Monday, December 1, 2014

Getting Back to Active: Bob's Story

Bob (left) with Dr. Christopher Morse (right) at a recent follow-up appointment at Mass General
Bob (left) with Dr. Christopher Morse (right) at a recent follow-up appointment at Mass General

64-year-old Marstons Mills resident Bob Hazelton has always lived an active lifestyle. He is an avid cyclist, scuba diver and sailor, and his job as a marine surveyor keeps him on the go, traveling around world.

But for years, Bob suffered from chronic acid reflux and heartburn.

“I’d never heard of reflux before, but when I mentioned to my primary care physician that I sometimes woke up at night with stomach acid in my mouth, she told me that it was reflux,” he says. In 2005, Bob was diagnosed with Barrett’s esophagus, a condition that affects the lining of the esophagus. This put him at a higher risk for developing esophageal cancer, and he underwent routine upper endoscopies to monitor his condition.

In August 2011, Bob’s gastroenterologist noticed an abnormality during an endoscopy. A biopsy later confirmed that Bob had early stage esophageal cancer. He sought an appointment with William Brugge, MD, a gastroenterologist at Massachusetts General Hospital, who was highly recommended by a close friend. Dr. Brugge performed an endoscopic ultrasound and subsequent tests to understand what stage of cancer Bob had and to determine the next phase of his care.

Bob was confirmed as an ideal candidate for a minimally invasive esophagectomy (MIE) and was referred to Christopher Morse, MD, a thoracic surgeon at Mass General. Both Drs. Brugge and Morse are part of the multidisciplinary care team of the Center for Thoracic Cancers within the Mass General Cancer Center.

During an esophagectomy, the diseased portion of the esophagus (and sometimes the top portion of the stomach) is removed and the stomach is connected to the remaining, healthy portion of the esophagus, creating a new esophagus. Dr. Morse says that most patients who need an esophagectomy are candidates for the minimally invasive, or laparoscopic, procedure.

“MIE is performed with small incisions rather than separating the ribs or making a large incision, as in the standard open esophagectomy,” says Dr. Morse. “Using a camera in the patient’s abdomen and chest, the procedure is completed using video images and instruments passed through other small incisions known as ports. Compared to the standard open esophagectomy, patients undergoing MIE often have fewer respiratory complications and a shorter length of stay at the hospital, leading to a faster recovery.”

Compassionate Care from a Collaborative Team

Prior to meeting with Dr. Morse, Bob was a bit anxious and full of questions. “Dr. Morse explained to my wife and me the status of my disease and the need for surgery. He even made a diagram of what he was going to do and explained the MIE surgery and recovery period in detail,” says Bob. “We both felt much better about the procedure after our first appointment.”

The day of his procedure, Bob had a chance to meet with Dr. Morse and other members of the care team, including an anesthesiologist, to ask any remaining questions. The MIE procedure took approximately five hours. In addition to creating a new esophagus, Bob’s surgical team removed the cancerous tissue and adjacent lymph nodes.

“Bob’s operation was incredibly straightforward, as was his postoperative recovery. Fortunately, his disease was an early stage, and he was able to avoid chemotherapy or radiation. From my perspective, it was a total success,” says Dr. Morse.

After his procedure, Bob spent almost a week at Mass General–two days in the intensive care unit and four days on the thoracic surgery unit. “I would describe my entire care team as compassionate and caring,” says Bob. “The nurses on the thoracic surgery unit not only took excellent medical care of me, but they took to time to chat when I was up to it. They explained everything they were doing and why. I can’t say enough how important they were to me in those first difficult days.”

Pedaling Forward through Recovery and Beyond

Bob at the 2012 Pan-Mass Challenge, less than one year after his MIE procedure
Bob at the 2012 Pan-Mass Challenge, less than one year after his MIE procedure.

Bob’s care team created a personalized recovery plan for him to follow at home. A thin feeding tube called a J-tube was inserted into Bob’s intestines for the first two weeks, giving him all of the necessary fluids and nutrition he needed while he healed. Bob’s recovery plan included daily activity that increased progressively for the first couple of months, allowing him to regain his strength and endurance.

Despite side effects from the surgery including weight loss, some recurrent aches and pains, and a modified diet, three years post-surgery, Bob has been able to resume his active lifestyle. He has participated in several Pan-Mass Challenges, starting in 2010 and most recently in 2013. The Pan-Mass Challenge is an annual 192-mile, two-day bicycling fundraiser that raises money for the Dana-Farber Cancer Institute through the Jimmy Fund.

Bob plans to start training for the 2015 Pan-Mass Challenge. He is also active in several online esophageal cancer support groups, and recommends Mass General and Dr. Morse when given the opportunity. “The MIE procedure has not slowed me down, that’s for sure,” says Bob. “I’m more motivated now than when I started, and I ride for those who can’t.”

For more information about the MIE procedure, visit massgeneral.org/MIE

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