Many people have asked many questions about Susan. Here are some answers.
- Can you describe the surgery? Susan had an esophagectomy and partial gastrectomy using the Ivor-Lewis approach (a long incision on the front of her abdomen from just below her sternum to just below her navel and an incision on her right side and back that runs under her shoulder blade). They removed some lymph nodes from near her left kidney and some lymph nodes from her chest. They removed the top 1/4 of her stomach and bottom 2/3 of her esophagus along with the junction (GEJ) between the two. They fashioned her remaining stomach into a tube, brought it up through her diaphragm and attached it to what is left of her esophagus, so her remaining stomach is in her chest, not in her abdomen. They also installed a small feeding tube (J-tube) from her small intestine through her lower abdomen on the left side of her navel. It's a couple of inches long outside her body and ends in a port to which a six-inch extension tube is attached for slack.
- How did the surgery go? The surgery went very well. The recovery has gone mostly well, but there have been a couple of complications:
- Some fluid collected in her lung cavity and partially collapsed her left lung. They drained it and there has been no further problem with it.
- She developed an infection in the incision on her abdomen. They had to reopen the incision. It was left open and is healing using a Wound V.A.C. (Vacuum Assisted Closure) for packing and closure. The healing of that wound with the V.A.C. has gone okay, though a small new bit of infection flared up yesterday. It is being monitored (by her physician and a home-health nurse that comes three times a week), medicated with antibiotics and treated with the V.A.C, so we're led to believe everything is still proceeding acceptably on that front.
- Can she eat? She can eat, but not much yet. We give her enteral nutrition through her J-tube until she can build up to consuming enough calories. She's starting carefully and avoiding foods that might be hard to digest or foods that might irritate her. So far we haven't had any major issues with her eating, but it's slow going. Her stomach is still a little traumatized from the surgery and a little paralyzed by the pain narcotics so it isn't emptying as fast as it should, but this is only temporary. Once she can eat enough (maybe a month or two), the J-tube will be removed.
- How does she take medication? She's had some trouble with nausea still, so we give her most of her medication through her J-tube. The liquid we inject with a syringe and the pills we crush, mix with water and inject with a syringe. Once she can swallow better and the nausea isn't such an issue, she'll take her medication orally and we won't need the J-tube.
- Any lasting effects from the surgery? Her stomach is much smaller, so she won't be able to eat very much at one sitting. She'll eat several small meals each day. Also, there is no sphincter/valve at the top of her stomach, so she has to be careful about lying flat or elevating her body above her head, lest the contents of her stomach come up her throat. This is mostly a problem for a couple of hours after eating, but it's a minor problem at all times. Our bed has to inclined to at least 30 degrees.
- What about the cancer? Before the surgery we had hope that the cancer was all gone. The last two PET scans in July and November showed no evidence of disease. When the tissue removed during the surgery (lymph nodes, esophagus and stomach) was examined, however, active cancer was found. This means she certainly had cancer at the time of the surgery and it would certainly have grown had we not gone ahead with the surgery. The question now is, "Did they get it all?" We hope so, but we know the statistics are strongly stacked against us. For now Susan needs to focus on recovering from the surgery. In February we get new scans to look for cancer. So, we wait and we hope.
Hello, friends. Thanks for your concern. I trust you're well.
Later. Love.

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