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Archive for April, 2010


Right Liver Lobectomy (Part 1 of 2) – The morphine button.

April 29, 2010

(Note: This post come in two parts. I tried to digest it in appreciation of the time you give to read this post. However, I apologize if I over-extended your kindness.)

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The medical terminology is lobectomy or the removal of one of the lobes of an organ. It can apply to brain, lung, or liver. In my case, I am having a right liver lobectory or a hepatic lobectomy of the right lobe. That’s what it says on the procedure form in front of me for April 20.

Name and date of birth please?” the receptionist asked of me.

I have this funny feeling that I am going to be asked this question many times over, so I better not forget. It was 6:00 am at the 5th floor day-surgery reception area and place was already crowded patients and family members. It reminded me of my early Monday morning travel days at O’hare International airport. The airport will be already jammed with business travelers early mornings, but this was a Tuesday and it is just us sick patients with our families.  Yes, this hospital is that busy.

Good morning, Mr. Alvarez. We have all your forms ready, but you have to sign one more consent form.” I already did a lot of this pre-op paper work the week before but there is always one more form. Let’s kill some more trees.

“Your procedure will be done in the 7th floor. So after you are done with the paper work, you and your wife will be escorted to the 7th floor surgery.”

At the 7th floor, my wife was shown the family room with a big flat screen monitors that lists all the surgeries for the day and their status.  There was phone which nurses/doctors can call to inform the families. (See what I mean when I say this hospital is just like O’Hare airport with its flight status monitors.) I was escorted to cubicle 7 in the pre-op area and was told by the nurse, Rosemary, to remove all clothes and change to the hospital dressing gown. There is no escaping now.

Could you tell me your name and date of birth?” I knew it. Some of resident doctors/nurses were inventive by asking me to spell my last name.  Ah, the trick question.  I wonder how this works with deaf and dumb patients. I digress.

A series of doctors/nurses come and see me and asks me the same question. What medication am I on? Am allergic to any drugs? Last meal? They were always courteous and would always ask after if I needed anything else or if I was comfortable. They have access to my veins and was slowly infusing me with antibiotics and nutrients. The heart and blood pressure monitors were working correctly, and I was ready. Later, my wife was brought in.  I missed her already. It was good seeing her. I tried warning my nurses that my wife is a nurse too and she gets protective about me.

“Watch your step around her, ladies” I thought to myself.

The nurse anesthetist walks in and marks my right abdomen with the initial MA (the initial of my doctor). As if on queue, Dr. A walks in.

Good morning.  So, are we ready?” He greets me with a smile. He is a very likeable man. God is in the “house”.  Woohoo!  Dr. A briefs us on the length procedure and other details. With that, my wife kissed me and I was slowly brought to the operating room. I was gone.

I woke up in the ICU hearing voices around me. I don’t remember anything and I even wondered if the procedure has started. Reality, inspite of the haze, started to set in. I hear the monitors beeping, my throat hurt, I could feel something in my nose as a suction, and air was flowing as well. I started to gag and felt an urge to vomit. The urge contracted my stomach and pain shot up.

Morphine pump on left and all gadgets hooked up to me

Breathe, hon. It is over. Press your morphine button.” my wife’s familiar voice assured. I press the PCA pump button (discharges morphine) and a warm feeling covers me. Ahh… It was pass noon already. I have been in surgery for four hours.

“Hi, Mr. Alvarez. My name is Abby and I will be your nurse during the day” she introduce herself as she checks my vitals.

“Ok” I replied and press the morphine button again.  Hallelujah.  Now, where was I or where am I?  I digress again…

Abby, that’s the name of my second daughter I told her. The funny thing is my night nurse’s name is Natalie, that’s the name of my first daughter. I have both my pretty angels taking care of me. I got to know Abby more since I was more awake during the day. She really took care of me.  I told her about my experience running the marathon and it inspired her to run, for the first-time, the Chicago Rock N Roll Half Marathon for me.  I will be there to cheer her on.

I am always touched by the kindness of other, like Abby, Natalie, or Rosemary, when you are most vulnerable. I met many of you through this blog or through my story, helping me when I most needed it.  I wish I can name all the names who have helped come me this far, but you know who you are. Thank you very much.

With nurse Abby. "You got to start moving and sitting up!" she tells me.

Cheers.

PS:  My wife had warned me of the length of my incision.  She was not kidding.  I will post a picture of it Part 2, so this is a warning to the faint of hearts.

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I hurt but I am ok.
April 25, 2010

got discharged from hospital last Thursday, April 22.  Most were surprised that I got discharged that quick.  A major surgery removing the right lobe of my liver on Tuesday, April 20, then out of the hospital by April 22.  I will explain in another post.

Since then I have been recovering at home.  First night at home was brutal and one of the most painful night I have experienced, even with all the narcotic drugs prescribed.  I am slowly recovering and very glad to be home.

Tomorrow, I go back to the hospital for checkup and removal of a drain in my hip.

Will write again.  Thanks for your prayers and thoughts.

Cheers.

PS:  Did not make it to the Lakefront 10 miler as the starter runner yesterday.  Go runners!

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It’s chopped liver time.

April 19,2010

omorrow is my liver surgery. My doctors will resect or remove the right lobe of my liver and hopefully any remaining cancer cells there.

I must say I am anxious.  I have done everything I can to prepare for this moment, like in a marathon. For the past couple of weeks, I have been going to the gym to be gain strength and have been eating lots of protein for recovery. Like night,  when my wife and I had our date night. I took her to PF Changs, where I had my favorite dish Mapo Tofu (more protein) and Vegetarian Lettuce Wrap. I love these two dishes, it is the bomb!

Then this morning, I biked to the gym at 5:00 am for the Group Power class (cross-training with weights), and had a good breakfast after. Later, I accompanied my wife to her physical therapy session, and we had lunch. In the afternoon, I rested and prepared some things I want to bring to the hospital tomorrow. To finish off the afternoon, I ran 3 miles at 10:57 pace.

I am ready. I know I have to do this. Several of you called, sent me email, and text messages to wish me well for tomorrow.  Thank you, I really appreciate it. It gives me strength and confidence to get through this. Like you, I am praying for healing and quick recovery. I will be back.

Cheers.  Mazel tov.

PS: One of the things I will miss, due to my surgery, is the opportunity to be the starter runner at the Lakefront 10 miler. My good friends at Novacare, Jamie and Noreen, had invited me to be the starter runner early this year. I said yes on the condition they give me the Number 1 bib, as joke.  They did arranged it but I may not be there.  Sucks!  It was one of my goals for 2010 (see post ‘Welcome 2010‘). Maybe I can still make it if discharged early from the hospital and with enough pain meds to stand there or maybe next year again.  Good luck, runners!  Next year this Kenya will be there.

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I got the call.

April 14, 2010

was out on errands with my mom and daughter yesterday when the call came through.

“Hello?” I answered.

“Bo? This is Lori from Dr. A’s office. I am calling to let you know we have a schedule for your liver surgery.” Lori has a sweet voice that she makes you comfortable right away, but I was still anxious knowing I was about to receive news on my impending surgery.

“Yes?” I hesitatingly replied.

“We have you scheduled next week, Tuesday, April 20 for your liver resection.  In preparation, you need to come in for a physical exam prior to the surgery.  I am trying to get this scheduled for you this Thursday, April 15, but could not confirm it yet.”

Oh…oh.  There it is.  It is chopped liver time.

I should have been ready for this call but when it came, it still sent chills down my spine. It is really going to happen, and that soon too.  They are going to open me up, remove part of my liver, and then I have to heal.  I know I wanted this done, I know my doctor is good, but I still could not help being anxious.

I also notice the change in my mom’s mood when she over heard me talking to Lori about the schedule.  She was hoping that I do not have to undergo the surgery, as if wanting all the distress to stop.  That’s the protective mother’s instinct.  She just kept silent and prayed.

No use backing out now. Thy will be done.

Lori was going to give me the details of my schedule as soon as she can but for my April 20 surgery date, she told me to be at the hospital by 6 am.

It will be another Tuesday event for me.  I am really a Tuesday person (see my previous  posts ‘Tuesdays people‘).  I received the call on a Tuesday and will have surgery next Tuesday, April 20.  When on treatments, I have my chemo Tuesday and recovery Tuesday (see related post ‘Recovery Tuesday is here‘.  I think it is just appropriate to end this with a song from the Rolling Stones ‘Ruby Tuesday’.

‘Yesterday don’t matter, if it is gone’ – Rolling Stones.

Enjoy.

Let’s do it.

Cheers.

PS:  I think I will have a barbeque party this weekend and serve grilled liver or pate with red wine.

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It’s complicated*

April 12, 2010

(*Footnote: The title of this post reminded me of the 2009 movie ‘It’s Complicated‘ starring Meryl Streep, Alec Baldwin and Steve Martin. Most often, it is also used as common American expression to describe a difficult predicament/situation.)

As if saying why does life have to be complicated?

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ast week Monday (April 5), my wife and I found ourselves in the patient room waiting for Dr. A, the liver surgeon (see related post ‘Meeting Dr. A‘). This appointment was already set several weeks ago to assess the resectability of my liver. The previouls week (March 31 and April 1), I had a series of scans of my liver, chest, and whole body (PET).  The PET scan came out negative with no cancer cells detected, soI was curious to find out what Dr. A would recommend.

“Wow. You look burnt, Dr. A. I hope you had fun!” I jokingly said upon seeing him walk through the door.

He smiled and said “I took in too much sun while on vacation in Arizona.” I suppose you forgot to put sunblock. 🙂 We exchanged further pleasantries and then he got down to business.

“As I had previously mentioned in our last meeting, we have a surgical review team that go through all our cases every Friday, and your case was among those reviewed.  For your case, it was reviewed by the radiologist, oncologist, and surgeon. They reviewed the results of your scans and medical background, and came to the conclusion of surgery to resect the tumors in your liver.”

There it is again. Reality looking me in the eyes. I could not reconcile in my mind why these learned doctors would recommend resection of my liver when my scans were negative. Why? Seeing my apprehension, Dr A. continued.

“I understand that the PET scan shows negative presence of cancer cells. To me this is the litmus test of the resectability of your liver.  The negative PET scan, tells me you have responded to your chemo treatments. If you did not respond to your treatments or your PET still showed positive presence of cancer, it is useless to resect your liver. No point in opening you up when you don’t respond to chemo.  It does not buy you anything.”

Ok. That make sense.

“Also, the negative PET scan results does not mean that your cancer is not going to come back.  For now, nothing can be detected or identified.  A resection of your liver would increase your chances of remission or the cancer not coming back. I know this is a lot to absorb, so you might like to think this over before deciding.”

He gave me other details of how long is the recovery period and if it will be partial or full resection. Right now he is looking at an open surgery to take out the right lobe of my liver. Gulp! Recovery is about four weeks in order for the left lobe to grow and take over. I would have to give up drinking or drink in moderation since I am left with one lobe.

This is complicated, but if you think about it I am being given an opportunity to increase my chances of remission. My right lobe for a better life. It is no different from the choices given up by other cancer patients, like LisaK, a breast cancer survivor of 11 years. Lisa is my yoga-mate and I recently got to know her more.

She is a graphic artist and entrepreneur with her own company (Pisa Design).  Eleven years ago, she was in the same predicament I am in now.  To increase her chance of remission she had a double mastectomy; moreover,  she even went further to have her ovaries removed. Now, how does that compare to me giving up drinking and her giving up up the chance to have kids of her own?  Cancer makes give up things for a sliver of hope of remission.

You have to give up something in order to get something of value. Sounds familiar. It happens everyday, like paying for goods and services; but put this into perspective of something of real value.  It is like giving up something for a chance to smell the roses for many more years, hold hands with your wife or love ones, a chance to see one more sunrise, or a chance to stand at the starting line of the NYC marathon or London marathon. Would I give up a liver for that?

Yes, I would.  It is not complicated.

Cheers.

PS: I would know in the coming days when my liver surgery will be. For now, I being weaned out of chemo toxins in my body. To help in getting rid of the toxins, I am running, cycling, cross-training, and doing more yoga.  Hopefully, I will have an easy recovery from surgery, as well.  I will keep you posted.

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Early Easter for me: Hallelujah

Apri 2, 2010

NOTE:  You might like to play the video below then go up again and start reading.

y phone rang while I was in the middle of baking brownies and cake. I see the caller id saying it’s Swedish Covenant Hospital, where I have my doctors and chemo treatments.  Hmm….

“Hello.” I answered.

“Bo? This is Dr. B from Swedish.  How are you?

(NOTE: Dr. B. is the head fo the Interventional Radiology Department and the one who performed the chemoembolization to my livers last December 2009).

I have not forgotten you and have always kept you in mind.   I am calling about the result of your PET scan” he continued.

Somehow the world around me seems to slow down. I forget about my baking and just held on to every word he said. I paused and held my breath. I just had my PET scan in preparation for meeting Dr. A, the liver surgeon, and it is suppose to tell any presence of cancer.

“I talked to Dr. M, your oncologist, and Dr. K, your colon surgeon, and I had askedf them if  I can be the one to call you regarding the results of your scans. I carefully reviewed the scans and compared it with the previous one. We can no longer identify the metastases in your liver or in your right axillary lymph node. It’s gone.”

I gripped the phone trying to absorb what he just told me.

“Gone?” I asked.

“Yes. Your cancer is gone. The lesions in your liver are gone or non-detectable.” he said.

A rush of emotions came over me while I still hear him explain the rest of the results. I felt tears falling as I absorb the significance of his words. Gone. Not identifiable. I could not believe it. I have conquered the beast again. I did it.

“Bo, let me add that it may not detectable but it does not mean it will not come back” Dr. B adds.

“I know Dr. B. I have been in this situation before in October 2008 when my PET scan result showed no recurrence of cancer but in came back a year later in November 2009. You, Dr. M, and Dr. K gave me my life back again.  I know it can be taken away again but I am very grateful for your help.  Thank you.” I replied.

He further explained what needs to happen and after we finish I woke up the wife who was sleeping prior to working her night shift.  Dazed from sleep, I told my wife the result of my scan.

“It’s gone, hon.  My cancer is gone.  Dr. B called and it’s gone.” I said.  After making sense of what I was trying to say and absorbing the impact of the news she cried in happiness. Oh my God, she said, it is a miracle. Indeed. We called up my Mom and brother in the Philippines.  We told her the good news, then she wept in great thanks to God. I love you, Mom.

It is not always you are given your life back the second time around. I am a totally different person now. I know everybody has to die sooner or later but in my case, and those who still suffer from this dreaded disease, we know if we stop taking our chemo treatments or taking care of ourselves it will be sooner than the rest. So we savor each day given as a gift.

That’s it. Enjoy the day given. So, I laced up my running shoes, dressed to run, and headed out the door. I want to give thanks to God the way I know, when I am at peace with myself. I want to feel the fresh spring air in my lungs, the wind in my tearful face, and the soreness of my tired knees. Thank you, Lord. I love thee. I am different person thanks to You, and those of you who have prayed and supported me. That’s you, my friends and family.  You have followed my ups and downs, my pain and recovery during treatments, and have given me encouragement when I most needed it.   Thank you very much.

Easter is about rebirth, redemption, and salvation. I had an early start for my Easter.  In behalf of my famly, I wish you and your family have a blessed Easter.

Cheers. Mazel tov.

PS:  I am still going to keep my appointment with Dr. A, liver specialist, next week to hear his opinion.  Lastly I leave you with this song from the late Jeff Buckley; Hallelujah.  I was humming this while running.

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