At 7:30 tuesday morning, the anesthesiologist gave me a shot to which I responded, “It’s like a glass of red wine.” The anesthesiologist asked, “Would you like another?” I hummed in reply, “Hmmmm.”
When I awoke from surgery two hours after they finished, I could hear the doctors talking about me and they asked me, “Did you know you had surgery?” I snapped back “Of course I know I had surgery, why did you ask me that?” They told me later that I was correctly adding to their conversations as they were talking shop. This lucid contribution shocked them all since this is not normally the case. Where the heck did my attitude come from?
The surgery went well, better than expected. Dr. Wang (pronounce Wong) began cutting around 10am after two hours of preparation. He started on my back with an incision about a foot long along my spine, cut vertically along the incision through a few inches deep of muscle along both sides my spine, and then retracted the muscles apart to fully expose my spine. He then removed my L1 lamina to decompress my spinal cord, stetched me out to make me a little taller (since my vertebrae had fractured last week and I had shrunk down a half inch) and then placed two rods along either side of my spinal canal and decided to attach them to the three thoracic vertebrae above (T10, T11, and T12) and the two lumber vertebrae below (L2 and L3). A couple of Dr. Wang’s eager residents then closed me up to conclude the first phase, ending just before 2pm.
Without waking me up, they repositioned me onto my right side to expose my left. Dr. Gelabert, the vascular surgeon, joined the show at 2pm and made the second incision, about six inches long, following the angle of the last couple ribs on my left side. Gelabert removed my floating rib as he went inward to give them more room work. He intentionally depressed my diaphram which intentionally collapsed my lung, making even more room to work. Gelabert then moved my major blood vessels forward and my kidney backward to expose my spine. He explored the previous resection area at this point and was further impressed by the quality of work of my surgery in 2003.
Dr Wang then took over. In short, he removed the tumor, which was bigger than they had all thought, about the size of a grapefruit. It was well encapsulated and mostly in a single blob, though, this step required several hours to perform. After tediously exploring the cavity, Wang explored the extent to which the tumor invaded the previous resection area around my vena cava. There was significiant scar tissue and no tissue “planes” to distinguish pathology. Wang poked a bit here and there but decided it best to leave the scar tissue alone since it is too easy to bust through one of the major vessels.
The embolizaation on Monday blocked three blood vessels feeding the tumor. This helped reduce bleeding within the tumor during the resection. That being said, I still bled quite a bit and required two blood transfusions during surgery. They had ordered six and were surprised that I only needed two.
The spine reconstruction involved placing a titanium “cage” in the place where my L1 vertebrae once was. Wang ground up the floating rib (from earlier), added some bone glue, and packed the cage full of the concoction. Over time, this will re-grow into living bone and fuse my spine to together. This new bone could eventually be so strong that I may even break the 5.5mm titanium rods; something that often happens in patients my age (this is not a bad thing). However, having chemotherapy in the near future may affect the quality of regrowth and I may need a surgical revision many years down the road to tighten the screws holding everything together. Furthermore, Wang placed a titanium plate alongside the cage connecting the L2 and T12 vertebrae for further support. Gelabert then took back over and worked his way back out and closed me up, ending around 8:15pm.
From start to finish, it was about 13 hours. They moved me to the ICU so they could watch me closely and I’ll probably leave here tomorrow (Fri) morning. Most of the staff here are surprised by my alertness since the patients here normally cannot talk. Michael, my ICU nurse, says “It’s good to see patients like you…getting better all the time.” I spent most of last night pressing a button every ten minutes to recieve pain meds and was able to sleep in two minute intervals inbetween the infusion into my IV and the onset of the nausea/groggy side effect. In the middle of the night I switched to oral pain meds since those last longer and don’t cause nasea (but they’re not as strong so I feel the pain more). I was able to sleep an hour or two last night and a bit more today.
By morning, I was able to talk somewhat normally and had a discussion with Dr. Diaz, one of Dr Wang’s residents with whom we had been talking with since we came ot UCLA. Dr Wang had reluctantly flown to Switzerland yesterday (wed) for a workshop that he is leading and will be back Dec 18th. Dr Wang had squeezed me into his schedule due to the urgency. Diaz reassured me that I am doing “really well” and will be able to move out of the ICU shortly. This makes me anxious since I am in such great pain at times. David and Marie almost passed out while watching the nurses move me a couple inches from one side to the other with a sheet pull. Diaz calmed my nerves by telling me, “This is a BIG surgery. No, this is a HUGE surgery. Dr Wang only does a surgery like this about once a month and he operates at least four times a week. Some surgeons don’t ever do a surgery like this. And the fact that you’re vital signs are stable, you don’t have a fever, you’re alert and able to talk almost immediately after the surgery is phenomenal.”
My meals consist of spoonfulls of chicken broth and jello. Last night I was able to eat about ten spoonfulls of broth over a two hour period. I was able to eat a whole bowl this morning. For physical therapy yesterday (wed), I was able to sit at the edge of my bed but nearly passed out because my blood pressure dropped so quickly. Today (thur) I was able to stand and take a few steps. I’m even able to watch TV a bit today and found “Terminator 2” and was able to relate to Arnold saying, “I am a cybernetic organism, living tissue over a metal endoskeleton.”
Thanks again for everyone’s thoughts and prayers. They’re still working. We love you lots,
David and Clare