Quick Surgery News
I made it through the surgery yesterday (Sept. 11, 2007) and got home today. I don't know yet if it should be counted as a success or not. The goal was to track the discharge tract back to the source and elmininate it, which was done. But another goal was to not have to remove all of the synthetic mesh. We didn't achieve that one.
It turned out that 50% of the synthetic mesh was involved. I haven't discussed in enough detail yet with the surgeon to really understand what that means (or if I did, the Dilaudid kept me from remembering what he said). Portions of the mesh had also become detached. So with both the detachment and the involvement, he removed all of the synthetic mesh. This left a small hole which he sutured together, but we know that won't last.
So the current plan is to try to delay the abdominal wall reconstruction until after the first of the year. I don't have enough leave available to go through that this year. He also took cultures to see if there is an better antibiotic we should be using (I've been on the Invanz since the middle of July). We'll keep the PICC line in and continue IV antibiotics for a couple more weeks.
We had also planned on this being outpatient, but, of course, there were other complications (apparently, I wouldn't have it any other way :)). My blood pressure was very low (hypotension). I think the lowest was around 65/38. Which also meant that I couldn't have pain medication for most of yesterday and last night. Additionally, I bled a lot after getting to my room, so my red blood count was also down (the normal value is around 45 and mine was around 26). So we had to wait until that level stabilized before I could be discharged. It's still no where near normal, but it did stop going down as the bleeding stopped.
I'll have more news after my follow-up visits, but wanted to go ahead and get something out. I want to thank everyone for their prayers and support.
Labels: complications, medical, surgery
Surgery, round infinity
So much since the last post....First, some background. In November, 2000, I developed a perforated colonic diverticulum. This required emergency surgery, a bowel resection, and a temporary colostomy. The surgery went okay, but I started my history of complications during the recovery period. My stoma died, and the colostomy was reversed early. We had planned on waiting three months, but had to perform the reversal surgery after about six weeks. What happens when a stoma dies is that the end of the bowel that is protruding through the adbdominal wall basically rots and falls off due to lack of blood supply. It's not uncommon in obese patients, but was still a bit disconcerting when pieces of me started coming off in the shower.Everything went well for quite a while. In 2002 I went to see a surgeon because I was having abdominal pain and my abdomen looked distended under strain. It turned out that I had developed a "giant" ventral hernia. This means that there was a hole the size of a softball in my abdominal wall where the incision from the previous surgeries had been made. Because of the size of the hernia, and the thin wall over the previous colostomy site, I had two pieces of double-sided synthetic mesh implanted. We thought the surgery went well, but I developed a post-operative fever that wouldn't go away. After a week I was back in the hospital undergoing tests. On the day I was due to be released (again) because the tests had all been negative, we discovered a pinhole in my small intestine. Apparently during the surgery something had nicked the small bowel, and it was now leaking into my abdominal cavity. So back to the OR to remove the mesh, because once synthetic mesh is contaminated with bacteria, there is no way to remove the infection. Antibiotics don't work because there's no blood flow into the mesh to deliver them. The treatment for a condition like this is to allow the bowel to rest and heal. In this context, rest means no digestion. So I got my first PICC line and started on a couple of months of TPN instead of taking any food or drink by mouth. This was all actually not nearly as bad as is sounds (or as bad as it sounded at the time). So six months later (February, 2003) the hernia repair was redone, this time without complication.Then everything was quiet for a while. I had a very minor sinus surgery to alleviate some recurring sinus infections, but it was simple and really helped a lot. Then in early 2006 I started having pain in my shoulders and elbows. It was getting so bad that I was afraid to drive. I went to an orthopaedist, who diagnosed a herniated disc. As part of the diagnostic process I had an MRI. This was the test that found the thyroid cancer, which I've talked about already. At this same time, our cat of 18 months decided she really didn't want to live with us any more and bit me. The bite got infected, which required four days in the hospital, another PICC line and two weeks of antibiotics.The treatment (surgery and radioactive iodine) for the thyroid cancer (papillary carcinoma) all went well, and I haven't had any problems.Now back to the present...In March, 2007, I had surgery to repair two new hernias and remove my gallbladder. I've had some gallstones for a while, and though they weren't causing a lot of trouble the surgeons wanted to go ahead and remove it before there were problems especially given the large synthetic mesh that I have. One of the new hernias was around the edge of the mesh, and the other was were the mesh had detached from the abdominal wall. Instead of synthetic mesh, this time a new product called AlloDerm was used. This is basically connective tissue harvested from cadavers. It has advantages over synthetic mesh, especially in patients who have had more than one hernia. The surgery went well, and I was out of the hospital quickly. Of course, this quick recovery was too good to be true. As the wound healed I started developing fevers, and we discovered an infection. Antibiotics would knock it down until the wound closed up again, and it would start over. To break this cycle, I had another surgery in May, 2007. In this one, the wound was reopened and the cavity was flushed. Also, the wound itself was not closed, but was left open so that it could heal from the inside out. Everything seemed to be going good for a while, but of course there were more complications.The wound never healed completely. The discharge continued, and after a CT scan we found pockets of infection. At this point, the surgeon feared that the old synthetic mesh had gotten contaminated. As a first step, I got another PICC line. So now I've been on IV antibiotics for over a month, and the discharge still hasn't stopped. I've now got another surgery scheduled in a month to do another "wound exploration and debridement" procedure similar to the one in May. This time it will be more aggressive, going all the way to the mesh, and he may even remove a small portion of the mesh if it appears that the infection is originating from there.The hope is that this will finally resolve the infection, and everything will heal. If not, and the mesh is still contaminated, it will have to be removed. It is very large, about 8x11 inches. Removing any mesh is not easy, but for something this large it would effectively be taking out my entire abdominal wall, and would require extensive reconstructive surgery. But more on that later....Oh yeah, it's also time for the radiation follow-up. I'll be having another scan a couple of weeks after the surgery, but all tests so far have been negative for any recurrence. At least that's still going good.Labels: complications, medical, surgery
All Clean
Well, I've made it through the surgery, radiation and body scans. Some time I'll post more details to help others (particularly men, since they're very under-represented in thyroid disorders). For now, a quick summary will have to do.
The recovery period for the surgery was harder than I expected. The radiation therapy itself was really no big deal. The hard part was the preparation: 6 weeks without any thyroid hormone at all. My TSH level was over 60 a week before I got the low-dose radiation for the first body scan (a TSH level of 3 to 5 indicates a hypothyroid condition). I've never been so tired for so long. I resumed the thyroid hormone at 100 micrograms after being released from the hospital (the high-dose radiation is done inpatient). After a month at that level, I finally got a dose adjustment to 250 micrograms. Gee, think maybe that explains the fatigue?!?
I also had two very successful full body scans. The first was done with a 2 millicurie dose of I-131 (radioactive isotope of iodine). The second was done utilizing the residual radiation from the high-dose (150 millicuries) treatment. They both showed that there were no thyroid cells anywhere else in my body. That effective means that I'm cancer free.
I'll have to follow-up in 7 weeks for a thyroid level check. They will be checking to make sure that my TSH levels are low enough (indicates a sufficient hormone therapy dosage) and that I don't have any cells anywhere producing thyroid hormones on their own (which would be an indicator of cancer recurrence). Around the 1 year anniversary of the radiation therapy, I'll have to have a radiation follow-up. At least this one won't require the month-plus weaning period, so I should be physically much less affected.
Labels: medical, surgery
Well, today's the day. I go in for a total
thyroidectomy. I had been having pain in my arm which led me to an orthopedic surgeon. He diagnosed it as a cervical nerve problem. He ordered a
MRI to confirm the diagnosis and pinpoint the location. On the MRI they spotted a mass on the left lobe of my thyroid gland. An
ultrasound showed that it was not a cyst (if it had been, then it would have been known to be benign). Off to my "regular" surgeon, who performed a
needle biopsy (they insert a large needle through the skin into the mass under ultrasound and suck out bits). The needle biopsy
pathology report came back as "highly suspicious" with two types of possibly cancerous abnormal cells present. If the biopsy had been benign, they would only have removed the one lobe, just to make sure that it didn't enlarge in the future and cause difficulty swallowing or breathing. But the suspicious findings indicate a removal of the entire thyroid gland. This means synthetic thyroid hormone therapy forever. In addition to the normal possible complications present with any surgery, this one has some added bonuses:
- Possibility of damaging the laryngeal nerve that goes to the voice box. If damaged, it causes a hoarse voice, likely permanent.
- Possibility of damaging the parathyroid glands. These are small glands just behind the thyroid that control calcium absorption. If damaged, calcium isn't absorbed efficiently resulting in the need to take large doses of calcium supplements, again forever.
- Possibility of traumatizing the parathyroid glands. This is a little more common, with the effect of needing the calcium supplements, but only for a limited period of time.
- Bleeding is more dangerous. Unlike the abdomen which has a large cavity for any internal bleeding to enter, the neck is a small enclosed space. Internal bleeding there builds up and constricts the airway.
The current tentative diagnosis is
papillary carcinoma. This is a very survivable cancer, with a long-term mortality rate not too much different from the general population. The actual final diagnosis can't be made until the
full-tissue biopsy of the removed gland is performed. If it does come back as cancerous, there will be treatment with
radioactive iodine. The thyroid gland has a large affinity for iodine. So the iodine will be absorbed by any leftover glandular cells that either weren't removed (it's not possible to get every cell) or that have migrated anywhere else. They will also be able to detect (via the radioactivity) if there are any cells which have migrated.
All in all, I've been pretty okay with it. I know intellectually that this is not a rare condition and that it has a good long term prognosis. But it's still difficult to not be weirded out about having the dreaded C-word somewhere in my body. I also worry about being able to get health or life insurance if I change jobs. That's in addition to the worry about causing anxiety in my wife, my kids and my family.
Labels: medical, surgery
