Wednesday, June 10, 2009

Diagnostics - continued III

May 8
Back home from second biopsy. They got a lot of good tissue for analysis. Worn out and going to sleep in front of a movie. More details later.

May 9

So Thursday I had a second biopsy surgery. The reason for this is simple. They could not get a definitive diagnosis from the tissue taken durring the original procedure. Nothing my surgeon did wrong, just bad luck on what he collected. This time it was performed at the NIH. The surgeons worked closely with the Lymphoma team and the pathologist to develop a surgical plan that had the best chance of getting a good enough sample from the tumor for a definitive pathology/diagnosis. They decided to go through the same incision but lenghthen it and remove some cartilage from between the ribs for better exposure. It was definitely a more invasive procedure. If the first one was like getting stabbed, this second surgery was like getting stabbed with a wooden stake. I spoke to the surgeons in recovery after it was completed and they and the pathologist were very pleased with the tissue that was recovered. They indicated that they collected samples from at least three different areas of the tumor. In fact they communicated with her while I was on the table in just in case they had to take a different approach and go in from the side (thorochotomy).

The recovery was most definitely reflective of a more invasive procedure. The original surgery was an outpatient procedure. I showed up at 11:00; surgery at 1:00, and by 6:00 I was on the way home. This time they sent me to the ICU to recover, and kept me overnight. And it was a LONG night. The pain was significant, and they had me on a continuous morphine drip plus an on demand pump I had a button for. That pump would give me a dose every 6 minutes if I hit the button and I was watching the big clock on the wall to make sure I hit that button on the minute.

The real dificulty in recovery began when my catheter (sp) fell out. I discovered last time that IV narcotics make my bladder clamp down, so even if it's full, it won't release. So not only did I have the discomfort of the surgery to deal with, but I could barely pee, adding a second discomfort. At some point after midnight it got bad enough that I agreed to let them put in antother catheter. My night nurse tried, with no success. Then some of the back up ICU staff tried, also unsuccessfully and with a bit of bleeding as well. At this point they paged the surgeon on call (NOT the one who had done the procedure). He wanted to try again but I had had enough. The first two hadn't worked, and I began to feel like I was working with the "B" team. He went over the various risks of not being able to drain and such trying to convince me but I wasn't having me. Based on my previous experience I told them I wanted to get off the IV morphine and also get on my feet and start walking around. Their way hadn't worked, and I was insistent to try it my way at this point. So they turned off the continuous morphine drip and let me up to walk around. I had a LITTLE success afterwards, putting out a small amount. It wasn't close to empty but it got me a small amount of relief. The nurse wanted me to try to fill her beaker but I told her I was lucky to get anything out, and my comfort was gonna take precedence over her record keeping.

At this point I tried to get a little sleep. The problem now became all the alarms they had me hooked up to. My oxygen saturation sensor kept dipping below 90% which would trigger a bell. I suspected it was not working great, but it could have been my depressed breathing from the morphine so it was hard to tell. Every time I would get close to a cat nap the thing would go off. At one point they put me back on the nasal oxygen. Then the monitor dropped below 80 and I knew something was wrong with it. The nurse changed it and, surprise, my oxygen saturation went back over 95% and stayed there for the duration.

Around 7:30 they finally took out the morphine drip for good and disconnected me from the IV. They switched me to percocet for pain. I had been really laying off the pump for most of the night since I know it was contributing to my bladder problems. Now I was able to get up at will and wallk around, but was still barely moving any urine. When my surgeons came by in the morning we discussed the situation and he indicated that at some point they would have to look at retrying the catheter if things didn't improve. At least there would be a urologist available now to handle it since the nursing staff had such a dificult time of it. My belly was really disteded from the full bladder and they gave me a bladder volume test (some kind of ultrasound machine) that showed I had about a liter retained. I was just about resigned to the catheter when things started to move along It wasn't emptying but I was passing enough volume to get some relief. Things slowly improved throughout the mornig and by lunch time I was in pretty good shape. The last volume measurement they did was nominal, about 14 cc's. I wanted to say "I told you so" to the whole nursing staff there.

After that there were some requisite follow ups to do. Surgeon had to remove a small drainage tube from my chest; then a follow up chest X-ray to check the inflation of the lungs. The surgeons were finally able to OK my release around 5:00 pm, but at that point no one could get ahold of the Lymphoma service to OK my release since I was officially under their care. Even at the NIH, government people shut it down early at the end of the week. Around 6:00 they finally called back with the OK. Got discharged with an RX for percocet and was able to hit the road home with my mom. We got some carry out and got back to the house close to 8:00. Ate a little, took my meds and hit the bed exhausted. Tried to watch TV but I could barely keep the screen in focus. Wife and kids came back from a piano recital shortly after 9:00 (inconvenient timing!) so I was able to greet them before I passed out. Slow to get out of bed this morning but I'm starting to feel normal.

Here's the lates incision picture. Like the last one, only bigger.

Second incision

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