Had a follow-up post-op with Dr. Chatson today (Wednesday). He removed the dressing and I got a chance to see the wound. Colorful. There was still dye on the skin and you could see a closed wound similar to that eye that was drawn with the sharpie, but this time a closed eye.
I thought he would be putting fresh bandages on, but no. The stitches were in deep and they are self-dissolving. The skin is held together with something similar to super glue. The area was slightly swollen but looks much less mutilated than I had imagined. The drain is actually under the skin though a 'hole'. Once the output is less than 10 cc within a 24 hour period, I can come in to have it taken out. They will place a guaze pad until the hole seals up.
He's thinking Friday. The latest Monday. Until that's out I can't bathe. [So glad I cut my hair]. All I'll get is a sponge bath.
Just call me stinky.
Wednesday, April 29, 2015
Released
I woke up with the sun at 6AM. I turned on the TV and watch early morning programming. More on Baltimore, Nepal and the Mt. Everest climbers. Also the traffic report showed that I wasn't missing anything and was glad to be left out.
Sandy came in and tried pushing more pills to no avail and asked if I had ordered breakfast. I had not, so she gave me room service. Calling down, the person who does my floor hadn't come back yet, "but will right up when he does". Not too long after he was up taking my order from their limited menu. "Breakfast will be up at 7", he said.
A different nurse came in and told me that the hospital was going to be giving me my daily meds, but they didn't have one of mine in stock. So I was instructed to just take that one. OK. I normally take them when I get up so I took that one - only. Apparently the meds are given at 10. Whatever. I need coffee.
Seven came and so did the breakfast. Plain cream of wheat, warm but not crisp french toast, three bacon strips, orange juice and coffee. I ate/drank everything. I updated Facebook, 'liked' comments, checked email, sent some "I'm alive" emails to coworkers and made some calls to family and friends.
Every three hours - check the vitals and push those drugs. I called Dr. Moore's office to check in and remind them of my FMLA paperwork and soon was greeted by the day nurse (not as friendly as the others - and not a drug pusher either).
Doctor Moore stopped by and shook my hand. He asked if I remembered his stopping by after the operation because I seemed very groggy. I told him yes. Once again he said that things had worked out well and that Dr. Chatson will be monitoring the drain and determining when it can be removed. He asked that I schedule an appointment [I thought he said] a week.
Mary came in and said that I would be released after lunch. She would be processing my discharge paperwork and would be in around noon. YAY! I arrange for a ride home and waited until my lunch arrived which I ate/drank everything.
Around noon, Mary came in with a pile of documents for me to take (for my records) and a discharge summary, which she reviewed. I received a script for pain pills and was informed that a visiting nurse would be contacting me because I live alone.
I was wheeled out and left at the curb. My ride took me to Walgreens where I filled my script and I was finally home. Watched some TV, read the paper and took a three hour nap. Had a salad watched some more TV and went to bed. Every three hours I instinctively woke up (damn them) but manged to make it useful by visiting the bathroom. Slept better overall, but couldn't turn on my left side which caused my neck to go out on my right. No Chiropractor scheduled until next week ;-(
The biggest bummer of the day was when I stepped on the scale and found I gained 5 pounds. How? I hope it's water weight. I didn't eat much over the last few days. I was hoping to see five pounds LESS.
I have a follow up appointment with Dr. Chatson this afternoon.
Sandy came in and tried pushing more pills to no avail and asked if I had ordered breakfast. I had not, so she gave me room service. Calling down, the person who does my floor hadn't come back yet, "but will right up when he does". Not too long after he was up taking my order from their limited menu. "Breakfast will be up at 7", he said.
A different nurse came in and told me that the hospital was going to be giving me my daily meds, but they didn't have one of mine in stock. So I was instructed to just take that one. OK. I normally take them when I get up so I took that one - only. Apparently the meds are given at 10. Whatever. I need coffee.
Seven came and so did the breakfast. Plain cream of wheat, warm but not crisp french toast, three bacon strips, orange juice and coffee. I ate/drank everything. I updated Facebook, 'liked' comments, checked email, sent some "I'm alive" emails to coworkers and made some calls to family and friends.
Every three hours - check the vitals and push those drugs. I called Dr. Moore's office to check in and remind them of my FMLA paperwork and soon was greeted by the day nurse (not as friendly as the others - and not a drug pusher either).
Doctor Moore stopped by and shook my hand. He asked if I remembered his stopping by after the operation because I seemed very groggy. I told him yes. Once again he said that things had worked out well and that Dr. Chatson will be monitoring the drain and determining when it can be removed. He asked that I schedule an appointment [I thought he said] a week.
Mary came in and said that I would be released after lunch. She would be processing my discharge paperwork and would be in around noon. YAY! I arrange for a ride home and waited until my lunch arrived which I ate/drank everything.
Around noon, Mary came in with a pile of documents for me to take (for my records) and a discharge summary, which she reviewed. I received a script for pain pills and was informed that a visiting nurse would be contacting me because I live alone.
I was wheeled out and left at the curb. My ride took me to Walgreens where I filled my script and I was finally home. Watched some TV, read the paper and took a three hour nap. Had a salad watched some more TV and went to bed. Every three hours I instinctively woke up (damn them) but manged to make it useful by visiting the bathroom. Slept better overall, but couldn't turn on my left side which caused my neck to go out on my right. No Chiropractor scheduled until next week ;-(
The biggest bummer of the day was when I stepped on the scale and found I gained 5 pounds. How? I hope it's water weight. I didn't eat much over the last few days. I was hoping to see five pounds LESS.
I have a follow up appointment with Dr. Chatson this afternoon.
Post Op
I remember waking up at 5:30 PM. I was back at surgical day care in bay 2. I was quite groggy and in pain. Really bad pain. A nurse noticed I opened my eyes and asked if I needed some pain meds. With a scratchy voice, I said yes.
I slipped in and out and around 6, I was asked if I needed more pain medication. "Yes."
I can vaguely remember that Dr. Chatson came in around this time to see how I was doing and to tell me that everything went well. He said that Dr. Moore was able to leave fat cells that were needed for the reconstruction. Dr. Chatson said he was please with the results and asked that I have a post-op visit Wednesday.
Shortly after, Dr. Moore stopped by to see how I was doing and he said that things turned out well. He said that working with Dr. Chatson allowed less tissue removal, but enough to take the tumor and associated tissue out. He did say that he took two nodes out. The sentinel node had some cancer cells so he went to the second and found some there so he took both out. The third node was biopsied and that appeared to be OK. I do recall his saying that the initial results showed 'some' cells in the first two nodes but a thorough pathology will be done and those results won't be known for about a month. He said he's 90% certain that all the cancer is out. But there is still that 10% chance that I may need radiation and/or chemo. So I'm not completely out of the forest yet - but hopefully optimistic.
By 6:30 I was feeling more awake and less in pain when they said I would be moved to room 215. Arriving at my room, the nurse introduced herself and said her shift was over at 7:30, but a new nurse would be in for the transition. She asked if I needed any more pain medication. I said I was doing OK. But she did say that taking the meds would help me sleep and keep ahead of the pain. I agreed and took a pill. She asked if I needed anything to eat since I had been fasting almost 24 hours. I wasn't too hungry, but thought that a turkey wrap might be light enough to handle.
I made a few calls to let folks I was alive. It wasn't too long before the wrap arrived. At this point I could tell that the breathing tube made my throat sore (which explained my scratchy voice).
I dozed off and on with the TV on. The news was all about the riots in Baltimore and earthquake in Nepal - so sad.
I decided to shut off the TV and sleep when I was awakened by the night nurse, Sandy. She took my vitals and tried to push more drugs to which I declined. Every three hours the same thing. No drugs. Just sleep please. Very uncomfortable bed. Too small and confining. Can't turn over and there are so many tubes (drain, oxygen and other connections for vitals).
Hoping for a release Tuesday.
I slipped in and out and around 6, I was asked if I needed more pain medication. "Yes."
I can vaguely remember that Dr. Chatson came in around this time to see how I was doing and to tell me that everything went well. He said that Dr. Moore was able to leave fat cells that were needed for the reconstruction. Dr. Chatson said he was please with the results and asked that I have a post-op visit Wednesday.
Shortly after, Dr. Moore stopped by to see how I was doing and he said that things turned out well. He said that working with Dr. Chatson allowed less tissue removal, but enough to take the tumor and associated tissue out. He did say that he took two nodes out. The sentinel node had some cancer cells so he went to the second and found some there so he took both out. The third node was biopsied and that appeared to be OK. I do recall his saying that the initial results showed 'some' cells in the first two nodes but a thorough pathology will be done and those results won't be known for about a month. He said he's 90% certain that all the cancer is out. But there is still that 10% chance that I may need radiation and/or chemo. So I'm not completely out of the forest yet - but hopefully optimistic.
By 6:30 I was feeling more awake and less in pain when they said I would be moved to room 215. Arriving at my room, the nurse introduced herself and said her shift was over at 7:30, but a new nurse would be in for the transition. She asked if I needed any more pain medication. I said I was doing OK. But she did say that taking the meds would help me sleep and keep ahead of the pain. I agreed and took a pill. She asked if I needed anything to eat since I had been fasting almost 24 hours. I wasn't too hungry, but thought that a turkey wrap might be light enough to handle.
I made a few calls to let folks I was alive. It wasn't too long before the wrap arrived. At this point I could tell that the breathing tube made my throat sore (which explained my scratchy voice).
I dozed off and on with the TV on. The news was all about the riots in Baltimore and earthquake in Nepal - so sad.
I decided to shut off the TV and sleep when I was awakened by the night nurse, Sandy. She took my vitals and tried to push more drugs to which I declined. Every three hours the same thing. No drugs. Just sleep please. Very uncomfortable bed. Too small and confining. Can't turn over and there are so many tubes (drain, oxygen and other connections for vitals).
Hoping for a release Tuesday.
Operation
Being wheeled into the operating room, I was immediately reminded of my last real operation when I was in the fifth grade. I was going in for my last skin graph for a burn I sustained when I was 14 months old. I'm not sure if it was the same area but it sure looked the same. I recall the staff telling me at that time Lorreta Young was operated in that O.R.
[Trivia - does anyone remember her claim to fame? - http://en.wikipedia.org/wiki/Loretta_Young]
Back then the hospital was called Bonsecours it was a Roman Catholic hospital staffed by nuns dressed in white habits. So their touting of Loretta Young was apropos for the time.
I was wheeled into the room and was shifted to the table where they immediately started prepping me. They gave me an oxygen mask that said it was a mixture of anesthesia. They asked me to take five deep breaths. With each I could feel myself slipping away from reality until nothing.
[Trivia - does anyone remember her claim to fame? - http://en.wikipedia.org/wiki/Loretta_Young]
Back then the hospital was called Bonsecours it was a Roman Catholic hospital staffed by nuns dressed in white habits. So their touting of Loretta Young was apropos for the time.
I was wheeled into the room and was shifted to the table where they immediately started prepping me. They gave me an oxygen mask that said it was a mixture of anesthesia. They asked me to take five deep breaths. With each I could feel myself slipping away from reality until nothing.
Surgical day care
Surgical day care was a hub of activity. Not unlike an ER room, there were many patients and twice as many medical professionals. Each bay was facing the center console area that looked very much like a Star Trek set.
Nurse Jean greeted me as the lorry dropped me off at bay 2. She quickly got me my an assigned bed for my stay and as it was wheeled into place I was instructed to disrobe and slip on a johnny with the opening in the front. I was provided with two plastic bags for my personal belongings and soon transitioned into one the patients.
I was asked may questions about allergies, sensitivities and past history of surgeries and anesthesia. I probably spoke with six or seven professionals. Dr. Moore arrived if full surgical garb (I almost didn't recognize him). He asked which side was being operated on and quickly whipped out a sharpie and wrote something on my chest (that I couldn't read from my angle). [It may have said 'this one'.]
At first I thought he was joking but with the number of patients he and other professionals see and the stories we have heard about the wrong side being operated on, it's probably a good practice to mark the territory.
Dr. Moore reviewed what what going to happen and asked if I had any questions of him. Yes I did. "I hope you had a nice restful vacation and that your are as sharp as a razor - no pun intended." He chuckled and replied that he did. "It was very restful and invigorating for the mind and body." Earlier in the day [probably because the blog had not been updated], my sister had sent me an email that said she assumed that I was NOT having surgery (today).
She wrote:
In the nuclear industry we keep track of human-error precursors. Workers are more likely to make a mistake on the first day back from vacation. Since Dr. Moore had been on vacation till April 26, I’m glad you are not under the knife today, his first day back on the job!
Thanks for the jinx Les (LOL)
I responded with:
Nurse Jean greeted me as the lorry dropped me off at bay 2. She quickly got me my an assigned bed for my stay and as it was wheeled into place I was instructed to disrobe and slip on a johnny with the opening in the front. I was provided with two plastic bags for my personal belongings and soon transitioned into one the patients.
I was asked may questions about allergies, sensitivities and past history of surgeries and anesthesia. I probably spoke with six or seven professionals. Dr. Moore arrived if full surgical garb (I almost didn't recognize him). He asked which side was being operated on and quickly whipped out a sharpie and wrote something on my chest (that I couldn't read from my angle). [It may have said 'this one'.]
At first I thought he was joking but with the number of patients he and other professionals see and the stories we have heard about the wrong side being operated on, it's probably a good practice to mark the territory.
Dr. Moore reviewed what what going to happen and asked if I had any questions of him. Yes I did. "I hope you had a nice restful vacation and that your are as sharp as a razor - no pun intended." He chuckled and replied that he did. "It was very restful and invigorating for the mind and body." Earlier in the day [probably because the blog had not been updated], my sister had sent me an email that said she assumed that I was NOT having surgery (today).
She wrote:
In the nuclear industry we keep track of human-error precursors. Workers are more likely to make a mistake on the first day back from vacation. Since Dr. Moore had been on vacation till April 26, I’m glad you are not under the knife today, his first day back on the job!
Thanks for the jinx Les (LOL)
I responded with:
Thanks for the words of comfort.
I do have surgery today Never assume...
There's a note on my PC to call you if I don't make it.
Her response:
Good luck! It’s Joe Page’s birthday, so I’d appreciate it if you didn’t spoil the day by dying. JK
Not long after, Dr. Chatson arrived and had a briefing/consultation which involved dueling sharpies. Dr. Moore said, as he drew, "I was thinking of...". Dr. Chatson said, as he drew, "Yes, right here and here and where ever you need to cut for the node(s)..." Both were in agreement and each asked if I had any questions. "Not at this time" I said. "Ok, we'll see you at around 1:30", Dr. Moore responded.
After they left I looked down and saw what appeared to be an eye with my nipple being the iris. To me it looked like far less tissue being whacked off. Encouraging.
Waiting for the clock to move, there was some excitement. Someone said they could smell something burning. Apparently there was a brush fire in the back of the hospital and it was permeating into the air exchange. At first it was reminiscent of incense, but it got stronger and I thought that we would have to be evacuated. Luckily it dissipated and an announcement on the intercom settled everyone's concerns.
It got to be close to 3PM when I was told I was being moved to the operating room. Here we go.
The day has come
Having enjoyed the weekend despite the so-so weather, I woke up at 5:00 AM without the alarm. The body does get conditioned as we age. I had some notes from the doctor that said that I needed to fast (since midnight) and I could only take my regular meds with very little water.
Coffee, coffee - I needed coffee. But no coffee for me. I tried to keep busy. I read the previous night's paper, caught up on some e-mail, paid some bills online and updated my Facebook status. Right at 8:00AM I called Holy Family. Spoke with Lisa who was especially perky for the day and time. She asked very few questions. [I assumed they had all my answers to other questions asked each time I showed up.] She said that I needed to have an ISO (injection of radioactive isotopes and imaging for node tracking]. That was scheduled for 10:15. She paused and said she was checking to see if my insurance was still current. "Yes, your insurance is current and your co-pay is $150.00. I can take that now." [Of course you will.]
I got a ride to the hospital and arrived at 8:45. Stopping off at the main reception I was directed to the second floor - surgical day care. I met with Kristen who said that I needed to pre-register. I told her I did it over the phone. With a suspicious look she picked up the phone and spoke to someone and said, I have a patient that 'claims' to have pre-registered. [Claims? - What would I get for lying?]
Her expression changed when my 'claim' was verified, then with a comment that sounded like an excuse, she said, "she's sending it right now." [I did have my receipt from my credit card app for the $150.00 I paid earlier if things got ugly, but it wasn't necessary.]
I was instructed to sit and wait. I would be called to be escorted to radiology.
About an half hour later, Jean (nurse) came and got me. She said that she would be with me up to the surgery hand-off. Nice to have a guide at times like these. A wheel chair was summoned and I was carted to radiation.
I was instructed to lay on the slab at the imaging machine and a nuclear radiologist came in, asked the required questions, name, DOB, then a few background questions. "How did you find this tumor?" And other related informational gathering questions. He told me that they were going to slather some topical numbing agent to deaden some of the pain from the injection of radioactive dye. He did say that he was going to inject me three times and he was quite clear that it was going to hurt and sting badly despite the topical agent. I attest, he wasn't lying. His assistant said that I could have used a stress ball. I guess she could see my clenched folded fingers pressing as hard as I could to distract from the sting. Not pleasant. Even after they were done it burned inside. I was told I needed to wait 20 minutes before the area could be imaged. Apparently this radioactive dye, injected into the tumor makes its way to the lymph nodes and the surgeon uses the image and a Geiger counter to zero in on the node(s) that need to be biopsied. Medical marvels.
After twenty minutes the technician said the other machine just opened up and she thought it might be more comfortable than the slab. It was, I had been in that one previously for the bone scan. She took many shots and had huge plates of glass (like daguerreotypes) that she shuffled about. Initially she explained what was displaying on the screen, but to me it looked like a Rorschach test. I won't comment on what I 'claimed' to have seen.
When everything was done, the lorry arrived for my ride to surgical day care.
Coffee, coffee - I needed coffee. But no coffee for me. I tried to keep busy. I read the previous night's paper, caught up on some e-mail, paid some bills online and updated my Facebook status. Right at 8:00AM I called Holy Family. Spoke with Lisa who was especially perky for the day and time. She asked very few questions. [I assumed they had all my answers to other questions asked each time I showed up.] She said that I needed to have an ISO (injection of radioactive isotopes and imaging for node tracking]. That was scheduled for 10:15. She paused and said she was checking to see if my insurance was still current. "Yes, your insurance is current and your co-pay is $150.00. I can take that now." [Of course you will.]
I got a ride to the hospital and arrived at 8:45. Stopping off at the main reception I was directed to the second floor - surgical day care. I met with Kristen who said that I needed to pre-register. I told her I did it over the phone. With a suspicious look she picked up the phone and spoke to someone and said, I have a patient that 'claims' to have pre-registered. [Claims? - What would I get for lying?]
Her expression changed when my 'claim' was verified, then with a comment that sounded like an excuse, she said, "she's sending it right now." [I did have my receipt from my credit card app for the $150.00 I paid earlier if things got ugly, but it wasn't necessary.]
I was instructed to sit and wait. I would be called to be escorted to radiology.
About an half hour later, Jean (nurse) came and got me. She said that she would be with me up to the surgery hand-off. Nice to have a guide at times like these. A wheel chair was summoned and I was carted to radiation.
I was instructed to lay on the slab at the imaging machine and a nuclear radiologist came in, asked the required questions, name, DOB, then a few background questions. "How did you find this tumor?" And other related informational gathering questions. He told me that they were going to slather some topical numbing agent to deaden some of the pain from the injection of radioactive dye. He did say that he was going to inject me three times and he was quite clear that it was going to hurt and sting badly despite the topical agent. I attest, he wasn't lying. His assistant said that I could have used a stress ball. I guess she could see my clenched folded fingers pressing as hard as I could to distract from the sting. Not pleasant. Even after they were done it burned inside. I was told I needed to wait 20 minutes before the area could be imaged. Apparently this radioactive dye, injected into the tumor makes its way to the lymph nodes and the surgeon uses the image and a Geiger counter to zero in on the node(s) that need to be biopsied. Medical marvels.
After twenty minutes the technician said the other machine just opened up and she thought it might be more comfortable than the slab. It was, I had been in that one previously for the bone scan. She took many shots and had huge plates of glass (like daguerreotypes) that she shuffled about. Initially she explained what was displaying on the screen, but to me it looked like a Rorschach test. I won't comment on what I 'claimed' to have seen.
When everything was done, the lorry arrived for my ride to surgical day care.
Communication log jam
How many times have we found ourselves in situations where the other party was assuming the other party was taking care of things?
Since my last blog, I called Dr. Moore's office to try to get confirmation of the 4/27 surgery date and pre-op stuff. I had called on a Wednesday and the 'person' had left for the day. On Thursday I called again and 'the person' had called in sick. Sharing my frustration with the office worker, he placed me on hold and was soon connected with Lisa. I had dealings with her before and was hopeful that she would once again pull through.
After bringing her up to speed, she said that Anna was taking care of that but she would get the folder. Soon after she said, "Yes, she has you scheduled for the 27th at Holy Family with Drs. Moore and Chatson". I asked about pre-op and the doctor's telling me that I needed an EKG. She said they could do it the day of the surgery. As far as the time, she was going to get back to me because the time was not filled in. Lovely.
I did not hear back that day. Friday morning at 9AM I called and spoke with Anna. YAY! She told me that she penciled in 4/27 but was waiting to hear back from me. Really? For what? I said I was operating on that premise since talking to the doctor the previous week. She said, "Don't worry about a thing I'll firm everything up today". She did say the surgery was at 1:30, but the hospital will be contacting me with pre-op information. "What's the best number to reach you today?" I gave her my work cell. I left it on ringer so I wouldn't miss a call. Ok, this is going to happen.
All day I kept looking to see if my phone was still on ringer and if I had any missed calls. I had no calls. Finishing up the day and making sure things were left in order during my departure, I trekked home. Getting home, of course I had seven frantic messages on my answering machine from Holy Family asking that I call them to complete some pre-op questions. Well I guess Anna did start the ball rolling, but Holy Family didn't get the part about calling my work cell.
I listened to each call and each call back and extension - all different voices and extensions. I started to call and each brought me back to the main menu where I received a recorded message that the office ours where 8 - 4:15. There was one message that asked that I arrive at 10:15 for processing and tests. Looks like I needed to call at 8AM and pre-register. I planned to be there at 9.
Let the weekend begin.
Since my last blog, I called Dr. Moore's office to try to get confirmation of the 4/27 surgery date and pre-op stuff. I had called on a Wednesday and the 'person' had left for the day. On Thursday I called again and 'the person' had called in sick. Sharing my frustration with the office worker, he placed me on hold and was soon connected with Lisa. I had dealings with her before and was hopeful that she would once again pull through.
After bringing her up to speed, she said that Anna was taking care of that but she would get the folder. Soon after she said, "Yes, she has you scheduled for the 27th at Holy Family with Drs. Moore and Chatson". I asked about pre-op and the doctor's telling me that I needed an EKG. She said they could do it the day of the surgery. As far as the time, she was going to get back to me because the time was not filled in. Lovely.
I did not hear back that day. Friday morning at 9AM I called and spoke with Anna. YAY! She told me that she penciled in 4/27 but was waiting to hear back from me. Really? For what? I said I was operating on that premise since talking to the doctor the previous week. She said, "Don't worry about a thing I'll firm everything up today". She did say the surgery was at 1:30, but the hospital will be contacting me with pre-op information. "What's the best number to reach you today?" I gave her my work cell. I left it on ringer so I wouldn't miss a call. Ok, this is going to happen.
All day I kept looking to see if my phone was still on ringer and if I had any missed calls. I had no calls. Finishing up the day and making sure things were left in order during my departure, I trekked home. Getting home, of course I had seven frantic messages on my answering machine from Holy Family asking that I call them to complete some pre-op questions. Well I guess Anna did start the ball rolling, but Holy Family didn't get the part about calling my work cell.
I listened to each call and each call back and extension - all different voices and extensions. I started to call and each brought me back to the main menu where I received a recorded message that the office ours where 8 - 4:15. There was one message that asked that I arrive at 10:15 for processing and tests. Looks like I needed to call at 8AM and pre-register. I planned to be there at 9.
Let the weekend begin.
Sunday, April 19, 2015
Follow-up with Dr. Moore
anx·i·e·ty
aNGˈzīədē/noun
noun: anxiety; plural noun: anxieties
a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.
There are so many plates in the air right now. Although it keeps my mind off of all things medical, it's getting quite stressful. A new administration brings fresh eyes but no historic knowledge resulting in many questions. Legislature is taking its time hammering out an early retirement incentive plan and the day to day continues. It's Spring allegedly, so the construction season begins resulting in road closures, detours and more traffic.
Finally able to connect with Dr. Moore he confirmed that April 27th was the date of the surgery. He also confirmed that Dr. Chatson would assist. Although I had a verbal, I've received nothing in writing or any new forms to complete. Dr. Moore indicated that an EKG is standard and 'they will find a way to squeeze it in'. Hmmm, even if they mailed out information on Friday, the holiday will delay any communication. On top of things, Dr. Moore said he was leaving for vacation and returning 4/26. Needless to say anxiety levels are pretty high.
More to come.
Saturday, April 11, 2015
Things appear to be moving into place
Dr. Chatson left a message on the house machine today asking that I call him. He left his cell number and indicated that he had an update on his write-up/request for medical approval for the mastectomy, reconstruction and reduction.
I called him and he said the insurance company gave him the thumbs up. [I didn't ask, but I assume he got something in writing. I'll follow-up on that.] He said he still intends to attend as Dr. Moore performs the mastectomy and provide input and guidance on what 'parts' of me would be beneficial if they could be 'left' (not removed). He said that fat cells would help make the reconstruction easier as well as surgical filet of skin flaps.
I had mentioned that Dr. Moore had a death in the family and he would be available Monday. I also provided an update on my abdominal aeortic aneurysm and current desire to wait until after the cancer and reconstruction/reduction surgeries.
He sounded eager to start. Mentally I'm ready to begin. I still have some follow-up and loose ends to tighten up with Dr. Moore.
Maybe April 27th will be the day. More to come.
I called him and he said the insurance company gave him the thumbs up. [I didn't ask, but I assume he got something in writing. I'll follow-up on that.] He said he still intends to attend as Dr. Moore performs the mastectomy and provide input and guidance on what 'parts' of me would be beneficial if they could be 'left' (not removed). He said that fat cells would help make the reconstruction easier as well as surgical filet of skin flaps.
I had mentioned that Dr. Moore had a death in the family and he would be available Monday. I also provided an update on my abdominal aeortic aneurysm and current desire to wait until after the cancer and reconstruction/reduction surgeries.
He sounded eager to start. Mentally I'm ready to begin. I still have some follow-up and loose ends to tighten up with Dr. Moore.
Maybe April 27th will be the day. More to come.
Friday, April 10, 2015
Vascular surgeon consultation #2
The office of Dr. Pare, the vascular surgeon recommended by Dr. Mehta called me Thursday to remind me that my appointment was today (Friday). I arrived at his office. Waiting room was empty and three professionals were busy updating their Facebook status. Finally someone from the far end of the counter asked if he could be of assistance. Yes, I'm here for an appointment.
Without eye contact, "Name?" Page, Richard, I said. Do you have your insurance card? Yes, here it is. Still no eye contact. He then began asking me a series of questions. The same questions I answered at each appointment. I guess he was completing the form electronically. I suppose that was more efficient, but I'm sure there's something in the HIPAA laws that should have protected my answers and discouraged someone from soliciting this from across the room in the presence of third parties. Apparently their status updates where more important and there were no patients there so it probably didn't matter much. After all they probably have access to all patient files anyway. Just odd.
When he was done entering my responses, he looked at me and said $20. After processing my credit card payment he said, "Come on back" and had me follow him to the examination room where he asked me to wait for the doctor.
I had done my research and checked out the doctor using all online resources so I knew what he looked like. I did see him walk past a few times. It wasn't like he was working with other patients or updating his Facebook status. I guess it's protocol to make all patients wait.
I guess he figured I had him pegged because he dropped in on his last walk by and introduced himself. He asked a few questions with one being who referred him to me. Dr. Mehta from Holy Family referred you. Dr. Pare said, "Who is he?". My oncologist at Holy Family. "Oh you have cancer?" He starts looking at the chart and his notes and quickly comes up to speed.
He indicated that he looked at the CT scan and by his measurements the aneurysm is 4.8 cm. Like others and what I've found through research, he said that generally it has to grow to about 5.5 cm before there is surgery. Until then the risks of surgery out weighs the risk of rupture.
He wanted to 'look at it' now so he asked that I get comfy on the examination table. He rolled over the ultra sound and asked me to lift my shirt. He slowly moved the gooey device below my rib cage and above my belly button on my left. He then asked me to lower my pants so he could see if I had aneurysms behind my legs (where they bend). I know I had one area that looked like varicose veins, but attributed it to age and years of standing. After his examination he said that the veins were big but no aneurysms were found. (YAY).
He got some paper towels and rubbed off the guck and asked me to get dressed. He sat down and said he could really concentrate on my AAA with the ultra sound and recommended that I do nothing. And suggested that I come back in three months to see if it grows. He said that he has had patients where the aneurysm had stabilized and grew no larger. Because we have no history of when I got this and how long it has taken to get to this size he now has a base line to compare future images. Given the size and the reasons stated earlier. He suggested taking care of the cancer first.
I asked him a number of question that I had as a result of my online research. He answered them to my satisfaction. [The body is a marvelous creation. If a vein is closed due to insertion of a stent, it finds an alternative way to get blood to the organ or muscle.] I even asked if he had heard about the modified EVAR (with the polymer). He said he did but he thought there wasn't enough information yet, but he also thought that eventually that would be the preferred option. He remarked that I had very intelligent and informed questions. The Internet is a wonderfully scary tool, I said.
I made a follow up appointment for July.
Every day more information affects the information received the previous days and results in more questions and change in direction.
At this writing and until I get more input from Drs. Moore/Chatson I'm leaning to waiting and monitoring the aneurysm. Something Dr. Pare said today made me think of something Dr Kansal said - It's my choice and gamble on whether to wait or not. Due to the size, I do have time.
I don't see the benefit of rushing into something that can wait - as long as it's monitored this may be the best option - for now.
Without eye contact, "Name?" Page, Richard, I said. Do you have your insurance card? Yes, here it is. Still no eye contact. He then began asking me a series of questions. The same questions I answered at each appointment. I guess he was completing the form electronically. I suppose that was more efficient, but I'm sure there's something in the HIPAA laws that should have protected my answers and discouraged someone from soliciting this from across the room in the presence of third parties. Apparently their status updates where more important and there were no patients there so it probably didn't matter much. After all they probably have access to all patient files anyway. Just odd.
When he was done entering my responses, he looked at me and said $20. After processing my credit card payment he said, "Come on back" and had me follow him to the examination room where he asked me to wait for the doctor.
I had done my research and checked out the doctor using all online resources so I knew what he looked like. I did see him walk past a few times. It wasn't like he was working with other patients or updating his Facebook status. I guess it's protocol to make all patients wait.
I guess he figured I had him pegged because he dropped in on his last walk by and introduced himself. He asked a few questions with one being who referred him to me. Dr. Mehta from Holy Family referred you. Dr. Pare said, "Who is he?". My oncologist at Holy Family. "Oh you have cancer?" He starts looking at the chart and his notes and quickly comes up to speed.
He indicated that he looked at the CT scan and by his measurements the aneurysm is 4.8 cm. Like others and what I've found through research, he said that generally it has to grow to about 5.5 cm before there is surgery. Until then the risks of surgery out weighs the risk of rupture.
He wanted to 'look at it' now so he asked that I get comfy on the examination table. He rolled over the ultra sound and asked me to lift my shirt. He slowly moved the gooey device below my rib cage and above my belly button on my left. He then asked me to lower my pants so he could see if I had aneurysms behind my legs (where they bend). I know I had one area that looked like varicose veins, but attributed it to age and years of standing. After his examination he said that the veins were big but no aneurysms were found. (YAY).
He got some paper towels and rubbed off the guck and asked me to get dressed. He sat down and said he could really concentrate on my AAA with the ultra sound and recommended that I do nothing. And suggested that I come back in three months to see if it grows. He said that he has had patients where the aneurysm had stabilized and grew no larger. Because we have no history of when I got this and how long it has taken to get to this size he now has a base line to compare future images. Given the size and the reasons stated earlier. He suggested taking care of the cancer first.
I asked him a number of question that I had as a result of my online research. He answered them to my satisfaction. [The body is a marvelous creation. If a vein is closed due to insertion of a stent, it finds an alternative way to get blood to the organ or muscle.] I even asked if he had heard about the modified EVAR (with the polymer). He said he did but he thought there wasn't enough information yet, but he also thought that eventually that would be the preferred option. He remarked that I had very intelligent and informed questions. The Internet is a wonderfully scary tool, I said.
I made a follow up appointment for July.
Every day more information affects the information received the previous days and results in more questions and change in direction.
At this writing and until I get more input from Drs. Moore/Chatson I'm leaning to waiting and monitoring the aneurysm. Something Dr. Pare said today made me think of something Dr Kansal said - It's my choice and gamble on whether to wait or not. Due to the size, I do have time.
I don't see the benefit of rushing into something that can wait - as long as it's monitored this may be the best option - for now.
What we have here is a failure to communicate!
I had a follow-up appointment with Dr. Moore scheduled for today. When I arrived I was informed that the doctor was out due to a death in the family. Wow! That's too bad, I said. I'm sorry to hear that. "Yes, it's his father in law. The doctor will be back Monday." To myself I thought that this would have been nice to know in advance. I'm almost certain that this didn't all transpire today, but who knows and who am I to question?
The front desk professional said the doctor would be calling me on Monday and my surgery had been scheduled for April 27th. [First I heard of this.] Not wanting to get into it I mentioned that my CT scan indicated an aneurysm (triple A). She said, "that sounds serious. Please go to an emergency room if you need medical attention." I grinned and said yes, but was thinking - DAH.
Also I was waiting to hear back from Dr. Chatson, who said he was going to call Dr. Moore to discuss his being part of the surgery. I'm hoping that Dr. Moore was more up-to-date that his front desk. Not that they have to be. They have a role to fulfill like informing patients that the doctor is not in today.
Wasted trip. Glad it wasn't in Boston. Communication at its best
The front desk professional said the doctor would be calling me on Monday and my surgery had been scheduled for April 27th. [First I heard of this.] Not wanting to get into it I mentioned that my CT scan indicated an aneurysm (triple A). She said, "that sounds serious. Please go to an emergency room if you need medical attention." I grinned and said yes, but was thinking - DAH.
Also I was waiting to hear back from Dr. Chatson, who said he was going to call Dr. Moore to discuss his being part of the surgery. I'm hoping that Dr. Moore was more up-to-date that his front desk. Not that they have to be. They have a role to fulfill like informing patients that the doctor is not in today.
Wasted trip. Glad it wasn't in Boston. Communication at its best
Vascular Surgeon Consult - St Elizabeth's Hospital
A few days after my last post I was booked for an appointment with Dr Kansal, Chief of Vascular Surgery at St Elizabeth's Hospital in Brighton.
I guess that I should consider myself fortunate that I have a job and am still able to work. Apparently the 'failing health club', to which I'm now a probationary member has little say on when appointments are scheduled. So far, each appointment starts with "Doctor So and So will see you on....". I've not heard "When is a good time for you?" I guess when you're dealing with specialists their time is more valuable - to both them and their patients. So I'm at the whim of the scheduler when it comes to appointments.
During the last few days of Massachusetts' Governor Patrick, an informal session passed legislation that would be enacted in 90 days from being signed into law. One of these bills that happened to squeak by was the windshield wiper law. Basically, in Massachusetts if you have your windshield wipers on, you must now have your lights on. Obviously a safety measure forcing drivers to 'be seen' during bad weather. The intent of the law makes sense, but the application and enforcement does make one raise their eyebrow (if not their ire). For example, if your vehicle has day running lights (DRL), that doesn't count. If the wipers are on, then the lights must be on. We all know that turning on the lights dims the dashboard display (for most cars). Of course if it were night time, you wouldn't want the glare distracting your view of the road and traffic. But dimming the dash during the day only makes it very difficult to see how fast you are going or what song was playing on Sirius XM. Also, this is primary enforcement. Unlike seat belt 'lack of use' which is secondary - meaning they can't pull you over for just that, you could be pulled over, ticketed and surcharged (for six years plus the current year) if you did not have your headlights blazing while wipers are engaged. [Live Free or Die residents can laugh here].
[Post script: Do I have to turn on the lights when I spritz the bugs away?]
My appointment was scheduled for mid day. I figured that traffic during that time getting to Brighton might not be too horrible. HA! As fate would have it, it was lightly raining. Not only do drivers forget how to drive when there's any precipitation, but this new law - taking effect that day would be put to the test.
I gave myself two and a half hours figuring I'd have time to get lost, find parking and meander through a vacuous hospital complex. Good thing. Besides seeing four sets of vehicles pulled to the side of the road due to accidents, pot holes, etc., the cops were out in full force. Yes, there were many electronic signs about the law, but they are distracting because by the time the whole message is displayed - you've passed it, unless traffic comes to a crawl as it does often.
I took no chances and turned on the lights and hoped I knew all the songs I was hearing on Deep Tracks.
It took almost two hours to get to St Elizabeth's Medical Center [although it wasn't playing, I could hear St Elsewhere theme in my head]. I was able to snag a spot on the top floor of the parking deck and walked to the first entrance I saw. Walking in I saw an information desk. I asked for directions to the Cardinal Cushing Pavillion. I was given a look like I had three heads. "Who are you here to see?' Dr Kansal. [The look of confusion, then some shuffling of papers.] "Oh he's in the Cardinal Cushing Pavillion." [Good to know DAH]. I got the 'can't get there from here' line but they gave complex directions which I followed - but got lost. Using the trail of breadcrumbs I left behind, I made it back and said that I couldn't find elevator G. "Oh, there's no sign for that. Just go past the ATM and it's on your right." [ Was this Hotel California?]
I made it to elevator G, then to the eight floor with 15 minutes to spare. Of course just enough time to fill out paperwork. I purposely left an answer blank and was never called on it. [Was that being passive aggressive?]
Met a professional to take my vitals then another who came in reviewed my answers. Nope, they never asked for that missing answer. I was instructed to disrobe and put on a one-size-fits-all "MC Hammer" shorts.
I was examined by a Physician's Assistant, Bill. Then asked to wait for Dr. Kansal.
Shortly after Dr. Kansal came in, introduced himself and began confirming information from his folder. He said that he reviewed the CT scan and reported that the aneurysm was 4.9 cm. Generally repair is needed when it gets closer to 5.5 cm. He said we could monitor it with an ultrasound and subsequent CT scan every few months, but said that it should definitely be addressed. As I already knew from my research, he spoke of the 'open' surgery which is the old standard and effective but had varying levels of risk. A small percentage die on the table, up to 30% die within 30 days, but after that the risk dramatically drops off. If people die after that it's due to other causes. This is major surgery with a recovery period of 3-5 months. He did not recommend this treatment. [Good. I don't either].
He spoke of EVAR (endo vascular aneurysm repair) where a 'stint-like' graft is fed through the femor arteries in the groin and attached to the aneurysm sac. The risks were lower compared to open surgery initially, but there are often subsequent procedures needed for endoleaks and/or migration (movement) of the graft. My research confirmed this. Although not the optimal result, it was better than the alternatives:
I wasn't thrilled with any of this at this point, but he did continue by saying that I was an excellent candidate to a third option - Nellix.
Nellix is an investigational EndoVascular Aneurysm Sealing (EVAS) system designed for the treatment of abdominal aortic aneurysm (AAA). It's the next generation of AAA therapy intended to treat more anatomies than currently approved endovascular stent graft devices, and is the only technology whose operating principle is centered around sealing the aneurysm sac.
Nellix was designed to address unmet clinical needs, and potentially reduce the need for secondary interventions following endovascular AAA repair. In initial clinical trial experience involving 34 patients outside of the United States 100% implant success was observed. In a two year follow-up, no aneurysm rupture, conversion to open surgery or stent graft migration has been observed. One secondary procedure for distal Type I endoleak had been performed. Physician feedback has been positive, particularly as it relates to ease of use and versatility to treat both standard and more challenging aneurysm anatomies.
This is cutting edge and an FDA approved clinical trial offered in only six locations in the US - Massachusetts - St Elizabeth's being one.
I've done much research on this (online), watched you tube videos on all three types of procedures and read all the white papers I could find of the European trials. (It's now standard in Europe).
EVAR requires a more invasive approach requiring exposing the femor arteries and subsequent pain/healing peiod. EVAS has reduced this with insertion points that may not even need a band aid. Dr Kansal said that the procedure would require an overnight stay and a day or two rest up, then limited activity for about a week. After that all restrictions are lifted. He said that patients often ask after surgery when will the surgery take place because there has been no impact. [Videos and white papers support this.]
I'm leaning to this. But I do need more information. Of course every decision has dependencies.
Dr Kansal recommends that I take care of the cancer first. Heal up, then come back to him for an ultra sound and CT scan. After the results are reviewed, I would go in for pre-op then have the surgery. There would be a some follow-ups and ultra sounds to ensure things went according to plans. This plan would affect the order of precedence. The reconstruction/reduction surgery would need to be done last. I'm not sure what that means to the other surgeons and of course the insurance company.
I have follow-ups with Dr. Moore, Dr. Rees, Dr. Mehta and a consultation with a second vascular surgeon.
I guess that I should consider myself fortunate that I have a job and am still able to work. Apparently the 'failing health club', to which I'm now a probationary member has little say on when appointments are scheduled. So far, each appointment starts with "Doctor So and So will see you on....". I've not heard "When is a good time for you?" I guess when you're dealing with specialists their time is more valuable - to both them and their patients. So I'm at the whim of the scheduler when it comes to appointments.
During the last few days of Massachusetts' Governor Patrick, an informal session passed legislation that would be enacted in 90 days from being signed into law. One of these bills that happened to squeak by was the windshield wiper law. Basically, in Massachusetts if you have your windshield wipers on, you must now have your lights on. Obviously a safety measure forcing drivers to 'be seen' during bad weather. The intent of the law makes sense, but the application and enforcement does make one raise their eyebrow (if not their ire). For example, if your vehicle has day running lights (DRL), that doesn't count. If the wipers are on, then the lights must be on. We all know that turning on the lights dims the dashboard display (for most cars). Of course if it were night time, you wouldn't want the glare distracting your view of the road and traffic. But dimming the dash during the day only makes it very difficult to see how fast you are going or what song was playing on Sirius XM. Also, this is primary enforcement. Unlike seat belt 'lack of use' which is secondary - meaning they can't pull you over for just that, you could be pulled over, ticketed and surcharged (for six years plus the current year) if you did not have your headlights blazing while wipers are engaged. [Live Free or Die residents can laugh here].
[Post script: Do I have to turn on the lights when I spritz the bugs away?]
My appointment was scheduled for mid day. I figured that traffic during that time getting to Brighton might not be too horrible. HA! As fate would have it, it was lightly raining. Not only do drivers forget how to drive when there's any precipitation, but this new law - taking effect that day would be put to the test.
I gave myself two and a half hours figuring I'd have time to get lost, find parking and meander through a vacuous hospital complex. Good thing. Besides seeing four sets of vehicles pulled to the side of the road due to accidents, pot holes, etc., the cops were out in full force. Yes, there were many electronic signs about the law, but they are distracting because by the time the whole message is displayed - you've passed it, unless traffic comes to a crawl as it does often.
I took no chances and turned on the lights and hoped I knew all the songs I was hearing on Deep Tracks.
It took almost two hours to get to St Elizabeth's Medical Center [although it wasn't playing, I could hear St Elsewhere theme in my head]. I was able to snag a spot on the top floor of the parking deck and walked to the first entrance I saw. Walking in I saw an information desk. I asked for directions to the Cardinal Cushing Pavillion. I was given a look like I had three heads. "Who are you here to see?' Dr Kansal. [The look of confusion, then some shuffling of papers.] "Oh he's in the Cardinal Cushing Pavillion." [Good to know DAH]. I got the 'can't get there from here' line but they gave complex directions which I followed - but got lost. Using the trail of breadcrumbs I left behind, I made it back and said that I couldn't find elevator G. "Oh, there's no sign for that. Just go past the ATM and it's on your right." [ Was this Hotel California?]
I made it to elevator G, then to the eight floor with 15 minutes to spare. Of course just enough time to fill out paperwork. I purposely left an answer blank and was never called on it. [Was that being passive aggressive?]
Met a professional to take my vitals then another who came in reviewed my answers. Nope, they never asked for that missing answer. I was instructed to disrobe and put on a one-size-fits-all "MC Hammer" shorts.
I was examined by a Physician's Assistant, Bill. Then asked to wait for Dr. Kansal.
Shortly after Dr. Kansal came in, introduced himself and began confirming information from his folder. He said that he reviewed the CT scan and reported that the aneurysm was 4.9 cm. Generally repair is needed when it gets closer to 5.5 cm. He said we could monitor it with an ultrasound and subsequent CT scan every few months, but said that it should definitely be addressed. As I already knew from my research, he spoke of the 'open' surgery which is the old standard and effective but had varying levels of risk. A small percentage die on the table, up to 30% die within 30 days, but after that the risk dramatically drops off. If people die after that it's due to other causes. This is major surgery with a recovery period of 3-5 months. He did not recommend this treatment. [Good. I don't either].
He spoke of EVAR (endo vascular aneurysm repair) where a 'stint-like' graft is fed through the femor arteries in the groin and attached to the aneurysm sac. The risks were lower compared to open surgery initially, but there are often subsequent procedures needed for endoleaks and/or migration (movement) of the graft. My research confirmed this. Although not the optimal result, it was better than the alternatives:
- waiting it out and hoping it doesn't get bigger (ticking time bomb approach);
- having open surgery with high risk of immediate death or complications/death within the first 30 days.
I wasn't thrilled with any of this at this point, but he did continue by saying that I was an excellent candidate to a third option - Nellix.
Nellix is an investigational EndoVascular Aneurysm Sealing (EVAS) system designed for the treatment of abdominal aortic aneurysm (AAA). It's the next generation of AAA therapy intended to treat more anatomies than currently approved endovascular stent graft devices, and is the only technology whose operating principle is centered around sealing the aneurysm sac.
Nellix was designed to address unmet clinical needs, and potentially reduce the need for secondary interventions following endovascular AAA repair. In initial clinical trial experience involving 34 patients outside of the United States 100% implant success was observed. In a two year follow-up, no aneurysm rupture, conversion to open surgery or stent graft migration has been observed. One secondary procedure for distal Type I endoleak had been performed. Physician feedback has been positive, particularly as it relates to ease of use and versatility to treat both standard and more challenging aneurysm anatomies.
This is cutting edge and an FDA approved clinical trial offered in only six locations in the US - Massachusetts - St Elizabeth's being one.
I've done much research on this (online), watched you tube videos on all three types of procedures and read all the white papers I could find of the European trials. (It's now standard in Europe).
EVAR requires a more invasive approach requiring exposing the femor arteries and subsequent pain/healing peiod. EVAS has reduced this with insertion points that may not even need a band aid. Dr Kansal said that the procedure would require an overnight stay and a day or two rest up, then limited activity for about a week. After that all restrictions are lifted. He said that patients often ask after surgery when will the surgery take place because there has been no impact. [Videos and white papers support this.]
I'm leaning to this. But I do need more information. Of course every decision has dependencies.
Dr Kansal recommends that I take care of the cancer first. Heal up, then come back to him for an ultra sound and CT scan. After the results are reviewed, I would go in for pre-op then have the surgery. There would be a some follow-ups and ultra sounds to ensure things went according to plans. This plan would affect the order of precedence. The reconstruction/reduction surgery would need to be done last. I'm not sure what that means to the other surgeons and of course the insurance company.
I have follow-ups with Dr. Moore, Dr. Rees, Dr. Mehta and a consultation with a second vascular surgeon.
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