So by 11 a.m. I staggered back into the house after today’s adventure in the Mayo’s high-powered operating arena. The scheduled surgery did not happen, a conflict of opinion among the distinguished doctors did happen, and I enjoyed a painful but interesting procedure to scour out the inside of my boob.
Here’s what happened.
Bright & early today, we (i.e., me and wonder-surgeon Dr. P, who despite my endless complaints does have a sterling national reputation) had scheduled the third attempt to excise enough boob tissue to obtain clear margins on an encapsulated papillary carcinoma which has proven to be significantly larger than indicated by repeated mammography and ultrasound. Assuming the pathology reports continue to show no sign of invasive cancer, the next surgery, if this fails again, will be a simple mastectomy.
Meanwhile, though, after the last surgery, I developed what appeared to be an infection: redness, heat, swelling, pain. Two (much lesser!) doctors diagnosed this as an infection, but Dr. P felt it was a large hematoma that had filled the surgical cavity. Nevertheless, I’ve been on cephalexin since the 4th, with apparent improvement.
Okay, come 6 a.m. we’re on track to try again. However….
On Thursday I started to come down with a cold. By Friday it felt like someone had stuck a blowtorch down my throat, and I was running a fever ranging from 99.5 to 100 degrees (“normal” for me is about 98.4, so that’s pretty high). Saturday the sore throat cleared, leaving a congested cough and a lot of post-nasal drip (unclear whether the cough proceeds from the chest, or is only a response to the throat irritation from the little nasal waterfall, but it’s probably the latter). Sunday the fever drops into the more or less normal range — 98.4 to 99, up and down). It’s worth knowing that before the virus came along, the temp would spike off and on to 99.5; Dr. P said that was consistent with a surgical hematoma in the breast.
Today I show up to be prepped and of course tell them about this new development..
Nursing staff and her resident believe the procecdure, which requires me to be knocked out with anaesthesia, will be canceled. Dr. P begs to differ. She says we should go ahead and orders her staff to Make It So.
Now one Dr. M, a gray-bearded anaesthesiologist who looks fully senior and wise as the ages, appears on the scene and asks if I’ve had a fever. I tell him about the 100-degree spikes on Friday and Saturday. He thinks about this for approximately three seconds and then says, “It would be foolish to proceed.”
I personally do not argue, because that’s my own private opinion, which as everyone knows is infallible.
Dr. P resurfaces, and she is peeved. She disagrees, but since the man is simply not going to do it, she’s now stymied. She reschedules the excision attempt, but while I’m there she hauls me into the OR to clean out the boob under a local. When she opens the thing up to suction out the fluids, she finds no pus or other indication of infection — just a lot of old, stale blood. She expresses her satisfaction that her diagnosis is now proven correct: not an infection. I think, uh huh… after I’ve been swallowing cephalexin 4x a day for the past week or ten days, and the red areas that concerned the other two docs have receded to the point of disappearance. On the other hand, the incision split open on Thursday; the hematoma has been quietly draining since then, and that also could account for the apparent improvement.
She administered an IV antibiotic, suctioned and cleaned with élan, treated the wound directly with antibiotic, and closed with antibiotic-laced sutures.
The procedure was pretty painful despite liberal amounts of Lidocaine. At one point my blood pressure, which is usually in the 130s/80, went up to 297/120. It dropped fairly quickly into the 150s, which itself is unacceptable but at least not a sign of an impending stroke. The nurse said pain often causes BP to go through the roof. Hope that’s all it is…but now to add to my joy I’ve got to go back to measuring my GD blood pressure twice a day, a pain in the tuchus and yet another source of daily worry.
Temp is 99.6, not good. The cough is nastier than it was this morning. But after an oxycodone and an afternoon of sleep (interrupted by only two phone calls…), the pain is receding some and the swelling is to a large extent reduced, though there’s still some hard stuff in there that feels like the hematoma…I’m afraid it’s probably still bleeding inside.
Given that the cough is now worse and I’m gagging up stuff that’s choking me, I’m glad the anaesthesiologist brought a stop to the craziness. But it means I’ve STILL got two procedures to endure, at the very least. And what do you bet something else comes up to require another one?
We should get a blog pool going on here… How many more fun procedures before this comes to an end? Cast your bets, ladies and gentlemen!
Even though I hate the thought, maybe just have a mastectomy and be done with “procedures/surgeries.” Or, let yourself heal up for maybe 2 months without any interventions, then have another whatever comes up the chain from a mammogram (ultrasound?). If it’s still there, then mastectomy. Have you thought of contacting a malpractice lawyer? Sounds like the docs don’t know what they are doing. Just MHO.
The antibiotic probably helped with the inflammation even if not a full blown infection. I have taken that drug many times and it works.
Yeah, I suggested that to her. And in fact, this afternoon (Thursday) I just came from Young Dr. Kildare’s office — he has advocated the same and was peeved that she talked me into a third attempt at an excision. However, she feels there IS a halfway decent chance that she can get clear margins. The Mayo does not routinely have a pathologist working in real time; she proposes to arrange that for this third effort, and YDK agreed that greatly increases her chances for success.
I suppose I’d really rather have a little bit of boob left, rather than a blank space with a scar. So I suppose, maybe, it’s worth one last try.
One of my friends had SEVEN re-excisions by the time they finally decided to lob off the boob.
It appears, indeed, that re-excisions are fairly common. In 2012, for example, the re-excision rate for women undergoing BCS was 20% to 40% (http://www.medscape.com/viewarticle/770744). Dr. P said the Mayo’s rate is quite low: 8%. Apparently I’m among the oddballs here as everywhere…
The only part of the EPC that was visible either by mammography or by ultrasound was two small chunks that looked in the imaging like two separate 1-cm entities. As it’s developed, the “two” were really parts of one entity, which so far is measured at about 5 cm. Most of it, then, including the parts that she’s still trying to get out, was invisible to the imaging technology used so far.
I vote for “take a step back”. Just wait a month or two until your strength is back full force before any further procedures. Your poor body has been under assault and needs to get fully healed before the next round. I’m sure your weak physical state is also affecting your mental state and maybe you aren’t able to make the best choice for you right now?
From your accounting, if it were me I would find a new doctor. Nationally acclaimed perhaps but she sounds frightfully impatient, headstrong and careless.
Thankfully someone with a clear head Dr. M came in and stopped the “madness”. Surgery is dangerous enough but to proceed with a compromised patient in her 60’s?…No thank you… I’m with dee-dee… What’s the hurry ? Let’s take a breath and get a “handle” on exactly the size, shape, density and nature of your malidy. As I have said before, “in this neck of the woods” scans are done and considered a valuable tool in treatment. My Dear Dad had a “3D scan” of his lungs and provided a detailed map of his situation and then a plan of treatment for his cancer was arrived at. The surgeon who removed his lung was very forthcoming and tended to use the scans as tools that he said kept him from having “surprises”. This has certainly changed my view of the Mayo….”turf war”???…this is a person’s life!!!
Sounds perfectly awful. I’m so sorry that this hasn’t yet been cleared up — and allow me to add my voice to the chorus of, “What was your doctor THINKING, considering putting you under a general in this case?”
Turf wars. Can’t escape them. Except I always want to ask, “If it were your beloved parent in this condition, would you want him/her knocked out?”
Yeah, I would agree that being under the knife and under the pressure to make this many (big) decisions in so short a time calls for your taking some time to rest and recover.