Sandi Surgery Update

First, I am sorry I was not in the shape to update things here the last couple of days. It has been a hard roller coaster experience. That fact and how hard things are for me physically now meant I wasn't in the shape to be coherent and update folks here when I finally got home form the hospital each evening. I am sorry. It was not deliberate. It was sheer exhaustion and pain.

Thursday afternoon the cardiac surgeon operated on Sandi. The procedure itself went fine though it went in an unexpected way. Right after he got through the scar tissue in her lung and into her chest cavity he found a large mass. A large mass that turned out to be some sort of fatty tissue thing. While it was in the right spot according to the PET Scan and the CT Scan, this fatty thing should not have appeared the way it did on the tests. The cardiac surgeon was not convinced this was it.

After he got the fatty thing out of her, he went looking around trying to find the real deal. He didn't find anything besides what looked like a small spot on the surface of her heart. He could not biopsy that as the only way to take a sample from the heart is by stopping the heart and using a heart/lung machine on the patient. They were not geared up to do that, so he backed out and closed her up.

He came out and talked to me and overall things looked fairly good. The mass was out and it wasn't cancer. The spot clearly bothered him, but the cardiac surgeon wasn't sure whether or not it was anything to worry about. The expectation at that point Thursday afternoon was that most likely it, like her thyroid, would be something that would be watched for suspicious activity on some sort of regular basis. About three hours later she made it through recovery and was in her room. I hung around awhile longer and then went home with the understanding that at some point, probably in January, they would do some sort of detailed echocardigram to look at the spot.

Friday morning when I got to the hospital Sandi was sitting up, in tremendous pain, and a very unhappy patient. They had allowed her to order breakfast and then intercepted it at her door. The new plan was to do this deal where they would put her out and then run a camera thingy down her throat. They would run this camera probe thing down into her heart and go looking around. The spot deal had taken on greater significance overnight and it had been decided this was something that absolutely had to be checked out before she could go home.

What was supposed to happen at 1 ended up finally being done at 3:30 after booting me from her room as this was something they had portable equipment to do. I went down the hall to the waiting area and updated the boys before sitting back and watching the clock. This deal was only supposed to take about ten minutes. I knew the way the nurse was looking at me when she came to get me in the waiting room 45 minutes later the news was very bad. She was trying to be upbeat as she escorted me back and chatted with me, but it was obvious. So too was the doctor who was standing outside her room finishing up the paperwork. After he got me to sit down he delivered quite a shock.

Sandi has a large tumor of some type in the two right chambers of her heart. The thing is growing from outside of her heart, through the heart wall, and into both the right chambers. In one chamber there is a free floating piece barely attached to the main mass. That piece is hanging down and swinging back and forth in the her blood stream as her heart pumps.

They are as sure as they can be without a sample that this thing in her heart is her cancer back again.  They believe this is what was causing the heat signature on the PET Scan --also matches the size deal according to the Pet Scan too and the CT Scan---and was partially obscured by the giant fatty thing they took out of her Thursday. Apparently what the spot is on the surface of her heart that her cardiac surgeon saw is just the tip of the iceberg that is inside her heart.

The current plan is that next Wednesday morning she goes back to the hospital and checks in at ten am. Around noon they will move her to the catherization lab to  try and get a sample of the free floating piece. They will do this by running one thing down her throat and through the lung to the heart. The other deal will go up her leg and head for the heart. They think they can get the tools in there from each side. Once they get them in place bracketing the piece as it swings back and forth they will to do some sort of pincer move and snag it. Once they have it snagged and not moving, they will try to remove the swinging piece for a pathology sample.

This assumes that they can get to it and actually snag the thing as it swings back and forth in her blood stream. Once they retrieve it, the piece has to be big enough for pathology sample purposes. At this point, having measured it yesterday, they think while small, it would be enough to get the confirmation they need for treatment.

This deal is risky because trying to do this the way her heart is very tricky. There is also a major risk of perforating her heart. If they accidentally do that--basically put a hole in her heart--they would have to start emergency procedures to save her life by cracking her chest, getting the heart/lung machine going, etc. There is a definite risk to this procedure, but the only other option is much riskier and harder on her long term.

If this cardiac catherization plan for getting the sample does not work, the only option would be be to go in for major cardiac surgery sometime in late January. They would crack the chest wall, stop her heart, and while she was on a lung/heart machine, totally remove the entire mass and rebuild the right side of her heart. That would take roughly six or seven hours to accomplish. Assuming she lived through all that, she would face several months of rehab to get strong enough for the chemo and radiation.

Based on what she was told about six last night, chemo and radiation are both definite once they know for absolute sure if it is another lymphoma. If they have to go the other way, she probably won't be able to do chemo or radiation before May. Obviously, beyond the risks of surgery, removing the thing that way raises the risk of further cancer spread at the time of the operation as well as giving whatever cancer she has elsewhere that is starting a lot more time to grow and try again to kill her.

We are told that at this point she is not at a higher cardiac risk because currently the thing is not blocking the blood flow. They don't think the piece will just break free on its own. Theoretically, if it did--either because it broke free on its own or they lost it during the procedure--it would not do anything from a heart attack or stroke deal. What it would do is shoot through her heart and vanish into her body to lodge somewhere. Of course, that would give the cancer yet another foothold in her body somewhere.

Finally late yesterday evening we made it home. She is home for Christmas and that is good. A Christmas that certainly isn't as bright as we thought it might be Thursday evening. Right now, neither Sandi or I know what to think as we both are flat out stunned. While I had thought that maybe she was growing a spot of cancer on her heart, I never thought that she had a tumor growing through her heart.

Again, I am sorry it has taken me so long to update folks. I am working on e-mails so if you are awaiting a response to something you sent, please be patient while I catchup.


Kevin