10 Years Ago Today
October 20, 2010
10 years ago today - In surgery UPMC for an esophagectomy & pyloroplasty
#gratitude for James D. Luketich, MD, Chairman, Department of Cardiothoracic Surgery and Daniela Molena, MD (now Director, Esophageal Surgery Program at Sloan Kettering).
I was 50 years old. Our (Samantha Sam Horwitz) son was 3 years old. I was scared. Would I be able to practice anymore? Would I be able to lift my son? An esophagectomy is #6 on The 10 Riskiest Medical Procedures list.
I was diagnosed with Achalasia at age 27. An autoimmune swallowing disorder. The distal esophageal sphincter no longer works right & the esophagus loses its peristalsis - the 3 waves of smooth muscle motion which propel food/liquid down and signal the sphincter to open.
Swallowing became more and more difficult and fast forward to my mid 40s.
I had a Heller Myotomy. The esophagus is cut longitudinally in order to make the opening (sphincter area) larger so food/liquid gets down. But not too big to allow the gastric acids to get up. A fundoplication (a wrap around this area) is usually performed by my esophagus was so twisted that the surgeon made a "game time" decision not to do it. This was 2006.
This surgeon also did not listen to me, Sam, nor my brother (who was present) with regard to not laying me flat. If flat, I'd likely aspirate into my lungs. So he laid me flat - I aspirated into my lungs. And then he left plastic clips inside my esophagus.
Needless to say, the improved swallowing I had lasted only a few months and then got real bad.
During the summer of 2010 Sam and I flew around the country interviewing surgeons. I had done quite a bit of research (http://pubmed.gov) on Achalasia and Esophagectomy. I emailed 12 surgeons (you can find the lead author's email via the paper) and received 9 replies.
We narrowed down who we felt were the top four. I discovered that there were two "approaches" to the surgery. Two surgeons used one way and two the other.
Great- how am I supposed to know who is right? Which way is the safest? Which way has the best outcome?
For us, it boiled down to trust. I also asked about IV Vitamin C. This was a deal breaker for me. Either the surgeon agreed or I would agree to the surgery.
FYI: All the surgeons were quite interested in my case since it was extreme. Gotta love that! NOT!
Dr. Luketich had the right resume. Extremely confident, 1000's of surgeries, and he agreed to using the IV C. Most important, he looked at me eye to eye and said, "I will be in the OR from the time you are wheeled in until we complete the surgery. I will be performing the entire surgery with my team.
Done. Dr. L was the choice.
So 10 years ago today the surgery was performed. 8 hours - the staple gun kept getting hung up on the clips the prior surgeon did not remove! Lots of blood loss.
I had TRAINED for surgery - hard. Weights and hard, long cardio (Concept 2) so my body could last through the surgery. Got my Vit D levels up to 70 as per many recommendations.
The nurses thought I was crazy as I had the IV C in the OR and daily in the hospital.
I also arranged for acupuncture. UPMC had (has) an Integrative Medicine Center. Problem - the center was integrated (practitioners of many disciplines) but the center was NOT integrated into the larger UPMC hospital center. The acupuncturist was thrilled as it was his first actual in hospital, post-surgery treatment.
The nurses thought I was crazy. I was up walking as soon as I was out of the ICU (~24 hours) with every tube imaginable sticking in and out of me.
I said, "I'm out of here in 5 days." They laughed as the typical time was 10 days. One day the chest tube had to be adjusted. That felt just wonderful! NOT!
By day 5 I had had it. There was no ability to rest. Every vital sign/test was performed by a different staffer at a different time. Sam had to guard to door to let me get some rest. I told Sam "I need to leave, now."
We had a hotel room as we were instructed to stay 10 days after hospitalization to make sure there were no leaks.
A new "esophagus" was fashioned out of the top (fundus) of my stomach and joined (anastomosis) to the small portion of old esophagus they left.
An "anastomotic leak" would not be a good thing.
We left the hospital upon strong protests from the nurses. I got into an Epsom Salts bath and it was heaven.
I started walking outside the next day and got up to 30 minutes by day 10. I stayed out of work for 7 weeks - I was told I needed at least 12 weeks, but I could not find coverage for my office. Here is the Functional Movement Screen performed 10 weeks post-surgery.
Recovery was a long road. I got myself off of ALL pain meds by week 4. By week 2 I used them only to sleep. I also had an enteral feeding tube. I got that out as soon as I got home. I needed real nourishment.
Don't get me started about the crap enteral feeding formulas.
And in the hospital, I had to meet with the dietician. Sam told me to "just listen." Fortunately for me, the dietician was a woman (and I was still drugged up heavily). Otherwise I would have been in jail because the recommendations were joke.
Thankfully I knew about recovery. A friend is a phenomenal massage therapist and I started treatments with him as soon as I got home. What a difference! Scarring must be worked on. I was cold for 6 months. I just could not warm up.
But, I was able to hang from a pull-up bar after several massage appointments.
The key was attitude. There was NO WAY I was not going to come back. I was told I would never lift heavy and should not.
I gradually returned to lifting - baby weights at first. When my deadlift hit 135 I said, "OK, let's go for 225." And then 315, and then 405. And 21 months post surgery I pulled 475 in a meet! Thank you Jason Schreiber
So what's the message?
2. COMMITMENT to myself, to healing.
3. GET HELP - ask questions and find the answers.
That's it - #takeownership and get after it!