柯拿，大家好，
成日講：世事難料，幾時到你估，乜嘢事都可以隨時發生，絕不事前通知。
過去年零時間，因為舖頭嘅原因，成日都好似唔多實在，運動又疏懶，睇住個腩日益膨脹，連著咗成三十年嘅 Texwood Khaki 短褲，終於都著唔落。 所以過去寫過好多篇嘢，都話要搞搞個腩。點估到，原來終於要用個咁 radical 嘅方法⋯⋯！
我有好多經歷，所以我鍾意講古，唔止講，仲要寫低佢，時時話返畀我自己聽，我曾經做過尐乜嘢。好，開始講古：
2014年初。一次檢查，醫生發現我有幽門螺旋菌 Helicobacter pylori。呢隻嘢，我梗識佢，因為佢同澳州有關。上世紀八十年代前，一般醫學界認為：個胃有胃酸保護，咁重酸性，細菌好難喺胃部生存。袋鼠國有兩個醫生，佢哋唔信邪，1984 年，佢哋專登搵咗呢隻菌，其中一個醫生 Barry Marshall 仲「嗗」一聲，將細菌沖水吞服，一於以身試「發」，佢哋以為約一年時間，就會嚟料，點知只係三日後，馬素醫生果然發咗 ⋯⋯ 胃炎。由此，佢哋證實引發胃炎、胃潰瘍嘅原兇就係呢隻菌。當然進一步研究更指出，如果經常發炎，細胞病變嘅機率亦會增加！佢哋嘅硏究刊登喺 1985 年嘅澳洲醫學期刊 The Medical Journal of Australia，呢個係當年嘅醫學界一大突破，亦因此救返無數生命。2005 年，獲頒諾貝爾醫學獎，記咗佢哋一個大功勞。
我認識嘅呢隻菌，而家居然同我住埋同一個皮囊。不過，知道咗有菌就易搞喇，我只需要食一個療程嘅抗生素就搞掂佢哋。覆診時，醫生話：而家菌就冇嘞，不過個胃發過炎，又有胃酸倒流歷史，況且個胃都用咗幾十年，照下胃鏡，驗驗佢都好喎。不過又唔係咁緊張嘅，去完旅行返嚟至驗身都冇問題。咁樣，2014年初，我就去咗厄瓜多爾，加拉巴哥斯群島，尋找達爾文蹤影；又去咗秘魯，探索印加古道，訪尋馬丘比丘，得睹印加古文明遺蹟，去咗一個月。呢個南美之旅，我滿意到不得了。
有道：「蒼天雖無言，示之總有象。」好多時，冥冥中自有安排。佢又慌死你懵閉閉，走漏眼，仲處處留些少明示暗示過你。不過，凡夫俗子，硬係多嘢搞，硬係唔上心，更重要嘅，係慧根唔夠。呢尐明示暗示，就如水過鴨背，點滴不留。到後來先至猛然回頭，狂拍大髀，呵！乜原來係咁解嘅咩？！
南美旅行返嚟冇耐，我舖頭嘅商場易手，賣咗畀大陸資金，商場政策改變。加上呢一區，愈嚟愈多講㷛冬瓜嘅新移民，佢哋唔係我嘅客。我睇唔好個市，如果再簽五年租約，風險好大，當然租金亦傾唔埋欄，於是，年中，毅然退出做咗二十年嘅商場。為咗繼續箍住班舊客，就喺附近租咗間屋繼續營業。
睇返轉頭，2014 年，真係好大變化。五月廿九號租約期滿，隨即搬去「新舖」繼續開工。咁都只不過係轉換工作環境啫，對我嚟講，並唔係乜嘢新生事物。不過，我嘅人生第一次，就喺個幾月之後登場：2014年7月12日上午10點35分，人生嘅第一次全身麻醉 --- 照腸鏡 colonoscopy！
（拉開講一筆，本文所提到嘅事，全部都可以喺我個 blog 度搵到，所以略去故事詳情。要重溫可上 「嚤囉仔手記 kinfaichiangessays.blogspot.com.au ，每篇標題前都有日期。）
照完腸鏡，吉人天相，乜事都冇。覆診時又知多一樣嘢，原來照腸鏡同時係可以照埋胃鏡，我 2014 年頭已經想做照胃鏡！咁好機會，我竟然錯過咗，呢次冇照個胃，咁就嘥咗兩樣嘢：第一就梗係嘥咗麻醉喇，因為如果再做胃鏡，就要麻醉多一次。第二就係醫療保險嘅五百蚊墊底。不過又咁講，如果可以趕及喺年底之前照胃鏡，又可以唔使再交 500蚊，因為墊底費係逐年計。但係，我都冇咁做，因為雖然「舖頭」係比以前清閒，但係又忙於搞旅遊巴士司機牌，又去跟車學嘢，總之就多嘢搞。由年底到2015年初，仲實牙實齒去揸旅遊車、做導遊。2015年初嘅大事，就係要預備五月嘅土耳其、巴爾幹嘅旅行，咁就更加冇「閒情」去照胃鏡喇。講真，全身器官中，我最擔心嘅，就係個胃，尤其係食道。話雖如此，不過一路都食得瞓得，從冇話痾嘔肚痛，照胃鏡都係常規檢查，令自己安心而已，一於去完旅行至算喇。卒之，我玩咗個幾月，呢個一戰歷史之旅，又係一個滿意到痺嘅旅行。
其實，呢個皮囊都用咗大半個世紀，尐關節郁起上嚟， kick lik Kwark lark 會響，呢個情形，實在都有好幾年喇。前兩三年，手㬹、膊頭成日冤冤痛，雖然不至影響生活，但係都好唔舒服。所以醫生開咗非類固醇消炎藥 NSAIDS 過我，呢隻嘢非常有效，我知佢會傷害胃黏膜，所以要同胃藥一齊食，而且只係痛至食，一旦冇痛，就要停藥。除此之外，呢隻藥其實非常安全，我喺克羅地亞踩單車，都有幾日要啪粒 NSAIDS 止痛。2015 年尾，右手㬹冤痛影響長時間踩單車，卒之要去醫生度打支類固醇針消炎止痛。好嘞，得到手㬹好咗尐，整 side yard carport 時又拉傷咗左邊膊頭。照辦煮碗，又去醫生度打針，今次可能傷得緊要尐，復原得好慢。其實，我已經預備晒 2016 年旅行大計，機票、火車、住宿等都全部訂妥，其中有十幾日，計劃喺蒙古踩單車。而家個膊頭咁嘅款，點踩車！唔知三個月可唔可以好返？我十五十六。我有買旅行保險嘅習慣，退一萬步，萬一踩唔到單車，再改行程都得，一切損失，有旅行保險照住 ⋯⋯。
2016 年初，就要專心搞返掂個膊頭，仲要操返單車，唔夠 Fit ，點去旅行踩車？咦，丟低咗年幾兩年嘅胃鏡，幾時照？睇嚟，都係一樣樣嚟，而家當務之急，係要搞返掂個膊頭，照鏡就遲一步至算喇。
二月初，送羊迎猴，我嘅乙未羊年就咁過去。袋鼠國，新年照開工，我個車房舖頭都有尐生意嘅。星期五，係送鞋日，我將做好嘅鞋送去客人屋企，多數係嘉寧福區，就係我舊時商場舖頭附近。⋯⋯，咦，橫掂都經過商場，我睇開嘅診所就喺商場裏面。忽然，我心血來潮，今日不如喺附近食埋晏晝，順便睇埋醫生都好喎。拎起電話，預約個時間睇醫生。
呢個「心血來潮」，原來係人生咁大嘅交义點。冥冥中，真係有安排！諗起呢首歌：
夏韶聲
交叉點
作詞：鄭國江
作曲：N.Tsuyoshi
命途命途滿是得失分界線
每步每步都似踏進交叉點
當初不信命運但信機會
直到今天自信的心仍是不會變
只盼可以抓緊光陰一寸寸
往日那份衝勁自信不會斷
艱苦險惡道路續上一段段
論到得失未到終點誰又可計算
用自信心完成每一天
過去了似未能還完
爭勝心是長遠
苦困皆自願 心願自信定能圓
一切皆自願 只管耕耘成敗不去算
步伐也許難如往常那麼顛
過去已是永遠也是
只在今天共明天
苦困皆自願 心願自信定能圓
不理多辛酸 只管耕耘成敗不去算
今天陽光正暖 我的心更暖
唱完歌，繼續講古：
好快送完鞋，他他條條食個晏，兩點十五分準時睇醫生。道明來意話要照胃鏡，我畀埋個專科醫生個名佢，呢個GP，我睇咗佢廿幾年，佢知我病歷，冇托手㬹，仲話，雖然冇痛冇盛，呢個年紀， look see 真真都係應該，即刻寫介紹信過我。我亦手快腳快， 即刻約咗呢個腸胃科專科醫生，佢就係兩年前幫我照腸鏡嘅 Dr Tim。
一個禮拜後見添醫生，佢係寡言嘅人，說話唔多，句句到題。佢問我見點？「其實冇乜特別，只係多咗胃氣 ⋯⋯ blah blah blah」，佢知我有胃酸倒流嘅歷史，二話不說，撳咗我個肚幾下，就幫我約時間去醫院照胃鏡。足足拖咗兩年，喺我嘅心血來潮下，終於有胃鏡照嘞。
年半前，我照過腸鏡，哎唷都有些少經驗。照胃比照腸簡單得多，唔使食瀉藥，唔使提早節食，只需要六小時前禁水禁食就得嘞。照鏡前一晚，仲同大小姐去韓國餐館食人蔘燉雞𠻹。
二月二十五日。今日要全身麻醉，成日都唔揸得車，仲一定要有人接返屋企。大少爺、大少奶一早就嚟接我，時間尚早，中途，仲可以食個早餐。我梗係冇得食，連水都冇得飲。其實唔使飲，唔使食，有時間同阿仔、新抱仔一齊，傾偈都飽喇，使乜食呢又。
十一點，喺麥覺理大學醫院，換好晒手術袍，十二點左右，麻醉師喺我右手手背揷上針筒，鼻哥戴上呼吸管，一陣涼氣由手背透上手臂，靚女䕶士畀個灰色圓型中間通窿嘅硬膠我咬住，我諗，內窺鏡就由呢度放入去。靚女䕶士向我微笑⋯⋯，畫面突然消失 ⋯⋯。睜開眼，係天花板，牆上個鐘指住十二點半。單嘢搞咗半粒鐘，䕶士要我攤多陣至畀我落地。十五分鐘左右，自己換返衫，行返出去休息室，而家可以坐喺高身單人梳化唞下。成朝未食嘢，䕶士捧出公司治及咖啡，一來醫肚，其實最緊要，係用嚟觀察我哋麻醉後嘅反應。飲完食完都冇事嘅話，咪就係冇事囉。臨走前，添醫生打電話嚟，話佢睇到胃壁有發炎嘅紅斑，仲幫我約埋下星期五去佢診所睇報告。
大小姐今日係佢實習嘅最後一日，做完晒實習嘅嘢，佢兩點左右就嚟醫院接我。麻醉過嘅人唔准自己走，䕶士帶我出去等候大廳，交畀大小姐，大小姐就車我返屋企喇。⋯⋯ 發炎紅斑？乜嘢嚟㗎？要等下個禮拜五睇報告就知喇。⋯⋯ 乜嚟呢？
二月二十六日，星期五。又係派鞋日，朝早做埋幾個雕字，執好要送嘅 jobs，預備中午後出發。iPhone 有短訉聲，係添醫生診所打嚟，個心一沉，即刻回電，係添醫生太太嘅聲「你喺邊呀？點解唔聽電話？醫生想見你，十二點四十五前到診所。」我梗問乜事咁急，答案又梗係預期嘅「醫生會話你知，即刻嚟喇。」個醫生搵得你咁急，唔通趕住請你飲杯茶，食個麭咩，嗰時我個心諗乜嘢，唔使畫公仔畫出腸，大家都感受得到喇啩。
睇下個鐘，就嚟十一點。我即刻打多幾個電話，希望聯絡多尐客，快快趣將尐 jobs 還返畀客人。我有個預感，可能有一段長時間唔使開工。
未入到添醫生診所，就聽到添太太，亦係佢嘅秘書嘅聲音，佢係唔停得口嘅人。我一入去，坐喺佢辦公枱旁邊。「你終於嚟喇，點解唔聽我電話？」「係咪好大劑？」我直接問。「添醫生會話你知，我唔講得」。我都明白，收口。⋯⋯⋯⋯。靜咗一陣，佢嘅個性格，點忍得住頸，佢開口：「乜你冇 symptoms 嘅咩？有冇肚痛、肚痾、冇胃口、出血 ⋯⋯ ？」佢咁講，我都估到八八九九嘞啩，我答：「真係乜都冇喎。」「咁點解要照鏡呢？」「又真係心血來潮喎。」⋯⋯。
坐入診症室，如常，添醫生唔會講嘢住，就只係對住尐報告，打字入自己個 laptop，似乎係將新資料撮要入我嘅個人病歷裏面。冇耐，佢抬起頭，一邊將內窺鏡影到嘅相畀我睇，一邊對我講：「真係好難睇到，少尐經驗，甚至眨下眼都會走雞 ⋯⋯⋯⋯ 。」睇佢眼角神情，佢似乎對自己嘅發現非常自豪，雖然佢係好有經驗嘅專科醫生，對病人經常保持平靜嘅情緒，可能今次佢覺得「咁都畀我睇到」，就難掩滿意之情。佢繼續解釋，噚日喺胃壁睇到嘅紅斑係胃黏膜發炎，Tim 醫生專喺最可疑嘅地方採集標本，總共割咗十二粒出嚟化驗，化驗結果今朝出嚟。有六粒係正常，有四粒變緊，仲有兩粒已經變咗 Adenocarcinoma。
我聽咗梗係好唔開心喇，不過又唔係震驚嗰隻，講真，揸車嚟診所時已經作最壞打算，同添醫生太太嘅對話已經好清楚喇啩，而家只係醫生正式話畀我知而已。跟住落嚟最緊要問嘅，就係跟住要做尐乜。
添醫生即刻幫我寫介紹信畀外科醫生，又寫紙要我即刻去驗血同埋做 CT scan ⋯⋯。添太太仲親自幫我打電話預約排快期。呢個下晝，我唔得閒驚，亦冇時間諗埋尐無謂嘢嚟自己嚇自己。診所附近就有化驗所，好彩早餐後滴水未進，即刻驗咗血先，二十分鐘搞掂。不過做CT scan 就要之前要飲一大支水喎，喺街邊買咗支水，一路揸車一路飲，半粒鐘都唔使，就去到嘉寜福 Scan 診所。
之所以要做電腦掃描，係要睇下其他部份有冇異常。幾乎等都唔使點等，就入咗掃描室。換上環保不織膠袍，瞓喺撿查牀上，放射師喺我右手臂插上針筒，注入碘顯影劑，一陣微暖由手臂散出，好快，成身都感覺到呢種溫暖，不過，係冷冰冰嘅溫暖！眼前係個大冬甩，我舉高雙手扶住個冬甩，張牀喺個冬甩圈出出入入，我又要聽住指示呼吸，冬甩中間一排燈仔一味喺度轉，摩打喺我耳邊轟轟聲 ⋯⋯。
而家瞓喺鐵牀上，我終於有時間感性一下，我今朝仲係一個健健康康嘅人，大佬，仲開緊工，幾個鐘頭後，烏啄啄變咗一個病人！呢個病，仲唔係少嘢嗰隻。我成日話「世事難料，絶唔會事前通知」，有冇講錯呢！此時，胸口有一股悒悒悶悶嘅感覺， 要吸一大啖氣嚟紓緩。Hah 唔知係咪古人所講嘅「悲從中來」呢？
「悲」係醫唔到病嘅，而家亦唔得閒悲住，下晝仲有好多嘢要做。做完掃描都未夠三點，掃描報告四點鐘可以攞得，趁有一個鐘頭時間，即刻送埋鞋畀尐客，客人都喺附近，好快一一搞掂，隨即返去攞埋掃描報告，去埋嘉寧福診所，一五一十將情形話畀 GP 聽。至此，今日要做嘅，都大致完成。
坐返上車，舒一口氣。今日兩手空空出嚟，五個鐘頭後，攞住一疊二疊報告、文件返屋企。到而家，其實，件事已經好清楚喇啩，條路係點，亦都明明白白擺喺眼前。跟住要做嘅，就係通知家中至愛，whatsApp 大小姐、大少爺、大少奶，今晚，我安排一個庭會議。仔女新抱，我好有信心，佢哋喺情緒上絶對可以應付呢個消息。最擔心嗰個，係陪伴咗我近半個世紀嘅至至愛，佢而家身在香港，我應該點樣同佢講？佢喺香港已經煩緊外父嘅事，而家聽到呢個消息，佢又會點反應？真頭痕。
大少、大少奶今晚要同客人開會，趁呢個機會，我同大小姐已經交代一切。黃昏七點半，家庭會議開始，一如所料，大家都好正面去接受呢單嘢，大少奶家姐係醫生，即刻將所有資料通知佢，等佢畀尐專業意見。我哋一路講，家姐醫生一路餵料過嚟，其實氣氛都幾輕鬆，大家積極而正面，我沉浸喺關懷之中，實在好溫暖。正當大家七嘴八舌之際，我提出呢個問題：「點樣通知媽媽？」全部收晒聲，你眼望我眼⋯⋯。
打破沉默嗰個梗係我，因為我最瞭解佢。其實我已經有個打算。我相信，佢係一個好硬淨嘅人，愈係困難，佢愈能夠沉著應對，但係佢亦有一個特點，就係反應過快，同埋即時嘅反應有時候會 over react 咗。呢個消息咁埋身，佢即時會點反應，我預計唔到。不過，如果佢喺接到呢個消息嗰一剎那，有人喺身邊支持緊，咁我就放心好多。佢對人真心，喺香港好多真心老友，其實好容易就搵到支持到佢嘅人。不過，我搵咗李小姐同簡小姐，因為歷練關係，呢兩位小姐見慣世面，隨機靈活應變，不作第三人想。
我嘅提議，大家當然舉腳贊成。事不宜遲，即刻 whatsApp 電話兩位小姐。我係男人，有尐女人嘅睇法，我真係猜唔透，估唔到兩位小姐都有相同嘅憂慮：「如果佢知道你唔係第一個通知佢，佢會點諗？」呢一層，我真係冇考慮到，但係我都堅持要咁做，因為佢始終明白我咁做嘅動機。兩位小姐唔太認同，但係都照我計劃行事：一於約佢，共三個人，聽日（廿七號）香港三點左右，下午茶，到時，我就會同埋大小姐、大少奶 FaceTime 佢。大計已定，都冇乜好做，返屋企瞓覺。瞓喺牀，諗返今日：二月二十六日，星期五，我要記住呢一日，我真係做咗好多嘢。跟住大覺索，咦，又冇話失眠喎。
星期六。一早再要送 jobs 畀尐客。有個客住得稍為遠些少，佢唔想我嘥油費，「使乜咁急？下周我自己嚟攞都得啫。」但我堅持要送。去到佢屋企，搞掂交收之後，佢直接問我：「Tell me, Kin . Are you sick ？」原來我嘅古怪行徑，人哋係睇得出嘅。我係冇秘密嘅人，我照講可也。佢講咗一輪鼓勵嘅說話，雖然老土，但係好有心，我好多謝佢。 跟住，佢講：「Kin, can I pray for you？」「Oh sure, thank you .」好少鬼佬矮過我，佢係其中一個。佢走埋嚟，左手搭任我右膊，我條件反射，又用我嘅左手搭返佢右膊，佢開始為我祈禱。內容梗係求主賜福，令我早日康復，跟住「in the name of Jesus ⋯⋯」，我唔係教徒，睇得多，我都識一齊講「Amen 」。唔理乜嘢宗教，有人誠心為我禱告，內心實在感到溫暖。返歸，將件事講畀家人聽，大家都好感動。不過大小姐就笑我，人哋搭我肩為我祈禱，我只需低頭，而唔使搭返人膊頭，佢話個畫面好搞笑！乜咁嘅咩？
一個朝早，終於將所有 jobs 搞掂晒，順便敬告所有客人，由今日起，五個星期內我都唔再接 job 。希望之後，可以盡快再次服務街坊。
噚日，我仲食咗一個大早餐。今早冇晒胃口，煎咗嗰個番茄都食唔落，要倒咗落垃圾桶，我未試過咁樣嘥食物，下晝肚餓，但係都係只食得落一包即食河粉。原來我以為自己睇得開，裏面深藏嘅情緒，可能真係無法控制。原來真係食乜都冇晒味。
我哋黃昏六㸃，即係香港三點。大少奶、大小姐同我，齊集大少爺屋企，大少今日要開工，未克參與行動。三點二十六分，李小姐 whatsApp 話行動可以開始。
首先由大少奶出動，先問吓佢喺香港係咪好頻撲，又講下 shopping；再由大小姐講自己實習嘅㸃點滴滴。到我講，我先叫佢戴上耳機，就一五一十，將要講嘅嘢都講晒，佢間中問些少問題，雖然冇乜聲，都感覺得到佢係好 shock ，但係聽得出佢神色鎮定。聽完後，佢話會盡快返嚟 ⋯⋯。行動結束。之後，再 whatsApp 兩位小姐，確認一切妥當，大家都放心晒。在此，再次多謝香港兩位小姐支援，感激萬分。我有咁多人誠心支持，心情又真係好返好多。哦，有尐肚餓𠻹，三支公去唐餐館食個晚飯。哈，原來係大少奶最𩟔得，我見大家都放開懷抱，胃口又好返尐喎。
星期日。大小姐驚我一個人會太悶，連每個星期日做開嘅教會領唱，都叫人幫住先，今日，成日陪住我。中午，佢仲叫埋占士陪我食咗個越南午餐。佢同占士各有各忙，好難得有個星期日，我做人老豆，梗係好通氣，放佢哋一個下晝。大小姐好乖，話返嚟陪我食晚飯，詐嗲係我拿手好戲，我唔會 say no。
喺見外科醫生前，我哋都要做尐功課，今晚約咗史提拉，佢係經驗老到嘅外科䕶士。根據佢嘅經驗，呢個情況都應該係初起，而且係局部嘅。因為佢係行內人，我問佢識唔識呢個外科醫生？佢雖然唔識，但睇資料，史提拉認為佢係合適人選。而家網上訊息發達，我哋都摷過佢嘅 profile ，發現佢做好多減肥手術，我哋乜都唔識，可能認為做「減肥」，會唔會有尐「不務正業」嘅感覺？史提拉解釋，呢尐「減肥」，一尐都唔少嘢，行內叫 Sleeve Gastrectomy ，實在就係將部份胃部切去。既然佢係切胃專家，做呢個手術就係佢嘅本行，絕對適合。佢嘅睇法同家姐醫生好相似。佢仲解釋咗好多有關手術嘅問題，又教我哋喺見醫生時要問尐乜嘢，同埋尐專有名詞點講。多謝史提拉，佢令我對呢個情況，有一個較有系統詳盡嘅概念。能夠知多尐，先至可以開懐咁接受現實。多謝晒。
三月一日，踏入袋鼠國嘅秋天，新嘅季節，打開新的一頁，為實踐新嘅生活，努力！過去兩三日，我哋都喺澳、港兩地分頭做功課，為三月一日見外科醫生做好準備。早上七點幾，我同大小姐企喺機場 A 出口。如常，佢一個人推住四五件行李行出嚟，行李超晒磅，都唔知點解航空公司畀佢過。見到面，緊緊擁抱，一切盡在不言中。好開心佢仲帶住笑容，我低估咗佢控制情緒嘅能力。
下晝兩點半，史密夫醫生診所。醫生約四十幾歳啩，好斯文，據佢嘅 profile 講，工餘時間，佢仲係一個義務救生員！生得高大，都好運動型。我哋自我介紹後，就問准醫生，大小姐會將說話內容打入 iPhone 記低。以下就係大小姐嘅記錄：
Meeting with 史密夫醫生 with the present of Kin, Shan, Harching and 凱莉䕶士
1 March 2016
2:30pm
史密夫醫生 St Leonard's clinic
What's the situation
How is my oesophagus
What is the proceWhat's the situation
How is my oesophagus
What is the procedure
What will the procedure involve
Do I need to do any pre or post treatment (eg chemo, radiation)
If so, what will that entail?
What is the cost?
--------
Dad:
Countdown to 2013- had some reflux and when I eat I get gassy
2014- colonoscopy (found nothing)
No symptoms really, just gassy
I take Mobic for my shoulder
1 month of taking it every day
No surgery in the past
Doctor ：
Oesophagus
Fundus
Atrium
Biopsy of the different parts of the stomach and found in the ATRIUM there were some tiny bits of cancer.
From the pictures, he didn't find a big lump or anything, just some early changes perhaps.
That's a good thing!
It doesn't appear that it's spread. The main way to treat it is to do an operation that involves removing all or most of the stomach, staying in hospital for ten days and then changes to your diet.
Metaplasia happens sometimes- (early cancerous changes everywhere, then you have to remove the whole stomach.)
If this is confined to the bottom part, then you only have to remove the bottom part and it makes it easier for you to eat in the long term.
From what I can see, there doesn't appear to be any cancer anywhere else. No malignancy in the upper part, it doesn't appear he's done any biopsy from the fundus (do another endoscopy and take some biopsy up here to make sure if we leave some stomach it'll be okay).
Lots of the time, patients have much larger cancer than yours, those patients need to do chemo prior. Your cancer appears to be very, very early you can make a strong argument for not needing to give chemo.
What we would do instead is remove it, remove lymph glands. Whenever we do surgery for stomach cancer we remove these too; it helps improve the cure rate and helps give information about whether we should do chemo or not.
Remove the cancer THEN see if we need to do chemo after. Worthwhile visiting the oncologist who looks after it.
Strong argument for just surgery.
You should visit the oncologist beforehand.
Dad:
I always think there's something wrong with my oesophagus...
Dr:
No. It looks fantastic!
No pre cancerous change. The redness is nothing. It's fine.
Process:
Endoscopy tomorrow, we're going to map the stomach, take lots and lots of biopsies because we want to do an operation that can leave a portion of your stomach.
Cut, cut; bring small intestine up because it stops bile from coming up.
Mum:
Is it early stage... Pancreas and kidney can create cancer too...
Do we need to check all the organs...
Dr:
A good quality CT is enough.
When you take biopsy they can tell it hasn't come from anywhere else. They can tell it's come from the stomach.
Sometimes it's hard because symptoms hard to see.
The test tomorrow is to find the spread: that is the mapping
(Intestinal metaplasia; if there's any displasia then we would have to do a different surgery)
You've done the CT.
Sometimes you do a PET scan, but I don't think you have to; you can talk to the oncologist if you'd like to regarding that.
We'll meet up over the next few days.
Mum:
We'd love to do the operation ASAP so the test is tomorrow and the result?
Dr:
Wait two days for the results.
Hopefully we can do the operation next week.
(Oncologist is away.... All of them)
Worthwhile for Doctor to speak with them over the phone instead since they're all away.
Recovery wait for stomach cancer:
Hospital for 10 days and when you leave you'll have small frequent meals
Normal food
5-6 meals a day and energy levels may be low, not much pain.
You could probably still work, walk around, you'll probably want a nap for 2-3 weeks.
Eating and drinking wise you won't be able to have a big meal, and you'll find that you'll feel things are heavy.
You may lose weight but your energy levels WILL come back around four months on.
Survival rate:
Cure rate with a very early gastric cancer is around 90%. You are very lucky.
We see lots, and maybe only one in thirty we'll find this early.
Stomach cancer generally is difficult to cure because it's often diagnosed late.
But most patients aren't actually diagnosed this early.
It can be relatively aggressive yes but MOST IMPORTANTLY Is the spread and the stage.
Yours is very early.
You have GASTRITIS that turns into metaplasia, displasia and then cancer
Helicobacter can give you gastritis.
Lots of Asians can stomach cancer in general.
The anti inflammatory medication has nothing to do with it
Bacon and pork is fine; the problem is mainly from Japan (where they eat a lot of smoked and pickled food in Japan and Korea) NOT from helicobacter.
Beer and coffee is fine.
You can definitely backpack and cycle!
It's normal to be anxious but this is lucky and good. This is very early.
GASTROSCOPY TOMORROW
consent form
I'm going to be the one doing the Gastroscopy.
------ end --------
大小姐果然犀利，攞住 iPhone 將所有對話都記低。其實，史密夫醫生都已經有手術計劃，不過為咗更加準確，聽日，三月二日，佢會幫我做多次胃鏡，主要係睇清楚受感染部位，佢稱之謂 mapping，咁就可以決定手術範圍。
三月二日，上午七點，北岸私家醫院內窺鏡部門。一個星期內第二次麻醉，北岸醫院又真係幾唔同，個大堂似酒店多過似醫院。等候麻醉前已經有私人病房，其他設備都比較精美。已經係第三次做內窺鏡，程序都大同小異，駕輕就熟喇。推入麻醉室，麻醉師拮針前，史密夫醫生嚟同我打招呼，後面雙掩門打開，原來就係照鏡嘅地方喇。一如既往，麻醉師打針後，就即時冇咗畫面，到掰大眼時，已經喺返私人病房。又係一如以往，瞓醒後就有三文治、咖啡做早餐。今次有尐唔同，就係 breakfast in bed。仲有，前兩次照鏡，阿珊佢都唔喺我身邊，今次可以陪住我嘆報紙食早餐，非常溫暖。
三月四日。呢個係手術前嘅覆診，以下係大小姐嘅記錄：
2nd meeting with 史密夫醫生 with the present of Kin, Shan, Harching
4 March 2016 Friday
3:30pm
史密夫醫生 St Leonard's clinic
All the results are good!
Remember that this is where the cancer is (lower part). It's very subtle. Usually it's big on most people yours is very early. We took biopsies from everywhere except the bottom because it's gonna be removed anyway. We don't have to take all the stomach.
It's the best scenario.
It's called a radical subtotal gastrectomy. There's good room for food.
That's subtotal- we're not taking all the stomach. Radical means we're
going to take a lot of the lymph glands around. If they have any cancer around we will get rid of it all.
It'll take about five hours under general anesthetic. You'll get an epidural catheter in your back so you'll be comfortable when you wake up. You'll spend 2 weeks in hospital probably.
One week after the operation you'll have something to drink and eat then you'll gradually be eating normal foods.
Start on liquids like soups then soft food like pasta and congee. No rice for a while; after three weeks you can start again. Small frequent meals like six or so when you go home.
When you're in hospital you'll see a dietician.
This will take four to five months to get over. You'll always know you've had a gastrectomy, you'll feel a little different. You'll lose some weight and not put it all back on again. Your energy levels will come back and then you can do base camp again,
This won't affect you for the rest of your life in any big way.
Dad:
First week?
Dr:
You'll have a tube in your nose and side and catheter. Those will come out after the first couple of days. You'll be up walking straight after with it all attached to you. This is a big operation. But the likelihood of any significant complication is low. You're very fit for your age.
Surgical complications are making sure everything heals up nicely. I wouldn't expect any problems to occur for you. You'll be monitored at all times. I'll see you every day until you're right to go.
Mum:
Is that the only/best option?
Dr:
Well there are different operations:
One option would be to do an operation like this called a bilroth 2 operation-
Where you join the bowl to the stomach like this...
This is easier but for the patient it's not as good.
The one we want does the best functional result. In terms of treatment
of the cancer we need to remove it all and we need to remove the lymph
glands.
There's no other real option so any other option would be a compromise.
Let's say you were 85 and we only removed the cancer and not try and
cure you. We could do it endoscopically. That would not cure your
cancer.
Ours is the internationally accepted option as the best option.
Two reasons we take a lot of stomach
1. These can spread under the mucosa for a while
2. When we take the lymph glands we take the main blood supply which
means we have to take a lot of it
Mum:
So it won't come back?
Dr:
Priority number
1 is do a good cancer operation
2 is don't put the patient in danger
3 is get a good functional result so in five years you can enjoy your life
Mum:
My dad did an operation too, and it spread. So I'm quite nervous
Dr:
Gastric cancer typically (your father's story is not uncommon it can
come back) but most patients don't have such an early subtle lesion.
You're very lucky.
This is a nice conversation. Many times I'm operating on big ones which have already gone into the lymph gland.
If you were fat we'd do a keyhole. But you don't get a good dissection on the lymph nodes. Also, if you have the availability of an epidural then the benefits of keyhole aren't that great anyway.
On balance for most people I would do this as an open.
Mum:
After the op? Does he need another round of chemo or radio?
Dr:
Well I don't know. Usually if it was big we would give pre and post op chemo.
Let's say we do yours and there is some in one or two lymph nodes. Maybe you'd need some post op chemo and maybe radio.
There is some evidence in Japanese literature where they give post chemo. Most of my patients are either white or Chinese. Sometimes the oncologists will apply the Japanese chemo therapy to the Chinese patients. Nonetheless that's how the oncologists do it.
With stomach cancer there's a European literature and there's an eastern literature (mainly Japanese). What we will do is when we have the pathology then we will talk to the oncologists and see what they think.
Ching:
You've spoken to the oncologists?
Dr:
Yeah! They say it's early. I spoke to the oncologist after the surgery and he will talk to you about all his stuff.
Friday 18th? That's the earliest I can get the whole day. The hospital sometimes gets you to come up to a pre admission clinic and they show you around blood test chest x-Ray etc...
On the day of op just come in in the morning. During this period just take it easy. Do everything normally. The hospital to call you but just be fasted from the night before as
with your GASTROSCOPY.
It's so small some people can miss it!
In hospital you'll see a dietician and there will be plenty of
information about what to eat and so on and so forth.
---- end -----
以一個普通人嘅常識去瞭解呢件事，史密夫醫生嘅解釋已經好詳細。謝過醫生，再喺櫃檯搞埋尐手續，診所會繼續跟進入院、麻醉師 ⋯⋯⋯⋯ 等等，而我就照常生活，等候三月十八日嘅來臨。
醫生話，手術後會瘦，而且唔會容易肥返。估唔到我減極都減唔到嘅肚腩，會用呢個方法搞掂佢！果然夠晒 radical 。佢又話能量水平會返返嚟，甚至可以再去 base camp ！我大大力捽住嚿木，承佢貴言。
由二月四日嘅覆診到十八號，足足有兩個禮拜時間。心情都有上上落落，靜思時，間唔中會有古怪念頭飛嚟飛去，此乃人之常情，對我亦唔算乜嘢困擾。至愛嘅關心，我當然感受得到。大少爺大少奶大小姐，佢哋咁上下又會發個短訊畀我，大小姐又盡量抽時間喺屋企食晚飯、睇電視。再唔講阿珊就24小時陪住我。湊啱個個有時間，又會出外飲茶晚餐。其間乜都講得，毫無忌諱。老實講，我哋呢家人，都算係咁喇。
其實我嘅感覺，我個身體係完全乜事都冇，係知道消息嗰兩三日，就真係冇晒胃口，情緒真係好影響人。如果唔係心血來潮，烏啄啄走去照胃鏡，到今日，甚至一年以後，我都可能唔知呢件事發生緊。好感恩。
⋯⋯⋯⋯。
三月十八日。大家都準備好。等我瞓醒
再噏過
嚤囉
Mr Chiang, hope your surgery went well. Take care and get well soon!
ReplyDeleteCheers,
Shirley