A Direct---and Slightly Confusing---Quote

A selected excerpt from the radiologist's report on my latest Pet Scan:

{...}Abdomen/pelvis: Post surgical changes are evident related to hysterectomy and bilateral oophorectomy. Clips are also present related to pelvic and retroperitoneal lymph node dissection. Fluid collection along the left external iliac chain vessels is stable in size measuring 4.8 x 4.6cm, on axial CT image 118. This again is likely related to a lymphocele{...}

Yep, kids. This is what the problem is. If anyone can explain it to me better than it has already been so---which is to say, not well enough to get it through my thick skull---have at it in the comments section.

The More Clarification Update Simply Because I Don't Want to Start Another Post

So, basically the deal is that I have fluid in my pelvis. This is a complication from the surgery, and it's a pretty common one at that. When they removed all my bits and bobs, they also removed a boatload of lymph nodes, which they then sent to the pathology department, where they were dissected, to see if the cancer had spread. Fortunately, it had not spread, but I'm short about forty lymph nodes in my abdomen and pelvic region as a result. Good times, no? Unfortunately, however, scar tissue has formed around where a lymph node/nodes used to reside, and fluid is collecting there---and isn't draining. Apparently, this thing has been there for a while---as in it was visible on the pet scan back in November---but because it wasn't causing me any troubles, they weren't worried enough to relate the information to me. Again, it's a pretty common situation and not one to worry about, unless it causes me pain.

The nurse practitioner palpated my belly---which they always do--- and while she was at it, I asked her what this particular bump was, because it'd been there for a bit and that's the same general vicinity where the pain was. I told her I didn't have enough information about the general state of where everything was located now to make any calls on whether that should be there or not. She felt it, felt it some more, put a questioning sort of expression on her face, and then she went running for Dr. Academic. About five minutes later, he strolled in and poked and prodded, and told me I was a first for him: he'd never actually felt a lymphocele on an abdominal exam. Usually, said he, they're on the posterior side of the pelvis, not on the anterior, but as I have a shallow pelvis (or a platypellic pelvis, which just made me giggle, because all I could think of was 'duck billed platypus' at the time), it made sense to him that he should be able to feel it. They said they didn't know why it would be causing me pain, but one proposition, though unlikely, was that it had become infected. It is, apparently, very rare for them to become infected this far out from surgery, and since they didn't pull blood to see if my white count was high, I gather they aren't too worried about that being the cause.

As far as treatment is concerned, they can stick a needle in the thing and aspirate it, but the problem is that it will most likely just fill back up again, and then we're back to square one. Which would be a waste of time to me. I want permanent solutions, not half-assed ones. Apparently, however, according to Dr. Academic, there's a radiologist at another hospital here in town who has had good luck in dealing permanently with these things by draining them, and then inserting alcohol to create more scar tissue so it won't fill up again because there wouldn't be any room for it to do so. (And, no, according to Dr. Academic you don't get a buzz when they insert the alcohol, so it's got that going against it.)

Before I go running to that guy, however, the pain has got to get a lot worse. Because the pain is really not all that bad (not even enough for me to take an advil for it) and I don't want to have to commit myself to more procedures and another hospital stay until I have observed the situation from all angles, we're in a wait and see mode. I'll have a CT scan done in five weeks, and then I'll meet with Dr. Academic to see where we go from there. The Pet Scans are all well and good, but they're really set up to look for cancer, and, apparently, are pretty radioactive, because he asked the nurse practitioner to set me up for something a little less nuclear. Good times, no? (As it turns out, my former employee who used to work at Dr. Academic's office has now moved over to the pet scan place, and I had a nice chat with her last week. But her visit was somewhat short, and she didn't even enter the room where I was waiting for the radioactive FDG to kick in so they could scan me. She simply pointed to the radioactive sign on the door, smiled and then walked away. I knew I was nuclear, but I didn't know I was that nuclear.)

The husband is getting a little pissed off about all this. Sigh. I can understand his frustration. I want to move on. So does he. He just wants this whole nightmare to be over with, as do I. Unfortunately, it's not that simple. He wanted to know why Dr. Academic didn't just go in and cut the damn thing out. Then we had to have the conversation about surgery creating scar tissue and any new surgeries would likely do the same, about this being a less invasive procedure, less time in the hospital and less time recovering, and, perhaps, not doing anything about it at all if the pain resolved itself. I think he's resigned himself to the situation, but I know he's not happy about it.

I'm not really happy with it either, but I trust Dr. Academic---he knows what he's doing. Besides, as he was wearing scrubs, even though it wasn't one of his surgery days, it was obvious that he'd had to perform some surgery nonetheless. You can tell that, on those days, when he's spent some time in the operating room, he doesn't want anyone to have to go back in there if they don't absolutely have to. He's not one of those kinds of doctors, quick to put people under the knife and who thinks surgery is the be all, end all. He doesn't want to have to go there if he doesn't have to, so he was pushing for the 'wait and see' approach and I concurred.

So, if the pain gets worse, we'll move the CT scan up. If it doesn't, then we'll wait and see what's going on in six weeks. Either way, I get the feeling that something's coming down the pike. We'll just have to see what it is when it gets here.

Posted by Kathy at February 20, 2008 06:00 PM | TrackBack