Tests at VM

Well we're finished with two days of testing at Virginia Mason (VM).  John underwent cardio and pulmonary evaluations, including a treadmill stress test, and he's healthy as an ox.  He just has cancer.  Go figure.  We met his surgeon, Dr. Donald Low, who is a rock star.  He is reputed to be not only one of the best in the U.S. but one of the top thoracic surgeons in the world dealing with esophageal cancer.  As an added bonus, he's Canadian and hails from -- as he said -- "a little town called Toronto."  I told him I'm from the "small Canadian hamlet of Windsor" right across from Detroit.  I'll ask that they play "O Canada!" in the operating room during John's surgery.  We don't know as yet when that surgery will be.
John also had an endoscopic ultrasound (EUS) which gave a 3-D picture of what's going on and  "staged" his tumor.  Dr. Jiranek, the GI doctor who performed the EUS, told us John's tumor is a low-level T3.  Tumors are staged at various levels of T1 through T4.  While we were hoping for a T1 or T2, the fact that it is a low-level T3 is good news.  Combined with John's earlier PET (full-body) scan done last week in Bellingham, it's all very positive news.  Both John's surgeon, Dr. Low, and Dr. Jiranek said that the report from the PET scan alone showing no visible cancer elsewhere is most excellent.
The next step...VM's "Tumor Board" will meet Wednesday, Feb. 2.  This board is comprised of Dr. Low, Dr. Jiranek, VM oncologists, radiologists, etc.  Their job is to review patients' tumors, including John's, and  make recommendations for treatment plans.  We are pretty sure that John's path is going to lead him to chemo and/or radiation prior to surgery.  How much treatment we don't know.  What we do know is that when Dr. Low is satisfied that the tumor and any radical cells that might be floating around somewhere are stabilized and, where possible, destroyed, there is a 4-8 week waiting period.  Surgery will occur SOMETIME during this period.  But as I've already mentioned we don't know exactly "when."
So it's a long road yet to travel.  We're taking all of your prayers, good wishes and kind comments with us on the trip.  Each of you can never truly know how much your support means to both of us.  John reads every email and comment you post.  It is not only a comfort but a giant boost for him to know his friends and family care.  So onward; I'll keep you posted.  With loving thanks...Nancy

On to Seattle's Virginia Mason

Well at 8:00 this evening Sonja from Virginia Mason's Thoracic Surgery Department called.  The ball is starting to roll.  John has appointments next Thursday for a cardiovascular evaluation (stress test) to determine whether or not he is a surgical candidate and an appointment afterwards with his surgeon, Dr. Low.  On Friday, he is scheduled for an endoscopic ultrasound (EUS).  This will stage his cancer, hopefully Stage 1, and will tell Dr. Low if John will need chemotherapy and/or radiation to pretreat the affected area(s) or if he can be scheduled straightaway to surgery.  Straightaway means the end of February.
We just have a very, very basic idea of what surgery entails.  Basically a portion of the esophagus is removed, replaced with a tube of some sort and the stomach is "stapled" into place, higher up than normal and with a reduced capacity.  The procedure takes 6-9 hours and involves a hospital stay of 8 days to 2 weeks; recovery 8-10 weeks.  There will be some adjustments, some temporary, but we will get through with your support.  It means so much.
And that's what we know as of tonight.  A woman by the name of Dana, the Thoracic Surgery Dept.'s coordinator, will be calling tomorrow with reconfirmation of John's appointments and answer any questions we have at this time.
It's sounding more than a bit daunting, but here we go.  Together.  Thank you and we'll stay in touch.

Post-Scan Upate

After John's two scans (the CAT scan this past Tuesday and yesterday's more comprehensive PET scan), we received the BEST possible news from G.I. Jane this morning.  The cancer has not spread.  It shows it is "isolated to the one lesion [tumor] in the lower esophagus" and shows one lymph gland slightly enlarged and a spot on a nearby rib.  We are immeasurably relieved and are very, very optimistic that John's cancer can be tackled successfully.  The next step will be to get paperwork handled for the referral to Dr. Low at Virginia Mason in Seattle who we hope will be the surgeon handling John's case.  We don't know at this time what pre-surgery action needs to be taken with regards to any chemo, radiation, etc.
John did extremely well with yesterday's scan.  The PET is conducted in one of those famously confining tubes that many of us find very claustrophobic.  There was no prep involved with this scan (unlike the barium -- without  vodka -- for the CAT scan).  John had to follow a high-protein/low-carb diet for 24 hours prior to the exam and fast for 6 hours before his appointment.  So after being on the "Atkins" plan for a single day, he probably lost 2 pounds.  Because certain foods get stuck (steak and chicken are the biggest culprits), I'm trying to stick to softer foods...Like tonight's pasta bolognese which should take care of those 2 lost pounds.
Words cannot express the appreciation for the thoughts and prayers from each and every one of you.  I know people say that all the time and it sounds so cliche.  But it is truly impossible to thank you all enough for your support.  Please know that you  so very treasured as friends and family.  Keep those prayers and wishes going.  We're not out of the woods yet, but at least there's now light coming through the trees.  We'll keep you posted on any further news.  Love you all...

First steps...

Today was John's CAT scan, the first of two initial scans.  He had to prep with two SUBSTANTIAL bottles of barium prior to arrival at the clinic.  His comment..."It's needs vodka."  This first test was quick; only about 10 minutes.  Wednesday's PET scan supposedly takes 90 minutes+.
We did receive some very good news from Dr. Stiner's nurse, Jane.  (GastroIntestinal -- G.I. -- Jane...get it?)  She's terrific.  Anyway, she phoned us mid morning to let us know that John's blood test results, checking for kidney/liver/iron/bone blah blah blah all came back normal.  This indicates that his organs are  functioning as they should and there are no elevated levels of anything else to be a worry, at least at this time.
So thank you for your prayers and good wishes.  I like to think that your support has us off to a positive start on this journey.

Getting Started

First off, thank you to everyone we've spoken to so far about John's diagnosis.  The love and support of friends and family is appreciated, literally, more than we can say.  So thank you.
I thought starting a blog -- isn't that what everyone does these days? -- would be the best way to keep you all up to date with John's progress.  And that's how we're going to approach this whole challenge...as a progress.
You probably know all the details so far, but here's where things stand right now.  John had been experiencing minor difficulty swallowing beginning late summer.  He would have the sensation of food getting "stuck" behind his breastbone.  A drink of water took care of it.  This initially only happened at lunch when he'd head out to his car to read and eat.  But then it started happening at dinner and he told me about it.  So I said to go to the doctor.  Our family doc, Dr. Martin Piatt, gave John a prescripton for Prilosec and referred him to a gastro-intestinal doctor, Dr. Dana Stiner.  Last Tuesday, Jan. 11, John went to see Dr. Stiner who ordered an endoscopy which was performed the following day.  They found a node and took a biopsy.  On Thursday we got the diagnosis of esophageal cancer.  (I never knew how to spell "esophageal" without looking it up in the dictionary.  Pretty crappy way to learn something.)
Where things are right now?  John's gets to drink two big bottles of barium tomorrow before a CAT scan tomorrow.  Wednesday, he goes in for a PET scan.  The results of these two scans will give a better picture of the tumor and determine if radiation and/or chemo is needed to shrink the tumor prior to surgery.  Surgery will in all likelihood be at Virginia Mason in Seattle.  We don't have a schedule yet and will know much more after seeing Dr. Stiner and getting the scan results.
On a positive note, John's appetite is just dandy and mine has tanked.  That's a good thing.  He's going to work, feels the same and is being the pragmatic one about the whole thing.
So we're on this journey together.  And by together, I mean all of you.  Thanks for your thoughts, love, prayers, chants, candle lighting...whatever your mode of sending good "ju-ju" is.  You are each one loved and appreciated....Nancy