Tiffany Thinks #10

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Avasarala said:
I'm really curious to see her response after speaking the gynaecologist, I think that may be the most shocking appointment for her. I could see a uturn on wanting the surgery after that appointment.
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This has been my prediction/feeling all along, that she will ultimately decide not to have it, but so far she's proving me wrong by the way it looks lol, guess we'll see!
 
H&N said:
She's more realistic than Matt... she says in 5 years time, cos that's the time you have to go through to be cancer free according to the medical field. In the car, check Amma, she's been crying. She needs to start eating, the plate Matt brought into the living room... I hope that was just for T and not for them both? How can they eat so little;
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I guess what I was trying to say is that I think for Tiffany to be talking about 5 year survival is... ambitious. Just my opinion. She has age on her side, but she doesn't care for herself nutritionally or psychologically.

I felt for Amma, she looked shell-shocked in the car whilst the two love-sick horny teenagers were joking about boxer's eating raw eggs.
 
I don’t think she understands the enormity of this surgery and the fact that she’s going to be in hospital for weeks afterwards and is going to have a long, painful recovery that’s going to take months to heal from and afterwards she’s going to have a very different lifestyle from what she has now. She seems to think it’s going to be over & done with and that the cancer stuff is just going to disappear after this surgery is over. She’s looking at a good 6 months until she’s properly back on her feet again and physically she’s never going to be the same again.
 
I was really hoping that she was going to meet with all the other surgeons when she was in the hospital for the latest examination under anesthesia. Asking to not do those appointments must have caused the surgeon some alarm. Have to wonder if the surgeon will make any change after hearing that - like require a psychiatrist to do a mental health evaluation.
 
AlwaysScience said:
I was really hoping that she was going to meet with all the other surgeons when she was in the hospital for the latest examination under anesthesia. Asking to not do those appointments must have caused the surgeon some alarm. Have to wonder if the surgeon will make any change after hearing that - like require a psychiatrist to do a mental health evaluation.
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she needs it for sure. how can you ask to not see the doctors ? only if you are in a state of denial. the doctors should refuse to do the surgery as long as there are doubts about her mental health. she´s crying already and doesn´t know the whole truth yet.
 
Avasarala said:
Could the surgeon hold off until she's approved by a mental health evaluation?
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Under English law, he'll assume she has capacity to consent unless there's something significant to suggest otherwise. There are rare exceptions to consenting, for example, if Tiffany was to tell her surgeon she simply does not want to know the risks of surgery, but those cases are extremely rare, and would probably take extra time to seek advice from the trust's legal team, as the usual practice is to obtain written consent, especially for such an extremely involving surgery like exenteration.
 
ellyjelly2 said:
With them now having to take the colon out higher ( thanks to WW 🙄) that makes a difference doesn’t it regarding her stoma? Am I wrong in thinking the higher up the bag the more liquid the output? I’m sure I read in here someone saying this.
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Correct. In the colon the fluids are resorbed and the mass thickens. So the higher they make the stoma, the more liquid the output. And also the chance on leakages and other accidents increases.
 
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Agree with all of you. I'm all for being hopeful but realistic. From the British Journal of Cancer Research (2018) in regards to pelvic exenteration for rectal cancer " The prognosis of T3 tumors is much better than T4 [28], where the 5-year survival rate of patients with resected T3 tumors was 65.7% and 39% in patients with resected T4 tumors."

This does include both recurrent and non-recurrent. I think she'd be considered in the middle. She didn't show evidence of disease at one point, but she probably still had some active cancer; however, she does have new cancer growth after treatment as well. I'd expect her odds to be both better and worse - better because she's younger and is being cared for by a highly rated hospital, but worse because of her general frailty and lack of taking care of her body with healthy food and exercise (which at least should be under her control in the future).

Also, we need to remember that we may not know how well the surgery went until the biopsies come back on the surrounding tissue that they leave in. It's called an R0 resection if they find no cancer - they think they got it all. Her chances go up in that case. R1 means there was microscopic cancer remaining and R2 means there was more than microscopic cancer remaining. Obviously, R0 is what they are aiming for, but they could close her abdomen and find that she is R1. Nothing is guaranteed.

She should be hearing all these facts during the doctor's visits but is choosing not to share them with her "family." I do think she's not preparing her viewers very well for the reality of what's about to happen and the risks of recurrence. I can see why so many of her followers think she's going to be "all done" after this.
 
H&N said:
I think the surgeon noticed this, she's still in denial of how life would be after the surgery. That's why he asked how come you are so positive?
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Ah, yes, I forgot about that part, I thought that was really weird. A surgeon asking how you can be so positive, maybe he's seeing that she doesn't really grasp it yet. He's got to have some inclination of her childish mentality after she kisses his hands, has hissy fits if she can't see him and then gives him cuddles..:rolleyes:
 
Oh boy this one was really revealing. Take aways for me:
-I think the surgeon knows exactly when he will have that team ready to go, He is waiting to tell her the date pending her meeting
and agreeing to all the potential components of the surgery. I do not believe with the cancer spreading in her body they are going to
wait until Jan. If they operate it will be no later than mid Dec. unless surgeon is not convinced she is clear on everything.
-Tiff saying she would prefer not to meet any of the surgeons indicates she is still in denial and this lead surgeon is probably very
concerned about this. Everything will be spelled out in detail and consented to in writing. Taking this idiot Matt in there is crazy.
-Amma looked very upset in back seat...she is the most in reality and had to go to Elodie's after the hospital trip. That home will be
her refuge.
-Matt is getting more air time and I find the guy just creepy and frankly his comments are stupid. He really bothered me this time more
than usual. I don't know how Amma can be around him. That banter between them when Amma was running into the store was just gross.
-I think the thing that will be the most difficult for Tiffany to accept is the probability that this may not be 100% curative. No surgeon
will give her that assurance...it is simply her best chance. I don't get the feeling she understands that.
-I think the surgeon is on purpose stringing all these meetings out to give her time to absorb what will happen. He is being very
careful. This must weigh heavily on him as he sees this group.
-WHY in the world are they having to stop at a pharmacy to get pain meds???? It would just be standard protocol to take with you
every time you leave the house.
-I think the gynecologist meeting may well be more than she can handle....I note that one is first.
 
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