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Saturday, June 17th, 2006

Post-Op

Thursday morning got to be quite hectic. Without going through the sequence as I figured it out, the consulting radiologist and my oncological surgeon had gotten together and decided to change my procedure. Unfortunately, everybody involved thought that somebody else was going to call me to let me know, and I had a last minute change to adapt to.

I had thought that I was slated for a general anesthesia procedure, where the surgeon would slice me open and remove the offending lesion. The revised procedure was to use only local anesthetic and extract it with a probe guided by ultrasound. Fair enough – it sounded less invasive, safer, and probably would have faster recovery. Plus I could drive myself home. The big downside, which really amused the scheduling assistant when I complained about it, was that I wouldn’t get the opportunity to have gory photos taken that I could post on my blog. See, Readers – I try and keep your interests in mind!

One thing that struck me as strange was that, when the scheduling assistant was giving directions for where I was to go, she was really vague when I asked about the sign over the desk where I was supposed to check in. When I got to the building and rode up to the second floor, I saw why – it was the Women’s Imaging Center. And she was right – they were expecting me. At least, while I was waiting to be checked in, there was a very well picked over newspaper lying around – the only remaining section was Sports!

I may have cracked a huge secret, guys. If you want to be pampered, to have a small crowd of women hovering over you, fetching pillows, offering juice, explaining everything as you go along, and laughing at your feeble jokes: go get treatment at a women’s center! It got to the point where I was unnerved. I made the observation that I was used to more brusque treatment, and they just laughed and hovered some more! It was pretty cool.

On to technical details. I lay down on my back for the initial ultrasound examination. At this point, I discovered that the lump seemed to have gotten bigger again – by my probing fingers, it seemed a good 3 cm wide by 1½ – 2 cm. Worse, we had trouble discerning the boundaries of the lesion on the ultrasonic display. I could see the whole thing on the display. While we were doing this, the doctor asked about the history on this lump. I ran down the list – PET scan, needle biopsy, MRI. She was interested in the biopsy, and from my description she said it sounded like a fine needle biopsy, and she didn’t seem surprised that it was inconclusive. I questioned the doctor about the size, and whether she would be able to remove the whole thing. She responded that if it had been smaller, she could probably had removed the entire lesion but, as it looked, she thought she could get 50% of it. This disappointed me – I was hoping that this was going the end of the entire episode, other than an after action report. The doctor said that we would definitely be getting a large enough sample size to conclusive identify the lesion.

I was pricked a few times as local anesthetic was injected into the area, which didn’t burn the way I recalled, but seemed to numb everything up, and I didn’t feel a thing as the doctor made a small incision and inserted the probe. There was some pushing and twisting, and soon enough I could see the probe in the ultrasonic screen. The aspirator was turned on, after they warned me first – they didn’t want me to be startled by the noise. The probe that was being used is known as a Mammotome® probe, and its use is illustrated by this graphic I pulled of the Johnson & Johnson site:
Mammotome® procedure

Poke, suck, cut. That’s the idea. The poking went fine – I didn’t feel it at all. Then the suction started. I felt that – it varied from a gentle pressure to feeling like a small black hole had popped up inside my chest. But the cutting – I felt every bit of that. After the first one, I informed the doctor that I had felt it, and we paused to stick me with more locals. Then she started again, but there was no difference, possibly because the local had gone into my bloodstream, because I apparently bled like a stuck pig afterwards, and the doctor commented that whatever it was, it had a rich blood supply. The noise wasn’t a help – the cutting edge was apparently on a ratchet. I held up through it for three or so more cuts, then observed aloud that the pain was getting a little intolerable. I was trying hard not to flinch or move at all, and I got about the same reaction as I had from that PA at Camp Mackall, so long ago, when he was dubiously stabbing his thumb into my foot, telling me and everyone around that there was no way the bone was broken, when an x-ray would later show I had a complete fracture of the third metatarsal. (I’ll always remember the x-ray tech at the hospital at Fort Bragg, coming out with a hand of films to the five of us that had been driven over – “You’re fine, you’re fine, you’re fine, you’re fine, you can all go back – and you,” turning to me, “you’re not going anywhere.”) It’s not that I don’t feel pain, it’s just that early in my military career I made a point of learning how to endure it silently. I always figured that one day it might save my life, or better yet, the lives of my buddies, if I was grievously injured while we were trying to, say, sneak up on an enemy position, or trying to elude some soldiers who thought that stabbing a hiding place with their bayonets was a good enough search. Most of you would probably consider it macho bullshit, but Those Like Us know what I’m talking about. (Catch the Gardens of Stone reference?)

But that was it. The doctor announced that she was finished, although I could see from the ultrasound that there was still a good bit remaining of this abnormal growth that had formed in my body remaining. I’d like to say that I pressured her into going for taking more of it out, but in truth, I’d had enough. I was wishing then that they hadn’t changed the procedure, and that I had gone under and they had got the whole thing out, but it was a bit late for my input. Now that I think about it, I kind of resent that. I’m fairly certain that I’m going to have to go under the knife again.

Then the probe was withdrawn, and I had to wait through a lot of sissy-ass treatment for my bleeding. They had gotten me on a roll, chatting me up and admiring any bravado I showed, while a little bundle of gauze was pressed on the tiny hole, and I had to go wait in the post-op room for another half hour because the doctor was “concerned” about blood loss. Overall, they were really polite and considerate, but it just wasn’t the treatment I was used to, and it left me with a longing for the “deal with it, soldier” attitude to which I was inured.

I should have the results of the biopsy by Tuesday.

Posted by Greg in Melanoma, Posts About Me

2 Comments »

This entry was posted on Saturday, June 17th, 2006 at 13:59 PST and is filed under Melanoma, Posts About Me. You can follow any responses to this entry through the comments RSS 2.0 feed. Both comments and pings are currently closed.

2 Responses to “Post-Op”

  1. Nancy (from Boston) says:

    Greg,
    it sound like you are more than an ideal patient. I do not understand why they did not give you some IV sedation, that can really take the edge off. If you arrived to your appointment thinking you were going under GA, then you must of not had any food or drink for 8 hours. Next time they change the ‘plans’ demand some IV sedation. Its in all of the Radiology departments. Yes it takes a consent, and a few other minor questions but what the heck to endure that type of procedure with out any thing but local is crazy or just plane cruel.
    I hope the big biopsy give the docs the answers they are looking for and know I am hoping for a negitive results.
    take care
    nancy robbins (mri tech)

  2. Greg says:

    lol!

    Don’t you know that Pain Builds Character?

    I normally turn down sedation during locals unless I have to lie in an awkward position for an extended period of time, when the muscle relaxation is desirable. Plus, I like observing what’s going on.

    I can’t say that the locals were insufficient because the mass was unexpectedly blood-rich. Wouldn’t that just carry away anything injected into the site?