November of 2021 was a difficult month for retired Seattle firefighter, Douglas Hortin, and his wife, Sherri, a former respiratory therapist with UW Medicine. COVID-19 was still a big concern, especially for older people such as Hortin, who was 79, but during that time he also received a cancer diagnosis: stage 3 esophageal cancer.

The diagnosis was especially disheartening since Hortin was athletic and healthy, walking three to six miles each day, plus skiing, hiking and regularly cycling the Rim Trail at Crater Lake. Because he had been a firefighter, though, Hortin was 62% more likely to develop esophageal cancer, according to the National Institute for Occupational Safety and Health. Hortin was a firefighter with the Seattle Fire Department for 31 years until he retired in 2001.

Hortin began experiencing a strange “hesitation” sensation when swallowing, as if food and liquids did not want to easily pass through his esophagus. At first, he went through a battery of heart and lung tests to see if there was a problem that was causing the abnormal sensation. But when that all checked out, his physician ordered an endoscopy.

The test was performed the Tuesday before Thanksgiving. It showed cancer.

With Thanksgiving plans to visit family, the Hortins flew to Minnesota for the holiday to see their son, daughter and extended family. They were anxious and unsure whether to share the news, but when they did, everyone rallied around them.

Hortin started treatment a month later with proton therapy. His team of physicians, including Smith Apisarnthanarax, MD, recommended protons along with chemotherapy and surgery, in part because of his age and the location of the tumor.

“Mr. Hortin’s age was at the upper limit for patients who are candidates for a major operation like an esophagectomy, because there can be complications related to the lungs and heart,” said Apisarnthanarax. “Radiation therapy can increase those risks. Proton therapy provided the best way to reduce radiation exposure to those organs as much as possible.”

That’s because the unique properties of protons — they are particles not rays — allow physicians to plan the radiation dose so it stops directly in the tumor and to control the dose with greater precision. This helped set Hortin up for a successful surgery.

Hortin said his treatment went well. He found his care team kind and attentive, and they understood what he was going through. Both he and his wife gave the team “exemplary marks.”

While Horton’s overall care and treatment experience was positive, he did experience side effects.

He received chemotherapy once a week for three months followed by surgery. Three weeks prior to the surgery, he was so dehydrated from his radiation and chemotherapy that he required daily saline infusions. He also had to maintain his weight with protein shakes — a drink he says he never wants to see again now that he’s done with treatment.

Despite the side effects, he recovered very well after surgery.

“I think his surgeon, Brant Oelschlager, MD, said Doug was one of the oldest patients he’d done this surgery on,” said Sherri. “And it’s thanks to his fitness that he did so well. You have to move, even if it’s not easy — it makes a huge difference.”

The Hortins also attribute Doug’s positive spirit to the positive outcome — he remains cancer-free two years later.

Even though he’s active and quite healthy, Hortin still faces some short- and long-term challenges.

The surgery removed his esophagus and moved his stomach up into his chest. He had a feeding tube for a while that had to be flushed regularly and he had to slowly add new foods to his diet. Moving forward, he will always have to watch the size of his food portions and eat very, very slowly.

“You have to find your sweet spot when it comes to eating, and everyone is different,” said Sherri. “We surround ourselves only with good friends and family, people who are understanding and compassionate. But it hasn’t stopped us from traveling, though we eat out a bit less.”

The couple likes to travel and has plans to go to New Zealand with family in the fall. They hope to continue to hike the many trails of the Pacific Northwest with friends. Their favorite destinations are Mount Rainier, Yellowstone and Minnesota, where their grandchildren live.

“We’re just so grateful to have survived the cancer, and we will take full advantage of it,” said Hortin.

“Doug is very happy that at his age he went through with treatment — if there’s hope, you should do it,” added Sherri.

This story was published by Fred Hutch News Service on June 20, 2024. It is republished with permission.