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Cancer: The Thing in My Chest (Part II)

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(Click HERE for Part I)

The Next Step

It’s been a long few months since I was first hospitalized after the Pulmonologist was alarmed by my chest x-ray. I am beyond happy to be done with chemotherapy, and to be growing my hair back. While I will miss the nurses that I saw when I would go into the infusion room, I will not miss that infusion room for one second.


There were multiple steps to this process of taking care of this thing in my chest. The first, longest, and arguably toughest step was Chemotherapy. Unfortunately, it takes some time for all of the Chemotherapy to exit my body. So, following my final day of Chemotherapy came a little over 6 weeks of letting the remaining Chemotherapy in my body finish doing its job and working its way out of my body.

In the meantime, I got back to as much of a normal routine as I could. Fortunately, I was able to exercise and, for the most part, be active. However, I did have weight restrictions when it came to weightlifting exercises for obvious reasons. Nevertheless, I did what I could to keep myself in as best shape as I could in preparation for what was to come.

Surgery

After that, came the next big step: Surgery. Now, it was known from the very beginning of this entire process that the tumor would eventually have to be surgically removed. However, it was still surgery, and anytime you need surgery, it’s a pretty big deal. This was certainly no different.

Again, any surgery is nerve-wracking, but this was not just any surgery. The tumor was in the mediastinal region of my body, which is in my chest by my lungs. Not only that, but there were major veins and arteries that may need extensive repairs, or even replacement, due to the tumor.
This was basically open-heart surgery, but not since they weren’t operating on my heart. They had to crack my sternum to get to the tumor. Once they got to it, they had to carefully remove it and assess any damage it may have caused just by its physical presence (never mind the possibility of any cells spreading – which I will get to a little later).

One of the biggest concerns was what kind of damage, if any, was done to my Aorta. Fortunately, the tumor was up against my Aorta, but did not invade it, which meant that no further operating was needed on the Aorta. Unfortunately, the tumor did partially invade my Superior Vena Cava, which is the largest vein in the body (similar to the Aorta).

The original plan was to go up to Sloane-Kettering Hospital in New York City to have the surgery done. My oncologist suggested it and felt that it would be the best option since she had worked with them before in situations like mine. However, I ran into a couple of issues along the way.
A big issue I ran into was insurance. Because of the type of insurance I have, the coverage is limited to a local network of hospitals. Unfortunately, Sloane-Kettering was out my range. Even if I was able to have my Oncologist over-ride the limitation and allow insurance to cover it, I would be balance-billed. In other words, what insurance didn’t cover, I had to pay. Given that the remaining cost, even with insurance, would be more than anything I could possibly afford, I explored other options within my network.

After talking with my Oncologist about other options, I met with two potential surgeons, one from Fox Chase – where I went for Chemo – and from The University of Pennsylvania (Penn) to discuss the surgery.

I’m not going to sugar coat it, I was pretty nervous talking to the doctors about this. It wasn’t just because we were talking about surgery – which is scary regardless of where it is. I was also nervous because they ran through multiple scenarios and options that they might have to do. For starters, one thing that they were going to do no matter what was break my sternum in order to get to the area where the tumor was.

Just to put this into perspective, in the 27 years I have been on this planet, I have only been in a hospital, as a patient, once before this whole situation. Back in 2011, I had to have my appendix removed after abdominal pains were found to be appendicitis. It was also the only time I can ever remember having surgery. Not only that, but an appendectomy was a pretty straight forward and routine surgery compared to others.

They talked about how they might have to make an incision down my chest and to the right in a “J” shape, they might have to either patch up, or altogether replace the superior vena cava all together. And, depending on how much work was needed on the Vena Cava, they might have to put me on a bypass machine which would make recovery take that much longer.

What They Actually Did

Fortunately, for all of the things they said they might have to do, they wound up making an incision about 6-7 inches long straight down my chest, but not in a “J” shape. Despite having to patch up my vena cava, they didn’t have to put me on a bypass machine. So, by only having a scar straight down my chest, and not having to go on the bypass machine, I came out of this in pretty good shape – relatively speaking.

I got to the hospital around 6 AM, and after several pre-surgery procedures, and emotional hugs and kisses from my family, I went back for surgery. About 5 ½ hours later, I woke up from surgery and was in the Cardiac Intensive Unit for the next day.
As I was being taken up to my room, I wound up being taken back down to the ICU. My stomach had basically stopped working, so a tube was placed up through my nose to help with things. Interestingly enough, if you ask me, that tube was the worst part of being in the hospital. It hurt getting it put in, and it was annoying the whole time it was in.

My chest was pretty sore, and it was going to be several weeks before my sternum healed completely. However, by not making a “J” shaped incision, I didn’t have to wait even longer for muscles to heal. I was going to be in the hospital for at least a few days, which was expected, but God knows, it could have been so much longer. However, I quickly learned something about the sternum…

You Might as Well Take My Thumbs

As I mentioned above, I had only ever been in the hospital once as a patient before this whole situation with my tumor. Also, I’ve never broken a bone in my body. As a baby, my feet had to be corrected so I could learn to walk, and I sprained my ankle a few times, but I had never broken a bone.
That was until I had this surgery. Granted, I didn’t break it, the surgeon did out of necessity. But still, it was my first broken bone. I have to say, for someone who had never broken a bone before, a broken sternum is one hell of a broken bone to recover from.

I was fortunate that it was broken in a controlled environment and in a controlled manner though. Having been through that, I cannot begin to imagine how painful it must be to break it “the hard way”. Even still, it is very painful while it is healing. What’s worse, is you don’t realize how much you depend on the sternum, as well as that whole area of your body, for the most basic of functions.
If you’ve ever had a broken sternum you know this, but for those who haven’t, here is a list of some basic things we do without thinking that you can’t do without pain or discomfort if you have a broken sternum:

– Taking a nice, deep breath (although it gets easier the more you do it)
– Anything in which you push up with your arms (push-ups, pull-ups, getting out of a chair with your arms, pushing in a chair, pulling anything, etc.)
– Coughing
– Sneezing
– Anything that involves lifting your arms over your head (i.e. washing your hair – unless you use one arm at a time)

Those are just a few of many things you rely on the sternum and surrounding muscles for. Obviously, your entire body is important, but the sternum and surrounding muscles are just as important as your thumbs.

Ouch-choo!

One of the most painful things to do with a broken sternum is coughing. It’s something that will happen whether you want to or not, and it’s actually good for your recovery and your lung capacity as well. In my case, anyway, coughing – as painful as it was – was a way to keep fluid and other stuff away from my lungs while I worked on my breathing to expand them back to normal. During the surgery, they also took a small piece of my lung as well. Anything I can do to strengthen my lungs again, I was all for.

I was given a nifty pink lung-shaped pillow to push against my chest whenever I coughed. When I coughed, it would slightly jolt my sternum, which was healing from being broken and put back together. By holding the pillow against my sternum, it held it still so it didn’t move as much which made it less painful.

However, there is one thing that is more painful than coughing. As a matter of fact, it’s probably the most painful thing to do with a broken sternum: Sneezing. Yes, it was also something that was bound to happen whether I wanted it to or not as our body does it involuntarily. But when I did, it really jolted my sternum a lot, and boy did that hurt. The first time I sneezed was a couple of days after my surgery, and – no exaggeration – I didn’t move for nearly 5 minutes because I was in so much pain.

Post-Op

I was finally discharged from the hospital five days after my surgery, and what a relief it was! It’s not just a matter of not having tubes in my chest and not being hooked up to a heart monitor and IV. There is also a psyche you deal with that comes with spending several days, or longer, in a hospital. It happened when I was discharged from Fox Chase after a week of inpatient treatment, and it happened again when I was discharged from Penn.
A few weeks after I was discharged, I went back to Penn and to Fox Chase to follow-up with my surgeon and oncologist respectively and see how my surgery went. Both appointments were on the same day, although the two doctors were following up from two different standpoints.

The appointment with my surgeon was following up from a purely surgical standpoint. In other words, how the surgery went and my next steps to recovering from the surgery. The appointment with my oncologist was following up from the standpoint of “What does this all mean, and where do we go from here as far as any further treatment for the cancer?”

First up was my appointment with my surgeon. He came in, and was pleased from the very beginning. He said that the surgery was very successful. They were able to get the tumor out in one piece. They said that it was the size of a grapefruit when they took it out – and that was after it shrunk by 50-60% from the Chemo.

At that point, my family and I were awaiting the results of the pathology. After they removed my tumor, they sliced it into very thin pieces and studied it under a microscope to determine how much, if any, live and viable tissue was in there. The surgeon was confident that, in the unlikely event that I needed more Chemotherapy, it would only be a little bit more and nothing like what I got before. He also looked at my scars and was very pleased with what he saw. I had to take it easy for 3 or 4 more weeks, but after that I was cleared to lift more than 5 lbs – the maximum weight I was allowed to lift following my surgery.

Later that day was my appointment with my oncologist. The follow-up with my surgeon could not have gone any better, quite frankly. However, there was still one more doctor to hear from. The tumor was successfully removed, and the majority of it was necrotic – or dead – tissue. In fact, encased within the tumor was less than 1% of viable tissue.

So, what that meant was that the Chemotherapy had done its job. It didn’t get rid of the whole thing, but Chemo typically doesn’t do that with large masses. It did, however, shrink it tremendously. The surgery had also done its job and got the tumor out of my body. At long last, I finally heard the two words I’d been waiting for months to hear from my oncologist: I was officially CANCER FREE!! I won! I beat this thing just like I had no doubt that I would.

It’s hard to put into words what it feels like to overcome cancer, even if my situation had a positive outlook and prognosis from the very beginning. To say that this victory was sweet is like saying that Wayne Gretzky was a halfway-decent hockey player.

Un-Pause

At this point, I am currently cancer-free and finally getting to “un-pause” my life – which had seemingly been put on hold since April. I still have follow-up appointments with my oncologist, but they are simply to monitor me and check if anything spread throughout the body or anything new showed up. Although the chances of that happening are (fortunately) very low for me, there is always a chance of this happening any time someone is dealing with cancer of any kind. These appointments will initially be bi-monthly, but will eventually be every other month, and then eventually even less frequently.

In the meantime, I am happy to be able to get my life back. I will soon return to work, and have already gotten back to exercising and putting on muscle. I was not happy that I was rendered so skinny by the Chemotherapy, but at the same time it gives me a chance to put that weight back on in a healthy manner and give myself the muscular and built look I’ve wanted to have for a long time.

Teamwork Makes the Dream Work

An important thing to keep in mind, not just in my case, but when anybody battles something like cancer, is that it’s far from a solo battle. Yes, it’s kind of cliché, but it’s so true. Sure, it’s ultimately up to you on how you go about fighting this, and the attitude you choose to have, but you are not going at this alone. I know I certainly did not.

Mom, Dad, Alicia, Tony, Matt, Mike, and Maria, I can’t thank you guys enough. My family is one of the closest-knit groups of people I know, and at the drop of a hat we are always there for each other no matter what and no matter where we are in the country.
Mom and Dad, you guys are the greatest. There was already enough on your plates, but you took this on head-on and powered through it right beside me. Dad, a big part of my attitude, outlook, and determination comes from you. After you suffered a stroke over two years ago, you were hell-bent on getting better and being known as “the guy” when it came to recovery. Well, it rubbed off on me as I faced the toughest challenge of my life, and I thank you greatly for that.

My girlfriend Lauren was thrust into a position she never thought she would be in. I was not worried, but it is no secret that medical issues like this can bring an immense amount of stress into a relationship. Fortunately, this was not the case for us. Not only were you there supporting me every step of the way, but you rode shotgun alongside me through this crazy eight-month journey. I love you so much and cannot begin to thank you for, not just being a rock, but for being my rock.

I also want to thank Dr. Elizabeth Plimack and Fox Chase Cancer Center, as well as Dr. John Kucharczuk, Dr. Nimesh Desai, and the Hospital of the University of Pennsylvania. A key component in my confidence in this fight was the confidence of Dr. Plimack and the other doctors who treated me at Fox Chase Cancer Center. The nurses there also made things leaps and bounds easier when it came to being there and undergoing Chemotherapy.
Dr. Kucharczuk did an unbelievable job of removing this tumor from my chest. It was a very scary thing to think about, but Dr. Kucharczuk and Dr. Desai did a great job of assuring me that everything will be taken care of and putting me at ease about the surgery.

As I resume my life and finally put this whole thing behind me, I hope that I was able to reach out with my story and help anyone going through a tough time in their life. Any way I can help, I will.

I got dealt a bad hand, but as Randy Pausch once said, “We cannot change the cards we are dealt, just how we play the hand.” God knows how much worse of a situation I could have been in. I look back on this now with the same thought I had going into this:

“As much as this sucks, I am very grateful for my situation.”

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