Placing the Portacath

The portacath is this medical device that consists of a 1) port, and a 2) catheter that is inserted below my chest -- above the boob (of course) and below the collarbone. The catheter connects the port to a vein -- usually a major vein located right above the heart. Instead of poking my arms with an IV every time I get chemo, the nurse simply needs to access the port, which can be identified as the slightly raised disc-like area in aforementioned above boob/below collarbone area. Efficient, much more resistant to infection, and easy to use.

I got my portacath in yesterday morning at USC.  The fellow who operated on me did a solid job, and the nurses -- Veronica and Fiji -- were incredibly awesome and fun. They gave me some Versed and Fentanyl, a powerful pain relieving duo, to help bring about my "conscious sedation" during the procedure. They actually gave me three times the amount they usually give folks because my tolerance to these drugs was so high (as in, they could tell I was totally with it during the process). The upped dosage, although administered in an attempt to get me to that lovely "conscious sedation" place, didn't actually work. Don't get me wrong -- this girl was relaxed and pain-free, but I sure wasn't sedated. I heard every word spoken in the operating room, felt every tug at my chest, and had the pleasure of listening to the back and forth as the main doctor instructed the fellow on how to close up the incision points. The main doctor definitely talked some smack at the fellow as he dressed my wounds, and in the process, I think she made him so nervous that he added a little too much glue to one wound which has resulted in a silly line of glue running down the right side of my neck. Oh well. I think it's funny.

Speaking of wounds, I have two -- one at the chest and the other at my neck (the catheter had to be snaked up my chest to my neck, then down into the major vein above my heart). Here I am with my new friends.

The portacath felt decently sore last night (imagine tweaking your neck really badly and having a foreign object under your skin), and the nurse said that it would be worse on Days 2 and 3 following the procedure. Lo and behold, today is Day 2, and the portacath feels awesome. Soreness is much, much less, and the wounds are healing very well. Man, I love when health professionals make predictions about how things are going to be for me. Crushing those predictions are my new favorite pastime.

Oh yeah, and guess who has gained almost 5 pounds since leaving the hospital about 3 weeks ago? Even if chemo takes a hit on my appetite next week, I've got a little cushion -- so to speak -- to work with...not bad, eh?

Tales of the NG Tube

Ah, tales of the NG tube.  These are even scarier than Tales from the Crypt, trust me. Now, gather around the campfire, bring your blanket, and try not to get too spooked. Let's begin.

The NG tube is not my friend. 

Our first encounter was not a direct meeting -- doctors, including Dr. Ramos, had made mention of this NG tube (its official name is "nasogastric tube" -- think about that unpleasant name for a second) during the first few days of my hospital stay when I was all stopped up (due to the mass in my colon, but nobody knew that at the time). "You might need an NG tube," the docs would say. They'd add, "It's not a pleasant thing." Nothing materialized pre-surgery, but once we knew that I had a mass and we were getting it out on Sunday, September 19th, Dr. Ramos asked that I attempt to get this tube in and ready for surgery on the prior day.

September 18th, 2010. My first face-to-face encounter with the NG tube. A very enthusiastic and kind nurse, Michael, was on shift the night before my surgery. He seemed to relish the dubious task of assisting the NG tube placement process, which consisted of shoving the tube up my nasal passage, down my throat, and all the way down to my stomach. Of all the things I've encountered during this little cancer adventure, including surgery, post-op pain, scans, portacath placement (post on that coming soon), and the pre-diagnosis vomiting, nothing -- NOTHING -- compares to the pure evil of the NG tube.

Back to the story. So Michael walks in my room, admits that the process will be "gnarly" but I'll "get through it," and sends my parents, Will, and my best friend Tim out of the room. I wish they would've walked down the street to avoid the terrible guttural sounds I emitted during this whole fiasco.

I closed my eyes. Michael started to feed the tube up my nose. So far, it feels like I'm underwater -- I can handle this. Then, a crack. More like a CRACK. What the hell? "Ohh, you've got some crystalline boogers up there," Michael observes. "Your nose is bleeding. Take a break." 

I open my eyes. Why, yes, my left nostril is bleeding. I tried to gather myself but Michael's definition of a break consisted of about three seconds. Before I could even realize my eyes were watering, the tube was back up the left nostril and -- BOOM! -- ran into the same crystal palace. We had made progress, though, so I was thinking maybe I'd have one more 3 second break and we'd make a literal breakthrough by the next go-round. But no. "Let's just do your right nostril," Michael declared, as I was busily sopping up the increasing blood flow from my nose.

My right nostril?! Noooo! It's the only good nostril I have left! "Oh...ok," I replied. I was trying to be a good sport, and honestly, if Michael is saying that people routinely get through this and this whole thing is merely "gnarly," I should be able to do this. Before I could even finish the thought, the tube was up my right nostril, breezed through the sheath of dried snot, and was down my throat. Holy cow. Gross.

I kept my eyes shut, trying to be as zen as possible. I can do this, I can do this, I can do this. Then I tried to inhale. I felt like my throat was about 90% NG tube and 10% not constricted normal windpipe. Eyes still closed, I told Michael, "Get it out, get it out, get it out." Michael, almost surprised, responded, "Oh yeah? You can't handle it? You want me to take it out?" Had I not been choking, crying, and bleeding, I would've punched him in the face. "Yes, get it out, get it out, get it out," I respectfully repeated.

He started pulling it out and I finally opened my eyes. Stomach juice and blood everywhere. At least I held out long enough for him to get it down to my stomach, and at least the blood was only coming from my nose, but wow. Worst thing ever. "Do you want to try again?" he asked. You can guess what I told him.

And when I gathered my loved ones from the hallway, blood on my hospital gown, blotting the tears that automatically sprouted to my eyes as a result of this terrible tussle, Michael admitted to all of us, wide-eyed and with stomach juice-soiled linens in hand, "Yeah, usually people are totally sedated for the NG tube placement." This kid was really lucky I didn't smack him. It would've been gnarly.

My third encounter with the NG tube came when I was fully sedated during surgery. Not a bad time.

The fourth encounter was post-op. I had anticipated this fourth encounter, and told Dr. Ramos how much I hated the tube and couldn't live with it and would be so unhappy if I woke up from surgery and it was down my throat. He explained that it was incredibly important because it prevented me from getting backed up while my digestive system was remembering how to do its thing. We negotiated (of course, I'm a lawyer), and he said that I needed it in at least 24 hours post-op. Alright. I could manage that. The first 24 hours after surgery with the dreaded NG tube were fine. I hated it, but I also had a delicious painkiller, wonderful family and friends visiting me, and the eye of the tiger about beating this cancer, so I wasn't thinking about it too much.

I count post-op hours 25-36 as the fifth encounter, because relations between me and the tube started to turn sour at this point. I want you to imagine a dry, plastic tube in a dry throat, and that dry throat trying to swallow and necessarily rubbing against that dry, plastic tube. Not cool. I've also failed to mention up until now that the NG tubes are ONE SIZE FITS ALL. If you've seen the size of my hands, feet, or ears, you can imagine how petite my nasal passage and throat must be. And yet, I had this ONE SIZE FITS ALL thing lodged in my throat (and shoved up my nose without any pain meds or sedation courtesy of gnarly Michael).

When I realized that I had held up my part of the bargain (living with the tube for 24 hours post-op), I started paging the nurses and begging them to page Dr. Ramos. "Tell him I need this *bleeping* tube out of my body," I'd request. Will started texting Dr. Ramos (yes, Dr. Ramos texts -- he's so cool) about removing the NG tube. I started asking doctors who were not my doctors to take out the NG tube. Desperation and an elevated use of curse words ensued. 

Finally, after what seemed like a lifetime, dear Dr. Ramos entered my room. "OH MY GOD, YES! THERE YOU ARE!" I screamed from my bed. "GET THIS THING OUT OF ME, DAMMIT! GET IT OUT!"

Dr. Ramos looked at what the NG tube had sucked out of my stomach -- a serious amount of brownish green liquid. During those hours where desperation bled into delirium, I named the liquid. Stomach iced tea. I even gave it a flavor: Summer Breeze.

"Gloria, this NG tube is doing its job and I'm just not sure we should take it out." Dr. Ramos tried to reason with me, but I was as unbending as the plastic monstrosity in my throat. "You're going to vomit," he warned, "and I'm taking out this tube against my better judgment." I told him I didn't care and that I'd vomit 400 times with a smile on my face if that was my fate without the tube. He relented.

"Do it fast," I instructed, as he started to pull the tube from my nose. "No, I can't do it fast," he said, as he pulled it out in an impressively deft manner. I gagged a couple times as it came out -- this thing was LONG -- but it was over in mere seconds. I was FREE! With tears in my eyes, partly because of the gagging and partly because of pure joy, I grabbed Dr. Ramos. THANK YOU. I LOVE YOU. YOU'RE MY HERO. THIS IS AMAZING. He smiled, laughed, and said I was cool. I don't know if I was anything remotely resembling cool in that moment, but I appreciated his kindness. I've been a new woman ever since.

There are a few morals to this story.

1) Do not let nurse Michael convince you that shoving the NG tube in your body is merely "gnarly" -- it is far, far worse than that.

2) Negotiate about post-op time with the NG tube. You're going to need 200 ice chips per swallow by Day 2 post-op because your throat will feel like a desert. A sore, bloody, desert littered with large pieces of plastic.

3) Name your stomach iced tea. For fun.

4) Be glad that, at this moment, you don't have an NG tube in -- I know I am.

Ready for Chemo!

Well, folks, we're locked and loaded and ready for chemo, which starts on Monday. A couple of hurdles needed to be cleared before then, and they were cleared with flying colors. 

First: my incision -- I met with Dr. Ramos yesterday so he could take a peek at his handiwork and determine if the incision had healed well enough for me to begin chemo. If it was infected, say, or nearly infected, chemo would have been delayed. Ramos took one look and said I was good to go. Then I got two hugs from him. Nice.

Next, and this didn't actually preclude chemo, but was an important thing to find out prior to going forward: my PET scan results.

I got my PET scan done on Tuesday, but didn't want to tell you guys about it until I had the results, for obvious reasons -- let's not all be on pins and needles for two days, right? I try to be considerate, especially to you folks. One thing about the PET scan procedure that is worth sharing: I got some Valium prior to the scan (which is highly unnecessary since I don't get nervous when getting CT scans or the like -- resting in a strange plastic tube while my body is being scanned doesn't weird me out in the least). Valium was pretty great, and I had the tech laughing like crazy during the scan. I wasn't totally out of it, but I think my thorough joy in being so relaxed and Valiumed up tickled her. I like to keep people laughing, what can I say? :)

So, the results: they couldn't have been better -- there is no cancer anywhere else in my body save this gut, and the tumors in my gut had not notably grown between diagnosis and now. Awesome times, and what a relief. I was feeling confident the whole time -- prior to the PET scan and up until the moment I learned of my results -- but it's nice to have that confidence validated and it's even nicer to know that I just need to fight this battle on one front.

If you want some proof of my optimism and confidence leading up to the PET scan, here is a picture I took of myself prior to heading in (and prior to the Valium, so this is a truly authentic expression)...

Chemo starts on Monday, and I couldn't be more charged and ready to go. This chemo is supposed to be fantastic -- it not only yields solid results, but it doesn't make you lose your hair nor does it kill your immune system. That means I can keep rockin' the bangs and, most importantly, I can keep hanging out with my loved ones (without having to wear a surgical mask).

Because I tend to get a little rashy from drugs/scrubs/plastic hospital beds/neosporin, I'm going to get a nice shot of Benadryl to start things off. That means that this WunderGlo is going to sleep like a baby during the entire process. By the time I wake up, cancer will have been dealt a serious body blow. Meanwhile, I'll be rested and ready to fight some more.

Food (Nom Nom Nom)

I realize that I haven't given you the full back story of my time in the hospital prior to diagnosis and post-op. I will give you that full story, but in bits and pieces because it's more fun that way (also, I need to lobby for the word "funner" to make it into our lexicon because, come on, "funner" is more fun than "more fun"). Today, I'll tell you about the things I ate in the hospital (or lack thereof) and my subsequent goals and challenges regarding food and weight gain.

At the hospital, I was either completely NPO ("nothing per oral" -- as in I couldn't eat or drink anything including ice chips and water) or only able to "eat" ice chips for the solid majority of 2 weeks. If you know me, you know I'm not only a foodie but (and yes, this is a contradiction) also quite accepting of all foods including those of the fast variety. One day you could see me at Bazaar in Beverly Hills, and the following afternoon I could be contently chomping on a Happy Meal. Bottom line: I am a fan of food and a fan of eating. So two weeks without any of it? I was practically hallucinating about El Pollo Loco and my favorite high end Italian bistro in tandem. I wasn't hungry, mind you, during this time, since I had this crazy muscle milk-looking stuff flowing through my IV -- but man, I wanted to eat.

Soon after my surgery, Dr. Ramos gave me the green light for clear liquids. Oh, chicken broth! Dear jello! Delicious apple juice! All remarkable foods at the time, and I'm not going to sell them out now and call them bland or not exciting. I'm pro-clear liquids. Delicious. 

I quickly progressed to full liquids (think milky clear liquids -- butternut squash soup, pudding, etc), and after I successfully kept that food down, Dr. Ramos said the words that almost brought tears of joy to my eyes: "No dietary restrictions." My eyes lit up. "Wait, doc, do you really mean NO DIETARY RESTRICTIONS? You mean...I can eat ANYTHING??" He gave me one of his adorable Dr. Ramos smiles, grabbed my hand, and said, "Yup, kid, anything you want." Oh baby.

It was on. I dispatched friends and family immediately. Some were headed to my high end Italian bistro for meatball pizza. Others ran out to secure pad thai, burgers and fries, chocolate chip cookies, and red velvet cupcakes.  I hauled my butt out of bed, grabbed a piece of cold pizza that my mom hadn't finished, and took a monster bite. Oh, food! My old pal! Happy doesn't even describe my state of being at the time. The world was my oyster. Ooooh, oysters -- yum.

I overdid it by lunch, taking about 4 monster bites too many of my beloved meatball pizza and two chugs too many of Sprite, and lost that bit of my lunch within minutes. But I learned a good lesson from that -- no competitive eating any time soon -- and have kept down every bite of food I've lovingly taken since then.

After a couple of days of semi-gluttonous feasting (I say "semi" because my appetite was actually not that large -- two weeks of no food in your belly can do that to you), my best friend Rhett started doing some research and dropped the bomb: to fight this fight from a nutrition front, I would have to eat very healthy and very different from what I was used to. At first, I put on earmuffs and took another bite of cupcake, but after an hour or two, I realized that he was right and I needed to avoid red meat, sugar, white flour, and all the other things that bring smiles to our faces when we ingest them.

At first, it was rough. My options seemed so limited and I was getting a touch discouraged. Dr. Ramos told my family that I would undoubtedly lose weight with this cancer, and that it was near-impossible to gain weight. With chalky gluten-free cookies and plain chicken breast with plain brown rice, I was starting to believe him. On the night we started this whole healthy eating endeavor, I shed a few tears and told my parents and Will, in frustration, "this food SUCKS and I am going to lose weight if this is all I get to eat." All this girl wanted was a damn egg roll or a bite of sourdough bread, and no luck.

That was all my mom needed to see (GloBo doesn't shed many tears -- at least of sadness or frustration). My hero (as always), she got in the car, headed to Whole Foods, and spent nearly $400 on a variety of food items that I could try out and accept or reject as I saw fit. Well, she hit the jackpot. Pretty much everything she bought was either decently tasty to actually tasty, and I've not looked back from my new, part gluten-free, part-vegan, no-red meat or white flour, low sugar diet.

And guess what? I've gained two and a half pounds since I left the hospital. Recently told my buddy Dr. Ramos the news, and he was more than pleased. I don't know if it's normal for a doctor to tell you how proud he is of his patient, but it's normal for us. :)

Near-impossible is nothing.

And maybe I should look into competitive eating. 

About My Cancer (And My Plan To Beat It)

So, what do you know about my cancer so far? That it's colon cancer, and that it's Stage 4.

This is only part of the story, and I intend to give you the full story. There is no need to keep you in the dark, and by understanding my cancer and my plan, I think you're going to feel even more confident about my eventual victory. I'd call it an "imminent" victory, but it's going to take several months to officially win this battle, so let's just go with "eventual" for now. It's sort of like Duke Men's Basketball (I just want to warn you right now -- prepare yourself for many Duke hoops references) -- you know they are going to have a ridiculously successful season by opening tip-off, but you need to ride it out 'til March to officially declare it so. I'd also like to remind everyone that Duke Men's Basketball are the 2010 National Champions. I was there. It was beautiful. Yes, I wept tears of joy. GO DUKE!

Ok, getting back on track. My cancer originated in my colon (one pretty large mass), affected neighboring lymph nodes, manifested itself via one small mass in my small intestine, and then decided to continue the party in my peritoneum, otherwise known as the membrane covering my abdominal cavity.

During my first surgery, which was on September 19th and performed by one of my favorite dudes in the world, Dr. Hector Ramos (a post solely dedicated to Ramos coming soon), the cancer in my colon, the neighboring lymph nodes, and my small intestine were taken out (or, for those medically savvy among us, "resected"). That means I've still got cancer in my peritoneum, and there's a pretty serious amount of it. 

Do not fret though, friends and family, because Stage 4 colon cancer is curable. There have been others with my exact same cancer, down to the biology of the tumors that are currently chillin' in my gut, that have been cured -- as in, came out of their battle totally cancer-free. Want to know how? I'll tell you.

There's this incredible surgery, pioneered by an incredible man named Dr. Sugarbaker, in which every scrap of cancer in your peritoneum is plucked out -- down to the tiniest cells detected by the human eye -- and following that, heated chemotherapy is injected into the peritoneum. I call it the "pick it out, pour it in" procedure. After this hardcore surgery, which generally takes 8-12 hours, the patient spends 3-5 days in the ICU, then many, many days in the hospital. Sometimes, it could take up to 3 weeks before a patient is released from the hospital. One incredible, awesome survivor I spoke with said it felt like being hit by a train with no brakes. I responded, "But come on, it kind of feels like a hot stone massage, right?" Obviously not, but I'm just going to go with that image.

This surgery is generally preceded by some months of chemo, then a bit of a break to build up the body for this difficult surgery, then the big "pick it out, pour it in" party, then a few more months of chemo. When the entire process is over, the patient will be 100% cancer-free. Doesn't that sound awesome?

So yes, this is the plan. 3 months of chemo with Dr. Lenz at USC (beginning in about a week), one month to go all Rocky Balboa on myself and get pumped for the "pick it out, pour it in" festival, then 3 more months of chemo just to make sure that cancer knows who's boss. 

One thing I left out -- who is doing the surgery? None other than the man who invented it, the brilliant and heroic Dr. Sugarbaker. He is very selective, and generally doesn't accept patients this early in the game (before they've started chemo), but due to the persistence of my wonderful friend Sabrina, the soft spot existing in the heart of Dr. Sugarbaker's wife, Ilsa (she is in charge of patient intake), and Dr. Sugarbaker's awesomeness, I was accepted as his patient just a couple of days ago. Some say he only picks patients he believes he can cure. I'm glad I've got another believer on board, and I'm ecstatic that it's him.

So, my friends, I am officially Team Lenz/Sugarbaker. I know that these incredible doctors, together with me, you, and the Baby Jesus, are going to see to it that I'll be cancer-free by next summer. Good times.