Day before surgery - thoughts (panic?)

Thursday, 18 November 2010 (t minus 1):

No solid food from breakfast on - only clear liquids. I had a couple bites of banana at 3AM when I couldn't sleep - that's before breakfast, right? It will all come out when I start drinking that stuff.

2:00 PM beginning drinking Golytely. UGHH I hate that stuff. Drink 8 oz. every 10 minutes until gone (2 - 2.5 hours).

7 PM take Metronidazole and Neomycin dose
8 PM take another dose of the above.
11 PM take final dose of above antibiotics. This is meant to kill off as much of the intestinal flora as possible to minimize infection when part of the bowel is removed.

DOUBTS?
Yesterday I got an email from my surgeon:

• Just wanted to let you know that Friday an ostomy nurse will be stopping by in the pre-op area to mark your skin. We are still planning on the neobladder, but I think we talked about this, under rare circumstances, the bowel won't reach down to the urethra and the neobladder surgery won't work. In that case, we default to the ostomy surgery and will use the pre-marked ostomy site provided by the nurse.

Now I am concerned. Much of my thought over the past few months has been weighing the risks of cancer coming back versus the quality of life after the treatment/surgery. I have rationalized the neo-bladder in this equation but have not rationalized the bag.

I remember discussion of the possibility that the cancer has moved down into the urethra to the extent that we cannot use it to drain the neo-bladder or that more has to be removed in order to keep it from being a potential source of cancer back into the neo-bladder.

My question this morning is about timing. My understanding is that the decision to remove urethra will be based on some real-time lab analysis of the tissue during the surgery. Is this done before the bladder is removed? If the neo-bladder won't work can we leave things alone and go back to chemo/radiation?

I understand that if cancer cells are found in urethra it means it has metastasized and all bets are off anyway. T think I've answered my own question but I'd like to hear it from the surgeon so I sent him all this in a reply to his email.

I will, of course, deal with whatever I am given after the surgery. I have to trust the surgeon's discretion to make the right choices once he is in there and he can see what the situation really is. As much as medicine has advanced -- to be able to do things like neo-bladders -- the standard of treatment for cancer is still to remove as much of it as possible and deal with whatever we have remaining.


Earlier Doubts:
Earlier in the week Debi and I were stressing about why we needed to go through with this surgery at all when we have survived chemo and all tests (CT Scan, blood tests, urology) are negative. Why not wait and see if it comes back? We know that these tests are only for active tumors and don't see activity of individual cells. Once the cancer has made it into the muscle tissue the cells are 'available' to the blood circulation system and if they move into the blood they can move anywhere in the body (metastasize).
But, given this, why not even go back in the bladder (with the cytoscope) and see if their is any visible sign of the original tumor. Why not biopsy some of the muscle tissue to see if cells are still there.

The question, of course, is: What if both these tests are negative too?
The answer is: Nothing changes. The tests may not be sensitive enough and the risk of leaving the bladder is too great for the return or spread of the cancer. The Standard of Treatment has not changed and the Neo Adjuvant chemo and all the subsequent tests are simply a part of this overall treatment strategy.

So, I'm having my morning coffee (and grateful to be allowed that) and I will not eat all day. I will psych myself for drinking that awful stuff and a long night of uneasiness (terror?). I have a couple books to read ( "Aragon" and "Street Lawyer" - John Grisham) and I can work on updating my web sites (this keeps my mind busy). And there are always more things to do around the house (put on storm windows, bring in more wood, etc.)