The Next Step

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.

Comments

[Scott Straley]

Brent,
Great news on the chemo treatment, glad it worked so well for you! If you can think of anything you need while in the hospital in Concord, just give me a call, I am literally 5 minutes away. You can e-mail me for my cell number, (even though we haven't met face to face, you almost made it down to the BBQ I threw a few years back) Heck, if you feel up to it a couple days after the surgery, I can bring you some wire...a tree....just kidding. But seriously, let me know. Fascinating procedure, also, sounds really promising. Hang in there.

Scott

[Vic Neece]

Brent, It's good that you've found a Dr. that you like and have confidence in. It really takes a load of worry off if you trust the person who is going to literally be up to his elbows in your gut. I've not had much in the way of internal problems, but it seems I may be crippled with arthritis eventually. Until then, I have an osteopath whom I trust completely to be honest with me in regards to my options, the pros and cons of each one, and his preference either way. You go in knowing in your heart that things are going to be o.k., and you come out that much ahead on the road to recovery. You will heal faster. I won't say that the pain will be less, but you won't mind as much knowing that "this too, shall pass". Don't push too hard to get back to normal, but do push. Thanks for keeping us updated. Vic N.

[Clyde]

Hey Brent,

I am so glad that things are moving along fairly well. Such good news about the tumor. One thing that is wonderful is that it definitely sounds like your Dr. has a plan and knows what he is doing.

Keep us up to date.

We will pray for what all of our friends with cancer want to hear. NED No Evidence of Disease. The fighters that want to know about what is going on and meet it head on (like you are doing) always seem to do better.

Hang in there my friend and as usual just say the word if I can do anything to help or encourage you.

[Irene]

My Prayers are for you as well fella! God is not finished with you yet and you still have so much learning to teach us all...
We are all so blessed to have you.
God Bless You
Irene