Monday, June 7, 2010

Waiting, Waiting, Waiting ....

Yes, I am waiting ... one of the hardest things to do when associated with the diagnosis of cancer.
 My wide excision and reconstruction and sentinel node dissection and excison is completed. I did fine. I was of course nervous about it never having had a general anesthetic before. My blood pressure was 174/70, a number which has quite a high systolic compared to my recent blood pressure control (since I retired). This was a sign of my anxiety. The nurse was worried about my blood sugar because it was 65, a little on the low side. I had been increasing my insulin to handle my sugars in conjunction with a reinstitution of prednisone for a vasculitis which relapsed now as well.
I took a book to the day surgery suite because I had been told that the nuclear medicine procedure that identifies the sentinel nodes takes about an hour and a half and I pictured that I would be sitting and waiting for this radioactive tracer to go up my arm to the node basin in the axilla. Yes one does wait but that occurs lying down under a camara. And the wait was only about 1/2 hour. Then they saw the nodes light up and marked them. So the whole nuclear procedure took about 1 1/2 hour but there was really very little down time which would allow reading -- only about 5-8 minutes while I sat in a wheel chair and waited to be wheeled into the nuclear medicine suite. Once I was back in Day Sugery it was bam, bam, bam -- start the IV, get the venous leg pump wraps on, the electrocardiogram monitor patches on, speak with the plastic surgery resident, speak with the anesthesia resident clarifying my history twice, getting my blood sugar checked one last time, and speaking ever so briefly with my plastic surgeon who came in to sign the left arm as the correct arm on which to do the procedure.
I told the anesthesia resident that I had received 8 mgm of Versed when I had my colonoscopy and never went to sleep at all even with the Demorol. She just commented that they had different things than Versed to use also. Shortly later the anesthesia resident said she had given me some Versed in the IV right there in the Day Surgery room and asked me if I was starting to feel relaxed as they were starting to wheel my gurney out of that little Day Surgery room. I said, "Yes, I feel a little drowsy." And that was the last I remember until it was all over and I started to hear voices around me in the Recovery room and opened my eyes. The nurse said, " Why don't you try a good hard cough; you have been clearing your throat a lot just now." I didn't know anything about that. So you do things and make sounds that you don't recall afterwards. There was a little trouble getting off the oxygen; I was desaturating with oxygen but seemed to be able to remedy that with coughs and deep breaths. I proceeded quickly back to the Day Surgery area. My blood sugar was 150 so that was OK. I recovered uneventfully in the Day Surgery room, got a hydrocodone, one pill for pain at about 130 PM after I was back in the Day Surgery suite for about 1 hour. At home by 3:45 PM and took one hydrocodone at about 5 pm and then another before I went to bed. I slept in two large periods of sleep and took another hydrocodone at about 5 am. I had some sweating from low blood sugar in the middle of the night and had to get up to get something to eat and some juice to drink. After that all I took for pain was two 500 mgm Tylenols for Thursday and then after the dose on Thursday night I took nothing further for pain. The plastic surgeon saw me Friday morning mainly because he had jury duty to do next week Monday through Wednesday and he didn't think he should wait to look at me until Thursday of the next week. He thought I was doing OK also. But he does want me to see an oncologist. I had begun to think about this and realize that the plastic surgeon doesn't want to follow up on this. There will likely be a need for imaging, maybe even CT scans from time to time and the oncologists will order this I think. So that is the likely reason for that follow up.
I wanted strongly to go to my son's home for the weekend because our 3 1/2 year old was participating in a daycare program on Saturday. My husband didn't think I should go and my son on the phone didn't think I should try to ride all the way down to Indianapolis just 2 days post surgery. But I really wanted to go. I was really feeling down and worried on Thursday and I thought that going would knock off 3 days of the wait for the pathology results. I would be with my grandkids even though I would need to rest while elevating my arm and I wouldn't be able to pick up Will at all. But the weekend would pass much more quickly and much more pleasantly. It wouldn't be possible to worry as much as when just sitting nursing my arm at home. That's what we did and I am glad that I did go. Enjoyed seeing Sam perform; he was put in the lead of the small group of children just as last year. I am sure that the teachers do this because they know that Sam takes instruction well and he will do exactly as he is supposed to do. When I am with those two little kids, I am not obsessing and I am reasonably at peace.
Now it is Monday I am back home and back to waiting. I probably won't know the results until Tuesday. Usually it takes 5 working days to get the pathology readout. I am worried about the sentinel node because the path report on the shave biopsy says that it was at least a Clark's Level IV. But this doesn't make complete sense because the depth of the shave was only 0.48 mm deep so how could they determine it was a Clark's Level IV. That level is usually 3 mm deep. I don't quite understand this even as a doctor and my son the surgeon didn't understand it either.
I keep imagining the call about my results. I imagine hearing the first words saying there is good news, the nodes are clear. Or I imagine hearing the worst that there is cancer in those nodes. Then I will have to proceed to complete lymph node dissection under that arm, a procedure that will I assume carry more side effects and more risk of post surgical lymphadedema as a long lasting complication. Also I think I would also likely be recommended to have Interferon as a immunotherapy for a year which can also produce a lot of side effects. I really dread both of these possible needs. I really am having trouble getting these vascillating thoughts out of my mind. Periodically I reach some kind of equilibrium with the statement: "Hoping for the best; preparing for the worst." Concentrating on this provides some degree of relief in my obsessional thoughts. Does everyone go through this when they have had a biopsy? Am I just a worry-wart, or overthinking the whole process like my son says I am? Or is this a function of my being a doctor and knowing too much? I just know that it is the hardest thing that I am having to go through, much harder than the pain and morbidity of having a surgical procedure.

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