Email this pageRichard's Story
A remarkable surgery saves Richard Cullinan from esophageal cancer.
The most frightening chapter of Richard Cullinan's story began when he choked on a piece of chicken.
"I felt like I had been coming down with a cold and sore throat," Richard recalls. "I was having trouble swallowing stuff. Then one night, a piece of chicken got caught in my throat. I drank some water to wash it down, and the water came out my nose."
Alarmed that there might be something more to his sore throat, he visited his primary care physician. He recommended that Richard have an endoscopic examination of his throat. An appointment was set up with Dr. Manish Madan a gastroenterologist at Gasteroenterology Associates, LLP.
The examination with Dr. Madan went quickly. Richard and his wife, Theresa, then waited in the recovery room together for Dr. Madan's diagnosis. Ten minutes later Dr. Madan came out. He sat down and held Richard's hand. Richard turned to his wife and said, "This isn't good."
Richard had a two-inch tumor in his esophagus. It was cancer. Dr. Madan quickly tried to reassure Richard and his wife. He told them, "I know a very good surgeon."
That surgeon was Dr. Jeffrey Peters, Chair of Surgery at the University of Rochester Medical Center. Richard and his wife were to meet with him one week later. For Richard, that was very long week. Esophageal cancer, Richard learned, is one of the most lethal of cancers. Only liver cancer and pancreatic cancer are more deadly.
"I was scared," recounts Richard. "I'm not going to kid you. I went right home and got my insurances in order, and signed everything over to my wife. Then we went over to see my parents, My wife had to tell them for me. I was just too broken up." Richard was 51 at the time.
Richard felt somewhat reassured when he met with Dr. Peters. "He told me it is not all doom and gloom. There was a light at the end of the tunnel," Richard says. "But he did say, we are dealing with cancer. Still, he and his nurse practitioner, Suzie Francis, had a way of putting you at ease, and keeping that hope factor in front of you."
Dr. Peters explained what he would have to do: Richard's whole esophagus and a portion of his stomach would need to be taken out in order to remove the entire tumor. Dr. Peters would then reshape part of Richard's stomach to form a new esophagus. The procedure—called an Enbloc esophagectomy—was highly technical and only available at the University of Rochester Medical Center and four or five other hospitals in the U.S.
Richard and his wife had numerous questions, and Dr. Peters patiently answered them. Richard was finally satisfied.
"That sounds like a plan," Richard told him. "We'll go with it."
Seven days later, Richard was on the 7th floor of Strong Memorial Hospital being prepped for surgery. The nurses on the floor kept him busy with things to do, helping to keep his mind off the surgery. Early the next morning, he was wheeled into pre-op and introduced to the surgical team.
The surgery would take close to 10 hours. Three incisions would be made, one on the left side of the neck, one in the center of his abdomen and the third along the rib cage under the right shoulder blade. Richard's entire esophagus was removed, as well as a quarter of his stomach and many of the surrounding lymph nodes. Part of the remainder of his stomach was fashioned into a new esophagus, then brought up and reattached inside his throat. He was then taken to the ICU for recovery.
Richard was surprised that, when he awoke, he felt very little pain. But in his words, "I had more tubes coming out of me than a bowl of spaghetti!" He assumed that his low level of pain was because he was still receiving pain medications through an epidural, which sent painkillers directly into his spine. But even when the epidural was removed three days later, he didn't feel any pain—just soreness.
For the next two weeks, Richard would not be allowed to eat or drink anything—all of his food and water would be delivered though a feeding tube and an IV, while his new esophagus healed. At the end of that period, though, he would have to prove that he could eat before he would be able to go home. During his 16 day hospital stay, Dr. Peters and his team looked in on Richard daily to check on his progress.
Richard chose his own first meal: Oatmeal and a cup of coffee. "I was so anxious to have something to eat or drink," Richard says, "that I inhaled it! It didn't stay down. But around 11 that morning, I called my wife and said, "I'm coming home!"
When he first got home from the hospital, Richard's diet needed to be modified while his new esophagus healed. With these dietary changes and the smaller size of his stomach, Richard's weight began to drop—much the same way it does in patients who have weight loss surgery. Before his surgery, Richard weighed 247 pounds. He would eventually get down to 183 pounds.
Six weeks after surgery, Richard began chemotherapy. Out of the twenty five lymph nodes that had been removed from Richard, five had come back positive for cancer. So Richard would need four cycles of chemo—5 days of treatment, followed by about three weeks off. Richard's treatment included adjuvant chemotherapy for cancer cells too small to detect. Recent research suggests a benefit to this type of therapy.
The end results were worth it. When Richard went in for his CT scan, he came back clean. And all his scans, including a Pet CT scan after one year, have been cancer-free ever since.
When asked what may have caused his cancer, Richard minces no words.
"Years of acid reflux," he says. "I'm the type of guy who had a bottle of Rolaids in my toolbox at work, and one in the ashtray of my car. If I was going to be having spaghetti, I would have four or five Rolaids first. I was a big overeater. I was oblivious to the fact that I was doing anything bad to my body."
A year and a half after his surgery, Richard's life is good. He has returned to his job as a machinist. He feels remarkably healthy. He is able to eat almost anything he wants. And he is thankful to Dr. Peters and his staff for getting him through the scariest part of his life.
"Throughout this whole thing," Richard says, "the hope was always there. Everyone was always so positive. Dr. Peters just put my whole family at ease. I just can't imagine going through this without someone of that caliber."
Along the way, Richard learned something else about Dr. Peters that gave him even more confidence: Prior to moving to Rochester, Dr. Peters had performed this very same surgery on Richard's uncle in California. His uncle never had a reoccurrence of his cancer.
Richard tries to pass along the remarkable favor he has received. Now and then, Suzie will give him a call, asking if he can speak to someone else who has concerns about having the same surgery.
"I never turn her down," Richard says. "That's one of the biggest rewards for me. Besides being healthy and on this side of the grass!"
