Enrique Right Now

Enrique's doing pretty well right now. He is healing quickly and his pain has dropped considerably. His neck is stiff and sometimes he feels blue, but mostly he's doing ok.

He felt his neck yesterday and told me, "It's nice not to feel that lump here anymore."

I bet.

Enrique's parents flew back to Mexico City today. He just spoke with them on the phone, they made it home safe. We just finished the last of the Mexican food Enrique's mother cooked for us. Pork with fresh corn and zuchini.

The Next Phase of Treatment

Enrique's next phase of treatment is radio-iodine. We're just beginning to learn about it.

He'll ingest radioactive iodine to kill off any remaining thyroid cells in his body. That means for a couple of days he'll be too radioactive to leave the house or sit next to me for an extended period.

We'll need to wash our clothes in separate loads and he won't be able to touch certain things (like keyboards) while he's radioactive because they'll retain the radiation.

We'll learn more about it later this week.

Thanks and Apologies

We've received a lot of calls, emails and cards from people over the past two months and they have really meant a lot to us.

If you're one of those people, I say "Thank You" and "I'm Sorry."

"Thank you," because sometimes a voicemail or a card has turned a bad day into a good one.

And "Sorry," because we haven't been able to respond to most of them. I owe calls and emails to everyone from my parents to a few blog-readers I've never met.

We're isolated from most of our favorite people right now - so the calls and the notes really do make a difference. Thanks.

Is That Thing Real?

No one has actually asked the question. But today is Halloween, so Enrique's bandaged neck is getting lots of stares.

At first glance, everyone thinks it's a costume. Then they look again and realize it's real.

He has a good sense of humor about it.

The second surgery doubled the length of the scar from the first surgery. It's not as long as we had been warned it could have been.

Like I said about the first scar, it's not going to detract from his good looks.

The swelling was a different story - but happily that's already gone!

Surgery Sale - 90% Off

We've been trying to figure out the statements that the hospital and Enrique's insurance company are sending.

As best we can figure out, the hospital sent the insurance company a bill for $50,000 for some portion of Enrique's treatment. The insurance company agreed to pay only $5,000.

It looks like they made the payment directly to his surgeon - rather than the hospital or the university. I can't really figure that out.

Enrique's share? He has to send the hospital $115.

It's a pleasure.

Home

We're home and it feels great.

Enrique is walking, talking and eating.

Before he left the hospital, his surgeon told him that the surgical portion of his treatment is over. That's a huge relief.

He's still got the radio-iodine treatment in 2-4 weeks and there is always the possibility of something unforseen.

But, it seems like it's going to be mostly downhill from here.

Our first visit to the hospital lasted ten days. It still hard to believe that we're home just 24 hours after we left.

Enrique is up and eating and doing well. He is scheduled come home after 2pm today. He's had some dizziness, but its been mild.

Enrique is in his hospital room, alert, happy, joking. Totally different from last time. No problems with calcium or nausea. We are elated.

Success - Enrique is Fine

Enrique's surgery was a success.

The surgeon was able to remove all the offending lymph nodes without cutting into his chest or breaking his clavicle. She said she didn't need to enlarge the scar significantly, which is great. Finally, it doesn't appear that there was any nerve damage.

Enrique is fine.

We are relieved and very happy. Enrique's mother, father and uncle along with my parents and I all exchanged hugs in the surgery waiting room. I felt bad for the other families waiting - but we could not contain our happiness.

After the first surgery, Enrique's parents gave his surgeon a small gift, but she refused to open it. "I'm not done yet. Wait till until we're all done." I reminded her that she could open it now. She said it was waiting on her desk.

We're all very grateful.

In an hour or so he'll be wheeled from the recovery room to his hospital room. We'll see him for the first time and I'll spend the night with him.

He should be able to go home in a day or two. In the meantime, they'll monitor his calcium levels and watch for internal bleeding. Neither is likely or dangerous.

I feel tremendous relief. None of us can stop hugging the others.

Enrique's father came over to me with a smile on his face I've never seen before. I keep forgetting I've only known him for seven weeks, always with the threat of cancer hanging over his son.

the surgery is over. It went well. The surgeon came down, all smiles. She removed all the lymph nodes without complication. We are happy.

We're 3.25 hours into the operation. No news. I am eating cookies and reading celebrity magazines. The hospital is getting quiet.

they wheeled him in early, but started 45 min late. At least they'd given him the happy drugs. He's 75 minutes into the operation. No word yet.

we all kissed him goodbye and they just wheeled him into the OR. On-time. The surgery is supposed to last about 3.5 hours.

The procedure enrique is having today is a "right radical neck dissection." So far his anestesiologists and nurse are all quite nice.

last night, enrique's parents told me, with great pride, of his past as the metroplitan tai kwan do champion of mexico city, age 12.

@ the hospital, waiting in pre-op. The whole place is crowded. Keep having to let full elevators go by, etc. I am blogging by text message.

Today is the Day

We're leaving for the hospital in about an hour.

Enrique is in a remarkably good mood for someone who is about to be operated on and who hasn't eaten all morning.

We both slept well - unlike the last two times we had to go to the hospital.

I am just now beginning to get anxious.

Yesterday Enrique's parents cooked up a storm of mexican food.

It's all waiting in our refrigerator. Hopefully we'll be home from the hospital tomorrow, ready to eat it.

That said, we're trying not to have too many expectations. Both of the last two trips to the hospital were full of surprises.

I'm hoping the surprise this time is the lack of surprises. We'll see.

Wish him luck.

Preparing for the Second Try at the Second Surgery

We went to the UCSF prepare clinic today for a 7:30 a.m. appointment to get ready for the surgery on Tuesday.

Over the course of 2 and half hours we met with four people. Most of it was routine stuff -- checking his vitals, getting his contact information, telling us where to go -- that we've done a couple times already.

The most important part of the clinic is meeting with an anestesiologist to go over the medications

He greeted us by saying "Mr. Sanzchez, I have some bad news for you."

We braced for the worst.

The bad news?

All his prescription information had been deleted from the computer and needed to be re-entered.

What a jerk!

Later, there was some confusion about which blood tests Enrique needed and we paged Enrique's surgeon for a clarification. She came by from her office across the street. It was good to see her.

She told us that it's likely he'll only need to stay in the hospital for one night. That was a surprise and a relief. I hope that's how it turns out.

We'll need to arrive at the hospital at 1pm on Tuesday. The surgery is scheduled for 3pm. The later time is too bad, because it means Enrique won't be able to eat for most of the day.

The Pregnant Teenager

Enrique's new hormones have been kicking in, so he's dealing with a lot of mood swings.

Sometimes he feels blue, other times he has food cravings and frequently he just feels strange. I've been joking with him that he's like a pregnant teenager.

The mood swing are to be expected and should subside with time and adjustments to his medication.

He's always apologizing for being in a bad mood - but Enrique in a bad mood is like most people on a good day.

On the bright side, we've both come out of the crisis mode that we'd been in for the past 6 weeks. For the first time since this all began, we've been able to see a couple of friends and live a relatively normal life.

Still, he's dreading going back to the hospital. I am, too. But we know what's coming, and we know to expect some surprises. I'm hoping we'll be able to avoid crisis mode completely.

The surgery is set for the 24th. Enrique's parents arrive two days before then and have promised to cook up a storm of Mexican food when they arrive.

A Third Date

We met with Enrique's surgeon on Friday and talked about his aborted visit to the hospital last weekend. We also talked about rescheduling his surgery.

She was very apologetic and Enrique really appreciated that. I liked that she didn't apologize for her decision to postpone the surgery (which was appropriate), just "the circumstances under which the decision was made."

It was good to leave her office and not feel any resentment towards her.

For now she has penciled in Tuesday, October 24th for the next surgery. Enrique's parents are planning on coming back to SF for the procedure. That means he may be out of work as late as early December.

We're both pretty exhausted. Enrique was sick with a cold for most of the past week, but now he's mostly recovered.

We've been watching a lot of television and going for walks when we feel up to it.

Some Answers

Enrique spoke with his surgeon today and got some reassuring answers (and an apology).

She couldn't operate yesterday because Enrique's level of TSH were too high for him to safely receive anesthetic.

TSH is a hormone that the brain secretes to stimulate the thyroid to release its own hormone.

Since Enrique no longer has a thyroid, his brain is releasing tons of TSH, trying to get his missing thyroid to work.

That shouldn't be happening. The thyroid hormone replacement pills (Synthroid) that Enrique takes should be tricking his brain into thinking that he still has a functioning thyroid.

The surgeon saw Enrique's high levels of TSH the day before the scheduled operation, but they were so high, she thought they were a mistake.

She decided to bring him in for the operation anyway and do another blood test just to confirm "the mistake."

We now know that the first test wasn't a mistake and that they surgery had to be postponed.

In retrospect, she (and we) wish she had let us know about the possibility of having to postpone surgery from the beginning. She apologized, which we really appreciated.

She is guessing that his body isn't absorbing the Synthroid because it is binding with his calcium supplements.

Now he's taking the two pills separately. Because these are slow-moving processes, we won't know if that will bring his TSH levels back to normal for a couple of weeks.

All this means that Enrique's surgery needs to be postponed another two or three weeks. Sigh.

Finally, the famous surgeon wasn't brought in due to any special complication with Enrique's case. He was just available.

Lots of Questions

We're still trying to figure out exactly what happened on Friday - and why we even had to go to the hospital at all, if Enrique's hormone levels were too high for them to operate.

One part of the mess we do understand: Enrique was taken into the operating room prematurely because the resident failed to wait for the results of a blood test.

Once he was in the OR, the anestesiologist put him on oxygen and was just about to put him under when his surgeon found him and said, "What are you doing in here?"

Not exactly the words you want to hear from your surgeon when you're on the operating table!

Then they sent him to the recovery room to wait. Around 3pm we learned that his hormone levels were too high to operate and he was released, hungry (he hadn't been able to eat since the night before).

In the waiting room, the surgeon told us that the operation would be postponed for at least a week. I asked her when they would do a blood test to make sure his hormone levels we low enough to operate.

Confusingly, she told me there probably wouldn't be a need for another blood test. I don't understand that at all. I was too tired to follow-up at the time.

Separately, we find ourselves wondering why the famous surgeon was going to be a part of the surgery. Is this an indication that Enrique's case is more complex than we thought? Or something else?

We're going to speak with the surgeon on Monday and try to get some answers.