Sunday, June 04, 2017

Post Surgery Update

I am so grateful for all of the support, encouragement, prayers, text messages, phone calls, visits, meals...everything.  God has richly blessed me and my family with a beautiful tribe of people near and far that we are so lucky to call our friends and family.  This experience has been frustrating and stressful, but also humbling and encouraging at the same time.

Wednesday afternoon, April 19th, after paying a small fortune to the hospital and also taking care of my pre-op blood work, I had a near panic attack regarding the surgery itself and what it entailed (the surgical mesh, the recovery, this void in my abdomen, to name a few).  I called the doctor's office, in hopes of speaking to a nurse, but got to speak with my surgeon himself! He patiently re-explained to me what his plan was, how the surgical mesh would work, and also assured me that this was the best and only option for what we were dealing with.  He is so fabulous, and I am so thankful we were referred to his office.    

My surgery was Friday morning, April 21st.  Our arrival time got pushed back by an hour, so we didn't have to leave our house as early as we had originally planned.  We arrived and waited to be taken into the triage area.  My surgeon came out, dressed in a suit and tie, and greeted us in the waiting area.  He's just so friendly and calming (and a few might say he is pretty "hunky"...ahem...my grandma).  Anyway, a nurse came and took us back to start getting prepped.  She took vitals, and then was successful in putting in the IV on the first try, which is apparently rare for me now.  She was so pleasant and kind, so that was a nice start to the day.  

Our doctor came into the triage area with a med student and told us he would see me in the OR.  He told Heath where he could wait and that he would come and find him as soon as the surgery was over.  Heath asked if he would pray with us, and much to my surprise, he did :)  

Soon, my little curtained-off area became very "busy."  The surgical fellow from my initial consultation appointment stopped by, said hello, and then left.  Then the anesthesiologist and his nurse stopped by and talked to me about the drugs.  I remember from the previous two surgeries that the anesthesiologist had offered me a "happy cocktail" to help me calm down before heading into the surgeries.  I gracefully declined them on both occasions because even in my stressed out state, I wanted to be able to remember walking (being pushed on a gurney) into the OR mostly due to sheer fascination.  This time, however, as I felt the waves of panic and fear coming over me, I asked him for something to help calm me down.  There was a super nice woman there (I can't remember if she was the nurse anesthetist or a nurse who would be in the surgery) who kept telling me it was going to be an easy surgery and that if I hadn't been nervous and anxious, she would have thought something was wrong with me.  She said it was totally normal to be having the heart palpitations I had been having and that everything was going to be fine.  Thank heavens for encouraging people just at the moment you need them.

I don't remember much after that.  They must have slipped me the happy juice shortly thereafter because I don't even remember being wheeled into an OR.  Nor do I remember waking up in post-op/recovery.  Honestly, my next memory was at the shift change that night...sometime around 7 pm.  I have no idea who my nurse was during that afternoon, but I remember meeting Rashni, my nighttime nurse Friday night.  She was very sweet, and had a fairly heavy accent, because I do remember not always understanding her.  Perhaps that was due to the heavy amount of pain killers?!

I spent the next six days in the hospital.  Overall, I had wonderful nurses who were kind and attentive.  I had one super awkward and not-so-great male nurse; we just didn't really gel personality-wise, and he spent more time hitting on my friend (offering her ginger ale on the rocks and asking if she would be returning the next day to visit) than paying attention to my case and my pain meds :)  We kindly asked the charge nurse for him to be placed on someone else's case the next day.

My surgery left me with an eight inch incision across my upper right abdomen, two JP drains (oh so fun), and an abdominal binder to help hold things together.  My surgeon removed a large portion of my abdominal wall...5.5 inches by 3.5 inches and about 2.5 inches in thickness.  The tumor itself was the full thickness of the abdominal wall, but thankfully had not adhered to my intestines.  His goal was to cut out the tumor and the surrounding tissue so that the likelihood of it returning was low.

 As I was waiting to be discharged, my doctor and two of his med students came to my room to discuss a few things, including the pathology report.  The good news is that the tumor was benign, a fibromatosis/Desmoid tumor as he had suspected from the beginning.  The bad news, however, is that he was unable to get clean margins after all, stating that the tumor was touching my lower ribs.  He mentioned that he didn't think it would be advantageous to remove portions of my ribs (thank you), but that there were microscopic fibers of the tumor left behind on not only my ribs, but also at the bottom of the sample he removed.  What exactly does this mean?  Well, it means that the tumor can still come back.  But, to be honest, even if he had obtained clean margins, the nature of these tumors is so sporadic and unpredictable that it could have returned on its own anyway.

That was kind of a "Debbie Downer" moment for me as I was leaving to go home.  All of this stress and worry and PHYSICAL PAIN for what seemed like nothing.  Enter the bombardment of crazy thoughts about what happens next when it returns, and how will he remove it again if he has already removed so much?  Will we have to explore chemotherapy or radiation?  What will that be like?!  I immediately asked him what we are going to do if it grows back.  His response was so laid back.  He said that for now, I needed to worry about learning to walk again, and just concentrate on healing and recovering, and that basically we will cross that bridge when we get there.  Have I already mentioned how great he is?

So, that is what I have been doing, or trying to do at least.  It has been incredibly challenging for me to recover.  I am not a sidelines type of person (unless we are dealing with sports, in which case I should ALWAYS be a sidelines type of person).  I don't love sitting around waiting for things to be done for me.  We have been so blessed by friends and family who have brought meals, come over to help with the kids and also to help with things like vacuuming or hanging things on my walls.  Did I mention that I hadn't finished unpacking before the surgery?  We have unopened boxes still lying around and things of that nature just staring at me and I can't do anything about it.  It is kind of driving me crazy.  My mom has been here since my surgery, basically taking care of the kids and their every need during the day until Heath gets home at night.  I have fairly strict lifting restrictions, so holding or carrying Kenton is kind of out of the question.  I had a home health nurse visit a few times to check my vitals and the drains, and also a physical therapist, but we decided that until the lifting restrictions are lifted, it is kind of waste of time and resources for now.

I have seen my doctor twice since the surgery, the first time being about ten days post op, and the second visit about three and a half weeks post op.  Other than nearly passing out during the removal of the first drain, he said everything else seemed to be healing and moving in the right direction, and that he didn't need to see me for six months unless I needed something or was worried about something.  At that time, which falls right before Thanksgiving, he wants an MRI to check my abdomen for any regrowth.  Hopefully I won't suspect any more tumor formation between now and then, and we will have a clean MRI in November.  My greatest risk right now is a hernia.  I have to be so careful not to lift things, which let's be honest, is almost IMPOSSIBLE, especially when there are little ones.  Also, sneezing, coughing and laughing too much are THE WORST as far as pain-inducing scenarios :)

I have included a few photos below.  Nothing graphic by any means, but I did have my doctor help me understand exactly what was removed by having him draw on a Google image I found of the abdomen.  #visuallearner #nerd


The blood typing bracelet they put on me before my surgery, threatening me hefty charges or surgery cancellation if I tampered with it or removed it!  Crazy.  

A lovely gif we received the morning of the surgery.  Nothing like a little comedic relief in the midst of a stressful moment.  




Lots of encouraging text messages and phone calls the morning of my surgery.  Did I already mention that I have the best friends?  There are so many more saved on my phone, but for whatever reason, they got a bit messed up when I tried to transfer them here.  
 
My favorite visitors in the hospital (no offense to the others) 😍😍


IV specialist was called in to fix my IV on day four, after I convinced my nurse that the IV was burning every time I received my meds.  This lady was so great, and also told me that from here on out, I should request the IV A-team every time because I'm such a hard stick.  :)  I was sold on that suggestion.  
At home, snuggling my babies on the "good side" as Finley calls it.  Kenton knows that I have a boo-boo, and that's about the extent of his understanding of the situation.  

Because I'm weird, this was one of the things I insisted on accomplishing the night before the surgery.  Boy am I glad, too, because I have been staring at it for five weeks now :)  At least I have something fun to look at (besides unpacked boxes and things I can't put away because of their weight).  


These were a couple of the images I took to my doctor.  The first one kind of illustrates a cross section of the layers in the abdominal wall.  He outlined where the tumor was, and then kind of added what would be my bowels/intestines, showing that the tumor thankfully had not adhered to any major organs, and was contained to the abdominal wall.

The second picture shows where the tumor was (the inside circle with the lines in it), and then the portion of my abdomen that he removed (the larger circle).  At the top of the outer circle, you see my ribs, where microscopic fibers of the tumor remain.  There are also microscopic fibers of the tumor remaining at the bottom of the outer circle.  
Perhaps the biggest thing I have done since coming home from the hospital...I BOUGHT A CAR ONLINE, from the comfort of my trusty recovery recliner :)

Thank you so much for all of the care and concern.  I'm so grateful for our tribe.  Bless you for making it through yet another lengthy blog post.  Hopefully the pictures helped :)

Wednesday, April 19, 2017

My Brief Medical Journey

The title of this post is a lie.  This is rather lengthy.  I tried to keep it as concise as possible.

A timeline of sorts...

November 2014 (Black Friday, to be specific) - I was about 25 weeks pregnant with Kenton, and we had just celebrated Thanksgiving with Heath's family.  We had also spent that Friday out on the ranch with friends.  I came home that night and shortly after eating dinner, I suddenly started to feel like I couldn't breathe.  I couldn't take deep breaths, and it felt like someone had put a vice grip around my rib cage.  My entire belly seemed to seize up, making all movement very uncomfortable.  I was sweating, and panicking, and at one point I remember lying on my mother-in-law's tile floor to cool off while simultaneously vomiting.  I tried lying down, going to the bathroom, walking around, and eventually crawling around.  This whole episode lasted for over two hours.  Heath was ready to take me to the hospital if it hadn't settled.  Finally, it seemed to subside, my belly relaxed, and I was able to breathe again.  I was determined to call the midwife when I returned to Tallahassee.

The following Monday, I called.  They told me over the phone that it simply sounded like Braxton Hicks contractions, to which I thought, "are you kidding me?!?!"  They didn't seem concerned, and basically told me to wait until my next scheduled appointment, which wasn't for another ten or twelve days.  In the meantime, I talked to a few of my mommy friends, and one of them adamantly proclaimed that it was my gallbladder, and that I needed to demand that they look into it.  So, at my appointment the next week, I mentioned it.  The midwife seemed skeptical, but agreed to refer me for an ultrasound of my abdomen to rule out the gallbladder.  It was early December at this point.

A few days after the ultrasound, I received a call confirming that I did in fact have a few gallstones, and that I would be referred to a surgeon after Christmas.

January 2015 - I met with the general surgeon, whose office was conveniently located right next to my OBGYN :)  He was super nice, and basically told me that I could try all of the home remedies I wanted, and that I could stop eating everything that was thought to be a trigger food, but that in the end, gallstones never go away, and I was a ticking time bomb no matter how you looked at the situation:  either I was going to have another gallstone attack, or I was going to have a baby.  At this point, I was 32 weeks pregnant.  He said it would be optimal to deliver the baby first, and then schedule a non-emergent, planned laproscopic surgery to remove the gallbladder.  So, that was the plan.

February 2015 (the night of the Super Bowl) - Gallstone attack #2.  It was rough, and scary, but at least I knew what it was, and since I knew it wasn't a heart attack, I waited for it to pass, and went on with life.

March 2015 - Kenton was born, safe and sound, via c-section.  I was convinced that my gallstones were pregnancy related, and that they would just disappear...

April 2015 - I was wrong.  I had gallstone attack #3 on a Tuesday night.  Heath was in Orlando, I was in Tallahassee by myself with the two babies and my mom, and I was scared to death.  I called and woke Heath up, and he ended up driving to Tallahassee the next morning, just for moral support.  I called the surgeon's office that next morning, and scheduled my surgery to remove the gallbladder for May 13th.

Five days later, a Saturday, gallstone attack #4 hit, and it was by far the worst.  It got so bad that Heath took me to the ER, with our six-week-old baby in tow.  By the time I was put in a triage room, it was nearly midnight.  Around 2 am, my surgeon stopped by and said that he happened to be on call, and that he would go ahead and take out the gallbladder the next day and put an end to this :)  YAY!

At around noon on April 26, my gallbladder was no longer an issue, and we were ready to move on :)

August 2015 - Just shy of six months post op (why is that such a magical number for surgical recovery?), something didn't feel right.  I called my doctor, told him that something seemed off, and asked for an appointment.  He assured me things were fine, and that it takes six months to completely heal.  To pacify me, they scheduled a CT to double check.  Everything came back clean, and he said it was just things shifting from having the baby and having the gallbladder removed.  It would be okay.

May 2016 - While doing some abdominal exercises on the floor, I felt a jolt of pain on my right side.  When I put my hand there, I felt something.  A mass.  It was small, but it was definitely there.  I called my doctor and asked for another follow-up.  He examined me, said he could feel something, but thought it was most likely scar tissue, or a mass of fatty tissue and scar tissue combined.  They ordered another CT to be done, just to double check.

June 2016 - CT scan results came back clean again, but because my surgeon had felt what I was talking about, he suggested an exploratory surgery, to be done whenever, because they weren't really concerned about it being anything other than scar tissue.  We scheduled the surgery for when I returned from our summer in Illinois, August 19th.

August 2016 - I spent too much time on Google prior to my surgery, and had also taken up the habit of watching Grey's Anatomy (which I know is completely dramatized and crazy), and basically gave myself a few panic attacks leading up to this surgery.  Do yourself a favor and don't Google abdominal masses...you'll find all kinds of scary things out there.  I was convinced it was a tumor, possibly a rare pancreatic tumor, and that things were going to be very bad.  I also worried that maybe it was a surgical hernia, and that he would just have to fix that.  Or possibly just scrape out a bunch of scar tissue.

My surgery was scheduled for 2 pm that Friday, but I ended up getting bumped behind a few emergent cases that had come in.  I remember going down into the pre-op area around 6 pm and meeting with the anesthesiologist (who was the same guy from the previous April).  The nurse in pre-op attended the church we sporadically attended in Tallahassee after we left FCC.  I remember my surgeon coming in and chatting with me, and I remember asking him what his plans were if the scary lump happened to be either a) scar tissue, b) a hernia, or c) a scary tumor.  He responded by telling me that a tumor was so far from his scope of possibility, and I remember crying tears of relief.  He held my hand and said it would be fine.

The next thing I remember was slowly waking up in post-op and hearing someone in the distance saying something about a spindle cell tumor.  She kept saying that the surgery was only supposed to be an hour, and that it ended up being almost three.  I remember asking her what time it was, and then in my groggy state, deducing that she was talking about me.  I remember panicking and asking her if he found a tumor and what was happening, and then going back to sleep.

Later that night, I was back in a room, and Heath was there.  He had taken my phone from me, and was being evasive.  I told him I had heard something about a tumor and I wanted to google what it was (see, it's an addiction).  My surgeon came by (I feel like it was close to midnight) and explained what he had found.  He referred to it as a spindle cell tumor, about the size of an egg, and that he rarely saw this type of tumor.  He guessed that by the pattern or shape or behavior of the tissue, that we were dealing with a benign tumor, but that they would obviously send it off to pathology for further investigation.  He assured us that he was confident that he had gotten clean margins, and that it was gone.  I stayed in the hospital through the weekend, and began the super slow journey of recovery.

***In the meantime, our house had flooded over the summer while we were gone, and we had to drive back to Orlando to stay with his parents.  You can read about that whole mess here.

We called the surgeon's office five or six days later to find out about the results of the biopsy, only to find out that my specimen had been sent elsewhere for further testing...ugh.  Okay.

Another week went by with no word from anyone.  I called again, and the results lady (not sure of her title) started digging around to find out why my pathology report still hadn't been returned.  She found out that my sample had been sent to Shands @ UF to a special soft tissue masses pathologist.  She also informed me that he was notorious for being slow :)

THREE WEEKS went by, and I was in Illinois visiting at a friend's house, and I actually missed the call from the hospital.  My nurse left a message for me explaining that the results indicated a BENIGN mass.  I cried, and was finally able to stop panicking.

October 2016 - It was about six weeks post-op, and the kids and I spent a week with my parents and my grandma at her condo in Siesta Key.  While we were there, Finley and I were playing in the pool, and after she jumped off my shoulders, she kicked my abdomen, right at my incision site, while swimming away.  I remember doubling over in pain, and immediately started panicking about internal sutures being affected.  A few days later, I felt a lump there.  So, of course I called my doctor.  The nurse told me it had barely been six weeks, and to give it ten days to two weeks and see how I felt after that.

Those two weeks went by, and I was still in substantial pain.  Obviously I could still move, but any bend in my core (which happens WAY MORE than I ever thought) hurt like crazy.  I called them back, and I was called in for an exam.

I told them I was scared and worried and concerned, and they assured me things were fine.  But again, they would order a CT scan for good measure.

Surprise, surprise, the CT came back clean :)  At this point, it was mid-November.  We decided to wait until after Christmas and re-assess.

January 2017 - I went back for my millionth follow-up, and he asked if it was the same, better, or worse.  I told him it was the same, and that there was definitely a palpable lump underneath the previous incision.  He could feel the lump, and he was also surprised when I winced in pain each time he touched the area.  He sat there at the exam table just pouring over my file.  He seemed stumped.  So, he ordered an MRI.

February 2, 2017 - MRI in Tallahassee.  At this point, we had made the fast and hard decision to move back to Saint Cloud.  So, this MRI took place two days before our first of several moving trips took place.

February 13, 2017 - My new nurse BFF called and asked if I could talk.  I immediately knew that something was going on, because she wanted to make sure I could talk for a few minutes.  She told me that the MRI confirmed a mass in my abdomen (duh, I had been saying this for months now), and that my surgeon wanted to do a CT guided needle biopsy.  Okay.  Perfect.  Sign me up, let's do this!   We scheduled it for a weekend that we were going back to Tallahassee to continue packing up the house there.  She and I were officially on a first name basis at this point :)

February 24, 2017 - I traveled to Tallahassee the night before the biopsy by myself.  Heath and the kids were going to join me after the procedure and take me home.  I got to the hospital impressively early, got myself checked in, and waited to be admitted.  I was taken to a room where a not-so-fabulous nurse had to get my IV started and what not.  She flipped out on me because I hadn't removed any of my rings (no one told me to do that) and also because I was a hard stick.  She bruised both my hands and my left wrist, I cried, and then she got all weird on me because I was crying.  NOT A GOOD START TO THE DAY.

I was taken down to the CT area around 9 am, and sat there alone waiting for this to get started.  The radiologist came in, sat down, and started asking me about my surgical history and how I ended up where I was.  He was very honest, and informed me that he had only just found out that I had already had a tumor resected from my abdomen less than six months prior.  He said that for whatever reason, my entire chart and history didn't make it into his hands until that very morning.  He expressed concern for the biopsy procedure, and told me that he felt that it would be doing more harm than good to do the biopsy.  He told me that he recommended I move to a tertiary location to be looked at by a specialist.  He felt that what we were/are dealing with is a Desmoid tumor.  He was so incredibly patient.  He went back to the pathologist and double checked my scans and the surgical reports from August, and again confirmed that they both thought we were dealing with this type of tumor.

*A Desmoid tumor is typically a benign but locally aggressive tumor.  I've done lots of research on these bad boys, and you can too.  Just google it :)

Anyway, this radiologist was so humble and just so great.  He suggested that I asked to be referred elsewhere, to a hospital like Shands, MAYO, Moffitt, UAB, or Emory.  The sound of Mayo Clinic obviously gave me heart palpitations, but, I felt like this was the right direction to go.  He left the room one more time and returned with a business card and gave me his PERSONAL cell phone number.  He said to call him if I had any problems, or if I hadn't heard from my surgeon's office by a certain day.  We cancelled the biopsy, I returned to my hospital room, packed up, got in my car, and cried a whole lot.

March 1, 2017 - My nurse BFF called me just before the deadline I had set before I reached out to the radiologist.  She told me that my surgeon was confused and a bit frustrated that I hadn't had the biopsy.  I shared with her everything that had happened that morning, and she said I would be hearing from my surgeon.

*Please know that I love this nurse, I'm grateful for all of her help, and that I thought/think my surgeon is a great guy and a very personable doctor.  No harm, no foul.  But apparently my crazy abdominal mess requires someone with a more detailed specialization.

March 2, 2017 - Nurse BFF called back and told me that my surgeon spoke to a reconstructive plastic surgeon in Tallahassee who recommended that I be referred to a doctor in Orlando.  PERFECT!  We live here now!

March 14, 2017 - Heath and I met my new surgeon.  He was INCREDIBLE.  He spent what felt like an hour talking to us and outlining a plan.  He specializes in soft tissue sarcomas, and also believes this is a Desmoid tumor we are dealing with.  These tumors are rare, but when they do occur, they tend to be found in women in their thirties who have experienced pregnancy.  They are hormonally fed, and can occur entirely sporadically or be a genetic glitch.  He explained that he believed the mass that had been removed in August was the same type of tumor, and that because my surgeon was caught off guard by its appearance, that he most likely did not remove every single tentacle of the mass.  Like I mentioned before, these tumors are locally aggressive.  If his guess is correct, this tumor took less than six weeks to regenerate and more than double in size.  According to the MRI, it is roughly four inches in length and about two inches in diameter, in an oval shape.  He said that based on the scans, he doesn't think this tumor has adhered to any organs at this point, and that it is only within the abdominal wall and connective tissues/muscles.

He recommended surgery to remove the tumor and all of its surrounding tissue, and that he will replace it with surgical mesh.  I asked if we could wait until after my brother's wedding and after Easter, and he said that should be fine.  We asked lots of questions, and he was very knowledgeable regarding this type of tumor.  He gave me his card and told him to call with any questions I might have.

March 21, 2017 - I called his office, and HE ACTUALLY CALLED ME BACK.  We "chatted" for almost twenty minutes about the whole surgery, the recovery, the outcomes, everything.  I was floored.

April 19, 2017 - Pre-op admissions and lab work

April 21, 2017 - The big surgery at 7:30 am in Orlando.

If you have made it this far, you deserve a reward.  I can offer to mail you a book mark, because you obviously like reading :)  Thank you for your prayers and concern.