So...as you can imagine the last week has been a little bit of a blur. We decided to still go to Vegas for Lindsey's birthday, which was a great decision. It allowed us to 'get away' and hang out with great friends for a bit and not just sit at home and dwell all weekend about my mortality. On Sunday (10/14) my cousin e-mailed and asked if we'd like help seeing a Doc at Stanford. We said yes and by Monday afternoon we had an appointment with a colorectal cancer surgeon at the Stanford Cancer Institute. We kept our initial appointment with the surgeon at ValleyCare in Pleasanton so we could get two opinions.
Since I work in medical devices, I am well aware that there are different levels of surgeons out there. I have one shot to get this right and I know that there is a greater density of great doctors at Stanford than at your local community hospital. That's not to take anything away from the local docs I'm sure there are some great docs there as well, just at a much lower density. So, I won't lie, as soon as we got the Stanford appointment I wondered if talking to the local guy was a waste of time. But, I told myself that if their treatment plans were the same it would make the decision easy and if they were different well...then we had some thinking to do.
Prior to meeting with any of the docs I researched the hell out of colorectal cancer. It's what I do. Having questions and not knowing drives me up the wall. I knew my tumor was low (more rectal and less colo), but I was still thinking it would be treated like Colon cancer for what ever reason. Going into these meetings with the surgeons I thought it would be surgery followed by chemo. I also thought that if I got out of the whole thing with food entering and exiting my body in the same place it does today, I'd be a lucky guy. Well...lucky may not be the best word to describe a guy that gets colon cancer when he's 34, but I think you get the point.
On Wednesday (10/17) we met with the surgeon at ValleyCare in Pleasanton. He seemed like a nice guy and a competent surgeon. He suggested that I do a round of chemo/radiation then surgery to remove the tumor and then a final round of chemo. So this was different than I was thinking. He said that patients that are treated with radiation and chemo first are less likely to have a recurrence of cancer in the pelvis. Sounds good to me...I'm sure this process is going to be fun...but I think once is more than enough for a lifetime. He was also confident that he could get the plumbing back together properly. So after the curve ball of this treatment plan it was time to do more research.
On Thursday Lindsey and I headed to Stanford for an 8:30am appointment with the surgeon there. My cousin joined us for the appointment so she could help us with questioning the doctors. The Stanford surgeon had the same treatment plan as the surgeon at ValleyCare. So that's nice, makes the decision on who to go with Stanford easy. The surgeon also did a digital exam. Now a digital exam doesn't contain an LCD screen like a digital watch nor a computer chip full of 1s and 0s, but it does contain a number one and a zero. But, I'll let you smart people figure out the rest. After the digital exam the surgeon nearly guaranteed (like lawyers, doctors will never give a 100% guarantee) there would not be a permanent colostomy. After we met with the surgeon he said we needed to make an appointment with a radiation oncologist as that will drive the timeline for my treatment. He told us to hang out for a moment and he would make some calls to see if we can get in with a radiation oncologist.
About a half an hour later we went in to see the radiation oncologist. We went over the what the radiation therapy entails. Turns out since the cancer is more rectal and less colo there's a 'shot' they can take with the radiation beams that they can't with cancers that are higher in the colon due to the proximity of other important organs. I also enrolled in a clinical trial (only after I gave the doc a little s**t about enrolling, got to keep these guys on their toes) to study the blood perfusion, as read by a special CT, in rectal tumors throughout treatment. I figure might as well help the researchers find out more information about this s**ty disease. They also said they'll probably use IMRT(Intesity Modulated Radiation Therapy) a special machine that more precisely delivers the radiation to the tumor and less to the surrounding tissue. But, I guess the insurance company has something to say about that, so we'll cross that bridge as it comes. Then they left to go see if they could get me in with a medical oncologist. We were only expecting to see a surgeon that day, but they were able to get me in to see my whole cancer team with little notice. Another great reason to do this at Stanford, one stop cancer treatment shopping and they're efficient.
A while later we see a medical oncologist, who proceeds to walk us through the chemotherapy plan. During the radiation portion of the treatment I'll be on a chemo drug called Xeloda. Which is in pill form. So no going in and getting infused via IV every so often. So that's a win. He started going over the side effects, which in all likelihood will suck. But, he left out hair loss. So I think to myself do they not just say hair loss because everyone knows that hair loss is a part of chemo or what. I ask, "What about hair loss?" He says I get to keep my hair. So that's another win. Although I still haven't excluded hair loss in my mind, just to be safe. We talk a little about the post surgery chemo. I'll go back on the Xeloda and have to do a 2 hours infusion via IV every three weeks. Again doesn't sound that bad. I had prepared myself for 48 hour infusions every two weeks (old program), but now it's a pill for two weeks and a 2 hour infusion every three weeks. Not to bad. So if the chemo cycle is a 3 week cycle and the full program is 6 months (24 weeks), that means there's only 8 cycles. I also get credit for the chemo (2 cycles) prior to surgery, so after surgery there's only 6 cycles left. Seems manageable.
Below is a rough draft of the treatment plan with some rough dates (of course subject to change).
I'm glad we got to Stanford. I'm not sure why anyone would go anywhere else if they could get to Stanford. It's like the Saks Fifth Ave of Cancer Centers. Everyone was super pleasant, it's a new state of the art facility, they basically developed radiation therapy, etc... Lindsey even got a chair massage while we were waiting at one point. Don't all start lining up to take me to appointments to get your free chair massage, at this point I think Lindsey gets dibs. Interestingly enough they don't provide massages to patients, which I guess makes sense since chemo makes your tissues friable. Don't want to turn the patients into balls of goo.
I went in expecting the worst from a treatment standpoint, so now I'm pleasantly surprised that it seems better than I expected. I guess my "expect the worst, hope for the best" thing is working. Hard to be disappointed when you expect the worst. There's still no doubt in my mind that these next 8 or so months will be pretty bad. But, I hesitate to call them the worst ever though, as I still get to wake up everyday next to my beautiful wife and my healthy little munchkin (sorry for the colonoscopy when your 24) makes me smile on a daily basis.
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