Tuesday, July 03, 2007

July 3, 2007 - The Surgeon Bows Out

This morning, I receive a voicemail message from Dr. Gornish, my surgeon. After examining the results of the ultrasound I had last Thursday, his recommendation is that I undergo an ultrasound-guided needle biopsy, rather than a surgical removal of one of the problematic lymph nodes.

The ultrasound, he said, reveals “three areas” of concern in the vicinity of the right neck. The one by the clavicle (collarbone) is “deep” – hard to access, in other words. The one by the mandible (jawbone) is “mild” (by that, I think he’s meaning to say it’s not so swollen as the other one). He doesn’t mention anything more about the third location.

Dr. Gornish is very clear, though, that he’d rather not proceed with an excisional biopsy. The combination of my breathing issues and the deeper-than expected location of the one lymph node would require “more extensive surgery.” By that he probably means general anesthesia, rather than the conscious sedation he was proposing to do. The only concern is that the needle biopsy will produce a large-enough sample for the pathologists to examine.

That’s fine with me. I can go with that. I’m feeling a bit frustrated, though, that it took this sort of trial-and-error approach (one that involved nearly a month of waiting for a surgery date, then a trip all the way to the operating table) to make that decision. Couldn’t we have just gone with the needle biopsy in the first place? I’d have had the results weeks ago.

It may have been Dr. Lerner who was pushing for the excisional biopsy. He remembers, I’m sure, the difficulty grading my cancer back in December of 2005, after the needle biopsy of my abdominal mass. That core sample ended up being mostly scar tissue, with only a small portion of it being useful to the pathologists. There was a difference of opinion between two doctors over that one, with the pathologist from Memorial Sloan-Kettering ultimately overruling the pathologist affiliated with our local hospital. The small size of the tissue sample, I was told at the time, was the reason for the discrepancy.

A subsequent series of phone calls with Janet, a nurse in Dr. Lerner’s office, confirms that my needle biopsy will take place sometime on Tuesday, July 10th, at the interventional radiology suite at Ocean Medical Center.

That means I’ll need to decide whether it’s worth my time to head up to our Adirondacks place after the 4th of July, for a long weekend. I’ll probably jump at the opportunity. With subsequent medical appointments, both locally and at Memorial Sloan-Kettering, it may end up being the only time I get up there this summer.

Like I said before, cancer takes no vacation.


Vance said...

We nearly always prefer to get a whole lymph node when we can. When we cannot, then a good core needle biopsy may suffice. The surgeon was right to try, and probably also right NOT to try now.

Whenever a surgeon does NOT want to operate, it's usually a good idea not to twist his arm.

I hope the needle biopsy yields the information your doctors need.

Carl said...

I agree, Vance, about the virtues of conservative thinking in a surgeon. I very much appreciate that his decision helped me avoid what could have been a larger-than-expected incision, as he went hunting for the elusive lymph node.

I just wish he could have figured that out when he examined me in his office, rather than making me wait three weeks, then go to the operating room. But, I guess that's the way those judgment calls get made, sometimes.

In any event, I'm glad we're moving forward again, with some kind of plan.

Thanks for the reassurance.

Duane said...

Wishing you the best with the biopsy. I'm sure it will go well.

Thinking of you.