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Critical Care Key After Complex Surgery

CancerWise - January 2009

By Dawn Dorsey

Dick Clowe’s cancer journey reads similar to a fairy tale: Like Rip Van Winkle, he had a long sleep; like Sleeping Beauty, he was awakened with a kiss.

After surgery to address the effects of thymus cancer, an extremely rare type of cancer that is frequently fatal, Clowe spent more than two months in the Intensive Care Unit (ICU) at M. D. Anderson — most of that time in a medically induced coma.

The race begins

Dick Clowe

The thymus is a small organ in the upper part of the chest, behind the breast-bone. Before a baby is born and during childhood, the thymus helps produce lymphocytes, a type of white blood cell that helps the immune system fight infection. It reaches its peak size, about one ounce, during puberty. Then, in most people, it begins to shrink and be replaced by fat tissue.

In many cases, cancer of the thymus (also called thymic cancer) has no symptoms. Even though Clowe knew something was wrong, he went to several doctors who were unable to find the problem.

“When I was in high school and college, I ran the quarter mile,” Clowe, now 74, says. “It’s the hardest race in track, and after you run it, you’re out of wind and your chest burns. If you’re in good shape, it goes away in 15 or 20 minutes, but I was feeling like that all the time.”

Complex surgery removes tumor

Finally, in the fall of 2006, Clowe was diagnosed. Few cancer centers have experience treating thymic cancer, and Clowe decided to come to M. D. Anderson, where he became a patient of David Rice, M.D., a thoracic surgeon and associate professor in Thoracic and Cardiovascular Surgery.

The tumor was pressing against Clowe’s lungs and heart, and it seemed to be growing quickly. In hopes of shrinking the tumor or at least slowing its growth, he had three chemotherapy treatments. But they didn’t seem to affect the tumor.

By the time Clowe had surgery, the tumor had grown to 8 centimeters (about 3 inches). In the six-hour procedure, surgeons removed the tumor and the cells around it — however, it also was necessary to remove about 5% of the right lung, the nerve that controls the right side of the diaphragm and part of the pericardium (the fluid-filled sac around the heart). Because the tumor had grown around the superior vena cava (a vein that carries blood from the upper part of the body into the heart) part of the vein was removed, and the remaining portion of the vein was grafted together.

A lifesaving decision is made

As Clowe recuperated in ICU, everything went fine at first. But on the sixth day, the vena cava graft stopped up. Rice decided to replace the clotted graft with a larger one that created a direct connection between the jugular (the vein in the neck that brings blood from the head to the heart) and the heart.

Unfortunately the second graft also clotted. Because of swelling in Clowe’s face and upper body from the vein blockage and the fact that his right diaphragm no longer worked, he couldn’t breathe on his own and required being on a ventilator (automatic breathing machine).

Rice felt a third graft would not be likely to succeed. Instead, Clowe’s body would have to grow new blood supply capillaries to allow blood from his head and chest to return to his heart. He was placed on a ventilator and sedated so his body could begin this process.

Tale has a happy ending

For two months, the ventilator breathed for Clowe as his body healed and grew the necessary veins. When the process was complete and his swelling had lessened, he was allowed to breathe on his own. His wife, Jan, stood beside the bed waiting for him to regain consciousness.

“As he began to wake up, the first thing he said was ‘Kiss,’” she says. “He wanted three kisses. My sister was there and just started crying. My daughter was beside the bed too, and she said, 'I want to find someone who loves me that much.' ”

Now recovered and cancer-free for more than two years, Clowe plays lots of golf and drives to Texas occasionally to visit relatives and catch some high school football.

“I still can’t play golf on the mountain ranges yet because the high altitude makes it hard to breathe,” he says. “But I can play in Cabo San Lucas, Mexico, and I can play in Austin. I’ve made a deal with Jan that she won’t worry about me.”

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© 2015 The University of Texas MD Anderson Cancer Center