Friday, February 22, 2013

Tumor Board Results


This morning, I was getting ready to leave for a routine mammogram appointment in Porters Neck when the phone rang.  It was the oncologist/GI surgeon, Dr Vohra, calling because the tumor board had met and given their recommendation.  She was still waiting to talk with my gastroenterologist in NOVA, Dr Brown, to get his input, but the overwhelming recommendation was for me to have gastrectomy once Matt returns from his “vacation” in the Middle East.  So, now, what exactly is a gastrectomy?  A gastrectomy is the removal of either a portion or all of the stomach…in my case, the recommendation is to remove the entire stomach.  (I did ask Dr Vohra just to make sure we were on the same page…and we were.)  It was very touching to have MY doctor call and talk to me about this instead of having a nurse, an assistant, or a PA relay the info from her.  I was even more touched by her thoughtfulness because in her opinion, it’d be better for my whole family to have Matt back here when it happens…especially for the kids to have dad here with them while mom was recovering from surgery…or at least that he would be available to spend time with them if it was needed.  There was 1 caveat to this whole deal…I need to be scoped every THREE months until the surgery.  As long as everything stays the same and there are no unexpected surprises, the surgery will be delayed until sometime after Matt’s return.  I’m hoping to have it done at the beginning of the summer, 2014.

All of this brings up a bunch of questions like how are things going to go for me without a stomach? I know people can live without one, but I'm already living without so much of my digestive tract that I have no idea how this will impact everything else. AND since the GJ-anastamosis site has problems because the stomach tissue isn’t meant to handle digestive juices like the small bowel does.  This causes ulceration and inflammation and ultimately causes an increase in the malignancy rate for the GJ-anastamosis.  Well, I know from talking to Dr Vohra, that there are even more problems associated with hooking up the small bowel directly to the esophagus…just think of all the people who have reflux…this would be like that be amplified.  On top of that, I still need to see the small bowel transplant surgeon at Duke. This was just something my gastro wanted me to discuss "just in case", but with the upcoming gastrectomy, having additional small intestines would be a huge thing...especially since I have adenomas in my new duodenum AND in my pouch and could eventually be facing ANOTHER Whipple procedure and ANOTHER j-pouch surgery.  UGH!!  Isn't that "special"? I hadn't even thought of those two, but Dr Vohra pointed out that it's possible for me to have another Whipple if polyps grow in what is now my new duodenum. Can you imagine the nightmare that would create? I do not want to even think about it…or having a new j-pouch created. My Daddy asked if they can transplant some small intestines, why can't they do it for a stomach or a colon...now THAT would be VERY NICE!! Then we could keep a list of organs removed & replaced & be added to yet another category of rare people in this world.

Obviously,  this is all quite overwhelming…not just about having the surgery, but I am also overwhelmed by the God who created me and loves me and sent His Son to die for ME.  He has me right where He wants me…right where I need to be…in the right place…at just right time.  That is no accident; it is not a coincidence.  This is divine providence that is showing up in so many ways:

1.   I have specialists who know what to do with me and who are interested in what’s best for me.  Even though it is rare to have a patient with so many digestive organs removed (in part or in whole), I am not a total anomaly to them.  AND they have no problem admitting when they need to look into something or get additional input.  This is so much better than the guy I saw down in Wilmington…looking back, he was clearly overwhelmed and had no idea what to do with me.

2.  I have a very good friend who had a gastric sleeve done and has to follow a modified diet.  Now, she will be the 1st to admit that her diet and situation are nothing in comparison to what I’m facing, but I disagree.  I think that if you have any type of deviation from the normal, then you can relate to someone else in a similar situation…maybe not entirely, but you can find the common ground and then exaggerate it to get to a better understanding of the extreme of another person’s situation.  This is definitely the case with my friend.  I admire her so much because she’s so good at planning her diet.  When she’s home, she sets the timer to go off every hour and alternates between eating something small and drinking to give her body what she needs.  When she goes out, her purse is packed with snacks like grapes, almonds, protein bars, etc.  I cannot even fathom being that organized but know that I will have to be.

3.  One of my neighbors and a very good friend is a chef…well, she says she was a chef before she became a full-time mom, but really, she’s a chef.  On top of that, she has a child with Prader-Willi Syndrome, a very rare but complicated genetic disorder.  Food is like a drug to her child who gets the same euphoric feeling that drug users do.  The brain always signals that it’s ALWAYS hungry even if the child just finished eating.  On top of that, her child’s body uses every single calorie consumed.  Since NOTHING goes unused, my friend makes nutrient dense foods to keep her child’s body as healthy as it can be and to control the tendency of PWS patients to become obese (think about it…it the brain is always sending signal that it’s starving AND it keeps every calorie consumed).  Anyway, this dear, sweet friend offered to help with my transition to eating with my stomach-less plumbing once the time comes.  She will take care of E-V-E-R-Y-T-H-I-N-G…from talking to a nutritionist (with me present), to planning meals (with me), to shopping for the food, prepping, etc.  I just need to sit down with her to learn what I need to know so I can eventually take over the responsibility for myself.  This is soooo amazing because she automatically took this on herself…she volunteered to do this without any asking on my part.  On top of that, I already KNOW how good she is at this because #1, she is a chef, and #2, she does this for her child.  She’ll take care of all the overwhelming stuff while I’m trying to recuperate, and then, she’ll teach me to do it myself. WHAT…A…BLESSING!

4.  I’ve gained some weight lately.  Most of it is from the naturally occurring changes in metabolism once a woman hits her 40s.  I even joked about this a couple of weeks ago…without knowing what was coming up. My diet hasn't really changed, but I've definitely gained enough “uncomfortable” weight that I’d like do something to tone things up (especially butt & thighs), but since I’m still dealing with whiplash from the accident, I can’t do much in the area of exercise.  Looking at my track record, it appears that every time I gain weight, something happens where I will benefit from the additional weight to have a larger buffer to keep me from dropping below 100 lbs. So as much as I don’t like this extra weight, I do think it's good because it’s more weight to prevent me from going below 100.

Well, I think that’s enough questions and information for anyone to digest right now…no pun intended.  I greatly covet your prayers as I continue this journey of living with FAP.

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