Coming up to surgery...

I really wish I had better veins- last thursday mum and I went to calvary for my CT scan and finding a vein took longer than the procedure itself (not that its a very long procedure!). It was strange though- for the first time in ages they tried a vein in the inside of the elbow (or elbow pit as I so ingeniously and efficiently called it as a small child). I barley felt it go in! So painless! I envy all of you your decent veins so much more now, knowing how much easier it could be. But alas, nothing is quite straight forward in the Saga of Katie's Cancer Journey. They wound up putting the canular in the side of my wrist below the dip under the thumb. I was not even aware there was a vein there. Strange. But it worked, they got the dye in and did the scan and we headed off.

Next day we saw the surgeon. We all got a look at the CT. From the PET the oncologist had deduced that the bulk of the tumour was in the top lobe of my left lung and just through the inner pleura. In my mind this sounded ok, because it seemed removing that lobe would probably make a pretty clean job of removing the tumour. However with the CT (which uses dye to show where there is.. well, mass I suppose, solid- as opposed to activity as is the case with the PET) we saw that the tumour is actually through both pleura and appears to be in the chest wall muscle a bit. The red bit on the picture below is roughly where it is. it may be bigger or smaller, the bulk of it may be dead or alive or sleeping, it might be further up or down the lung, but it gives you a more visual idea. The ribs are outside the chest wall pleura, so there will be externally apparent difference appart for a big backwards C shaped scar.



Note my incredible computer graphics skills! Red scribble! Haha.

So what the procedure is now technically know as is something like: thoracic lobectomy... something something... chest wall resection... rib removal? I know there was something in between thoracic lobectomy and chest wall resection, it may have been the rib thing, but I cant remember. Anyway, the one they're most certain will take place is the lobectomy, chest wall resection fairly likely, and rib removal possible (but hopefully not). But thats the general idea of the procedure. Its expected to last 5 or 6 hours and the surgeon said "this will be a tricky one for me" or something like that. However, I have every faith in him. He sounds very experienced and is very focused. He's a cardio-thoracic surgeon (heart and chest surgeon, so he's used to intricate stuff and lots of blood, which considering the location of the tumour (lots of veins and arteries in the area, and the chest wall resection will probably lose me a bit of blood) seems perfect.

We met his registrar today when mum and I went into TCH today for my pre admission appointment. He also seemed good- on top of things. Having what I have I find I am quite often the one doing the telling about what I have and what is going on with it, but today it was him telling me. He was efficient and informative, but not cold. Exactly what I wish all doctors should be. As well as him we spoke to a nurse and an anaesthetist. The nurse was mostly putting paper work in order I think, but she also gave me some very general pamphlets on epidural and patient controlled analgesia.

These were elaborated on by the anaesthetist (not my anaesthetist, as she was elsewhere and he was standing in in terms of gathering and providing information and such). He explained that he was not really keen on epidurals for chest surgery, as the tube is put in higher in the spine than with giving birth. This poses greater risk as the space to insert it into is somewhat smaller, and there is actually the spinal cord up there. However, he also conceded that it may have significant benefits for me specifically over a morphine pump thing because of the differences in the mechanism of their action. Morphine works in the brain, preventing you from consciously experiencing the pain, whereas local anaesthetics (like epidurals) prevent the nerves from actually picking up the pain in the first place. The difference is that with morphine your body still experiences all the stress of pain, its just you cant feel it so much and your ability to form coherent sentences is greatly diminished. Anaesthesia I guess keeps your whole body from knowing about the pain, so it doesn't stress you out. This doesn't only make a difference in the short term, but recent studies have apparently shown that using morphine and allowing your body to experience the pain increases the risk of further spread of cancer.

Though that kind of sold me, it turned out that the surgeon himself was not a fan of epidurals (for whatever reason, I suppose the other risks they pose, including infection etc) and planned to put in a "pain buster" as well as give me the morphine drips. The pain buster is a small tube inserted into the area, to periodically (i think) release local anaesthetic to be picked up by the nerves. This means I wouldn't need as much morphine, but I'd still be getting the local without the epidural. So it seems like a good compromise. Course it means yet another tube sticking out of me post surgery! Oh well.

I think my access to the internet will be greatly restricted in the first few days post surgery (pain, drugs, fatigue and surgery ward rules) so my plan is to make a post that is just a heading or something wednesday night on this blog. My family will update you all on my progress by commenting on that post, so for updates you will have to check the comments on the post.

Though I dont think it'l be on their priority list to update it, I know a few people have asked specifically about an update after surgery on the day at least, to know how it went and that I'm alright. I'm sure it'l go well and I'l be fine, but I'l try make sure someone puts something here to confirm that.

In terms of visiting, I will be in ICU for 24 hours after the procedure, and I dont really think I'l want many people round until I have a few tubes removed and am back to wearing nighties instead of hospital gowns. So it'l be a few days. I suppose I'l post something on facebook when I am back online and have a phone so people will be able to contact me and organise visiting times.

Thank you all for your kind words and comments and emails and tweets and facebook messages and texts etc. I will update as soon as I can type efficiently again! xx