“It hit me like a bolt from the blue,” says one patient. He still remembers exactly when lightning struck: On August 22 of last year, his family doctor called to come over immediately – the blood work done a few days earlier was catastrophic. He had only been to the doctor “because I thought I had a small gastrointestinal thing”. But now there was an ultrasound scan, followed by a heavy thunderstorm: a tumor on the pancreas.
Almost nine months after the diagnosis, Hubert Schneider is sitting (name changed) in an office in the Neuperlach Clinic, still a bit thin and transparent, but overall in a good mood. He’s had chemotherapy and surgery, and by all accounts he’s now cancer-free. A second chemo will follow in a few weeks, just to be on the safe side. The fact that the therapy has gone so well so far is partly due to the fact that the tumor was discovered at a very early stage. And on a special treatment concept in Neuperlach that the three physicians Natascha Nüssler, Mia Kim and Eva-Maria Jacob developed for their oncological patients.
Neuperlach is home to the largest colon cancer center in Germany. Many patients are old: “The disease peak of most cancers in the gastrointestinal tract is after the sixth decade of life,” says the surgeon Natascha Nüssler. Therefore, many patients are in a poor general condition at the beginning of therapy: malnourished, frail, suffering from sarcopenia, that is the loss of muscle mass. Based on the certainty that a physically reasonably robust person survives a tumor operation better than a weaker one, patients in Neuperlach are subjected to what is known as prehabilitation, aptly summed up in the catchphrase “rehab before the operation”.
Neuperlach is home to the largest colon cancer center in Germany. Many patients come here in old age and are first thoroughly examined here.
(Photo: Lorenz Mehrlich)
For this purpose, all bodily functions of the patient are first examined, especially with regard to nutrition, blood count and muscle condition. In terms of diet, they all lost weight to extremes because they stopped eating or couldn’t digest food properly. This is where Eva-Maria Jacob comes in, she is a nutritionist. “It’s not like the patients are no longer allowed to eat a lot of food,” she says. “But you have to know what you need and how to deal with it properly.”
Hubert Schneider, for example, gave in to his appetite for white sausages some time after the operation – and that didn’t do him any good, his stomach rumbled terribly. Eva-Maria Jacob then explained to him that white sausages are very fatty. The pancreas makes an enzyme that helps digest fat – normally. Hubert Schneider lost this ability as a result of the operation. So if he gets crazed again, he would have to artificially substitute the enzyme.
Minerals, vitamins and a bit of exercise make patients healthier
The doctors can see what else is missing from the patient’s blood count. Often the iron. Because this is needed for the production of red blood cells, anemia results, which in turn can mean that larger amounts of blood have to be transfused during the operation, which is always associated with risk. Such deficiencies – as well as those of other minerals or vitamins – can be quickly treated with dietary supplements. Finally, the state of the muscles shows how much the patient is physically capable of: a bit of sport is part of the pre-habilitation, it can range from simply going for a walk to going to the gym.
Hubert Schneider says he didn’t find it difficult to train, he’s played sports all his life. Well, he used to ride his bike 100 kilometers – now he just goes for a walk. “But that can be expanded,” he says. “A little faster with Nordic walking, and maybe jogging again at some point. That’s the goal.”
Mia Kim heads the colon cancer center in Neuperlach; Like Natascha Nüssler, she is a surgeon – and gives her profession a rather bad report: “Some surgeons tend to focus exclusively on the surgical technique. The great thing about our concept is that we look at the patient holistically.” Obviously with success: Prehabilitation patients suffer fewer complications after the operation, they need less painkillers and get out of bed faster. Just like Hubert Schneider at the age of 74. But now he has to go, practice with his band, he plays guitar, banjo and ukulele to country folk and bluegrass. “When we have the next performance,” he calls out to his doctors as they say goodbye, “I’ll invite you all.”