Kemer 2.0 - "We can build him better!"

November 12, 2005.

I have been diagnosed with cancer in my lower esophagus. It is an adenocarcinoma caught at the earliest possible moment. The fact that it was caught so early is a very good thing, because it is a very bad cancer. It currently is a very small "focus," not even a tumor, and is not in the esophageal muscle or in the lymph nodes. Consequently, I will not have to suffer through either chemo or radiation therapy and can look forward to a true cure. The bad news is that we now know I have an esophagus that has figured out how get into such mischief, and it can no longer be trusted. As a result, most of it will be removed in a surgical procedure called a transhiatal esophagectomy.

The surgery will be done by Dr. Michael Bouvet at UCSD Thornton Hospital on Friday, December 2. The surgery is expected to take about four hours and I will be in the hospital for ten days. After that, I'll be at home recovering; I've been told that I'll be pretty useless the rest of the month, and I will be out on medical leave through at least New Year's Day. With the New Year brings new hope, and I have good reason to hope that life then return to normal.

I hope that the following FAQ answers most of your questions for now. You are in my thoughts, as I know I am in yours; the blessing is mine.

FAQ

Q. Can you have ice cream after the surgery?
A. Yes, I can have it! However, since I won't be able to eat anything, that doesn't help me! Not to worry: I'm told I'll have some very fine drugs.

Q. Why did you pick UCSD and Dr. Bouvet when there are major medical centers, such as USC, the Mayo Clinic, and John Hopkins, that are so well known for this procedure?
A. UCSD's new Thornton Hospital and Moores Cancer Center are state-of-the-art facilities with world-class staffs. Dr. Bouvet is a specialist in this kind of complicated surgery and does over 20 per year with a top-notch record. Given that both my surgeon and care will be as good as one can hope for, if not better, there is a tremendous advantage to remaining close to home.

Q. How did you get this cancer?
A. There is no simple or absolute answer. We don't understand why you can have two people under identical conditions in which one gets cancer and the other doesn't. Genetics may have some influence. That, and bad luck. This cancer has some relation to GERD, popularly referred to as "acid reflux disease." A small percentage of people with GERD get a condition known as Barrett's Esophagus, and a smaller percentage of those get this cancer.

Q. How did you discover that you had cancer?
A. As a part of my annual physical, I was referred to a gastroenterologist to have my first colonoscopy performed. In answering the routine questions, I told him that I had recently experienced mild trouble in swallowing ("dysphagia"). It was recommended that I also have an endoscopy done. Esophagitis was discovered as a result. In the follow-up endoscopy two months later, my doctor noticed a very small, slightly odd area upon which he decided to perform a biopsy. After that, things progressed quite quickly. Had my doctor missed that spot, or not done a biopsy, it is likely that we wouldn't have discovered anything until the cancer had progressed to a later stage. That would have been most unfortunate.

Q. What is involved with this surgery?
A. The transhiatal esophagectomy is a facinating and complex procedure. There will be two incisions, one in my abdomen and one in my neck. They remove almost all of my old esophagus and will reshape and stretch my stomach to serve as a combination stomach/esophagus (pulling everything a little higher), then sew it all together. After recovery I will eat normally, although with a smaller stomach; I'll eat smaller meals, more frequently. I may actually get down to my old high school weight.

Q. Can you keep your old esophagus?
A. Eeewww! That's disgusting! Actually, I wish I could, but I think the pathology boys are going to beat it up pretty badly. Serves it right: bad, Bad esophagus!

Q. Will you be able to play the clavichord after the surgery?
A. Of course! Sadly, I will still play poorly. The same goes for my vihuela. Surgeons can work many miracles, but this is not one of them.

Q. Does this mean you won't be able to talk?
A. No such luck! They are removing my esophagus, not my trachea. It's true that I will be heavily sedated for the first several days, and therefore atypically silent.

Q. Can I visit you in the hospital?
A. Not right away. This is non-trivial surgery and I will be under heavy medication. When conditions change, my sister Jean will post a note to this list.

Q. Can I send you flowers? Candy? Beautiful women? Money?
A. Let's don't, and say we did. Nope: can't eat it. Aletha will already be there. Sure, I'll send you a number to my Swiss bank account in a later message.

Q. Are there any other disgusting things you want to tell me?
A. Sure. I had all kinds of tests and when I had a PET/CT scan we learned that I have a horseshoe kidney: my two kidneys are joined together. I heard a story, which we can all hope is an urban legend, in which a surgeon encountered a horseshoe kidney and removed it, thinking that it was a tumor. Afterward, the pathologist ran screaming into the operating room, "It's his kidney, you fool, put it back!" Okay, I made up that last part. I suspect the first part is a story surgeons tell each other around the campfire, with flashlights under their chins, to scare themselves silly.