last blog update I have felt better in every way. I still have no physical pain and I have the nausea under control. I could still have side affects the next couple weeks but based on how I've been feeling the docs seem to think I should be fine. I now have two weeks of normal living ahead. I have missed the monotony of daily life. I will go to work at my regular time and leave at a regular time. I will pick kids up from school and activities. I won't take 6 giant chemo pills everyday. I won't drive to Denver everyday.

Beyond these two weeks, I have a vacation/sibling reunion planned in sunny Rochester, MN. Joni, John and I have rented a house for a few nights and will be partaking in such exciting events as various oncology consultations, CT and MRI scans, and blood work not to mention our planned reenactment of the classic film Fargo. While there the docs at the Mayo Clinic will come up with a plan for surgery. The surgery should happen in the second half of March. I'm hoping to avoid any surprises in the scans or blood work but we will deal with whatever happens. Beyond that I really have no idea what will happen but hopefully will involve the vigorous ringing of many bells.

Warhammer of Emotional Messiness

I am now over  halfway through my radiation treatment. I am happy to report that I am no longer taking any opiod medication. Over the last week I have been able to come off of the morphine and oxy without issue. The excruciating pain I was in just a few weeks ago is now non-existent. This means the radiation is working and the tumor is likely shrinking.

I am having some fairly standard side effects from the radiation and chemo pills. Fatigue has set in and I am pretty much able to sleep on-will but it never feels like enough. Nausea has also decided to show up. During my six months of chemo I did not throw up once. Well during the past weeks I have thrown up at home, in multiple vehicles and at work. I apologize to the few poor souls that had to witness one of these events. I always have barf bags at the ready now. They compliment my extra supply of poop bags nicely.

I am going to be open and honest about my current experience. This week I have been hit with the Warhammer of Emotional Messiness. I'm going to go ahead and claim it as another side effect. Much like my sleep, I have been able to cry on-will. I have had depression issues in the past but that never really made me a blubbering mess. Through out my cancer journey I have remained relatively calm and stoic. This week I cried one day on the radiation table. I cried at a sad song. I cried when I had a bag leak. The best part of it all was when I met with a palliative care doctor on Monday. I thought I was just there to talk about pain management and to make sure I was doing okay coming off the medications. Instead I sat in a room with the doctor, a nurse and a chaplain for an hour discussing my entire journey. It was a group therapy of sorts and I was the main attraction. We talked about my support system, my end of life preferences, grieving the loss of my pre-cancer life and all the other fun stuff one finds themselves discussing with strangers on a Monday morning.

I know I use humor to deflect the seriousness of my situation and that will continue to serve as useful tool. Having the Warhammer of Emotional Messiness smash down on my rather large noggin has perhaps given me a new tool. From last spring until November I was focused on the step by step process to get rid of the cancer. When I was told in December that I still had cancer I had little time to process the news before the physical pain took over. Now that pain is gone and I guess it's time to deal with a different pain. Don't worry. I will laugh at myself every time I cry over (literal) spilled poop.

Thanks everyone for your continued support. I really appreciate the company I have had on my daily trips to Denver. I'll do my best not to throw up in your cars but if you put on some mournful country ballad I will cry in your cars.