Tag Archives: surgery

All The Details

Published / by Kim / 4 Comments on All The Details

Hello, World! Yesterday, I checked out from you, but I’m back today. The Wallow Day is over and now I’m ready to get on with my life again. The Wallow Day included a complete break from the world, a box of Magnolia cupcakes, and games all day. Days like that allow me to hang on to my normally not-exactly-sunny-but-at-least-I’m-not-killing-myself-or-others disposition on other days.

Now that my outlook is feeling refreshed, I thought I’d share some of the details of the tumor and the upcoming surgery. It’s not particularly gory, so probably it’s fine even for the squeamish. Though consider yourself warned that I’m going to talk about “organs” and not the kind that might make you giggle.

I’ve been fortunate in that if you have to have cancer, I have the kind of cancer you should choose. The tumors of the past, while malignant, have always been non-invasive. As far as cancer goes, non-invasive is definitely what you want to hear. My oncologist did extensive staging during my first surgery in 2003 and discovered smaller tumors in various other non-girly part places, such as on my liver. Because of this, the cancer was staged as IIIA. Anyone who knows anything at all about ovarian cancer knows that stage IIIA is pretty much a death sentence if we’re talking about invasive cancer. For non-invasive, it means a lot of surgery, but not even chemo or radiation. On the one hand it sucks because the only treatment is keep cutting till there’s nothing else to cut out, but on the other hand it totally Does Not Suck because of the whole “I’m not going to die” part.

The type of tumors I’ve had are, according to my oncologist, unlikely to change into the type of tumors that are invasive. However, the most recent CT scan does show a spot behind my bellybutton that has the characteristics of an invasive tumor. The possibility of it having changed to invasive cancer is supported somewhat by some strange biopsy results after my second surgery, which showed that tumor had micropapillary patterns. Micropapillary serous tumors have a slightly higher risk of changing into invasive cancer. The risk is still very low, but it’s definitely elevatyed. However, given my history of recurrence, with it always being non-invasive, Dr. Firm Handshake feels pretty confident that it’s non-invasive this time just like the previous three times.

There will, of course, be frozen section biopsies in the OR as well as a more detailed biopsy following surgery. Dr. Firm Handshake is also going to conduct a thorough search of the house and grounds to try to find anywhere additional cancer cells may be hiding. Because of said thorough search and mostly because of the size of the tumor – 28cm is 11 inches for those of us who don’t use that mainstream metric system – the surgery could go on for a while. My internal organs are being squashed and shoved aside right now and there’s a very high chance that the tumor is adhering to several of them. Each of them has to be separately handled and detached from the tumor.

The tumor itself needs, if at all possible, to be removed in one piece. We can all use our imaginations to think about how Not Good it would be to have a tumor rupture and spill its contents all over the inside my pelvic cavity. The care needed to ensure its removal without rupture is something else that could take some time. Apparently this is also going to need a bigger incision than the last three. This I find shocking, because the previous three incisions already seemed huge to me. Bigger than 7 inches? Seriously?

This brings us to the part that makes me uncomfortable. Dr. Firm Handshake believes the post-surgical pain for a procedure so involved will be considerable. So much so that he plans to completely bypass messing around with a morphine pump for post-surgical pain management and instead I’m going to have an epidural put in before the surgery. That will remain in place for… I don’t know how long, but long enough that after the surgery they can just use the epidural to numb me for a while.

I must confess to you, Gentle Reader, that scares the crap out of me.

Scott and Dr. Firm Handshake were both kind of stunned when I said the epidural scares me more than the surgery, but it does. I know women have them every day but they’ve always terrified me. I’m trying not to even think about the fact that he thinks the pain will be so bad that I’ll need one. That makes me worry about what will happen when the epidural is removed. I suppose I’ll worry about that when the time comes, and that’s why they make Percocet, after all.

So now we should be all up to date. March 30. Shit’s gonna get real, son.

Final Pathology Report

Published / by Kim / 6 Comments on Final Pathology Report

First, let me say thanks for all your comments and good wishes. I usually reply to some comments by email, but something seems to have happened somewhere and I’m not getting comments sent to me by email*. But I’m reading all your comments and really appreciate them.

On Thursday, I went back to the doctor so he could check the wound.  While we were there, he discussed the final pathology report with us. Surprisingly to him, the cysts were not cysts and not benign. They were, in fact, a recurrence of the borderline tumors. No one was more shocked than my oncologist, because the growths he removed didn’t look like the previous tumors and the frozen section biopsied in the OR came back benign.

This is actually the second time the frozen section came back benign only to have the complete biopsy show a different story. That’s a fluke, of course, because the frozen section is taken at random, and it just happened that each time they took a section that contained benign tissue. The implications of this are dire for me if I have another recurrence, though, because next time, he clearly can’t trust the frozen section and has to just proceed as if it’s a return of the cancer. That means this was my last shot at preserving my ovary. Next time, it comes out, no questions asked.

And the thing is, since this is the second time this has come back, there’s a very high risk of it coming back again. To complicate matters, there was some ambiguity in the wording of the report. My original tumor – removed in March 2003 – was a serous papillary tumor, which is a borderline malignant tumor with a practically nil chance of turning into invasive cancer. The second time around – September 2004 – was the same type of tumor. This time, however, the pathologist wrote “focal micropapillary tumor.” (I may not have that exactly right, but it’s what I recall.) Apparently one of those words – focal or micro – means it would be the same type of tumor as the others, more or less, with an extremely low chance of becoming invasive cancer. The other word is a problem, though. (And I can’t remember which word he said meant which, and Scott and I each say the opposite.) The doctor said that recent studies have shown that borderline tumors with the other word have a much higher risk of recurrence and a higher risk of turning into invasive cancer.

So the fact that both words were used confuses the issue. He was presenting my case to his board yesterday and will be discussing it with the pathologist to get more information. He thinks the pathologist was just being extra descriptive, but is trying to get it cleared up so we know what’s what. Obviously, one type of tumor would require a lot more monitoring for me than the other.

He’s pleased with how the wound is healing, though, so that was a bright spot. He and the nurse seem to believe that it will be completely healed in just a couple of weeks. I find that difficult to believe, since it’s still so big, but I’m sure they know what they’re talking about.

*One of these days, I’ll get around to looking into that.

How about an update?

Published / by Kim / 8 Comments on How about an update?

This has been a really diffcult recovery, which is why I haven’t really posted since the surgery. Today, I’m feeling well enough to sit at my desk long enough to post, though, so it’s time for an update.

The surgery was on December 17 and it went really well. It only took about 2 hours, which is fantastic. (First surgery, 6 years ago, was 7 hours and the second, 4 years ago, was 4 or 5 hours, so 2 is awesome.) The really terrific news is that the cysts really were cysts, not a return of the tumors! Dr. Holcomb talked to Scott while I was in recovery and said the biopsies came back clean, he saved the ovary, and we’re clear to do more IVF if we choose. I couldn’t have asked for a better result.

I had a hard time with the IV pain meds the next day and couldn’t keep any of the liquid diet down, but that eased up as soon as they took me off the IV and I started the percocet. Everything seemed to be going great until Thursday night, when I developed a fever. It wasn’t too high, so they gave me some Tylenol and took a urine sample to check for a UTI. That fever went away very quickly. That was a miserable night, though, because I was still on the IV pain meds and feeling so nauseous on top of being hot from the fever.

Unfortunately, that day they took the bandage off and a few hours later I looked at the incision and noticed that it was red and the skin around it was hot, which meant the incision was infected. They started me on IV antibiotics to control the infection, but the red area around the incision kept getting bigger. So on Saturday, my doctor started opening the incision to look for pus, which he unfortunately found. He had to open half the incision to clean out the infection and irrigate the wound. That sucked. Hard. That was followed with several more rounds of IV antibiotics, but I had another fever overnight that night. So on Sunday, my doctor ended up opening up the entire incision and found more infection. At this point, my nice, neat surgical incision had become a 10cm long, 5cm wide, 5cm deep wound. This wound has to heal from the inside, so they put in a wet-to-dry dressing to keep it open and prevent it from closing over and healing with an abscess.

Finally, on Monday, they set me up with a visiting nurse service for home and released me from the hospital. All told, I spent 6 days in the hospital, when I was expecting to spend 3. My doctor also ordered a wound vac, which came a few days later and has been on for 10 or 11 days, though we’ve had some problems with the nurses not setting it up right. (A topic for another post.)

As a result of the huge wound, this recovery has been the worst of the 3 surgeries. Ironic, because the surgery itself was the simplest. I’m still taking percocet for the pain, which is considerable. At this point after the previous surgeries, I was off pain meds. So healing is slow and my mobility is limited and I spend a lot of time reclined, but I’m getting a little better every day. The wound is down to 9.5cm long, 4cm wide, and 2.8cm deep, as of this morning, so it’s healing well. It looks absolutely HORRIBLE to me, but I’m assured by the nurses that it looks excellent. Beefy red is good, they tell me.

Scott’s staying home one more week to take care of me, which is really good, because I still need him. He goes back to work next Monday.

So that’s where I am. How’s your world?

A Dr. K Memory

Published / by Kim / 1 Comment on A Dr. K Memory

Since going back to Dr. H and firing Dr. K, I remembered that I actually met Dr. K before. And I didn’t like him then, either.

After my first surgery, all I could eat was watermelon for a while. My stomach couldn’t handle anything else, but the watermelon was good because at least it kept me hydrated. After the second surgery, however, I was ravenously hungry and eating fried chicken the day after. Even though Dr. H had to repair a perforated bowel the day before. I felt really good and really hungry and I wanted fried chicken, so Scott said screw the hospital food and went and got me fried chicken.

When Dr. H came in and saw me with chicken, he said, “Good. You’re eating!” And that was that. But when he was off duty and Dr. K was making rounds for him, he was shocked. He called Dr. H to tattle on me, that I was eating fried chicken after a bowel perf, and Dr. H just told him, “She knows herself. If she feels like she can eat it, I’m going to let her eat it.”

I didn’t remember this until recently, after I fired Dr. K, but I wonder if it was in my subconscious when I had that consultation with him and was yet another thing that set up that visit to be adversarial right from the beginning.

Less than a week to go.