I can't believe I haven't updated since March 27th, but then, I have been one busy boy.
I finished radiation and chemo on April 16th. I breezed through the whole process up until the last week or so. Then the promised diarrhea and skin burn kicked in. The last three sessions of radiation were called the "booster series" and boy they weren't kidding. I got the same dose of radiation but the field was shrunk to 50% to zero in on the tumor itself. This meant that I get a twice as heavy dose in the areas affected. The result was a nasty burn of the buns that took almost a month to heal up.
But the payoff was better than we could have imagined. Last week I had a short colonoscopy from my new surgeon Dr. Kim and he says the radiation has nearly completely disintegrated the tumor. The only thing left is a small node that was the center. This gives him a lot more room for bowel resection and we can all heave a giant sigh of relief: No permanent colostomy. Next step is surgery that is scheduled for July 1. Below, I have made a record of the pre surgery consultation with Dr Kim which you may or may not want to read depending on your squeamishness or need to do more important things.
But first, I want to bring you up to date on the nursery and how the surgery and treatment will affect the business, as it is undoubtedly a major concern for customers as well as myself. I have been going like a madman. Since my buns healed and normal bowel function has returned, I feel better than I have for years. I have not wasted this time. We have been working from dawn to dusk trying to get the place in shape to function without me for two weeks as well as the odd days that I may be sick from post surgical chemo. I finished another seventy feet of bonsai bench for pre trained material, so that I have a place to store and care for trees that get photographed and placed in the specimen catalog of the website. Between the help of Dr. Bob, friends, wife, and a part time employee, we have actually managed to clean up the entire nursery and are basically weed and debris free at the moment. It has never looked this good. Hopefully it will never fall into a state of disrepair again.
I have upgraded the water system. The second well is in and functioning. The Jungle is organized, but the plants have not yet found permanent homes. This is my project for this month. I now have two injection ports for fertilizer that cover the entire nursery. I did the first fertilization with the new system this week and it works great, but still takes all day. I have kept up with business and have shipped a lot plants this spring, surprisingly so considering the depression level unemployment. I thank you all very much for your help in that regard.
I know that many of you are disappointed (once again) that the long promised specimen section of the catalog was stillborn, but like a phoenix, it shall rise again. Work on the plants continues, homes are being created where they will be cared for, and as soon as this ordeal is over, we will surely be moving in that direction. In the meantime, you are always welcome to inquire about your specific needs for plants. We have thousands of specimen sized plants, so just because it isn't in the catalog, doesn't mean that it doesn't exist.
It's subject to change, but right now, it looks like we will be shipping through June 28. After that we probably will not ship during the month of July while I am recovering, but July is dead month anyhow, so hopefully this will not impact your needs greatly. We will certainly be shipping again by August, barring complications.
The following is the plan for surgery and post surgery in detail for those that may be interested. The details are actually quite fascinating:
Susie and I went to see Dr Kim
yesterday, 7/3/09 for the pre surgical consultation. Now, I have a
pretty complete picture of what will happen for the rest of the
ordeal. Surgery has been scheduled for July 1 at the John Muir
Medical Center in Concord (just east of Oakland). I will probably be
in the hospital for five days and it will take another week for me to
get on my feet and be able to do light work. If I can really get that
far in two weeks, I will be extremely pleased.
Soon after surgery, I will begin
chemotherapy again. This will be a different kind than before and I
may not get through it so easily. The chemo that went with radiation
was to enhance it and was a continual low dose, so the symptoms were
not severe, in fact, I hardly had any. This time around they are
going after any cancer particles that may be floating around in my
body. Instead of a continual low dose, I get a big pulse or infusion
every other week. There will be eight of these, so it will take four
months. I will have to go to Santa Rosa again for the treatments but
only two times every other week. The first day I will get a big four
hour infusion of drugs and also the portable pump to keep up the
infusion for another 48 hours. Then, on the third day, I will go back
and return the pump. During this three day period, I may suffer some
bad side effects, but I really don't know yet, because people react
so differently to chemo. My progress so far would seem to indicate
that it won't be too bad for me. I may lose my hair this time though,
don't know yet. Hopefully, for the rest of the two week period, I
will be feeling semi human and be able to get some work done.
The surgery is much more complicated
than I had imagined. First it is done with laproscopy or with a
laproscope. That amazes me. Dr Kim says it is so tight in there, that
using your hands is almost impossible without a huge opening. The
radiation did such a good job of destroying the tumor that only a
little central node is left a couple of inches up from my anus. This
leaves him plenty of room for resection or reattachment of the colon.
First he has to remove the rectum and about a foot of colon to make
sure he gets all the cancer. Then, amazingly, he is going to pull
down a good size section of the colon, fold it over and stitch it up
along the outside and then remove the inner wall so that he creates
a a cavity called a J pocket. This is reconstructive surgery. He is
actually building me a new rectum. Since the rectum is bigger than
the colon and acts a reservoir, this enlarged area of folded colon
will serve the same function. His example was pretty good. Imagine
you take a garden hose and make a severe bend in it, so that it bends
back on itself and the outside walls touch for about six inches. If
you could stitch the outside seams in this bend, it would stay this
way. Now imagine that you can go inside the hose and cut out the
portion of hose where the two walls touch. That would give you a
cavity twice as big as the hose. Of course stitching the colon is a
whole lot easier than stitching a hose.
Then, this J pocket has to be attached
again to the anus. He has plenty of room to do this now. All this
cutting and stitching will take time to heal, and there is a good
possibility of leakage, which if it occurs, results in peritonitis or
infection inside the abdomen. That is nasty and very dangerous. To
avoid this, he will give the new section four or five months to heal.
He does this by also performing an ileonoscopy (my spell checker doesn't know how to spell it either, it's a shunt to the ileum) or a shunt from the
small intestine to the outside of my body. This is a small hole about
the size of dime. A patch goes over this which has an attachment for
a colostomy bag. The bowel movement will be diverted for the entire
four months while the colon resection is healing. At the end of this
period I will have to have a second operation to remove the
ileonoscopy. But this is a rather simple operation where the section
of small intestine is simply tied shut and pushed back into the
abdomen. Only a day or two in the hospital while they wait to see if
the operation works and I have bowel movements without problems.
I asked him about how normal I would be
after it was all over. He says for the first year, I will be anything
but normal, with multiple and frequent bowel movements, pretty much
anything goes. But, by the second year, I should slowly get better
and better. By the end of the second year, I should be almost
perfectly normal.
As far as timing goes, I should finish
chemo about mid to late October. Then I get a brief rest to recover
and then the second operation would be sometime in November or
December. So, it is going to take the rest of the year. All in all we are very happy with Dr
Kim. He is compassionate and takes the time to listen and answer
questions. He was very thorough in explaining all the ramifications
of the surgery.