Surgery and Recovery

Anniversaries

2009-08-23T10:50:00.000-07:00

This blog was a project that focused primarily on the first few months of my diagnosis and surgery. I last left off with the discovery almost a year after the surgery that a simple dilation procedure could transform my swallowing from a struggle to virtual normalcy.

It has now been almost four years. Late Summer is the start of an annual ritual of anniversaries and reflections. I don't think there has been a single day that I haven't told myself "I had cancer." Maybe I'll eventually get over it.

The first of these "anniversaries" was my initial colonoscopy and upper endoscopy, which happened in July four years ago. Fortunately, I didn't put the procedure off, as many do. I don't think the progression of early stage esophageal cancer is well understood, so there isn't a sense of how quickly it advances, but it is known to be an aggressive cancer. My surgeon said early detection probably saved my life. I can't help but occasionally think about the what-ifs.

The discovery of my cancer didn't happen with the first examination, but rather the follow-up a couple of months later. I, like so many men of my age, had GERD, resulting in erosive esophagitis, and ultimately Barrett's Esophagus. These are not guarantees of cancer, but they seem to be a breeding ground for the unlucky. Although statistically rare, esophageal cancer has been on the rise – approximately by 2% per year in white males. I suspect this is because of our diet and life style. I'm proud to say that my experience has convinced a handful of other men to get checked – fortunately, none uncovered cancer. The secret to survival is early detection: I'm the poster child for that.

The follow-up upper endoscopy turned up a suspicious, but tiny 1 mm spot. That resulted in a quick call to rush back to the hospital to get comprehensive biopsy. This was the start of a period of anxiety, as each step was a new experience that had the potential for more bad news. The next big anniversary was the formal diagnosis, which happened in October. It was followed by a flurry of tests and consultations, including an ultrasound endoscopy and a PET scan, both to try and determine the degree of invasion. All of the evidence suggested the most miniscule of spots – cancer in situ, not even a tumor, leading to renewed hope on my behalf that "it isn't that bad." The Cleveland Clinic confirmed that it was really cancer, the nasty variety, and I was simply stunned to learn that the recommended course was extreme: to remove the entire esophagus, not just effected area and a small margin.

The actual discussion of the diagnosis and recommended treatment remains a little hazy in my memory and possibly a permanent trauma: I was was in shock, even after weeks of considering the likelihood. I remember Dr. Lee trying to convey the scope of the surgery, that was very serious and that I didn't want to have just anyone doing it, and that I needed to hurry up and find someone. I couldn't believe that such a small spot, caught so early, would require such an invasive procedure. It wasn't fair!

I know that even many whose cancer is more advanced than mine balk at such extreme measures. Every specialist told me the same thing: very bad cancer, don't mess with it!

I was especially fortunate, as the surgery was devoid of any complications or extremes. I have returned to a normal life. I work a little harder at swallowing, I eat almost everything I used to. I can't eat as much as I used to, but that is a good thing. I'll take stomach acid reducers the rest of my life.

The biggest challenge has resulted from dumping syndrome. The surgery introduces a cascade of cause-and-effects. It is difficult to not cut the Vagus nerve, which runs along the esophagus, particularly in a relatively long and complicated surgery. Since the Vagus nerve controls the pyloric sphincter, that needs to be opened up permanently, or food simply sits in the stomach. As a result, the now vertically aligned and reduced stomach has a direct opening at the bottom into the duodenum. Food tends to pass through too quickly on to the jejunum, especially when I'm not careful, where they have a party. The result can be not only cramping, sometimes quite severe, but also impaired nutrient absorption. I now take daily iron supplements because iron tends to not get absorbed. Even worse is "late dumping," which results in shakes and sweats about three hours later. If I had half a brain, I would always eat right, thereby avoiding both dumping and its side effects.

Of course, the big anniversary happens the first week of December, when I had the surgery. It has been long enough that the details and perhaps associated trauma are eluding me. I keep telling myself I'm one lucky guy: I sure dodged that bullet!

A Year Later

2006-12-02T06:55:00.000-08:00

A year after my surgery people say—usually with surprise—that I look really great. By "great," they really mean that there is nothing to suggest I went through such an ordeal: there are no outward signs of trauma and my weight is as close to perfect as probably one could hope for. I proudly tell people I'm "the poster child" for transhiatal esophagectomies. I find myself often telling myself, "that wasn't so bad": I had no significant pain throughout, no complications, and not nearly the disruption to my life that I expected, or was lead to expect. People are often surprised when they learn I can eat essentially anything and have no physical limitations. It wasn't so bad and I would encourage others facing this surgery to worry about other things.

My eating has changed: I eat much less at any given time. This is a good thing, but I find people are often a little put off: "is that all you are going to eat?" We like to share in our gluttony. Unfortunately for me, there is a rather sudden line between enough and too much. Crossing that line still leaves me vulnerable to gastric dumping syndrome that is unpleasant enough, but which I have recently learned signals the pancreas to release more insulin. I have had several episodes in which I ate too much, got dumping and an hour later went into hypoglycemic shock. Needless-to-say, I have become cautious over how much I eat. (I find this particularly embarrassing at restaurants, when I'm convinced the waiter or waitress thinks I'm too cheap to order a real meal!)

The closest thing to a complication happened just recently. My anastomosis, the junction of what's left of my esophagus and stomach, developed a stricture from scaring. This was not unexpected and is easily fixed. A couple of days after Thanksgiving all I could swallow were fluids. No wonder: the opening into my stomach looks like it was about 3 mm. The picture they took before they stretched it out shows an undissolved pill that couldn't make its way down into my stomach. They stretched the opening to 20 mm, which resulted in an amazing difference in swallowing. I can tell that that opening has since shrunk, which is why they normally schedule a second dilation several weeks later. I will probably have to have this done periodically the rest of my life, but it's not a big procedure.

My goal this next year is to think less about cancer in general and my surgery specifically. I admit to a certain neurosis: every time I get some symptoms I've told myself, "maybe this is a new cancer." Last month I got a urinary tract infection and I was convinced I had prostate cancer. My latest experience with the stricture convinced me I probably had some horrible stomach tumor. I can laugh about these things now.

Medical Duct Tape

2006-01-20T16:41:00.000-08:00

I just had my 7 week checkup with Dr. Bouvet at the Rebecca and John Moores Cancer Center, the latest addition to UCSD's state-of-the-art medical facilities. Cancer is a daunting word; we all know someone who has tangled with cancer, not always successfully. We all dread the thought of experiencing it first hand, and so any facility with the tag "Cancer Center" tends to be the kind of place we try to avoid.

(This reminds me of the beginning of this experience. Last June, just before I had my annual physical, I started having some mild, but definite, problems with swallowing. I thought at the time, "what if this is some horrible cancer?" When the endoscopy indicated that I had erosive esophagitis, I was actually relieved, because we knew the problem swallowing was caused by something more benign and treatable. That relief was short-lived, as we soon discovered that I did indeed have some horrible cancer—it just wasn't causing that particular symptom!)

The first time I visited the Cancer Center, it was a surreal experience. "I don't belong here." It is profoundly disturbing the first time to see people who are in treatment. I found on my third visit that I noticed more the people who were on their first visit: both they and their spouse have that same anxious look I'm sure I had. I'm now a veteran—a survior.

Today's visit is a quick checkup. I knew how it was going to go: I'm doing great! I can't help but boast of it to the person at the front desk: "look at me, I had my surgery only seven weeks ago!"

Because UCSD is a teaching hospital, medical students are given the task of going in an making the initial survey by themselves, after which Dr. Bouvet comes in. I find I enjoy meeting these young, new healers. I had my list of questions for the doctor:

How much of my esophagus was left. (About an inch, which is what I thought. That inch is very important, because it's what squeezes food and liquid down into my stomach.)
So, when food gets stuck, its actually getting stuck in the top part of my stomach, right? (That's correct. That should improve with time.)
I have a chronic, dry cough: what's that about? (Don't know for sure. Some have it, some don't. One patient had it for nine months, then it suddenly disappeared.)
When can I get on a horse again? (Let's be conservative and wait until at least February.)
Can I actually get my surgeon pose for picture with a roll of duct tape? (Clearly unsure of the humor here, but sure: why not?)

I started back to work this week. I'll work four days a week for a little while, and I find a lunchtime nap is just the ticket. Life is returning to normal again. This is a good thing.

Four Weeks Later

2005-12-30T07:09:00.000-08:00

It is hard to believe that it was four weeks ago this morning that I went in for surgery. I have to be honest: it has been the longest four weeks of my life and I will be glad when another five months have passed and life is back to some kind of normalcy.

As you can see from the immodest picture, my eleven-inch belly scar is doing very well, and I expect that it will fade into a gentle reminder, a fashionable kind of "trophy scar." I'm beginning to suspect that my neck scar, which is not quite four inches long, will remain a more dramatic reminder, although it is usually covered by my shirt.

My stamina is growing steadily. I notice that my naps are shorter and that I'm going to bed later. However, I have never felt the need for naps more and I suspect they will be a regular part of my life for a while.

The big challenge is eating and my weight. My weight is down 18.5 lbs. (8.4 kg.) from four weeks ago, and it seems to be dropping by almost a half pound per day. This is expected and usual and will slow down, and then reverse itself over the next several months. It is gratifying to be at my ideal target weight and wearing clothing sizes when I first got married almost 33 years ago.

Meanwhile, I'm ready to greet the New Year and return to worrying about more mundane matters. And, I promise: no more pictures of my scars!

Cancer Free!

2005-12-21T06:58:00.000-08:00

Yesterday I had my first checkup since leaving the hospital. It is hard to believe that it has been only slightly more than a week since I returned home! All is well, my only challenge is a continuing and not unexpected loss of weight. I definitely need to get some new clothes!

Pathology on my esophagus and ten lymph nodes that were removed uncovered absolutely no signs of cancer. Dr. Bouvet said that it appeared that we caught this cancer unusually early. A very good thing, since he said that once it starts to spread it is very difficult to completely eradicate. In my case, I can be considered cancer free.

One friend asked if I regretted such a radical procedure in light of the knowledge that the actual cancerous area was so small and didn't show signs of spreading. The quick answer is, no: this cancer is poorly understood, especially in the early stages, and is so bad that you don't want to second guess it. Some lesser and experimental procedure would have left us wondering (and I'm sure testing) for years. However, the question opens an old wound: it is common when first diagnosed to try and "bargain" for something less invasive. I remember when I went to my oncologist, Dr. Just (a wonderful physician), with my list of alternatives. He gently shot each down. No, we wanted to go the path of the tried-and-true.

It's not entirely without feelings of regret. I am occasionally hit with the realization that I have had an often-used (if overlooked) organ simply removed and replaced by another organ (my stomach), which has been essentially mutilated to do double-duty. Consider the alternative: a likely early and rather ugly death. Whatever regrets I may feel quickly disappear. I'm sure I'll feel even more so once I can get into Shilo's saddle and ride off into the sunset with Aletha.

Working the (digestive) kinks out

2005-12-15T09:13:00.000-08:00

You don't just cut the volume of the stomach in half, widen the pyloric sphincter, and expect life to go on as before. I read about that in advance and intellectually understood it: smaller and more frequent meals. If only it were that simple.

I am now experiencing a fairly mild form of dumping syndrome, or rapid gastric emptying. This is caused when undigested food is pushed into the jejunum of the small intestine. "Early dumping" happens almost immediately and results in bloating and a shortness of breath with me; more serious cases can include nausea, vomiting and diarrhea. Several hours later you get "late dumping" with sweating, dizziness and weakness. Incidentally, dumping syndrome is one of those dark little secrets of gastric bypass surgery: you don't just sit back as the pounds fade away!

Today I made the mistake of eating two pieces of french toast: about two-thirds of what I would normally eat and I knew I was being a bad boy. The good news is that my appetite has returned, the bad news is that that was probably double what I should have eaten, especially since it was almost pure carbohydrate.

I realize now that even though I'm eating much less than before, I've still been eating more in a sitting that I probably should and still need to spread that out more. I'll have to be more careful as I work these kinks out!

Pain—or Not!

2005-12-14T09:01:00.000-08:00

I went into this surgery expecting a great deal of pain. In fact, I was warned of it. I have an 11-inch incision from my bellybutton, up and a 4-inch incision on my neck: how could I not?

The truth of the matter is that at no time have I experienced intense pain, just mostly background aches. One of the best things I did was wean myself from the morphine, which only seemed to give me bad dreams. I have had nothing but acetaminophen (Tylenol) for at least five days. They sent me home with a huge prescription for Vicodin, a powerful narcotic, which I have yet to fill!

Perhaps my seemingly incredible recovery is related to my pain "threshold." I'm thrilled to be on only low-grade pain killers and grateful that I'm not in a narcotic daze.

Meanwhile, even the little pain I was experiencing has diminished drastically overnight. It is no longer uncomfortable to cough of sneeze. I've been able to cut back even on the acetaminophen. Even better days are ahead!

Eating and Swallowing

2005-12-14T08:47:00.000-08:00

Changes in my eating lifstyle were inevitable, given my reconfigured upper digestive system. I was told my stomach has about half the volume it had before, and they widen the pylorus from my stomach/esophagus into my intestines.

Swallowing is a little different, at least for now. No more "big gulps" for me, but at least I have a reasonable excuse for my frequent burping. Perhaps that will get better. In fact, I was told that the anastomosis, that is the junction of my stomach to drastically shortened esophagus, will continue to heal for six months.

What I notice most of all is how quickly my little stomach fills up. There is a very fine balance between just right and too much. Too much food results in a very bloating feeling and hours of discomfort, which is exhausting. It is easily the most difficult aspect of recovery for me so far. I was told that the portion of my stomach below the diapragm will eventually stretch out, giving the stomach a more normal capacity.

All-in-all, I am the beneficiary of years of fine-tuning for this procedure. They now know how to shape the stomach just right, how to widen it just enough at the bottom to maximize operation. It's quite a miracle, when you think about it.

Quick Hospital Tour

2005-12-13T16:28:00.000-08:00

UCSD Thornton Hospital is a very modern building that was designed in conjunction with one of the big hotels. As a result, when you enter it, it has a real resort feel. Don't be fooled: it is still a hospital! It is built around a large and airy atrium that gives a tremendous feeling of grace and spaciousness. Actually, when one is recovering and need to get out and walk around, it is quite nice to have this alternate contrasting environment: contrasting to the rooms that, no matter what, tend to close on you. On the lowest level there was a grand piano fitted with a MIDI controller that tirelessly played inane Christmas ditties; one wishes they could at least put the late Schubert Sonatas on for a change.

As an added touch of elegance, the rooms actually have polished hardwood floors. However, if that bed looks comfortable, let me assure you it is not, or at least ceases to be very quickly. It has already had a thousand butts molded into it, and it feels like the mattress is WWII surplus materials. Still, a few homey touches, such as fresh roses from our garden, a couple of pictures and teddy bear— courtesy of my friends Sonja and Holger— plus a rather pleasant view out the window made for probably as nice an ambience as possible.

There was no escaping that it is still a hospital, and I'm grateful to be home.

Home at Last!

2005-12-13T07:34:00.000-08:00

December 11, 2005.

Hi, everyone! This will be a very quick (for me) note.

I'm back! I'm well! I'm very tired (a common theme for a while). I guess the hospital considers me a big success story. When one of the nursing staff said I was welcome to stay as long as I wanted I had to reply, "thanks, but no thanks!"

Thank you all your your letters, emails, calls and visits. While I'm home on recovery, feel free to give me a call; if I'm taking a nap, leave a message and I'll get back to you later. I'm sure all of your good thoughts and prayers were a big part of this success story: thank you. I especially want to thank my sister Jean for posting dates and for bringing copies of replys to my bed each day, and of course Aletha, who literally camped out in my room half the time and was my constant support and companion.

Kemer

It's Chip and Sip Time!

2005-12-13T07:32:00.000-08:00

December 9, 2005.

Dear Friends,

Well, there were no dancing beauties throwing rose petals, but the surgeon read the radiology report in the wee hours (!) and immediately ordered ice chips for our thirsty patient. Kemer was never so happy to see his nurse bring a cup of ice and some water in the middle of the night! He said he didn't know ice could taste so good. And today he graduates to jello. Life just couldn't get much better. I wish I could be there for the surgeon's early morning visit so I could kiss his feet!

Aletha

In his own words

2005-12-13T07:26:00.001-08:00

December 8, 2005.

Greetings all,

Leave it to Kemer to find a way to reach you over cyberspace without a computer! He typed the following message into his PDA, one letter at a time. Now that's impressive! Sadly, as I left Kemer tonight, he was still awaiting those wonderful two words, "ice chips," to magically appear on his medical chart in the form of a doctor's order. Surely, his surgeon must know the angst Kemer suffers while he himself heads home to a loving wife and dinner. Ah, but wait, I have the answer. The surgeon plans to hand deliver those precious ice chips in a silver goblet while accompanied by six scantilly clad beauties all dancing to an exotic tune and throwing rose petals around the room. Of course. He wouldn't have it any other way!
Aletha

Now Swallow This...

The great moment of truth in the transhiatal esophagectomy is in the swallow test. Now that the surgeon has sliced off all but a fraction of the esophagus, stretched out and slimmed up the stomach and then sewed it all back together, it is given almost a week to knit together. You then need to know if it leaks--or not.Most leaks are not too serious, they just mean several more days in the hospital and then another swallow test.

Oh, did I mention that from the day before the operation until you pass the swallow test nothing passes your lips? Actually, it's not as bad as you may think, but I think I've lost a lot of weight in the last week: my skinny legs are complete strangers to me.

Today was my big day. Let's jump to the good news: I passed, and I'm in bed dreaming of the doctor's imminent orders: Kemer shalt suck on ice chips, perhaps moving to real fluids tomorrow! Greater ambosia there is not, at least at this time!

The test itself was facinating. I assume that radiologists are considered strange by their fellow doctors--funny gnomes who live down in the cavern, worshipping giant machines, but I have considered myself more like them. They have always seemed genuinely enthusiastic, and today's proved to be so. He allowed Aletha to stay and watch. Right now she has a pretty good idea of where my newly reorganized organs are.

I, on the other hand, got to drink some magic concoction that tasted like chocolate run through a gerbil's digestive system; that good! That's okay: it was over soon and I know those ice chips will be sent over any minute now—in a silver goblet!

Kemer is walking his own doggy now

2005-12-13T07:24:00.000-08:00

December 7, 2005.

So, yesterday a nurse "walked the dog", meaning that as Kemer walked around, the nurse pushed the rolling rack to which he was tethered by his iv lines. Today, day 5, Kemer was confidently walking solo, pushing his own rack.

And he's lucid, really lucid. Back at his room after our walk we realized he and his rack were kind of tangled up in his iv lines. The rack had turned this way and that a few too many times, and a leaky iv line had required a quick fix at the nurse's station as well as towels to mop up the floor (see? it really is like walking a dog). I was curious to see what he would do next. He sat down on a chair, eyed it critically, and got it untangled. Somehow I doubt he could have managed that yesterday.

He said his head cleared up today when they took his nasal tube out and -- bingo! -- lucidity returned (that's also a warning, incidently). He still has the ivs, but the major tubes are out now, and he feels much better.

Day 6 is the swallow test and the burning question: when does Kemer get to eat again?

regards,

-jean

Jean Anderson

Kemer is moving from intermediate to a regular hospital room ... soon ... very soon

2005-12-13T07:21:00.000-08:00

December 6, 2005.

They unplugged Kemer's monitor today. Whew! No more alarms blaring, though I must admit it was sort of entertaining to watch his blood pressure instantly spike the moment the alarm would go off -- "yup, he's definitely alive!" (ok, I admit that must be the evil sister in me). He's ready to move to a regular hospital room, but hasn't yet. We suspect somebody may first need to get discharged and free up a bed.

He's also walking a little, tethered by his intravenous lines to the rolling rack a nurse pulls behind him (today I heard this cheerfully referred to as "Time to walk the dog!"). I'm sure "rack" isn't the right term for this thingamagig -- words fail me since I'm not in the health profession.

But words don't fail me when I say how much Kemer and Aletha have enjoyed and appreciated all the wishes, thoughts, prayers, and wit you've been sending in email. I've been printing the emails off and taking them in every morning. The first card arrived today and I'll take it in tomorrow morning along with the latest emails.

Many thanks,

-jean

Jean Anderson

Kemer has moved from intensive to intermediate care

2005-12-13T07:17:00.000-08:00

December 4, 2005.

Kemer was moved from intensive care to intermediate care today and is doing great -- he's cracking jokes now that the doctors don't understand (always a good sign). He can't eat or drink anything for another week, which isn't all that terrific, but everything needs to heal up well before he starts chowing down again.

Aletha says you should feel free to call her , but no cell phones are allowed in the room, so you won't be able to talk to Kemer.

Kemer has really appreciated all the email notes received so far. Feel free to continue sending them to me. We'll keep you updated as his recovery continues.

regards,

-jean

Jean Anderson

Kemer is Improving

2005-12-13T07:16:00.000-08:00

December 3, 2005.

Greetings, all,

Kemer has made much improvement since last night. When I saw him this afternoon he was sitting up in a chair beside his bed. I cheerfully said, "Kemer, you look as good as you did before the surgery!" He gave me one of those big brother glares and replied, "Feel as good, too."

Truthfully, he looks much better than I expected. Most importantly, he has cleared the major medical hurdles, which is truly excellent and encouraging. Now he needs to heal.

Aletha said that it sounds like Kemer will be moved from intensive care to intermediate care then to an actual room. The specific timing, of course, is uncertain. In other words, he's something of a moving target. I'm not a moving target, so if you would like to send Kemer a card, you're welcome to send it to me; just let me know and I'll email you back my snail mail. Or email me a note for him and I'll print it. Daily I'll deliver any cards/email notes that have arrived.

Thanks again for all the good wishes.

regards,

-jean
Jean Anderson

First Report after the Surgery

2005-12-13T07:13:00.000-08:00

December 2, 2005.

Kemer's surgery took five hours. He did great -- there were no complications, all his vital signs remained strong throughout, and none of the reserved blood was needed. His surgeon was quite pleased. Aletha was able to see him after they moved him into intensive care and says his color looks really good.

Thank you all for your care and concern! I'll post a followup when they move him out of intensive care.

regards,

-jean

Jean Anderson
(Kemer's sister)

Kemer 2.0 - "We can build him better!"

2005-12-13T06:57:00.000-08:00

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.