No stent for now

We met with Dr. N. today and discussed the possibility of a stent. We brought up what we had learned through our research. Dr. N. agreed that the concerns raised were valid. He further stated that a stent would not necessarily make E. more comfortable when it comes to eating and that a stent may not add all that much. He suggested that the timing of stent depends on how E. is doing clinically. Certainly if E. were unable to swallow food at all or if he had difficulty simply swallowing oral secretions (saliva), a stent would be warranted.

As E. describes it, he is able to swallow food pretty good most of the time. He tends to feel full very easily, even after small quantities of food. The biggest problem for him currently is that after he eats, he has very uncomfortable upper stomach pain. The pain shows in his facial expressions and is significant enough that he cannot sleep. Dr. N. explained that the pain might still be associated with food stuck in the esophagus due to the tumor, even though E. feels the pain in his stomach rather than his esophagus. Dr. N. was willing to prescribe sleeping medication and/or pain medication, but can anyone guess what E.’s response was? This is the man that wouldn’t even take Tylenol after a root canal. He simply doesn’t like putting “unnecessary” (according to him) medication in his body. So needless to say, he turned down all medication offers.

Because E. is still able to get food down, Dr. N. suggested this course of action:
· increase E.’s caloric intake (because of E.’s diabetes, we’re going to have to be especially creative…if we’re unsuccessful, they may just have to manage E.’s blood sugars through different medications to get the calories into him)
· “graze and sip” all day long, rather than trying to eat 3 big meals
· try to drink 2 Glucernas (diabetic caloric drink) each day
· increase non-caffinated fluid as much as possible
· track weight closely (as a side note, E. has lost 5 lbs. in the 10 days)

Dilation is another option to widen E.’s esophagus, although Dr. N. doesn’t recommend doing that regularly as it can be risky and possibly perforate (put a hole in) the esophagus, creating even more problems. A feeding tube would be considered only if a stent were no longer an option, as they like to keep things as “normal” as possible.

E.’s blood pressure was noticeably low today….quite possibly due to the fact that he has resumed his Diabetes medication and not gotten in enough liquids, and is thereby dehydrated. E., of course, thinks that it might also be related to the fact that he hasn’t worked out lately. He is anxious to work out again and received the okay from the doctor, although the doctor told him to take it easy and listen to his body as he would fatigue easily.

We also discussed the pending appointments with Dr. L. (radiation oncologist) and Dr. B. (chemotherapy oncologist) scheduled for Monday. In speaking with other people, we were not able to gather much information about these two doctors (either positive or negative), but had heard great things about Drs. S. and S. Dr. N. was very receptive to referring us to Drs. S. and S., but after a few phone calls, we discovered that the earliest we would be able to see either doctor was more than two weeks away. Therefore, we will continue with the current plan of seeing Dr. L. and Dr. B. on Monday. We are still hoping to been seen at UCDavis as well.