The Surgery: Sugarbaker Makes A Bittersweet Cookie

I have mentioned “the surgery” a number of times, but I haven’t really gone in to too many specifics.

The surgery is named after Dr. Paul Sugarbaker, who refined the procedure in the 1980’s. I won’t provide the whole history lesson here (you can find a lot on the web), but I imagine that when he proposed using this technique on people, other physicians must have thought he was crazy (or at least overly aggressive).

But after having positive outcomes, the procedure became standard practice, and is now used on people with abdominal cancers and other related conditions.

The diagnosis I have is a type of PMP (pseudomyxoma peritonei). In my case, my appendix burst (unbeknownst to me) 2-5 years ago (estimated), releasing of bunch of cancerous cells in to my abdominal cavity. These cells disseminated, took root, and then began to generate mucinous tumors.

Fun, right?

The surgery involves going in via a mid-line incision and then doing a complete surgical removal of the mucinous tumors (called debulking, or cytoreduction). This can also include the removal of a number of organs and other tissues.

Even after this aggressive measure, it is possible for microscopic cancer cells to remain, so they sew the incision shut about 70-80%, and then pump in heated intraperitoneal chemotherapy (HIPEC - hyperthermic intraperitoneal chemotherapy).

For 90 minutes they “massage” the peritoneal cavity to make sure the solution gets to all of those hard to reach places. Then they suction out the chemo solution and sew you up.

What gets removed during surgery is determined on a case by case basis. For me, the areas of mucin concentration seem to be in my upper left and right quadrants (near my diaphragm), down in my deep pelvis (near my rectum), and then some other sporadic areas.

In addition to the tumors, my greater and lesser omentum will be removed, my spleen might be removed (the spleen itself is fine, but because it is so prone to bleeding, and difficult to get to stop bleeding, they may decide to just remove it rather than to try to strip the tissues on/around it), my gall bladder is on a “to be determined” bases, my ascending colon might come out (which would then require a resection), and then, hopefully, they can work around my rectum...because after all of this, being able to poop out of my butthole would be a nice “win.”

There will also be “spot” removals from my liver and a few other areas.

In general, the procedure can take 12-16 hours. Because I have a low-grade case, Dr. Foster has said that it is possible that my surgery will only last 6-7 hours, but he won’t really know until he gets in there to see. It could just as easily push out to 10 hours or more.

So, as you can see, it is a big deal. And, bittersweet.

Sweet because what I have is treatable; bitter because not only is it a gnarly procedure, but my condition is technically “incurable.” Some people have to have this surgery performed a number of times throughout their lives.

And with that we have covered “Sugarbaker” and “bittersweet,” but not the “cookie.”

To be honest, I don’t have anything for the cookie part of the headline, except that I am going to be sure that I have a few between now and November 10th. :)

The plan is for me to be in the ICU 2-3 days, and then on the floor for another 6-7 days. Because the risk of complications is highest in the first 21-28 days, Dr. Foster has asked me to stay put in Omaha for four weeks post-surgery. I would like to be back in Seattle by Christmas, but it will all depend on how things go.

The “recovery time” he gave me was three months. And he was clear that he really means three months. He doesn’t want any “I was feeling really great so I...(fill in the blank; went out for a long run, did a hard workout, etc.)”

Seeing as how fatigue is one of the primary issues I will be dealing with, it is possible that I won’t have the desire to go do those things anyway. Then again, being pent up for so long might make me want to go do ANYTHING...just to get moving.

I don’t really sit around and ask myself the “whys.” At least not metaphysically. There are people who are much worse off than me and people who are much better off than me. The “meaning game” seems like a silly one to play.

Occasionally, however, I do wonder about the “hows,” in the sense of wondering how something like this happens. Medically, what I have still seems to be a mystery with no known cause, and that is the thing that piques my interest.

Just like we look back at the medical practices of earlier years and think, “Oh my god, I can’t believe they did that,” I wonder if at some point in the future people will look back at this surgery and think, “Holy crap, what were they thinking?”

But we do what we do because of the knowledge and the technology that we currently possess. This is where we are right now, and people’s lives seem to be extended because of it.

We are all just one more life in the unfolding evolution of humanity. And while being just one person in the entire history of humankind could make us feel small and insignificant, how we live is also our most important task. How will you spend this precious life?

For the moment, I am just living. Every single day. There will come a time, probably the day before the surgery when I check in to the hospital, where my mind will dabble in the fear and anxiety of the unknown future, but until then, I spend my time putting my affairs in order and doing the things that I enjoy.

Today, for me, that means going for run, eating yummy food, doing some reading and writing on my current interests and passions, and hanging out with Rose. Pretty difficult to complain about that. :)