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

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

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

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

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

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

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

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

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

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

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

Posted by: Kathy at 06:00 PM | Comments (2) | Add Comment
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You never really know what's going to come of a call to Dr. Academic's office.

I don't really call all that often any more, simply because I'm not having that many problems. I never called all that much to begin with, simply because I felt guilty taking time away from patients who could really use the help. I sucked up many of my complaints, and I was glad that, when they passed, I skipped calling for help. Going through chemo is like going through anything else: you get used to it. But even now that I'm through the worst, I nonetheless have to call in every now and again to get certain things taken care of---getting my vicodin prescription refilled is at the top of the list (due to idiotic Minnesota state law in regards to narcotics, you can't order a refill through the pharmacy, but rather you have to go through your doctor's office). Any time I have questions, though, they're pretty good about getting me an answer, even though Dr. Academic's main nurse, who is omniscent and omnipotent and is, generally speaking, AWESOME, has been on maternity leave since December and her absence has really been screwing things up. That aside, I called in the other day because, well, I've been having some pain in a place where I shouldn't be having any: my pelvic region. Particularly, in the area where all the trouble began.

I called in because, mainly, I was curious. It's not high-grade pain. It's very low on that 1-10 scale they use to rate your pain, and I was more curious about it than anything else. I thought, perhaps, this was me finally feeling the mysterious endometriosis, which I never knew I had until after I had my surgery. Dr. Academic had mentioned at our last meeting that he thought, perhaps, that the chemo hadn't killed it off, like they thought it would. Apparently, endometrial tissue is the cellular equivalent of a cockroach who's still putzing around after a nuclear war. I was told to keep an eye on things and to report in if I had any pain. I had pain, so I reported in.

The last thing I expected---and I seriously mean that---would be to receive a call back later in the day, telling me that Dr. Academic would really like it if I came in to give blood for a CA-125 test and to have another Pet Scan done, as well. Well, hello there sailor! Furthermore, even though I had my three month checkup already scheduled for next week, they wanted to move it up to a day when Dr. Academic was actually in the office. It makes your head spin, sometimes, when a doctor freaks out, and starts ordering tests willy nilly.

It had seriously never occurred to me that the cancer might be back, but even after this information had been related to me, I still had a hard time getting worked up about it. I really didn't think the cancer was back and was fairly certain that he was freaking out over nothing. Yet, I nonetheless went in for the CA-125 (and, man, was it ever weird being back in that office after a three month absence! All those worried, exhausted, sick people of whom I used to be one. It's just a sad place to be when you're well.), and the next day went in for the Pet Scan, and then went about my business. I knew that if the cancer was back, well, that didn't bode well. The odds are that if ovarian cancer comes back after an optimal surgery (which I had) and optimal chemo (which I also had), "Ovarian Cancer" would most likely be listed as the cause of my death on my death certificate. As in it would be inevitable, unless I died from getting run over by a bus or a Benz-driving Soccer Mom gabbing uncontrollably into a cell phone. That's just how it works. That's the point where a cure is forever put out of reach; you will simply receive treatment to keep you alive, but you'll eventually die of ovarian cancer, at some point in the future. It might be next week, or it might be thirty years from now, but it will happen. It's very sad, but it's very true, as well. Even knowing this, I just couldn't get worked up over it. It just didn't feel like cancer, which, I'll grant you, is ironic given my original OB-GYN said precisely the same thing before my surgery, but, still, it didn't feel like it. Cancer for me means lots of pain and fatigue that comes out of nowhere and demands that you take a nap. I'm not having any of that. Despite the fact I'm still feeling some of the aftereffects of chemo, for the most part, I feel great! My body is working the way it's supposed to. And while I'm absolutely certain that you can probably feel great and still have cancer, I was fairly certain that I hadn't recurred.

It turned out that I was right, too. The test results came back yesterday and the nurse called me first thing to relay them. My CA-125 is at 5.6, which is fantastic and the Pet Scan came back as normal, as well. I know we're no further along in figuring out why I'm having pelvic pain, but we can sort that out on Tuesday, when I have my appointment.

I suspect it's the endometriosis that's causing the trouble. I've been on HRT since July, and have been feeling some weird things in that region ever since I started up, but there's been no pain, until now. Endometriosis feeds on estrogen, which is, of course, what the HRT is supplying so I don't have to suffer through hot flashes and the like. But I'm also receiving progesterone, the anti-estrogen hormone (it's the predominant hormone during pregnancy, which explains why I'm fat, fat fat right now.) and that was supposed to combat anything the estrogen might do in terms of the endometriosis. Dr. Academic hypothesized that what I was feeling was probably adhesions, which were being charged by the estrogen in the HRT. Now, I don't know if they'll be able to treat it, so I can still stay on HRT, or if I'll have to give up the HRT entirely. It would be bad for me if I went off HRT, not only because I freakin' hate hot flashes, night sweats, and weeping like a ninny every time I turn around, but simply because thirty-seven-year-old women are not supposed to be in menopause. Without the hormones, your bone density deteriorates and the chances for osteoporosis go through the roof, and since osteoporosis jumps from branch to branch in my family tree with the greatest of ease, that's something I'd like to avoid. One of my greatest (and stupid) fears is that I'll shrink---and that one was already in play before I got ovarian cancer. It also means that my expected life span, which is pretty much back to normal since the cancer went on its merry way, would be diminished. So, I need the HRT until I reach the age when I should have hit menopause, despite what it might do to the endometriosis. The benefits, for me, are greater than any risks that might come with taking it.

But then again, I'm not a doctor, so I might be entirely wrong about this whole thing. It was this weekend last year that I was certain I was having a gallbladder attack and went to the ER for help---and we all know how well that turned out. The timing of all this aside (which, honestly, is one of the weirder coincidences in my life), I'd at least like to think I have a better handle on all of this medical stuff. I didn't freak out, like I did back in November, about receiving the results of the pet scan. Perhaps just having more distance between the rigors of chemo over the summer and now has helped. Maybe being at the hospital and getting over some deeply ingrained fears held over from the time I spent there has helped, as well. I don't really know. But, come whatever may on Tuesday (and I suspect something will come, even if I don't know what it is. I've learned that when a doctor freaks out like Dr.Academic did, it's generally something and something will generally come of it.), I've surprised myself this week by handling this pretty well.

Lately, I've thought that I didn't have a lot of emotional reserves left after battling cancer for the better part of a year. I freaked out at the least likely of things, and didn't really have a good grasp on that gift from God called "perspective." I made more of things than I should have. This week was a bit of a wake-up call in that department. Strangely enough, you can apparently bring the threat of cancer back into my life and I won't freak out. Oh, sure, I'll think about it a lot but, for the most part, I won't let it bother me. I wasn't paralyzed with fear. Mostly, as I told the husband repeatedly, I was going to be pissed off if the cancer came back. And I seriously meant that: all that...for what? Just to have to do it all over again? How fucking unfair would that be? What a load of hooey, I thought. I just don't have time for this crap! I feel well. I have been told repeatedly by all and sundry that it's time to get on with my life---only to have to put it on hold again because the cancer had reappeared? I don't fucking think so. And, yes, while I was relieved when the tests came back normal, it wasn't like the huge wave of relief that knocked me over when I received the same results in November.

So, it's been, on the whole, a very weird week. We'll have to see what happens on Tuesday, and on Friday, which is my one year anniversary, to see if next week trumps this one on the weirdness scale.

Posted by: Kathy at 12:27 PM | Comments (1) | Add Comment
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