Yesterday, April 2,we kept a full day's worth of appointments at the Clinic.
As it looks now, Paul will probably undergo lung surgery within the next two or three weeks at the Clinic's hospital.
Yesterday's tests included a molecular imaging procedure in the nuclear medicine department at the Main Hospital followed by a CAT scan of his brain in the radiology department . The afternoon was taken up first with three pulmonary function tests in the Crile building including a walking function that showed a need for oxygen, which the technician who walked with him supplied.
In the latter part of the afternoon we visited first Dr. Sudish C. Murthy, thoracic surgeon, and later Dr. Gildea, pulmonary disease specialist--he has been seeing Paul since 2004. Both have extensive biographies online at the Clinic website and are regarded as tops in their fields. They were liberal with their time, friendly, compassionate, and welcomed our questions and concerns. They were the exact opposite of the stereotypical arrogant specialist one finds in literature, movies and sometimes in real life!
Both had reviewed Paul's case file and earlier scan results (done in Medina), as well as the results from the morning's tests. Murthy's first concern was finding the exact spot on the left where Paul's cancerous growth is located. (The Medina scans weren't that good, and he has ordered another scan taken at the clinic next Tuesday). The options for Paul appear either surgery or radiation, or both.
As Murthy put it, in surgery we can't give up much lung tissue for an operation, and if the growth is in the middle of the lung it will present a difficulty because not only must the growth itself be removed, there must be enough lung tissue surrounding it to ensure that the cancer is removed properly. The result could be that the whole lung might have to be removed. If the growth is near the edge of the lung, it can be removed together with surrounding tissue, but even this would take some of the lung away. Any amount of lung tissue removed is serious for a patient suffering from interstitial lung disease
Radiation can burn away the growth, but collateral damage to the lung is a possibility.
Murthy wants Paul to have another CAT done at the clinic next Tuesday--to zoom in on the growth's position--and also a heart stress test on a treadmill to gauge the ability of the heart to handle the surgery. He pointed out that whichever therapy is chosen, we mustn't do the wrong things for the right reasons. We must expect Paul to have a reasonable chance to get through the therapy and have an expectation for an effective recovery with half a lung if that's what the picture turns out to be.
Our final visit for the day to Dr. Gildea yielded a difference in opinion. He is absolutely against radiation. for Paul's diseased lung. As he put it, "it could set off a firestorm in Paul's diseased lung." But he will conference with Murthy and they will bring other specialists into the debate and will come up with their best possible option.
For surgery, Paul will be in the hospital for about a week and recuperation time will take about eight weeks.
The Clinic resembles a small city. It has its own Intercontinental Hotel (God knows how much it costs to stay there--affordable anyway or the Saudi princes who come over for their regular checkups). We took used their own bus service--the greenline, blueline and whiteline run regularly between buildings. There are also indoor skywalks between buildings and for our last appointment I pushed Paul in a wheelchair from one building to another. Parking spaces for handicapped tags are close to the building and cost just $5 for the whole day. A Bon Pan cafe in the Crile building (where the pulmonary department is located) offers delicious food all day long.
Our next step is to keep the appointments for next Tuesday (April 10) for cat scan and heart stress tests. After they've been reviewed, the doctors should be able to come up with their next step.
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