How to treat a fighter

Our buddy Dr. Hausner stopped by yesterday with some very interesting news. I love talking with him, not only because he's helpful and informative but because he sounds like an Indiana Jones villain. I keep expecting him to have a medallion image burned into his hand. There was a lot of information he conveyed in a very short time, but the gist of it is Rich is even more unique. Based on Rich's tumor markers (blood work), the CT scan, and his overall lack of symptoms, everyone expected to open him up and find a lot of gelatinous green slime. This explains the tone to Dr. Hanna's voice when he called me Monday morning from the operating room. He was not distressed but did sound genuinely flummoxed.

The pictures he gave me show a large "pancake" covering his upper abdominal organs and it looks very much like tumors. Alarmingly large tumors. Dr. Hanna decided just to back away slowly from all that and take a very large sample of the tissue to study.

Dr. Hausner was then giddy (he was grinning) over the large amount of tissue he had to play with and run tests. When we talked with him yesterday, he said that the pathology doesn't suggest that it's tumor at all but is the slime they couldn't find. It appears that Rich's slime is disguised as tumors.

The tumors present problems because they tend to attach themselves to the organs, just like an ivy plant. To remove the tumor, you generally have to remove the part of the organ it's touching. When it's encasing Rich's stomach, half his small intestines and colon, that leads to a lot of quality of life issues. But if this truly is slime and not a tumor, it would be safe to scrape it off and not lose those organs. The treatment options get a lot more flexible then.

Dr. Hausner was very adamant that Dr. Hanna did "exactly the right thing by closing everything up and waiting." Had he tried to remove Rich's stomach etc. he could have been needlessly removing organs that are still salvageable.

Hausner also said that based on the pathology, Rich's tumor (in this case meaning any abnormal growth, whether slime or actual tumor) is very "well-behaved". He used that term several times and it cracked me up. He even said that Rich's numbers are so low that some people would not even consider this to be cancerous growth. I always assumed that cancer was a yes/no black or white thing, but it apparently is more of a greyscale.

There is the potential we could use monocolonal antibody treatment to attack the slime on a molecular level (which sounds awesome in Hausner's Czechoslovakian accent). That would have the power to shrink the mucin in his abdomen without the side effects that chemotherapy entails.

Your appendix produces mucin naturally, doing its job to lubricate the colon and help digestion. Theoretically, Rich's appendix sprung a leak many years ago, perhaps due to a benign cyst. Because there was no abscess or infection, it's not like appendicitis pain but more like "bad burrito" pain when that happens. The duct was blocked so it popped a leak and continued producing mucin. Therefore, for years he has been leaking mucin into his abdominal cavity.

The mucin in most people would look like the green slime we were all expecting. But they suspect that since Rich is so much more active than your average 40-something desk jockey, his slime has been walled off by the connective tissue in his abdomen and giving it the appearance of tumors. They specifically noted his "martial arts" as a factor, with its high activity level and being hit in the torso repeatedly with sticks.

The medical team is meeting on Tuesday to talk about what to do next, but things are looking very positive. They may try the antibody treatment and then might try another giant slime-ectomy surgery again down the line to clean it all out for good, now that they have better intel on what is in him.

I sent an email to Hausner and Hanna last night thanking them for all their detailed information. I also sent them a few photos of Rich's "martial activities" to help better explain that. I told them he's fought in the SCA for over 15 years, wearing minimal body armor and being hit with rattan at full force. He also is a hockey goalie that uses a lot of abdominal muscles and is non-plussed by the occasional pain, bruise or tender spot. It will hopefully give them more background on the uniqueness of Rich or at least entertain them.

I don't typically like the term of being a fighter, as I am much more the lover, the negotiator and the communicator type of person, but in this case I think for Rich it fits perfectly.