My latest PET Scan, performed Oct. 19, showed that the small mass in my abdomen, previously the size of an olive, had grown to the size of a quarter and that it had gotten even brighter, indicating an increase in activity. Time to take action, right? That’s what my new oncologist felt, and she had previously recommended a conservative wait-and-see approach. How could I protest this time?
Target: Mass in Mesentery
Off to the surgeon, off to Carl Westcott, Assistant Professor of Laparoscopic and Bariatric Surgery at Wake Forest University Baptist Hospital in Winston-Salem, North Carolina. The target of Westcott and his team was located by the two CAT and two PET scans (the latter actually combinations of both PET and CAT procedures) in the mesentery, a web of tissue linking the organs of the abdomen, which also happened to be in the blood supply for the small intestine.
Was this mass evidence of the reoccurrence of lymphoma, cancer in the lymphatic system, for which I had been treated extensively in 2002? Was it evidence of cancer in one of the nearby organs such as the small intestine? If so, why had the two PET scans failed to show the possibility of cancer in these organs? Or was it a response to infection, infection generated by the chronic condition known as diverticulitis, a problem in the intestines which had first been spotted in me during a procedure known as endoscopy in early 2002?
Envisioned as Diagnostic Procedure
Whatever the findings, it was unlikely that the surgery would include the cure for my problem. No, the surgery was always envisioned as a diagnostic procedure, as what is called a biopsy. As such, it was always seen as a method of finding answers, not a cure in and of itself, and it was always envisioned as requiring the services of a pathologist and his or her microscope to complete the inquiry.
My fear going into the procedure was that the minimally invasive device called the laparoscope would not work. In fact, Westcott himself had first planted doubt in my mind about the effectiveness of the laparoscope the first time I met with him in May. At that meeting, he raised the possibility that the mass, then the size of an olive, might be too small to find using the narrow pointed laparoscope.
Just One Night in Hospital
Now that the procedure is behind me, I’m glad to report that in fact the laparoscope did work. Because it did work, my recovery was quick. In fact, I only spent one night in the hospital –Wake Forest Baptist Hospital, that is. At first, I was shaky and needed to be very careful when I attempted to stand, but the fact is that I was able to stand on my own within about an hour of being moved from the recovery area to a regular hospital room.
On my shaved stomach three small incisions are in evidence. The largest of these—lower left—is just a little more than an inch in length. I assume that this was the entrance point for the initial scope, the fixture for the light source and video camera that are key to carrying out this kind of surgery. I’m thinking that the gas used to inflate the abdominal cavity was introduced using a tube through one of the other two incisions and that the third incision was used for the tool containing the extraction device for removing parts of the mass.
Two Samples Extracted
In laparoscopic surgery, the abdominal cavity is filled with a gas to force organs away from each other so that the surgical team can get a better view of the organs. As for the extraction, the goal of the team was the preparation of samples to present to the pathologists. In my case, two samples were extracted. Together the two samples added up to a large part of the mass itself—this according to an assistant surgeon who spoke to me the day after the procedure.
What are the results? I don’t know at this point. The chief surgeon told my wife that he thought what he was seeing through the laparoscope was evidence of the return of lymphoma, but he acknowledged that he could not be sure and that no one could be sure without detailed pathology studies. And so why am I not including the results in this posting? Am I being coy?
No Preliminary Pathology Report
Herein lies the most disappointing part of the whole story. Harriet and I had been led to believe that we would be presented with a preliminary pathology report at the time of the laparoscopy itself, but that didn’t happen. The surgeon gave my wife his supposition from his observation, but that is as much as we got. The pathology report is still awaited. In the next posting I will be reporting on its findings.
As I’ve indicated, I made a rapid recovery from the procedure. Only one night in the hospital after abdominal surgery—that’s pretty impressive, I think. The value of minimally invasive surgery is hard to dispute, but I would be remiss if I did not make clear that this surgery was not without its side effects. I had three. Two of the three were related to the process of being sedated for a period of three hours. The third was the result of taking a particular painkiller and also the discomfort to be expected from abdominal surgery of any kind. Two of the three had to do with elimination functions. The other had to do with having a breathing tube stuck down my throat.
One last observation. I found it very interesting how the incisions from laparoscopic surgery are put back together. No stitches. No staples. Surgeons are now using Superglue to close up such wounds. Anyway that’s what one of the nurses told us, and it explains why my small incisions are so bright and shiny. Superglue for surgery—that amazes me.
To reach the author of Mind Check, write Stephen.saft@gmail.com.
Copyright © 2007 by Stephen Alan Saft
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