Esophagectomy on a small person

My mum (67 y.o.) is going to undergo an esophagectomy in the next few weeks, having been recently diagnosed with high-grade dysplasia. She only weighs 45 kg (that's less than 100lb) and I worry about how she will recover from such a massive operation. I've read a lot of posts here about how hard it can be to put weight on after this op. How do people who already weigh very little get their strength back?

Our oncologist recommended high protein diet during chemo and pre surgically to try to build the right kind of tissue and get the weight up, and he had a feeding tube because he was already so depleted and very sick during treatment. He was able to swallow again at that point, so I got about 4000 calories a day going in, with as much protein as I could get into him (I actually bargained with oncologist to stop using g tube if I could keep pushing his weight up) . They usually come home from surgery with a j tube to continue feeding until they can maintain weight on their own. She never cared about fat content so I would do things like make shakes with premium ice cream (like Hagen Dasz or Ben and Jerry) with more calories and fat, milk (sometimes even used whole milk for him), syrup for flavor, and added Instant Breakfast to boost calories and protein more. It made for an 800-900 calorie shake every night. I would get a weekly reminder about how much better the surgical outcomes were for people who started out with reasonable weights.

No one mentions fluid much here. Just a reminder to all...hydration can make a huge difference in how much nausea and vomiting one experiences. Understanding hydration has been one of the most valuable things I have learned as we have made this journey these past few years. If you can stay hydrated, you will have an easier time with your weight.

 The second most valuable tidbit would be to eat an apple before bed to keep reflux down in the night. We go for peeled, but maybe unpeeled is okay too.

 Good luck with it all!

Thanks, that sounds like great advice. No-one involved with her case has expressed concerns about mum's weight and I find that really weird. She isn't going to have chemo so she doesn't have an oncologist and it sounds like a shame because they seem to follow your overall wellbeing more than a surgeon does.

It's a hard situation because she has no symptoms and it is so difficult to accept that she has to have this massive operation to get something so small out, which possibly isn't even cancer yet. I might post a separate question about that.

I really worry about such a slight person getting through the surgery. On the other hand we are lucky because if the op goes well her chances of recurrence will be small (so we are told).

I hope everything is going well with your husband. It sounds like he has a fantastic carer in you.

okay I am going to go out on a limb here. you might seriously consider a second opinion before your Mum undergoes such a radical surgery. I am trying to understand why she is having her esophagus removed when she doesn't have a staged cancer, is this correct?

there are three centers that have started doing Cryo-ablation to treat barretts esophagus,, the precursor to actual EC. Two are in TExas, and one is in Binghamton NY. This surgery a fancy endoscopy freezes tissue and has a great outcome. Please, before you take this huge step, get a second option.  

My husband is recoverying after stage 2 cancer, chemo, radiation and surgery (46 days in the hosptial- many complicatons, but finally home now. he has lost about 30lbs all told. Good luck.

Thanks for the info, TrueBrit. They are basically treating her as stage 1. I've read about cryo-ablation, barrx, photo-dynamic therapy etc. We have been for a second opinion and the second doctor agreed that the best course of action is surgery.   I think in the States there may be more options than where we live (Melbourne, Australia).

I hope your husband is getting better all the time. Sounds like the surgery was pretty rough. 

hi silvie,

i am now, 11 months post surgery and currently weight about 98lbs.  i was never overweight and had lost a lot of weight due to the desease.  i also went through advance chemo and radiation prior to surgery and that also took it's toll.  i am not sure of my weight when treatments were done, but it was probably around 100lbs.  in the weeks prior to my surgery, i did my best to build myself up as much as i could by drinking carnation instant breakfasts, eating lots of eggs and other high protein things.  i went into surgery at 111lbs.  i left the hospital at 98lbs and went down to 91lbs in the interim.  i also was very concerned about it and yet, no one else seemed to be....my surgeon simply told me the weight loss was to be expected and not to worry....'i was not going to fade away'.  i just took what she said and went with it.  right now, i have gained a lot of my muscle back but, i still can't seem to maintain a weight above 100lbs.  a few times i went above 100 but it would only last a day and the next day i was down to 98lbs.  i have learned to accept it at this point...i have learned that as long as i stay as healthy and as active as i can, i will be fine.  i am cancer free, now and i do believe that is a gift in itself...i really can't ask for more than that!

i wish your mom and you well... keep us posted and bring any questions you have to the board...the people here are remarkable and have helped me tremendously!

stay well and God bless!

-Stacey

i am not big, 5 ft 5" and weigh 150 lbs pre cancer. 125 lbs when i was dx with cancer in march. went to surgery last week 7/7 at 123 lbs and now i am at 120 lbs ie lost about 3 lbs from surgery. i dont know why i lost so little but i think having a feeding tube helps big time as i am getting about 1650 calories from the liquid feed daily.

so i guess one shouldnt fear of big weight lost after surgery but of course everyone is different.

 all the best to your mum,

andy

Thanks for your reassuring stories, Andy and Stacey. Mum is eating more healthily than she ever has in her life at the moment, so I think that will prepare her well for the surgery. She is very lucky that she does not have to have chemo - the surgeon said it was a "just in case" option but he was happy to support her decision not to have it, which she took in large part so she would be fit for the operation. 

The surgery is scheduled for 4 August. I think the best thing to do now is work hard to be positive and have faith that everything is going to be fine.   I guess the weight loss will be an issue that can be solved relatively easily compared to other complications so it is not something to panic about.

 

On 7/18/2009 TrueBrit wrote:

okay I am going to go out on a limb here. you might seriously consider a second opinion before your Mum undergoes such a radical surgery. I am trying to understand why she is having her esophagus removed when she doesn't have a staged cancer, is this correct?

there are three centers that have started doing Cryo-ablation to treat barretts esophagus,, the precursor to actual EC. Two are in TExas, and one is in Binghamton NY. This surgery a fancy endoscopy freezes tissue and has a great outcome. Please, before you take this huge step, get a second option.  

My husband is recoverying after stage 2 cancer, chemo, radiation and surgery (46 days in the hosptial- many complicatons, but finally home now. he has lost about 30lbs all told. Good luck.

 

Hi TrueBrit,

well, she had the surgery and they did find cancer, plus two lymph nodes. Just posted in detail here: http://www.cancercompass.com/message-board/message/all,39170

Hope your husband is going well,

Silvie