In this Cancer Interviews podcast, Hans Rueffert shares the story of how he survived Stage 3B gastric stomach cancer despite double digit surgeries that resulted in the removal of his stomach, jejenum and esophagus. Following the surgeries, he had to go on a regimen of chemotherapy and radiation. Hans, a chef by trade, achieved survivorship, but without a stomach, closely monitors what he eats and how much he eats. Incredibly, Hans Rueffert says he has as much energy as he had, pre-diagnosis, and is an active participant in pickle ball.
Hans Rueffert is a chef from Jasper, Georgia, and says in the restaurant business, stress comes with the territory. So, in 2005, when he experienced acid reflux, blood in his stool, and had trouble swallowing, he dismissed them as occupational hazards. But when he experienced what he thought was a heart attack, he called 911. He had severe chest pains and the left side of his body was numb. Soon he was in the hospital, where he was told his blood oxygen level was that of an infant, and doctors suspected internal bleeding. Further probing revealed a tumor at the junction of Hans’ stomach and esophagus. Subsequent biopsies resulted in a diagnosis of Stage 3B gastric stomach cancer.
As if his diagnosis wasn’t bad enough, Hans was told the five-year survival rate for his type of cancer was around ten percent. He says in 2005, the protocol was to perform surgery, followed by chemotherapy and radiation. The procedure would involve a partial gastrectomy and a partial esopagectomy, the removal of the top half of the stomach and the bottom of the esophagus. The procedure is also known as a gastric pullup.
The surgery was a success. Next up was the chemotherapy, which Hans said “cooked” the junction of the stomach and esophagus, known as the anastomosis. As a result of the chemo and subsequent radiation, Hans developed leaks in the anastomosis necessitating an additional dozen surgeries. Doctors concluded that to stop these leaks, they would have to perform yet another surgery, in which all of Hans’ remaining stomach and esophagus would have to be removed.
Without a stomach and an esophagus, Hans says he can chew and swallow almost anything, but without a stomach, the process of breaking down food becomes more difficult. As a result, he has to closely monitor what he eats and how much because there is less room to store what he has consumed.
Hans Rueffert is able to maintain a healthy diet and incredibly, he says his energy level has returned to what it was prior to his diagnosis. He has taken up pickle ball.
Additional Resources:
Support Group:
The Gastric Cancer Foundation: https://www.gastriccancer.org
TRANSCRIPTION
Bruce Morton: This is the Cancer Interviews podcast, and I’m your host, Bruce Morton. To greatly understate the case, it is not easy to go through life with a stomach and esophagus, but removal of them is part of what it took for our guest to survive gastric stomach cancer. He is Hans Rueffert of Jasper, Georgia. His is an inspiring story, which has him approaching life these days with vim and vigor. Now it’s time to hear that story, and Hans, welcome to Cancer Interviews.
Hans Rueffert: Thank you, Bruce. I am delighted that you asked me. Thanks for having me.
BM: We start all of our interviews the same way, Hans, and that is to learn a little bit more about you. If you would, share with us a bit about where you are from, what you do for work and what you do for fun.
HR: Jasper, Georgia is my home. It has been since I was four years old. My mom is from North Georgia, my dad is from Germany, hence the very German name., although my dad did not want to name me Hans. In Germany, Hans is kind of a joke name. For telling a joke, it is usually Hans and Franz. I grew up in North Georgia, and my family owned a restaurant for 43 years in the city of Jasper called the Woodbridge Inn. So, my sister and I were raised in a restaurant, which was in an old railroad hotel. It was built in the 1800s as a destination for Floridians to escape the summer heat here in the North Georgia mountains. So, from 1975, every single day we were responsible for washing dishes, clearing plates, removing bones from chicken or trout, we were 100 percent restaurant children, and my entire family, that was our life and our livelihood.
BM: Let’s get to your cancer journey, Hans. For all of us who have been diagnosed with cancer, there was that time in which your health went from normal to abnormal. For you, when did you notice something wasn’t right?
HR: I have to tell you, as one in the restaurant business, that it is extremely stressful. A lot of my symptoms were very easy to write off as stress-related. At the time of my diagnosis, I had just been on “The Next Food Network Star” show. I sent for three weeks to live in New York in this very competitive environment, going sometimes from five in the morning until midnight. The issues I was having, I was having a bit of blood in my stool, I was having acid reflux, difficulty swallowing. Every single one of those symptoms, in 2005, stress was definitely a factor in that. The opposite of a hypochondriac a the time, I just thought I was stressed out in a new environment, stressful situation. Fast-forward, after that show finished, I came back, and at the time I was hosting a local news program. One time, coming back from work, I thought I was having a heart attack. I ended up pulling over on the side of the road and calling 9-1-1. I had incredible chest pains, the left side of my body was going numb, I was getting tunnel vision, kind of all of those classic heart attack symptoms, and this was completely new. I had not had any of these particular symptoms before. I ended up in the hospital. They immediately saw my blood oxygen level was that of an infant. They knew that I had to be bleeding internally, immediately did a scope, and found a tumor at the junction of the stomach and the esophagus. They went on to do biopsies, the day before my thirty-third birthday, and we learned I had Stage 3B gastric cancer.
BM: We’re confident you’ll be able to learn some tips and tools to help you through your cancer journey, but first we’d like to invite you to give us a ‘like,’ leave a comment below and share this story with your friends. Kindly click on the Subscribe button below and click on the bell icon, so you’ll be notified when we release our next interview. And if you or a loved one are facing a cancer diagnosis, please click on the link in the Description and Show Notes below to check out our free guide, “The Top Ten Things I Wish I Knew When I First Got Cancer.” Finally, we want to remind you we ae not purveyors of medical advice. If you seek medical advice, please contact a license health care professional.
So, Hans, you have now gotten your diagnosis, and we have learned that each cancer is different in terms of its acuity. When you received your diagnosis, what did they tell you about survival rate?
HR: It wasn’t good. My oncologist at the time sort of put it at a ten percent survivability range. He later confessed that he was rounding up. He was trying to pick a number that was, pun intended, digestable. But in that moment when he said ten percent, I looked over his shoulder and I saw the wall behind and thought that there is ninety percent wall and ten percent door. I am not thinking about the ninety percent wall. I am thinking abut the ten percent door. So, having a number helped me. Some people don’t want to think about a number, and we all process it differently, but for me it was great to have that target and that became my mantra, that I am going for that ten percent doorway.
BM: And I am guessing that what it is next would be your initial surgical procedure. What did this encompass, especially with this tumor being where your stomach and esophagus come together?
HR: Yeah, and especially for younger folks, that seems to be a very common location for these gastric cancers. I am sure you have heard of Barrett’s esophagus. This is where the lining of the esophageal tissue is eroded from acid reflux. At that point, it becomes difficult to differentiate between what is the stomach and what is the esophagus. That’s definitely an issue. I was never diagnosed with Barrett’s esophagus because we found the diagnosis after the tumor had developed, but there was a strong suspicion that had been going on for quite some time. Again, I had had a history of acid reflux, but it had never been scoped. So, the original plan in surgery was to remove the top half of my stomach along with the bottom half of my esophagus and do what is referred as a gastric pullup, where they are taking what is like a velvet drawstring bag and cinching up the stomach and esophagus. That is called a partial gastrectomy, a partial esophagectomy, it’s a successful surgery, it happens quite often, but I will tell you, in 2005, the protocol was to do the surgery first, followed by intense chemotherapy and radiation, and that was exactly the protocol I went through. Essentially, it cooks that new junction, what they call the anastomosis. That anastomosis is very crucial real estate and it is important that that new bond forms and heals, but by bombarding it with radiation, they essentially cooked it. What my oncologist said at the time, if you have ever had chicken at a Mexican restaurant and how it is sort of stringy, that is kind of what happened to that new junction. I started developing leaks in that space and in the course of seven years I had about a dozen surgeries to repair those leaks. I had multiple infections throughout my chest cavity and eventually had a brain infection, which an entire different podcast. That is when they realized so much of a leak had developed that gastric juices were leaking from my half stomach and my esophagus into my lung and bacteria was able to communicate from there to my brain, so I ended up getting a pretty severe brain infection. Once they were able to get that under control, they needed to go in and replumb me entirely. So, after seven years with a partial stomach and esophagus, they had to remove both of them in full. I have to admit I didn’t know one could live without a stomach and an esophagus, but obviously, you can.
BM: As daunting as this sounds, describe what life is like without a stomach and an esophagus.
HR: The most frequent question I get asked is, “How do you eat?” Me, being a chef, food is my life. I am eating or preparing it or more importantly, I am preparing it for other people. Anyway, my smartass answer is, “With a knife and fork.” All digestion absorption happens in your intestines and your stomach is sort of this toxic waiting room that prepares everything you eat, mixes with the gastric juices, the stomach acid, some rhythmic kind of gestations that happen in there and it turns the food into something called chyme. This is something I think all humans should know but are not really taught. The stomach releases small portions of that chyme, which has the consistency of oatmeal into the small intestines in sort of small, truncated batches, so your intestines are getting this food that is ready for absorption. In my case, with the absence of a stomach and an esophagus, they took my jejunum, something I had`never heard of, but it is just below the stomach, and it has the same sort of downward squeeze that the esophagus does, it is called peristalsis. So, as you swallow, there is this rhythmic motion that pushes the food down, and the peristalsis performs the same function as the esophagus. As a result, when I swallow, my food goes directly into my intestines, which leaves me with a truncated, redacted GI system. I can chew and swallow practically anything, but the reality is I am missing that key step of breaking foods down. So, when I look at food, I have to change. As a chef, my previous top five priorities were fat and flavor and presentation, and nourishment might be number four; well now, for me, nutrition has got to be number one. As a chef, I want to make it delicious, I want to make it look good. I still want the joy of eating, but the food must have digestibility, and nutrition has to be at the top of the list.
BM: Hans, I want to take our vehicle and chronologically turn it in reverse and go back to you and chemotherapy. This is never pleasant for anyone, but in your experience, what was the toughest part of your chemotherapy experience?
HR: The toughest part involves eating. You got to eat, yet you are so nauseous during chemotherapy and food tastes so strange, whether it is metallic or off-putting, your appitite is so suppressed and just the idea of eating almost becomes a bit of a phobia. You really get to the point where you dread food, and so someone whose life is food, I suddenly had this love-hate relationship with food, and I would find that I had very small windows. I did Monday through Friday chemotherapy 24 hours, then disconnect the port on Saturday and Sunday. On the weekends I felt better and ate what I could, but half of my stomach removed at the time of my chemotherapy, I couldn’t hold a lot of volume and couldn’t meet my nutritional needs. I was paired with a feeding pump and at first I kind of fought that as a bit of a defeat. I thought not only do I have to do chemo, not only do I have to do radiation at the same time, now I have one pump pumping chemo into my body and another pump pumping nutrition into my gut, into my jejunum, where my esophagus used to be. It was a really down time for me mentally, because not only had I lost part of my anatomy, not only was I feeling sick, not only did I dread eating, but in reality, I think that feeding tube saved my life. Now, when I do peer-to-peer mentoring, and people express this dread about getting hooked up with a feeding tube, I tell them it is an amazing tool that allows people to get that much-needed concentrated nutrition at a time in which we don’t want to be thinking about food.
BM: Now, let’s do another U-turn and turned the direction of our conversation another 180 degrees, in a positive direction. At some point, you must have sensed that things were changing for the better. How did that feel and what was that like?
HR: Let me tell you, through all of these surgeries, there was one point in which I had gone septic, I was in screaming pain, and it was almost like an out-of-body experience. I was in so much pain and they had given me so much pain medication, I was beyond that threshold. I reached a point in which I thought, ‘I quit,’ and I want to die; but the nanosecond that that thought went through my head, I immediately started running away from that thought. I have been running away from that thought ever since. I am sure you have heard these motivational speechy-type platitudes, ‘for every up, there’s a down,’ stuff like that. I felt like hitting that low point was important for me so that I could conclude the only way I am going is up.
BM: And as things turned in a good direction, as your life was attaining as much normalcy as it could, let’s look forward to when things moved in that direction. With chemotherapy behind you, what was your diet like?
HR: Not having a stomach, it is technically different. For the beginning of my no-stomach journey, I kept trying to feed myself the way I used to eat. It was kind of a trial-and-error type thing. I kept a food diary, and finally, this nutritionist said, “Look, let’s think of it this way. You used to be a diesel engine, but now with all these surgeries, you are like an electric hybrid. If you put diesel in an electric hybrid, the engine might work for a time, but it is not going to run at peak efficiency, it is not going to hum along as it should.” I took that analogy and knew I had to learn this machine and figure out what works for me, and for me, it is plant-based protein that works best. I can still eat meat, but in the absence of not having stomach acid, it is hard to break that down. There is a lot of protein in meat, but it is a very complex, kind of a locked protein; so, I eat a lot of things like beans and high-protein grains like sorghum. They are low-cost and easy to digest, high-protein plant foods that check all those boxes. So, for someone who is a carnivore, one who thinks they have to have their meat, I would invite those people to try and change the portion so that meat becomes a small part of the meal and not the focal point. Everybody has a different engine, we all have to be tuned a little differently. So, it is important to keep that food diary, maybe invite friends and family to kind of help you observe the things that give you those highs and lows, surges and spikes and what things give you energy. I am super active guy. I play pickle ball every chance I possibly can, but if I don’t fuel this machine with the right fuel, I will crash.
BM: Hans, before we close, we want to acknowledge an organization that has been of help to you and can be of help to others. If you would, tell us about the Gastric Cancer Foundation.
HR: I was fortunate enough to know the founder, J.P. Gallagher, and I have been with the Foundation since its inception. J.P. was a fellow stomach cancer patient. He and I experienced the same thing around the same time, where when you went on the internet and you tried to look for resources, it was kind of a wasteland out there. It was the case at that time, around 2005, that when you did a web search for stomach cancer, it pretty much took you straight to an obituary. He saw the need for a repository of information. He established this coalition of people from different universities, people who had already been working in the stomach cancer field and we have grown to be a major foundation that provides a lot of patient support, but direct research dollars to encourage young scientists to come into this field. You can learn more by going to our website, https://www.gastriccancer.org
BM: Excellent, Hans. Thanks for a wealth of great information, information about the Foundation and information about your story in which you have overcome so much. Hans Rueffert, thanks for being with us on Cancer Interviews.
HR: My pleasure, and for anybody listening, take care of yourself or if you are the caregiver, take care of your loved one. It is hard to do this thing alone. I really appreciate your having this resource, Bruce. Patients need a lighthouse and your providing this platform is exactly that. I truly appreciate this.
BM: Thanks so much, Hans, and we close we will remind you that if you or a loved one are on a cancer journey, you are not alone. There are people like Hans Rueffert, organizations like the Gastric Cancer Foundation that are there to help. So, until next time, we’ll see you on down the road.
Additional Resources:
Support Group:
The Gastric Cancer Foundation: https://www.gastriccancer.org
SHOW NOTES
TITLE: Hans Rueffert – Gastric Stomach Cancer Survivor – Jasper, Georgia, USA
When Hans Rueffert learned he had gastric stomach cancer at age 33, he had to have half of his stomach and half of his esophagus removed, followed by chemotherapy and radiation treatment. However, because gastric juices were leaking into his lungs, he subsequently had to undergo surgery removing both his stomach and esophagus in full. It was a battle, but Hans achieved survivorship. He has to watch what he eats and how much he eats, but Hans has resumed his life as a chef, and is an active participant in competitive pickle ball.
Additional Resources:
Support Group:
The Gastric Cancer Foundation: https://www.gastriccancerfoundation.org
Time Stamps:
02:27 Hans says at first, he didn’t pay attention to symptoms.
03:46 Symptoms worsened, and while driving his car, he thought he was having a heart attack and went to a hospital.
04:22 A scope revealed a tumor at the junction of his stomach and esophagus, which led to a cancer diagnosis.
05:41 Chances of survival were low.
07:49 Describes surgical procedure, a gastric pullup, followed by chemotherapy and radiation.
09:38 Hans had a problem with his initial surgery, necessitating a dozen surgeries and complete removal of his stomach and esophagus.
10:55 Describes life without a stomach and an esophagus.
14:13 Toughest part of chemotherapy.
16:59 Recalls when his health began to improve.
20:04 Describes his post-treatment diet.
21:45 Advises those diagnosed with stomach cancer to closely monitor their diet.
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