The Plan

Lauri and I met with the Thoracic Surgeon today. We discussed what kind of surgery Lauri will have, the risks involved, schedule, and recovery. This will be another long post, with plenty detail on the surgery procedure. For those who prefer, here is the cliff notes version:

Lauri is scheduled for the first of two surgeries on October 17. The surgeon will work on Lauri's left lung to remove the tumor that is nearest the heart first. Six weeks later, on or near November 28, Lauri will undergo the second surgery to remove the two tumors in the right lung. After each surgery, a 5-7 day stay at the MD Anderson Hospital is expected, followed by recovery continuing at home.

And now for the details...

The Thoracic Surgeon confirmed that a "Stage Thoracotomy" is the preferred approach for Lauri's condition as opposed to a Sternotomy. A Sternotomy involves accessing the lungs via incision in the center of the chest, breaking the sternum bone, as in open heart surgery. This method, while providing access to both lungs simultaneously, generally results in the surgeon removing larger portions of lung tissue.

A Stage Thoracotomy involves working on one lung at a time. The surgeon generally only takes small sections of lung tissue in this case. For Lauri, the surgeon will work on her left lung first. There will be a ~4-5 inch incision parallel to the ribs, located around the middle of the rib cage on the left side of her back. Once incised, muscle is moved out of the way (a process referred to as "muscle sparing") and the ribs are literally spread apart enough to gain access to the lung.

The surgeon will use his hands and a bronchial scope (a scope placed through the trachea into the lung) to locate the tumor. The tumor will then be recessed (cut out) along with margin. Margin is simply surrounding tissue (about a millimeter to a couple millimeters thick), which is removed to guarantee the surgeon gets all of the cancer cells. According to the surgeon, he will not have to remove very much extra lung tissue, such as removing an entire lobe, to remove the tumor.

Chest tubes will be placed at the site to allow for drainage of fluids out of the area surrounding the lung. The chest tube is a large tube (perhaps 1 inch in diameter) that is placed near the lung, through the incision site, and connected to a container to collect the drainage. Once the wound is no longer draining, the tube will be removed. We expect this to occur around 2-3 days after surgery.

Lauri will be put to sleep during the surgery, as well as receive epidural pain medication during and after surgery. The epidural line will remain in place for around 3 days. Afterwards, Lauri will be put on oral pain medication for as long as she needs it...Yeah, that's what I'm thinking too...

We expect to be discharged from the hospital 5 to 7 days after the surgery. We will continue recovery at home, with expected "pain and discomfort" to persist for about 4 to 6 weeks. We will return to the hospital for the second surgery on the right lung 6 weeks after the first surgery, or around November 28. It is expected that Lauri will retain much of her lung capacity after both surgeries are completed.

The surgeon has decided to work on the left lung first because the tumor in the left lung is located near the heart. The two tumors in the right lung are not near other organs, and are considered lower priority (they can wait...).

The greatest risk of this surgery is the risk of pneumonia. To combat pneumonia, Lauri will have to do very frequent lung exercises using a tool called an "Incentive Spirometer". Open heart surgery patients use these too, so you may be familiar with them. The Incentive Spirometer requires the patient to inhale deeply and slowly, trying to draw enough air to keep a marker "ball" within a specified location. The device exercises the lungs while also providing a measure of lung capacity, and causing the patient to inhale deeply. Short breaths can lead to a pneumonia condition, and patients with chest pain are known to draw short breaths.

Lauri will also have to do arm exercises, basically stretches, to maintain full range of motion of the arms as the incision heals. She will not be permitted to pick up anything heavier than a newborn (so this means she can work then??). The information we received actually says that the patient cannot use a vacuum cleaner either, due to the pushing action....figures...

We really like our Thoracic Surgeon. He is very patient with us, and covered all of the details thoroughly. He has a good handle on Lauri's condition, and is very proactive in getting us all the help and information we need. He is also very straight with us, and wanted us to understand a very important point:

The chemotherapy and surgery process is 30-40% effective in curing the disease. While these odds are better than nothing, they are far short of a guarantee. We need to be prepared in the event the surgery is not successful in completely removing the disease. While Lauri's three nodules show up clearly in the CT scans, there may be more nodules out there, small enough to not show up on the scans and small enough that he cannot feel them during surgery. It only takes a single cell to split and grow into a tumor. If the tumors return, we will likely continue chemotherapy, followed by additional surgery.

I mention the above statement because while we have fought hard and fought well, the fight truly never ends. Even if we are cancer free after this surgery, others are not. We all have to work to prevent, in addition to cure, the cancer.

We are confident that the surgery will be successful in removing the tumors from Lauri's lungs. We must accomplish at least this in order to get to our final goal of becoming cancer free. We are blessed to have great doctors, family, and friends that fight along side us and keep us going.

It has been a hard path so far, having to stand by and watch as Lauri has lost hair, weight, and sometimes her lunch... But one thing she has never lost is her heart. It has been an inspiration to watch her continue to push forward even in the midst of great difficulty and pain. I pray that this surgery finally brings some release and reprieve from the cancer. But I am thankful that I am blessed to walk through life with such a great friend and wife.