A Father’s Day To Remember

Greetings to all the Father’s reading this blog.  This Father’s Day has presented us with some very good news.

We have my HIPEC surgery scheduled for July 15th!  The prayers we’ve been asking you for are being answered over and over.  Our latest prayer was to discontinue chemotherapy after the third round and to move to surgery as soon as possible.  Both of those things are happening.  Praise God!

In this blog I will give you my version of the HIPEC surgery.  While I’m describing it you may think, “why would anyone be so happy about that surgery!”  When I’m finished I hope you understand the whole process.  

Here is a three minute YouTube video of our surgeon, Dr. Nabil Wasif and his involvement in creating the first HIPEC department in the Mayo system:

https://youtu.be/LNKicWrPUs0

To begin with, let me summarize the range of emotions we’ve experienced since November until now, seven months later.  The Emergency Room doctor said, “you’ve got a lot going on in there, and I don’t know what it is.”  The Internal Medicine doctor gave us a brochure for Gastritis.  At this point Diane was sure I only had gall stones.  After that the CT scans and MRIs showed more in there that wasn’t normal.  Then, a biopsy indicated cancer…fear arrives.  Looks like Appendix cancer…”that’s not so bad, let’s take out the whole thing”.  Then, a diagnosis of Mesothelioma…a scary cancer.  We learned about HIPEC and asked our first surgeon about the procedure.  You may remember he scared the daylights out of us, comparing the surgery to an organ transplant…more fear.  Then we began to research the procedure and found a video from the University of Chicago that left us with the message, “HIPEC offers Hope”.  Then our Ironwood oncologist used this term: “HIPEC is the only thing that offers you “Long Term Remission”…more hope!  That became our new mantra.

Last Friday while discussing the HIPEC procedure with the Mayo doctors, our Surgical PA told us, “our goal is for you to leave here Disease Free!”  I don’t think I have to tell you what our new mantra is!

So, here’s what it’s going to take to be….disease free:

Mesothelioma is a cancer of the peritoneal lining of the abdomen.  It can spread to all of the organs in the abdomen cavity.  My case involves an amount of fluid that has built up called malignant ascites.  The only successful long term treatment is called Cytoreductive Surgery combined with Hypertheric Intraperitoneal Chemotherapy (HIPEC). 

The first step of the procedure is Cytoreduction, the removal of all visible and identified tumors that are large enough to target.  The surgeon has a good idea already of where those are based on all the diagnostic scans and, more importantly, the latest laparoscopic procedure where he took pictures.  I am aware that I have the mass near my appendix, a nodule in my diaphragm, and several other small spots he has identified.  Anything else he finds during this process is removed.  Then, he turns his attention to the ascites (the fluid build up) which is primarily found in the lining of the abdomen.  The cancer cells in the ascites are microscopic and not targetable in the same fashion.  He will identify where these cells collect and strip one layer of the lining in any of those spots.

Then my skin is temporarily closed.  The HIPEC contains chemotherapy and is delivered directly into my abdomen through a catheter.  The chemo is heated to 107 degrees.  This is a safe temperature and cancer cells are more sensitive to heat than normal cells.  To help spread the chemotherapy evenly the abdomen is gently shaken, not stirred, (that’s a James Bond pun) for about 90 minutes.  I’m told this is when the doctors might actually take a break!  After that the fluid is drained and the catheter removed.  They open me back up for a double check and close with stitches.  We’ve seen different estimates of how long this takes, anywhere from 8-12 hours!

The effectiveness of the heated chemotherapy placed directly onto the cancer comes from the fact that the chemotherapy dose itself is 6 times stronger than systemic chemo that travels through the bloodstream. 

Some of the above was taken directly from a Mayo booklet on the surgery.  Here’s my favorite line in the booklet:  “The goal of treating cancer of the peritoneal surface is to promote long-term survival and good quality of life…In certain situations, cytoreduction with HIPEC can cure cancer of the peritoneal surface”  Until we made it to Mayo, no doctor, no online search, no books ever indicated that Peritoneal Mesothelioma was curable.  That’s Hope!

One decision we have made is to not travel between now and July 15th.  I really had my heart set on getting to Alaska for 2-3 weeks during this time.  But, let’s face it Covid is still reeking havoc on families and the last thing I need is to delay this surgery.  So, we will hunker down here in Arizona and build weight and strength.  We feel like God prompted us to reconsider the trip to Alaska and we are trying our best to listen.

Health Update:

Currently, I am feeling nearly normal.  No more effects from chemotherapy, I’m gaining weight, and I feel I can do any normal activity.  We walk every evening and I plan to start riding bikes in the mornings with Diane.  We will look for a pickleball game or two every week as well.  

Here’s a fun picture I want to share with you.

This motley crew are the kids I grew up with. All but two of them are from the same grade school here in Phoenix.  Some I’ve known since first grade.  We sort of went our own ways for much of our adult life but for the last few years we’ve reconnected and meet a few times a year to drink cocktails and tell the same old stories over and over.  Sometimes, I say we were juvenile delinquents that avoided any serious jail time but the politically correct term for our behavior is, “we were mischievous.”  Our stories are pretty fun!  I feel really blessed to have these guys in my life for the last 60 years!