Radiation Today..

First day of radiation today..15 minutes and out..

Tired, a little nauseous and just general fatigue but I'm eating(feed bag) and looking forward to my first meal..more to come..

100 Day..

Ok so the first chemo session is done..in by 8:40 and out by 2:45?? They say it's a whole day but was able to sneak in a client before and one(Doug) after so it's not my "full" day..

So the feeling..like I've been bombarded with poison. Not sick but a low grade headache and some stomach activity. Thank god for the anti nausea medication.

So 100 day..Doug reminded me that we haven't done one in awhile so of course we had to try. Thanks to Doug for his patience as I tried to hang as long as possible..and did well but only went as far as I could. Yes very low on fuel as I left my feed bag home during the infusion earlier so went some time without calories.

And 100 day..100 reps in a row with low weight.. ie: 100 reps with a 45 lb bar..lat pull downs with 70lbs..etc.

So we did back, chest, shoulders and bis... all for 100 reps..try it some time. And of course I can help!

Now will see if it's pushed me over the edge for the evening..

Basketball Sunday..

Three days and counting.. wonder how I'll be feeling..??

Dietitian Just Left..

Dietitian just left..says she wants me on a little less than 3000cals per day. Afraid that I'll get fat if I go up too fast. Afraid I'll be getting a fatty liver if I get too fat!! Little does she know I'm controlling this and not her..

Heavy lifting and 4000cals should get me back up before treatment ends.. no now I'm not going to be doing anything stupid..if I don't have the capacity to lift heavy I won't but if I can, and have the energy I will.

So yes in two weeks I'll be doing the food scramble again as I run out before my month's allotment but hey.. I do have a plan..

Oh..and I'm sitting here now getting my doses of Cisplatin and CPT-11.. thought I was getting the Cisplatin only and my first dose of CPT-11 next week so I'll have to get an update on the scheduling..more to come.

Yum..Feed Me..

Chemo starts this am...don't know what I'm looking forward to more, the chemo or my new food source that was obtained yesterday after much effort.

I'm now on TwoCal HN, providing 2000 calories per liter instead of the 1200 calories that i was on.

This means I can reduce my time on feeding, 10 hours providing 2500 calories..

I actually probably stay on for 15 hours which will give me a much needed 3750 calories per day. I can use the extra time to get some additional water or Gatorade in if need be..

Well off to my first chemo treatment in a few hours. Wish me luck..

Runnung On Empty..

Just realized Tuesday that I only have enough cans of Jevity left for one more day.

Apparently my perscription was for 90 cans per month which is 3 cans per day..roughly 720 calories. My current intake is 15 cans and I'm barely maintaining my low weight at that rate.

So..at 15 cans, I need 450 cans per month minimum and not 90 as prescribed.

So today's goal is to obviously locate a supplier close by that has the feeding formula..

Again..be your own advocate..I've told the Boston docs, Exeter docs, my insurance co and no one listens..so time to get nasty..

Gotta Love..

...our health care system..

My insurance company has denied my CT scan on my abdominal region this afternoon..

Apparently my PT scan from the previous staging done at Brigham's was enough and they will not approve the additional test.

So my liver will have to wait unless Dana Farber can convince them otherwise.

Not really worried as Dr. Bueno has already indicated to me that the nodes were benign and he has already examined them when doing the J tube.

So the renal flow test has been approved though so off to Exeter we go..

More Tests..UGH!!

Back to nuclear medicine today for a renal flow test(...and later a abdominal CT Scan)..or a renal perfusion scintiscan, a nuclear medicine test that uses a small amount of a radioactive substance to create an image of the kidneys.

How the Test is Performed(renal flow test)

Before the scan, you will be asked to drink plenty of water so that you stay hydrated and to take a blood pressure medicine called an ACE inhibitor. The drug may be taken by mouth, or given through a vein (IV). The medicine increases the accuracy of the test.

You lie on the scanner table shortly after taking the medicine. The health care provider will inject a small amount of radioactive material (radioisotope) into one of your veins. Images of your kidneys are taken as the radioactive material flows through the arteries in the area. It is very important to remain still for the entire test. The scan takes about 30 minutes.

About 10 minutes after you receive the radioactive material, you be given a a diuretic ("water pill") through a vein. This medicine also increases the test's accuracy.


An abdominal CT scan is an imaging method that uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomography.



How the Test is Performed(abdominal CT Scan)

You will be asked to lie on a narrow table that slides into the center of the CT scanner. Usually, you will lie on your back with your arms raised above the head.

The health care provider may inject a dye into one of your veins. This helps certain diseases and organs show up better on the images.

Once inside the scanner, the machine's x-ray beam rotates around you. Small detectors inside the scanner measure the amount of x-rays that make it through the abdomen. A computer takes this information and creates several individual images, called slices.

You must be still during the exam, because movement causes blurred images. You may be told to hold your breath for short periods of time.

The actual scan time only takes a few minutes, although the entire procedure usually takes much longer.

Sutures and Cat Scans..

Had my sutures out at Brighams today(for the J tube)..Dr. Bueno, my thoracic surgeon, says not to worry about my upcoming cat scan of my liver..says the nodes are benign and nothing to worry about. Guess he was in looking around during the implanting of my J tube.

For those that don't know..the pet scan from 2 weeks ago indicated some nodes on my liver..apparently once they start looking around they find things.

Any case, all indications are that they are benign but Dana Farber wants a cat scan so guess Exeter will be doing one this week before chemo and radiation.

Basketball!!

Five games!! See how I do next week after first rounds of chemo and radiation..

Yes my shot was horrible today..like to blame it on the incisions in my abs but...no excuses..I was there and I played!!

Basketball Sunday!!

I know I'm a day early but cannot wait to play tomorrow..6am!!

Light workout this a.m. and probably a small run in Maudslay after my last client this afternoon..movies tonight and Basketball with the boys tomorrow morning.

My abs are feeling ok after surgery last week..did a few sets on the ab machine with light weight..and did my first couple of rings..yes the abs are pulling but I think I'm back to strength by end of next week. Just in time for the chemo and radiation.

Today will be my first full day on the feeding..getting use to the backpack/pump set-up and now have 1707 ml's in me since last evening around 11pm. So at 1.2 calories per ml (no I don't have my 2 cal per ml solution yet)..its around 2000 calories so far..best day I can remember in some time.

So yes the abs will be tight, my legs a little week and I'll most likely be sucking wind but I'll be up and ready to run at 6 a.m. ...

Oh..my oral intake on solids is zero and my best guess at liquids is around 10-20%..meaning I give back 80-90% so the tube has now become critical to my health. Little direct injection on the Gatorade first thing in the morning and I should be all set to play...

Portable Feeding..24 Hrs

So the docs would not do it so I did it myself.

Pulled the bladder out of my camelpack(thanks Tim!...Christmas present), replaced it with my drip bag(feeding bladder)..attached my feeding pump to the back with bungy cords and I now have 24 hr feeding..

Old method had me attached to an IV pole and feed bag so I had maybe 7 hrs on feeding at night. At 60 calories per hour, that would be 420 calories..not nearly enough calories since I cannot take oral calories any longer.

Also, I've bumped up my liquid volume from 50 ml's per hour to 125 ml's per hour(not recommended by docs)..

I've also convinced the docs to change from Jevity 1.2 to Jevity 2.0 which is now going to be 2 calories per ml instead of 1.2.

So the way I figure it, with the increased volume, increased caloric volume and increased feeding times, I can theoretically get 6000 calories per 24 hr period or 3000 calories hooked up to my pack for 12 hrs!!

Much better than the original 720 calories per docs instructions for 12 hrs.

Chemoradiation..

...chemo starts Thursday the 30th and radiation starts Friday the 31st at 2pm...

Probably 6 treatments, one each week of cisplatin and/or cpt-11..depending on the week..

Cisplatin will be the first and last week and cpt-11 will be staggered..2nd and 3rd week with a week off and then the 5th and 6th week and done.

Radiation will be every day at 2pm for 6 weeks..Mon-Fri..15 minutes in and out..not a big deal.

Then approx. 4 weeks off to get my blood count back up and then surgery followed by 1-2 weeks n the hospital.

Exeter Hospital

Click this blog title above to view Exeter's info...



Medical Oncology

Medical Oncology refers to the treatment of cancer with medicines, as opposed to surgery or radiation. In some situations, these medicines are used in conjunction with surgery and radiation therapy. Medical Oncology services provide chemotherapy treatment, immunotherapy, and treatment for blood disorders.

The Center for Cancer Care at Exeter Hospital is proud to have a relationship with New Hampshire Oncology-Hematology PA for the provision of Medical Oncology services to our patients. This outstanding group of physicians is consistently rated among the top cancer doctors in the state and also has an affiliation with Dana Farber Cancer Institute. As a patient of Exeter Hospital, the physicians meet individually with each patient to discuss their diagnosis and an appropriate course of treatment. Following the physician visit, the patient will participate in educational sessions with the oncology nurse, pharmacist, and social worker prior to the initiation of treatment. During treatment, the patient can relax in our comfortable infusion area where nurses and assistants are available to administer their medications and address their needs.


Radiation Oncologist

Radiation oncologists oversee the care of each cancer patient undergoing radiation treatment. They develop and prescribe the patient's treatment plan and make sure that every treatment is accurately given. In addition, radiation oncologists help identify and treat any side effects of radiation therapy. They work closely with other physicians and all members of the radiation oncology team.

Our unique and exclusive regional relationship with the Massachusetts General Hospital’s Cancer Center brings radiation oncologists from the world’s leading academic medical center to Exeter Hospital’s Center for Cancer Care. This affiliation allows us to offer state of the art radiation therapy services in our community.

Cisplatin Starts July 30th..

Looks like my first treatment will begin July 30th..Cisplatin is an extremely harsh drug so I'll be hooked up and monitored all day with plenty of fluids for my kidneys. I believe my second treatment will be on week 6. Probably will start my vitamin E soon after discussing this with my Oncologist.

Radiation doc at Exeter this afternoon..will probably receive the schedule for treatment then..more to come!

Vitamin E Protects against Chemotherapy-Induced Nerve Damage

One main concern of mine..peripheral neuropathy, which can result in numbness, tingling, pain, a burning sensation, or loss of sensation in the arms and legs. The hands and feet are most often affected.

In one study..

Supplementation with vitamin E in those undergoing cisplatin chemotherapy may reduce the incidence and severity of nerve damage (a common side effect of the drug), according to a new study in Journal of Clinical Oncology (2003;21:927–31). This is encouraging news for the thousands of people with cancer who undergo cisplatin chemotherapy as part of their treatment regimens and often suffer from permanent nerve damage.

Click on this blog posting title above to read the entire study..

Pre-Operative Chemo (CPT11, Cisplatin), Radiotherapy, Plus Surgery for Resectable Esophageal Cancer

This ongoing study here looks like the protocol I will most likely follow starting next week..

http://clinicaltrials.gov/ct2/show/NCT00160875

Cut and paste this link above or click on the heading to this post and it will take you to the study..

My Drugs of Choice.....Cisplatin & CPT-11 or Irinotecan

Looks like I'll be starting next Monday..


Cisplatin Side effects

Cisplatin has a number of side-effects that can limit its use:

* Nephrotoxicity (kidney damage) is a major concern when cisplatin is given. The dose is reduced when the patient's creatinine clearance (a measure of renal function) is reduced. Adequate hydration and diuresis is used to prevent renal damage. The nephrotoxicity of platinum-class drugs seems to be related to reactive oxygen species and in animal models can be ameliorated by free radical scavenging agents (e.g., amifostine). This is a dose-limiting toxicity.

* Neurotoxicity (nerve damage) can be anticipated by performing nerve conduction studies before and after treatment.

* Nausea and vomiting: cisplatin is one of the most emetogenic chemotherapy agents, but this is managed with prophylactic antiemetics (ondansetron, granisetron, etc.) in combination with corticosteroids. Aprepitant combined with ondansetron and dexamethasone has been shown to be better for highly emetogenic chemotherapy than just ondansetron and dexamethasone.

* Ototoxicity (hearing loss): unfortunately there is at present no effective treatment to prevent this side effect, which may be severe. Audiometric analysis may be necessary to assess the severity of ototoxicity. Other drugs (such as the aminoglycoside antibiotic class) may also cause ototoxicity, and the administration of this class of antibiotics in patients receiving cisplatin is generally avoided. The ototoxicity of both the aminoglycosides and cisplatin may be related to their ability to bind to melanin in the stria vascularis of the inner ear or the generation of reactive oxygen species.

* Alopecia (hair loss): this does not generally affect patients treated with cisplatin.

* Electrolyte disturbance: Cisplatin can cause hypomagnesaemia, hypokalaemia and hypocalcaemia. The hypocalcaemia seems to occur in those with low serum magnesium secondary to cisplatin, so it is not primarily due to the Cisplatin.


Irinotecan Side effects

The most significant adverse effects of irinotecan are severe diarrhea and extreme suppression of the immune system.

Diarrhea

Irinotecan-associated diarrhea is severe and clinically significant, sometimes leading to severe dehydration requiring hospitalization or intensive care unit admission. This side effect is managed with the aggressive use of antidiarrheals such as loperamide or Lomotil with the first loose bowel movement.

Immunosuppression

The immune system is adversely impacted by irinotecan. This is reflected in dramatically lowered white blood cell counts in the blood, in particular the neutrophils. While the bone marrow, where neutrophils are made, cranks up production to compensate, the patient may experience a period of neutropenia, that is, a clinical lack of neutrophils in the blood.

Maybe It's Time for a Story..

For those of you that have not read this before..some valuable suggestions..


Good Health Does Not Happen…It’s a Conscious Choice!

It was a hot, humid morning when I met Walter, much like many Florida days but this one was different for me, one of those days I won’t soon forget. It was my first summer competing in triathlons. The Disney World triathlon was my last for the season, and was quite a change from the cold Freeport Maine “Lobsterman” triathlon completed a few weeks before.

The morning started out hot, and the sun was out early and so were we. Struggling through a mile swim, and recovering somewhat on the 26 mile bike, I started out on the last leg, a 10K run. Two laps through the park and I would be done, at least for the season.

I struggled that summer, trying to put meaning as to why I was doing triathlons. I never was much of a competitive endurance athlete. I focused most of my past energies towards more explosive sports. Basketball, football, weight training and martial arts, to name a few. Sure I did some biking and running. But mostly for training or for fun, not for competition.

But Walter changed my thinking that day. As I approached from behind, I immediately knew there was something unusual about him. He had a constant pace, not really fast but purposeful and with a slight limp, much like many of the other runners I had seen.

However, Walter was different. I noticed immediately. Eighty-four! That was the number drawn on his left calf. Wow, 84!

You see, in triathlons, your age is written on the back of your calf in black marker. A sign for many that you’ve just been passed, or are passing someone of your age group. But to me, Walters numbers meant so much more. Almost twice my age, Walter was too old to be my competition but he immediately became my idol.

Wow, 84! This guy just swam a mile, biked almost 26, and is now beginning a 6.2 mile run. All on a hot, humid, sun drenched morning before most of us get out of bed.

I didn’t talk long with Walter that morning, but did learn from our brief conversation that he started training when he retired at 65. An age when most of us start talking about slowing down. When most start planning our health care, assisted living, and maybe start experiencing heart conditions and high cholesterol.

But there was something special about Walter. Yes his doctor told him he needed new knees, however that didn’t stop Walter . He told me he was going to use the ones he had as long as he could. Save the operations until he was old. When he was ready to retire.

Walter gave me a gift that day. Something you cannot get through written words. A gift that can only be experienced. I have always been healthy. Always had a passion for fitness and health. I loved sports. Loved to compete. Loved the feeling of being in shape. But much of my motivation was out of fear. Fear of growing old. Fear of losing my youth. Fear of losing control as nature took its course.

That man from Atlanta taught me there was more. Our brief, chance encounter made me realize we do have choices. I’ve always known this. I’ve always tried to make a conscious effort to make good choices along the way. Choose to be fit, choose to be healthy. Make choices to improve the quality of my life.

But Walter had shown me what these choices can do. Walter was a living, breathing example of a collection of all his choices. Walter chose to be healthy. He chose to be fit. When others were winding down their careers, Walter was just beginning to start another. Start another lifetime of being healthy, being fit and being happy.


I’m constantly reminded of the choices we all make concerning our health. The 65 year-old man that cannot climb the stairs. The forty-two year-old woman wasted by cigarette smoking, or too much sun. The 10 year-old child struggling with his weight, inflicted with childhood diabetes. They’ve all made choices. Most without even realizing it. Sure there are some who cannot help what nature has dealt and I pray for those less fortunate. Many of us are held captive by our genes.

But most of us do have choices. Most of us make these choices daily without realizing their effect. Bad genes or good, our choices made have a direct effect on how these genes operate. And, Walter showed us its never too late to start. Never too late to reverse years of abuse.

Make a conscious effort to make the right choice concerning your health. Illness is not something that happens. Illness is usually something we create. Illness is a collection of all of our bad choices. I know there are some of us that don’t choose cancer. Don’t choose diabetes or the flu. But for most of us, the sum of our choices can lead to a path of self-destruction, facilitating an unhealthy outcome.

You do have control of your health. You do have dozens of choices you can make every day. Start today! Start making conscious, healthy choices that improve your health and the quality of life for years to come.

Choose to be fit, choose to be healthy. Take small steps. Practice and prepare, and build off these as your health improves.

Choose activity instead of inactivity.

Exercise is one of God’s greatest gifts. Choose to take the stairs instead of the elevator. Stand at work instead of sitting. Get up a half-hour early every day and walk. Or go for a walk after a light dinner. Movement is exercise. Find a way to be more active. Find a way to move.

Strengthen your core and legs. A strong core alleviates most back issues. Strong legs support your core and rehabilitate knees and strengthen your back. Start now for years of pain free living.

Stretch for good health and posture. Loss of flexibility is probably one of the first signs of aging. Every wonder why some mature adults have no problem tying their shoes, or picking up a golf ball while others have trouble putting on their pants. Its because they remained active. They never stopped doing what had always come natural to them. Our bodies are not suppose to fail the way we’ve become accustomed to. The way we allow then to. Find a way to keep, or better yet increase, your range of motion.

Want one of the best exercises available to increase your flexibility? Squat for good health. Being able to perform a full body weight squat is probably one of the best exercises you may do to strengthen your back and knees, lengthen your hamstrings, support your core and build your glutes. So learn how to squat properly and squat daily and don’t stop. A few short minutes each day will add years of healthy living.

Choose to eat healthy.

Add more fruits, vegetables, nuts and seeds into your diet. Eliminate sugar, reduce your starch and add more fiber. Drink water. Next to air, it’s the one single most important life sustaining substance. Without it, you cannot live. With too little, you cannot lose weight.

Eat lean protein in small portions. Choose chicken instead of beef. Eat fish and egg beaters or egg whites. Select lean choices of red meat on a limited basis. Add a healthy protein drink as a quick meal replacer.

Make conscious choices about what you eat. Start a food journal. It’s a great way to become conscious of everything you eat.

Eat until you are fulfilled but not full. Most Americans eat way more at each meal than is necessary. Eat small portions 5 or 6 times a day. Small, frequent meals stabilize your insulin levels, allowing you to feel better, have more energy and loose weight.

Reduce or eliminate sugar! Sugar is perhaps the most addictive, destructive substance in the American diet and is fast becoming the most toxic additive in the world. The rise in sugar consumption is directly related to the worldwide increase of diabetes, obesity and cardiovascular related disease. Adult onset diabetes is becoming a thing of the past as more and more children develop the harmful disease, years before they become adults.

Eliminate table salt! Table salt is another additive that has worked its way into almost every type of processed food know to man. Salt, or sodium is an electrolyte, and without it we cannot live. But too much can be disastrous! Potassium and chloride are the two other important electrolytes necessary for human life. A proper combination of these three electrolytes are necessary for good health. Nature has done very well at balancing the proper ratios of these electrolytes for human consumption, and potassium to salt ratio is found in nature at 3:1 favoring potassium. But in the average American diet, a salt to potassium ratio is 10:1, a huge imbalance leading to an epidemic of high blood pressure. Eliminate table salt, Your heart will be glad you did.

Add essential fatty acids. These are the fats that are essential for optimum cellular health. In their absence, we age quicker and disease sets in sooner. Add them to your diet and your cells become rejuvenated, healthy and strong. So eat salmon, mackerel, flaxseed, nuts and avocados whenever possible. And eliminate hydrogenated oils, or artery clogging trans-fats from your diet. Don’t delay, start today.

Choose to eliminate toxins in your life.

If you smoke, stop! Smoking is one of the most destructive habits that is detrimental to our health. Again, let me repeat this. If you smoke, STOP!

If you drink, drink less. I know, we’ve all read those studies that say how good wine is for you health. But read the research. Look into who was behind those studies. Weigh the benefits with the inherent risk and decide for yourself. Drink casually but drink less. You will feel better and give your body the needed break.

Read labels. Look around your house. Laundry detergent, perfumes, body lotions and dryer sheets. Pesticides, lawn products, cleaning products and deodorants. Toxins are everywhere. You cannot avoid them but you can choose to reduce your exposure. Change to natural, biodegradable, wherever possible and get rid of the rest. If not for yourself, do it for your family.

Chemicals collect inside every tissue waiting for an opportunity to attack. Don’t give them a chance, choose to eliminate toxins wherever possible.

Eliminate stress, loose weight, reduce your blood pressure and cholesterol. Develop a passion, love thy neighbor and show up on Sunday or follow a belief system. Better your sleeping habits and improve your gum health. These are some more of the many examples we all have concerning our choices and the control we all have.

Lastly, change your beliefs concerning your health. Start realizing we do have choices and we do have control. Start today as its never too late.

Walter showed us how.

As I winded down my run that day, I could not help but think of Walter. About how well he had done that day. I guess it does not matter. Each day was a blessing for him. Each day he woke with passion and a purpose and was prepared to live another day. He was healthy, he was moving and he was strong.

Walter showed us how. Now its your turn!

I'm OUT!!

Yes..finally out and working once again! 5 days is more than enough..

Chemo doc today at Exeter and radiation doc on Wed..than hopefully starting the first of next week.

I believe the plan is for 6 weeks of radiation and chemo (chemoradiation) and 4 weeks off to build my immune system..than surgery with an average stay of 13 days. Now I know why after 4 days in the hospital for a feeding tube.

So..now I believe I need a port installed "port-a-cath" for the chemo..link above for more info..actually you have to click on the title to this posting to see the link..

Will write more once I find out scheduling..

Esophageal Cancer Staging

Do hope this helps..from all current info and staging test..mine appears to be stage IIA..

Detailed Guide: Esophagus Cancer

How Is Cancer of the Esophagus Staged?

Staging is the process of finding out how far a cancer has spread. The treatment and outlook for people with esophageal cancer depend, to a great extent, on the cancer's stage.

Esophageal cancer is staged with the imaging tests described above, combined with endoscopy and biopsy.

The most common system used to stage esophageal cancer is the TNM system of the American Joint Committee on Cancer (AJCC). The TNM system describes 3 key pieces of information. T refers to the size of the primary tumor and how far it has spread within the esophagus and to nearby organs. N refers to cancer spread to nearby lymph nodes. M indicates whether the cancer has metastasized (spread to distant organs).

T stages

Tis

The cancer is only in the epithelium (the top layer of cells lining the esophagus). It has not started growing into the deeper layers. This stage is also known as carcinoma in situ.

T1

The cancer is growing into the tissue under the epithelium, such as the lamina propria or submucosa.

T2

The cancer is growing into the muscle layer (muscularis propria).

T3

The cancer is growing into the outer layer of tissue covering the esophagus (the adventitia).

T4

The cancer is growing into nearby structures, such as the trachea (windpipe), the pleura (the tissue covering the lungs), or the tissue covering the heart (the pericardium).

N stages

N0

The cancer has not spread to nearby lymph nodes.

N1

The cancer has spread to nearby lymph nodes.

M stages

M0

The cancer has not spread to distant organs or lymph nodes.

M1a

The cancer has spread to distant lymph nodes but not to other organs.

M1b

The cancer has spread to distant organs.

Information about the tumor, lymph nodes, and any cancer spread is then combined to assign the stage of disease. This process is called stage grouping. The stages are described using the number 0 and Roman numerals from I to IV:

Stages

Stage 0 (Tis, N0, M0)

This is the earliest stage of esophageal cancer. The cancer cells are only found in the epithelium (the layer of cells lining of the esophagus). The cancer has not grown into the connective tissue beneath these cells. The cancer has not spread to lymph nodes or other organs. This stage is also called carcinoma in situ.

Stage I (T1, N0, M0)

The cancer has grown from the epithelium into the connective tissue underneath (the lamina propria). It may also have grown through that tissue into the layer below (the submucosa), but it has not grown any deeper. It has not spread to lymph nodes or to distant sites.

Stage II

This stage is split into 2 substages, stage IIA and stage IIB.

Stage IIA (T2 or 3, N0, M0):

The cancer has grown into the muscle layer called the muscularis propria (T2). It may also have grown through the muscle layer into the adventitia, the connective tissue covering the outside of the esophagus (T3). The cancer has not spread to lymph nodes or to distant sites.

Stage IIB (T1 or 2, N1, M0):

The cancer has grown into the lamina propria (T1). It may also have grown into layers below: the submucosa (T1) and the muscularis propria (T2). It has not grown through to the outer layer of tissue covering the esophagus. It has spread to lymph nodes near the esophagus (N1) but has not spread to lymph nodes farther away from the esophagus or to distant sites.

Stage III (T3, N1, M0; OR T4, N0 or 1, M0)

Either

The cancer has grown through the wall of the esophagus to its outer layer, the adventitia (T3). It has spread to lymph nodes near the esophagus (N1), but has not spread to lymph nodes farther away from the esophagus or to distant sites

OR

The cancer has grown all the way through the esophagus and into nearby organs or tissues (T4). It may also have spread to nearby lymph nodes, but has not spread to lymph nodes farther away from the esophagus or to distant sites.

Stage IV

This is split into 2 substages, stage IVA and stage IVB

Stage IVA (any T, any N, M1a):

The cancer has spread to distant lymph nodes (M1a). If the esophageal cancer is in the upper part of the chest, these lymph nodes are in the neck. For cancers of the lower part of the esophagus, these lymph nodes are in the abdomen. The cancer has not spread to distant organs or tissues.

Stage IVB (any T, any N, M1b):

The cancer has spread to distant sites, such as the liver, bones, brain, or more distant lymph nodes (M1b).

Survival rates by stage

These numbers describe the outcomes of patients diagnosed several years ago (prior to 2000).

Stage	5-Year Relative Survival Rate
I	50 to 80%
IIA	30 to 40%
IIB	10 to 30%
III	10 to 15%
IV	less than 5%

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Five-year rates are used to produce a standard way of discussing prognosis. Of course, many people live much longer than 5 years. The 5-year relative survival rate assumes that people will die of other causes and compares the observed survival with that expected for people without this cancer. This is a better way to look at deaths from esophageal cancer. Keep in mind that these rates are from people diagnosed and treated many years ago. Treatment and care has improved since that time, and people diagnosed today may have better outcomes.

OK...I'm Out of Here!

So I just checked the manufacturer's site on administration schedules for the Jevity formulas and it looks like I'm proceeding way too slow!!


The following sample administration schedules may be used for Abbott Nutrition Medical Nutritional Products as indicated. Adjust volume and rate according to patient tolerance and nutritional needs.



* Use under medical supervision. Not for parenteral use.

Sample Administration Schedules for Formulas Having Osmolality of < 600 mosm/kg Water*

Continuous Schedule

Day	Time	Strength	Rate (mL/hr)	Volume (mL)
1	1st 8 hours 2nd 8 hours 3rd 8 hours	Full Full Full	50 75 100	400 600 800
2	24 hours	Full	100-125	2400-3000

So..the way I read it..Brigham's started me at 10 cc's per hour and up 10 cc's every 12 hours..way too conservative so...now I'm pushing for release! More to come!

Eating Is Not Always a Choice..Jevity 1.2

Yuk!! Think I'd every want to put this in my body..??

Water, Corn Maltodextrin, Corn Syrup Solids, Sodium and Calcium Caseinates, Soy Protein Isolate, Canola Oil, Corn Oil, Fructooligosaccharides, Medium Chain Triglycerides, Soy Fiber, Oat Fiber, Calcium Phosphate, Magnesium Phosphate, Potassium Citrate, Gum Arabic, Soy Lecithin, Potassium Chloride, Carboxymethylcellulose, Sodium Chloride, Ascorbic Acid, Choline Chloride, Sodium Citrate, L-Carnitine, Taurine, Zinc Sulfate, dl-Alpha-Tocopheryl Acetate, Ferrous Sulfate, Niacinamide, Calcium Pantothenate, Manganese Sulfate, Cupric Sulfate, Thiamine Chloride Hydrochloride, Pyridoxine Hydrochloride, Riboflavin, Beta-Carotene, Vitamin A Palmitate, Folic Acid, Biotin, Chromium Chloride, Sodium Molybdate, Potassium Iodide, Sodium Selenate, Phylloquinone, Cyanocobalamin, and Vitamin D3. (FAN 8091-04)
Contains milk and soy ingredients.

Jevity 1.2 is a formulated product providing 1.2 calories per ml.. translated to 1.2 calories per cc. So my calculation is.. upon release I will be receiving 50 cc's per hour or 60 calories per hour.

If sleeping for 6 hours, that's only 360 calories..

Connected all day..that would be 1440 calories..time to ask for more!!

Stick with me..I'm trying to figure this out. An 8 oz can is 237 ml so 1 oz is roughly 29.6 ml's.

So if I'm trying to be released at 50 cc's...than that's roughly 2 oz's per hour..not much but it's a start..time to ask for more..

GET ME OUT!! ...and basketball..

I want out!! Sunday morning and I'm up and ready but apparently Brigham's has their own schedule. My IV finally came out last evening and they've got my feeding up to 30 cc's per hour and they need to get it to 50 before release. So I'm starting to get a little annoyed..boys are now as I type, showing up for basketball and I'm stuck here waiting..and waiting..

You all know how patient i can be.. ahh..I WANT OUT!

Yum..Feeding Tube..and Chicken!!

So..after loosing almost 25lbs, I decided to have a feeding tube inserted in my small intestine. My weight as of wed. the 15th was 158lbs!! I know a lot of that is water loss so when I'm able to get some carbs put back in me, I'll probably level off around 165-168 by the end of the weekend.

So a brief summation of the past few days..Wed the 15th, I had an EUS or esophageal ultrasound at Brighams. I little different than the esophageal endoscope which was performed in the beginning with the biopsy to determine the carcinoma..

Oh yeah..and my roommate Joe..he just left for another room..83 yrs old..stomach removed last Sept..had his esophagus stretched Thurs to open for eating and it ruptured..so yeah..my week may be tough but Joe has it worse! But hey..if he's tough enough to liberate Okinawa in 1943 at 17 than he's got a pretty good chance for a full recovery.

Back to the EUS..after fasting all day(like I really needed to)the EUS was done in the evening..a little numbing of the throat and light sedative was all it took. Had a chance to watch the whole procedure though as the sedative was not strong enough to knock me out like it did with the endoscope.

A little dazed from the sedative..I noticed the doc's pondering a foreign object between the uneven surface of the tumor of my esophagus. Chicken perhaps..most likely trapped during my first meal weeks ago when I first noticed the blockage and difficulty swallowing. And who said chicken is not good for you? Probably saved my life as it could have been months longer before noticing the blockage.

So the EUS is part of the staging process..that coupled with a Pet/Cat scan and endoscope is usually all that is needed to determine the stage. Briefly there are 4 staged of esophagus carcinoma..Stage I is surface cell, Stage II is surface cell involvement and deeper tissue involvement progressing into the smooth muscle and deeper with possible gland involvement..Stage III usually includes the surrounding glands and localized outer tissues and the dreaded Stage IV, metastasizing in various organs and glands throughout.

Mine fortunately looks like Stage II..I pegged it at II-III based on the large size of my tumor so thank god it looks like the low side.. I do have a small node on the outside wall of the esophagus but from what I am told, too small to be a real concern..

So after convincing the doc to add a feeding tube, the Pet/Cat was moved from Friday afternoon to Thursday the 16th at 7 am..so the tube could be placed shortly thereafter.

Thursday's Pet/Cat scan from what I am being told showed no major tissue involvement. Good news in the staging process. Some nodes did appear on the liver but my thoracic surgeon Dr. Raphael Bueno said they are malignant and not a concern.

From what I can tell and what is being relayed thus far, the Stage appears to be Stage II, oh..and the staging..stage I is surgery, stages II and III are 6 weeks of chemo and radiation( chemoradiation ) followed by 4 weeks of rest and then surgery with average hospital stays of 13 days..lets see if I can beat the averages..and stage IV starts with chemoradiation and various surgical treatments based on organ and tissue involvement.

oh..briefly..

stage II esophageal cancer (...ee-SAH-fuh-JEE-ul KAN-ser)

Stage II is divided into stage IIA and stage IIB, depending on where the cancer has spread. In stage IIA, cancer has spread to the layer of esophageal muscle or to the outer wall of the esophagus. In stage IIB, cancer may have spread to any of the first three layers of the esophagus and to nearby lymph nodes.

So I think maybe mine is IIA?? But I'm waiting to get a definitive answer from the follow ups next week.

I'm now sitting here at B & W's receiving 20 cc's per hour of "Jevity"..a product similar to Ensure or Boost. Planned progression is up to 50 cc's before I'm to be released.

The tube was inserted late Thursday after the Pet scan and feeding started last evening around 10pm..

And thank god for Cathi..she has been my support, my crutch..and my confidant and I could not be doing this without her or the rest of you! Yeah you probably already have guessed..She sneaked in a milkshake last evening when the hospital staff refused to give me more than apple juice. So between the feeding tube and the stolen calories from Cathi's hidden treasures..and Au Bon pain in the hospital lobby..I expect my weight to be rising soon..

Stay tuned for more..this has been a little lengthy but i have a lot of time and even more to say..