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Tuesday, October 5, 2010

Where has all the time gone? The acid reflux redux

It's truly hard to believe, to imagine, to have lived -- but three years ago this week I began an awkward two-steps-forward-one-back stumble to where I am today: healthy and wise, though still not wealthy. You know what they say about two out of three...

But seriously, A little more than three years ago I was confronted with the real possibility I wouldn't be here today. The dreaded "C word" crept into my life and quickly changed me from who I was to who I am.

Before, I overate with what I thought was impunity -- boy, was I wrong. Before, food couldn't be spicy enough. Before, I let stresses really get the better of me. Now, I monitor my intake and try to moderate it. Now, I still love and desire spicy foods, but limit the volume and veracity of my mouth-melting munchies. Now, I've walked through Hell so there's really not much that can get the best of me.

So it was three years ago, give or take, that I was diagnosed with stage T3, N0, M0 adenocarcinoma of my lower esophagus.

From the diagnosis, my entry into the world of high-tech, high-def medicine was rapid.

As I documented in this blog three years ago:
  • Dr. Philip Styne, the best gastro doc in Orlando, spotted the tumor at the base of my esophagus -- near the gastro-esophageal junction -- and sent me to the best person he could have: Dr. Lee Zehngebot.
  • Dr. Z walked me through what my next several months would be like. He told me about the chemo, radiation and surgery awaiting me.
  • Dr. David Diamond was next on my welcome to the world of cancer. He's a wonderful radio-oncologist and developed my radiation therapy. Together, Drs. Z and D had participated in a national trial of a new therapy to cure esophageal cancer developed through the Minnie Pearl Cancer Research Network based in Nashville, Tenn. So in Orlando I had the two perfect doctors to cure me.
  • They, plus surgeon Joseph Boyer, had handled dozens of similar cases and the project they'd worked on had increased the survivability percentage rate from the low-teens to the mid-thirties.
Yes, that's what I looked like after my
surgery in December 2007.
And it worked. With a few complications and setbacks, today I'm free of cancer. In the past few weeks I've seen Dr. Z, who gave me a clean bill of health but wants to keep an eye on me every four months or so. Dr. Styne did a recent check-up on me and said all looks good. He's shifting his focus and will work with Florida Hospital as it digitizes all of its records, so he's handed me off to one of his partners. And Dr. Boyer said all looks good after the original surgery and then three others -- all this year -- that were nominally related.

In the past three years, I've come to know some amazing people. Some were in the medical fields and others were the recipients of their treatments. I've also learned about several friends and relatives with some form of esophageal distress, including an aunt who developed the precursor to cancer called Barrett's Esophagus and a friend and professional acquaintance who just recently went through the wonders I experienced. Both of these are doing wonderfully, though a few other people I know or I know of didn't fare as well. In essence, this form of cancer is more common than one would think.

Esophageal cancer is out there and it is not going away. Americans, especially, are likely to see an increased incidence in the disease due to our wonderful "super-sized" eating habits. Greasy, fattening foods are supplying us with more than just the need for extra-extra-large pants. They are key ingredients in the development, over time, of Barrett's and the resulting cancer. Combine that with some salsa, pepper sauce and hot wings and here I am.

Call it the acid reflux reflex. Acid splish-splashes away in your stomach so much, fueled by those Buffalo wings. Some of those splashes seep up from the gastro-esophageal junction into the lower esophagus. You get heartburn and take a Tums. Feels better, more wings. After awhile, your esophagus responds. It tries to protect itself and physically alters -- stomach-like cells develop in the lower esophagus' lining to ward off those splashes. Barrett's esophagus is born. Since it is a mutation of cellular structure, it's not a far leap from Barrett's to cancer.

There are signs to notice. And precautions to take. If you've had heartburn and acid reflux for a while, see a doctor. Simple medications can and will help. If you haven't seen a doctor and the heartburn goes away -- get to a grastro doc quickly. That's a sign that you may have Barrett's and need immediate care.

According to the latest figures from the National Cancer Institute, nearly 10 Americans out of 100,000 developed cancer of the esophagus between 2003 and 2007. Of those, about eight were men. If you were under 20 you didn't develop this form of cancer, but folks of my age at the time accounted for more than 12 percent of the cases. During that period, 11 percent of the patients in my age group  died -- I was in the lucky 1 percent who survived.

Sadly, most people died of the disease during that period -- which was just as the treatment that saved me was coming online. So I'm sure later numbers will be better.

There are some good statistics, as well. While cancer of the esophagus was growing among Americans between 2001 and 2007 at 0.6 percent a year, it declined by 0.4 percent a year among women. And deaths from this type of cancer were down among men and women overall -- down 0.4 percent a year -- though that's mostly because of the decline in deaths among women of 1.6 percent a year. Deaths among men during that period were up 1.2 percent a year. Detection at an early stage is directly related to your chance of survival.

One sad note is that while the incidence of esophageal cancer is growing, funding is barely moving up. Federal funding for research into cures for this dangerous cancer has increased only $700,000 a year between 2004 and 2008, from $21.7 million to $22.4 million. That's just a sliver of a fraction of the total National Cancer Institute's $4.9 billion budget in 2008.

Here's a final note, and a warning, from the Institute three years after my diagnosis: "Based on rates from 2005-2007, 0.50 percent of men and women born today will be diagnosed with cancer of the esophagus at some time during their lifetime. This number can also be expressed as 1 in 200 men and women will be diagnosed with cancer of the esophagus during their lifetime."

Please don't be one of them.

Read through this blog and heed the warnings from myself and others. Have check-ups if you experience some of the things I experienced three years ago. And if you do have this cancer or know someone who does, feel free to contact me via a comment on the blog. If there's anything I can do to help, I will.