Foul Humors   May 11th, 2011

Maybe it’s no coincidence that the last fiction book I read was Ken Follett’s “World Without End”, which I started the day of my sentinel lymph node biopsy on April 1st. What now, in retrospect, seems poignant about the book was one of the main character’s struggles during medieval Britain with the common accepted wisdom of medical procedures. One of the procedures frequently advocated by the monks and men of knowledge in the book was bleeding the patient to drain the foul humors believed to be causing illness. For the most part, modern medicine has disposed of that practice, but I find it curious to be sitting here, writing today’s blog post, with a plastic tube attached inside my body, connected to a small plastic container clipped to my shirt where my “foul humors” are now collecting.

The drain installed in my body to drain off fluid build-up

The drain installed in my body to drain off fluid build-up

Okay, so I know it’s not really “foul humors”, but instead a way to provide a release for excess fluid build-up in my body now that part of my lymphatic system has been removed, but still – there’s an interesting sort of historical analogy here, as cancer treatment is still a rather inexact science (at least for many types of cancer, include the melanoma I have been diagnosed with).

As I wrote in my previous posting, I was scheduled for a lymphadenectomy this past Monday – a surgical procedure which is intended to remove potentially cancerous lymph nodes before the cancer can metastasize in other parts of the body.

At Mass General Hospital the morning of my surgery

At Mass General Hospital the morning of my surgery

I arrived by foot at nearby Massachusetts General Hospital (MGH) just before 6am on Monday, May 9th, with my family in tow. It didn’t take long for me to get processed through the surgical pre-operative routine and get parked outside Operating Room 3 (and MGH apparently has 50 operating rooms). By 8am or so, I was already under the proverbial knife in OR3, wielded by MGH’s chief oncological surgeon and melanoma surgical specialist, Dr. Kenneth Tanabe.

At 10:30am my wife Linda received a call from Dr. Tanabe explaining that the surgery went well, and there were no blatant signs that anything was amiss with the lymph nodes they removed. I personally did not regain full consciousness until sometime around 12:30pm, in the recovery unit, where I stayed until they found me a bed for the night in Ellison 7 – one of the wings where patients stay and are taken care of while staying at the hospital. I didn’t get moved from recovery to my room until about 4pm – it took a while to find me a free space.

I did discover a few things during my recovery that I had not expected. The first was that during surgery I had had a catheter administered to keep my bladder drained. I had never had a catheter before, and the ramifications were rather distressing – urinating hurt like the dickens due to a roughed up urethra, and, as I later discovered, my bladder lost its usual elasticity for a while, resulting in extreme abdominal pain later that night. That has fortunately resolved itself now.

The other thing I learned was that I had been lucky with the two prior excisions in that my post-operative wound pain was pretty minor. That was definitely not the case this time around, as my lymphadenectomy had resulted in the internal bruising (or possibly even some cutting) of muscle tissue in the area where my lymph nodes were removed). The consequence of this is significant pain anytime my abdominal or groin region tenses up, which in turn is caused by coughing, throat clearing, nose blowing, sneezing, attempting to lift my right leg, and transitioning between horizontal, sitting, and standing positions. Once I am sitting, lying down, or standing, the pain ends up going away. The unfortunate aspect of this is that I am having to utilize pain medication at present, which is not something I’m particularly fond of, as it makes my thinking a bit fuzzy (and, let me tell you, writing this blog entry coherently while on pain meds is a wee bit of a challenge).

Anyhow, shortly after I arrived in my room, my wife and children, and my “little sister” LaDonna – all of whom had been waiting for me in the Gray waiting area at MGH since 12:30pm, were summoned, and kept me company for a while.

Me in my hospital bed later in the day after my surgery

Me in my hospital bed later in the day after my surgery

I was in good spirits when they arrived, but pain was definitely a source of discomfort. LaDonna ended up leaving around 5pm because she needed to catch a train back to Maine, and my family left shortly thereafter to grab some dinner. It is definitely convenient living only a 5-7 minute walk away from the hospital, as Linda ultimately ended up making three trips to the hospital on Monday.

My nurse Natalie got me on my feet while Linda and the kids were away – it was painful getting up on my feet, but liberating in a way as well, since I could walk (shuffle) with only a modicum of pain once I was vertical.

Linda came back to visit for a bit after dinner, and then I had the rest of the night to myself – and my roommate Jack, numerous nurses, and non-stop sound and light. How anyone is supposed to get any rest and relaxation in a hospital I don’t know. Between the taking of vitals every four hours, the sounds of coughing from a roommate with pneumonia, constant alert tones and announcements, and my own bladder and pain management issues, I managed all of about three hours of fitful sleep.

When the chief resident came in the next morning to tell me that I was free to be released because I had managed to walk around the prior night, I felt greatly relieved – it was an emancipation of sorts. I didn’t think I would have been able to manage another day in the hospital (and not just due to the lack of restfulness, but also because of the unsuitable food – no real viable low-carb options – everything had starches and sugar, which would only serve to make me feel worse physically).

The process of getting back to our apartment was a bit of a conundrum. We had originally discussed the idea of having a taxi take me back, but I couldn’t see how it would possibly work considering how difficult it was for me to transition between sitting and standing, never mind that taxis don’t have a lot of leg room. So I opted for the more practical but tedious approach of shuffling my way back to our apartment on foot. A walk that would normally take about five minutes took closer to thirty minutes due to my slower and more meticulous pace. But the end result is that I am now safely back home, and after a pretty decent night’s sleep (7 hours with only one interruption), I am feeling “not too bad”. My right thigh is definitely swollen and tingly, but I have a nurse from the visiting nurses’ association (VNA) arriving shortly to remove my bandages and help me with wound care and other recovery advice.

So, what comes next?

I should have biopsy results from the removed lymph nodes by the beginning of next week.

The drain will stay attached until the bulb has collected only about 30cc of fluid for any given day (yesterday it was nearly 300cc for the whole day, and started off mostly blood, whereas now it is clearing up as the fluid collected has transitioned to lymph). The predication is that this will take a few weeks to achieve, so I will need to deal with the drain in some way until then.

And, I have my first round of clinical oncology meetings on May 31st to see what faces me next in terms of adjuvant treatments – immunotherapy with Interferon, most likely. That gives me about three weeks to learn all I can about cancer cellular biology and melanoma treatment possibilities so I can better understand my options.