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You are welcome to apply any part of this article to your own personal use. Please do NOT publish any part of the article or apply any part of it to any non-personal use without the express written concent of the author.
Hi all,
The surgery is tomorrow. Send me some good thoughts.
I won't be picking up email before the surgery, so you needn't respond to this message. I will arrange for another message to be sent out tomorrow after the surgery to report on the status.
For more details, read on...
After the radiation treatment, ending January 2, things went uphill very fast. As the radiation left my body my energy level improved. But before the first week was out I developed an infection at the site of the original 2 surgeries that happened only about 10 weeks ago (was it only 10 weeks?). Off to the doctor!
I learned that an infection in a radiation-treated incision area is not unusual. Because the cancer can "leak" into an incision region during surgery, that area is generally given extra radiation to clobber any of those little nasties that might have "leaked." Consequently my immune system is working overtime in that area trying to clean up radiation-damaged cells, and the staph and strep bacteria tend to get overlooked in those instances. Penicillin was prescribed for the infection. The antibiotic worked, albeit slowly, and the infection has now run its course.
Shortly after I started the antibiotic the very same region started to develop a scab. Off to the doctor again!
As before, I learned that this was not unusual. This was a radiation burn due to the extra radiation applied to the incision site. This was similar to a very localized second degree sunburn but without the discomfort. All we had to do was to keep the area moist with Polysporin®, an antibiotic ointment, and go about our business.
Yesterday we drove up to Gainsville, Florida. We're staying at the Rush Lake Motel (phone: 352.373.5000) in room 137. We'll be here at least until next Tuesday.
Today I had my pre-surgery appointments at Shands Memorial Hospital. The morning was fully occupied with an MRI, a CT scan and a visit with the surgeon. The afternoon started with a visit to the hospital's administrative group to handle paperwork ("...and your hospital bill, assuming a 2-day stay, is expected to be between $12 and $14. Thousand. Insurance covers 80%. How much of your 20% would you like to pay now?"). We finished with a visit with the anesthesia department where they took blood, did an EKG and made sure I was breathing.
All is ready... All systems are Go...
So, what did the doctor say? Lots, and all of it good and reassuring! The cancer mass has shrunk remarkably, due to the success of the radiation treatment. There's now a small chance that the remainder can be removed without taking out the nerve, but they won't know until they're in before they cam make that final assessment. Because the radiation treatment was so successful, they won't have to take as much extra tissue around the mass for a safe margin. Consequently they probably won't be taking any muscle tissue at all, except for perhaps a thin layer or two of the muscle sheath. So, they're not planning to reorganize the muscles to compensate for loss of tissue. The area of skin to be removed is also much smaller than originally discussed, so the amount of skin to be harvested for the skin graft will be considerably smaller. The skin for the graft, by the way, will probably come from the outside of my left thigh just above the swimsuit line. Yes, I will need a brace for several weeks until the skin graft takes solidly, which may be for 2-3 weeks. Rather than staying around Gainsville for 10-14 days, we may be released as early as next Tuesday. They plan to do the surgery with me being fully conscious, using only a nerve block in the upper leg for anesthesia. With the surgery expected to take only about 2 hours and my staying awake during the procedure, I should be in the recovery room for only a short while. I will likely be kept in the hospital for a day or two, maybe three at most.
Did the doctors say anything negative? As always with surgery, there are risks. If more extensive work is required, they will likely administer a general anesthesia to enable them to do that work. Any injuries to the area that had the radiation will take 30-50% longer to heal, and that'll be true for years. There's a chance, perhaps 1 in 10, that the healing process won't go as we want and additional surgery will be required. The skin graft will be located where the skin folds as the knee bends; any bending of the knee will interfere with the healing of the graft. My knee will probably be kept bent slightly by a brace, probably at about a 30 degree angle, to avoid interfering with the healing of the skin graft. For as long as I have the brace, maybe 2-3 weeks, walking will be awkward and may require crutches.
Because I'll be awake during the procedure, I told the doctors that they didn't get to say "Oh, oh!" at any time.
So tomorrow I will report to the hospital around 0600 Eastern Standard Time. If all goes as scheduled I'll go into the surgery theater around 0730, they'll start around 0800, send me into the recovery room by 1000, and into my regular room by noon. Any warm fuzzies you wish to send my way tonight and tomorrow would be greatly appreciated.
Fair winds,
Capt. Edmund "Bear" Downing
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