Not for the faint of heart . . .

I received a phone call from the cardiac surgeon at SF1 this evening. In addition to being an “outstanding” doctor (in the words of my doctor at NY1), he seems to be a very nice man.

He reviewed my imaging studies today. His first question, of course, was the same as that from all professionals that view these studies: “How are you feeling?” I could tell that he was surprised that I am still pretty much fully functional. And that I have no trouble lying flat when I sleep. And that I’m not on a diuretic or any other medicine.

He said that the cardiac tumor is in the left ventricle, just underneath the mitral valve at its papillary muscle and chords. It is mobile and probably invades the heart muscle.

I led off with a hypothetical question: “If the other metastases were not present, what would be the recommended treatment?” He replied that the tumor could be “debulked” (approximately 95% removal) to buy time and make me feel better, but that that would involve a mitral valve replacement procedure. And open heart surgery with a heart/lung machine. And a 4-6 week recovery of “increasing strength and energy”. It is his opinion that the tumor cannot be completely removed. I had already presumed as much.

I then asked that, given the metastatic spread, would it be worth it for me to have the surgery? “I have serious doubts” was his reply. He indicated that the hydronephrosis of the left kidney means that it is “not going to work much longer” and added that the pulmonary nodules are “worrisome”.

I said that I had already come to the conclusion that a systemic approach would be the first line of defense. He agreed and said that depending on the results the option of surgery could be revisited for palliative purposes (i.e., to make me feel better). But because I’m really not having much trouble related to the congestive heart failure, surgery doesn’t make a lot of sense at this juncture. (Really glad I skipped the urgent recommendation for emergency open heart surgery eight weeks ago.)

I asked how close the tumor is to the conductive pathway of the heart. He replied that it is not near that area so the risk of heart block or arrhythmia is not a concern. So apparently I’m not gonna suddenly drop dead from that – great news!

In closing, he suggested I take something with an anticoagulant effect such as aspirin, and recommended a “baby” aspirin (81 mg) once per day. How cool! Most people with metastatic cancer have to do gnarly chemotherapy – I get to take baby aspirin! Hopefully a cherry flavored version is available . . .

Anyway, a very productive discussion and I didn’t even have to drive to San Francisco! And it cost nothing! Who says there still aren’t great bargains to be found in the medical industry if you’re willing to shop around?

As I move closer to the fringes of the health care business (alternative therapies, clinical studies, and outlaw doctors) the mainstream medical establishment becomes increasingly smaller in my rearview mirror. Can’t say that I particularly miss it.

My long term goal? To kick this thing’s butt of course. Short term? To be the healthiest sick guy you ever met.