The first phase of my treatment for esophageal cancer required six weeks of simultaneous chemotherapy and radiation treatments. Now I faced esophagectomyÂ surgery to remove the tumor at the junction of my esophagus and stomach. But first, I needed to rest for 8 weeks to allow the radiation to get out of my system. My body needed to be in good condition to survive major surgery.
My mind was in total chaos. What would be the outcome?Â Would I survive and beat this monster, or would I be counting down the remaining daysÂ of my life? I was confident in my MSKCC team of doctors, but I knew the chances of surviving esophagectomy surgeryÂ were also dependent on me. Having a positive attitude and thinking of the saying â€œGod sits on my right shoulder and there is nothing that he and I together canâ€™t handleâ€ was a constant reminder that I was not in this alone.
My surgery would be a 4-5 hour procedure. First, the surgeon would remove two-thirds of my esophagus and one-third of my stomach. Next he would pull the remainder of my stomach up into my chest and re-attach it to what was left of my esophagus. In the end, the top of my stomach would be positioned in the middle of my chest.
This surgery is called an Ivor Lewis esophagectomy (named after the Welsh surgeon who first describedÂ this procedure in 1946.)
The surgery required two large incisions, one running from my belly button to my chest bone, the second from under my right arm to the middle of my back. Although no bones would be broken during the esophagectomy surgery, one lung would be intentionally collapsed so the surgeon could reattach my stomach in its new location.
Waking Up In The Recovery Room
When I woke up in the recovery room, I had a gastric drainage tube coming out of my nose to keep my stomach clear of any matter. I also had chest tubes on each side of my body to keep my chest cavity free of fluids, as well as a urinary catheter.
The plan was for me to stay the first night after esophagectomy surgery in the recovery room, then I would be transferred to the hospitalâ€™s Thoracic Floor for the remainder of my hospital stay.
Recovery: Week 1
Within one hour of arriving on the Thoracic Floor, they had me up and walking. They informed me that 14 laps around the floor equaled one mile, and I was expected to do that every day at a minimum.
In addition, they gave me a breathing device called a Spirometer. Â Every hour I was expected to do ten reps on the device to see how high I could get the indicator to rise. Iâ€™d received a spirometer before entering the hospital, so I knew my pre-surgical lung capacity. Now I placed the indicator at my previous highpoint, and tried each day to see how close I could get. It was a work in progress.
In addition to walking and using the spirometer, I was asked to deliberately cough tenÂ times each hour.Â Although it sounds easy, it was the most difficult thing I had to do. When I coughed my stomach vibrated, and the incision I had from belly button to chest bone would jump with pain. I found that holding a pillow tight to my stomach eased the pain and suppressed some of the stomach vibrations.
For seven days I did not eat or drink anything. Each day, the nurse would ask me to rate my pain. The focus of the post-surgical therapy was to reduce my pain to a tolerable level so that I could walk, breathe and cough without too much discomfort.
Recovery: Week 2
At the end of seven days I underwent a barium swallow, a procedure designed to tell if theÂ surgical connection was healing properly. The test confirmed that I did not have any leaks at theÂ new connection between my stomach and esophagus
The positive test results meant that I could be freed from the tubes that wereÂ inserted during the esophagectomy surgery. What a relief it was to be rid of all that excess baggage. Walking around the floor was so much easier that I was able to do more than the minimum daily goal of 14 laps around the Thoracic Floor.
Learning to Eat Again
On the seventh day afterÂ esophagectomy surgeryÂ I also started on a liquid regimen. By the eighth day, I was promoted to a soft mechanical diet which included Jello, puddings and even scrambled eggs. By the ninth day, I was eating off of the menu!
This rapid progression from liquids to solid food is rare today. New protocols are designed to promote fuller healing of the surgical join by keeping esophagectomyÂ surgeryÂ patients on a feeding tube or a soft mechanical diet for a longer period of time. But I was grateful to have madeÂ such rapid progress that I was able to leave the hospital on the tenth day.
Bart Frazzitta is anÂ esophageal cancerÂ survivor and the founder of the Esophageal Cancer Education Foundation (ECEF). ReadÂ moreÂ of his story here >