Surgery

Hello interstellar blizzard,

I was in agony in the recovery room (apparently they kept me there for 4 hours or so), holding my tummy, crying and constantly screaming that my pain levels were anywhere between 8 and 10 :) I don't have a very clear memory of that room, I can't remember faces there either as I think that they sedated me for most of the time I spent there. Then I was asleep/waking up and asking for more pain medication/asleep for most of the night :) Feeling much better (just groggy) and the pain medications are keeping me comfortable now!

Now that I am a little bit more awake, I will post a little something on this blog. On Thursday morning, my courageous chauffeur brave enough to fight early morning traffic picks me up and drives me to the hospital. I register at the Surgery Center. There, I am asked if there is a particular religious affiliation I would like to state. I am taken aback by the question. The person at the counter replies kindly that "if we need to call a priest for you, it's better that we call the right now".

Charming!

I am then led into the Pre-Op area where they ask you a ton of the same questions everyone has been asking you for the past few months. You dress up in a lovely gown, probably some 18th century fashion style, and you are left alone for an hour until the doctors decide it's time to come say hi. I use this time very wisely, getting educated in classic Spanish literature as you can see.

My oncologist drops by and reminds me that after this procedure, if I wanted to get pregnant, I will have to have a C-section to delivery. I thank her for this useful albeit late clarification and wish her well. She also says that my anesthesiologist is "Great".
The cute and great (and married with two kids) anesthesiologist finally comes by to start an IV. He is Swiss so we talk about his good old European days. He decides to start the IV on my left hand. He first numbs me (that's the uncomfortable part as the liquid that's used for that is quite painful), then just insert the tube. He misses the vein or did something wrong and he has to take everything out after messing about with the tube for a few minutes, thus creating a nice bruise. Meanwhile, he keeps asking me if I could feel something. I reply that I can feel a tube moving around in my hand, that it is rather painful and is making me feel nauseous. He thinks that it's strange since he numbed the area. He does it again on my right hand and everything goes smoothly this time around. I am so glad that he's a great physician. I wonder how many times a bad one would have had to try this.

I ask him how anesthesia worked. His response: "we really don't know. We know it does work but we don't know the mechanisms by which it works. But don't worry, we've done this plenty of times." Another reassuring tidbit of info from Dr. Anesthesiologist The Great. And if he's done it as often as he has inserted IV into people's hands, I am not sure that it is such a good thing.

Then because of my last "post-egg retrieval" PTSD experience, he wanted to give me something to knock me out and make me feel really relaxed. I thought that I could refuse but apparently not. He says: "you will feel things but you will really not care. I want to see how you're doing on it before I put you to sleep".

1 min later, I was totally out since I do not remember leaving the pre-op area, entering the OR, leaving the OR.

The next thing I remember is actually quite fuzzy. I remember feeling A LOT of pain in my tummy, holding it with my two hands and screaming as loud as I could. I have a very confused idea of where I am, I don't remember hearing the usual "your surgery's over", or seeing my doctor. I couldn't describe the recovery room to you. At times I hear "what's your pain level on a scale from 0 to 10". I start with a conservative 8 but whatever they gave me for this pain level didn't work. Next time I am asked the question, I shout back "25"!!! I have no notion of time, I don't remember how long I stayed in the recovery room. I just think that the surgery lasted for about 2 to 3 hours. I remember people holding me down, trying to keep me somewhat flat and motionless. I remember some orders flying over my head "4g of morphine" or "let's keep her on oxygen to help her relax". Then after what seemed to be a long struggle, in and out of consciousness and still experiencing some extreme pain in my abdomen, I vaguely hear "we're going to take you to your room now", feel the velcro portion of whatever they use to monitor your vital signs during surgery removed. Then nothing. Next I hear is "try to slide down more to the left. It's a softer bed, you'll be more comfortable". Then nothing. Then a lot of pain, rolling over to the side holding my tummy, nurses coming in and out to take vitals, adding morphine on a regular schedule and giving me valium every 8 hours and Percocet (2 tablets at a time) every 3 or 4 hours. I wake up for dinner, which was not vegetarian (they should have asked me about dietary restriction at the patient registration desk!), with no appetite and feeling quite nauseous, have a nurse take a picture and then go back to bed...

I spend the night with pain levels around 5 to 7, woken up every few hours...

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Oncologist #2 came by earlier today and we had a friendly chat.

- The good news is that the oncologist achieved clear margins after she removed the cervix (according to one of our past conversations, it doesn't mean anything but hey, it's still good news) and she even had a bit left to put the circlage around in a very elegant fashion.
- This also confirms that the cervix was full of cancer since there were no clear margins within it.
- The final pathology will become available sometime next week. We will do a special report on it. Stay tuned.
- She indicated that I could not douche, have intercourse, use tampons, take a bath or leave my house for the next three weeks, and no exercise for the next 1-2 months depending on how I feel. Wine seems to be OK, so we're cool.
- She then went on to say that I should wait for 2-3 months before becoming pregnant if I chose to do so. She thinks that it is better not to waste time waiting around. She will want to do an MRI at the end of this period and make sure it shows no visible sign of cancer. She also said that I should limit myself to a short period of time within which to attempt a pregnancy. If I am not successful within that time window, then I should abandon the idea of carrying a child and move on to Option 1.
- I did bring up the unanimous voice of most other oncologists I have talked to about the situation, urging me to go straight to Option 1. I also gave her some background as to which information they were basing their recommendation on.
- She said that her recommendation was based on the Stanford pathology report which states a different form of Sarcoma, much less aggressive in her opinion. Had she believed that this was a more typical sarcoma, she would not even have allowed me to go through an IVF cycle.
So she still feels confident that the remaining cancer if there is any, will grow slowly enough that it will be manageable after a pregnancy, through resection. She still recommends a hysterectomy afterwards and would support my desire to undergo adjuvant radiotherapy at that time.
- She said that she wanted me to feel comfortable with my decision and she would support me in whatever this decision is so long as she did not believe it entailed unreasonable risk. To help me better understand the risk of Option 2, she offered a referral at Sloan Kettering Memorial Cancer Center.
- I did mention that because this was so rare thus poorly understood, it would make sense to be conservative as the cancer could display unpredictable and potentially dangerous behaviors. She agreed that it was rare.

Let's wait for the final pathology report now.

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I had a pretty decent night's sleep, waking up every 4 hours or so only for vital signs check ups. I think that I was a little tired and glad that I could rest. One shot of morphine prior to the night and then regular pain killers (2 tablets) every four hours + valium certainly helped accelerate my trip to Dreamland.
I have two beautiful sets of flowers in the room and they remind me of how fortunate I am to get so much support from so many wonderful friends! I will take them home with me!

Waking up this morning was a little rough as I experienced some pretty serious cramping, much worse than yesterday afternoon/evening but not as bad as Thursday post surgery! Anything that would take me away from a fetal position this morning would send me screaming...These painkillers do wonders though, so I am pretty confident that it'll be a comfy day overall! I am off the morphine for now, still on antibiotics through IV. I took two tablets of pain killers, 1 valium and my regular morning medication. The painkillers are already causing a serious bout of constipation which is not good at all for the fissure but I still prefer this than being in constant pain. Hopefully the cramping will get a little better. The nurse said that they will probably send me home with a good number of pain killer tablets as it is not uncommon to experience bad cramping for over a week after this procedure. I will probably have some antibiotics for another 10 days to prevent infection.

I have decided to dress up as soon as I can and sit in the chair as opposed to this bed which I am starting to get sick of. I am looking forward to a day of reading by the window and with the sun shining through, it will feel like I am outside. I am trying to drink as much fluid as I can to give my body as much energy catalysts as it might need to recover quickly. The 3-4 hour sleep at a time last night certainly helped!

The nurses were pleased with the fact that I took a little walk around the ward yesterday. I will try this again today. Apparently, it really helps with the healing. I can't walk fast/jump because the vagina is now stitched up to the bottom of the uterus and any serious effort might get this to break loose, causing pain and hemorrhages, none of which I am too keen on.

I was blogging this morning and one of the nurses was very curious so I did a little tutorial on how to use blogger, showed some of the pictures on there and said that this was a free service. Hopefully, we'll have a new blog fan by the end of my stay!

Another resident working with my oncologist came by this morning to check up on me. She did a quick exam, indicated that it was quite red/bloody which was normal but that I seem to be doing great, and much better than expected. My blood pressure is back to low levels and other than feeling very drowsy from the valium/pain killers I feel great!! She did explain that if I wanted to attempt a pregnancy, it will be a very difficult one, that I would have to be followed very closely (assuming it even gets started), probably stay in bed for 20 weeks and not expect to delivery after the 32 week mark. She also said that there can be complications with the circlage (the stitch that's permanently closing my uterus now) as it can get infected. This is a very rare and usually noticed because of pain in my lower abdomen and some bleeding. There is a standard procedure done vaginally to remove/replace it so they said that I shouldn't worry about that. Just be aware, monitor it and notify a doctor as soon as anything out of the ordinary were to happen.

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The nurse came by to remove the IV...

I have a prescription to fill out today for more Percocet and colace (stool softener which I am already taking for the rectal fissure) to help with constipation. I will probably have to take painkillers every 4 hours for the next 5 to 10 days depending on how things go. Significant cramping is normal after this procedure.

Go home instructions say nothing in the vagina for 6 weeks but I guess that the latest is the one I want to follow.

Now, the reason for hospitalization and initial diagnosis is even more puzzling to me. It now says
Cervical AdenoCARCINOMA (not sarcoma) and Atypical Spindle Cell Malignant Tumor of the cervix.

Now, the worrying bit is that if some think it's sarcoma, other carcinoma, it could be both (mixed mullerian tumor) which would be really bad. Also, it sounds like they more or less agree that it is a very young tumor (and that I am so unbelievably lucky that they found it so early) which could explain why it hasn't been so aggressive yet. And maybe it wasn't malignant or just turning malignant around December/January timeframe.

Oh well, next steps make sense. Glad that someone at Sloan Kettering will look at this case. No one is arguing that it is not cancer and that I won't need a hysterectomy. It's the timing of it that's the crux of the matter.

Anyway, I am done with the Valium (just too the last one) which they gave me for PTSD.

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Actually, this diagnosis states BOTH carcinoma and sarcoma. Here's what it says

Discharge Diagnosis (post-op pathology to ensure clear margins): Uterine/cervix adenocarcinoma and malignant spindle cell tumor of the cervix (which is a sarcoma)

Principal Diagnosis: Same
Secondary Diagnosis: Mild Asthma

Reason for Hospitalization: uterine/cervical adenocarcinoma and trachelectomy for malignant spindle cell of the cervix.

Significant findings:
- PTSD: given valium post-op
- Regular diet post-op, started to eat on Post-Op Day #1 evening
- Vaginal Pack in until Post-Op Day #1
- Extreme pain post-op (given morphine, oxygen)
- Fever post-op: 39.3, given IV antibiotics, discharge temperature: 36.3 (morning)

Condition of patient at Discharge: stable
Home stay Medication: Percocet, Colace, hot pad
Physical Activity: nothing in the vagina for 6 weeks (no douche, no tampon, no intercourse), only mild walking at home in Post-Op week, no bath for 2 weeks Post-Op, slow walking around outside for < 1 mile/day Post-Op week 2, OK to attend medical appointments in Post-Op week 3. Require 24hr presence for Post-Op week 1 to watch out for infection and heavy bleeding. No heavy lifting for 4 weeks Post-Op, no exercise for 6 weeks Post-Op, mild exercise on week 7 and week 8 Post-Op. Resume normal activities Week 9 Post-Op.
Post-Op Follow-up visit on week 3 Post-Op

Rehabilitation Potential: Good. (thank God!)

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Really nice to be back home. I come home and find dinner and Amy ready for me. I sleep all night (minus a few interruptions for pain killers) wake up and find Nathan and breakfast. I sleep all morning, get up and find Othman and lunch. I sleep all afternoon, get up and find Kim and dinner. I have dinner and find Celia with chocolates and a nice movie (Super Size Me...do not watch prior to dinner...). I go to bed, wake up and Celia's ready for breakfast. I go to sleep, wake up and Sarah is ready for lunch. I go to sleep, wake up and Nathan is ready with appetizers and wine, I am resting up and Nathan and Lynn are cooking a nice cheese fondue...This is what I call LIFE!