Rossputin.com Rational Thinking About Our World

For those of you who read these pages regularly but who don't talk to me frequently, you've heard a bit about my having some recent medical turmoil. I thought I'd just get the whole story on (virtual) paper since it's slightly interesting in its own right...at least to me.

So....

Just before xmas, my wife was admitted to the hospital for what turned out to be nothing important, but the doctors making sure she wasn't about to go into early labor. While I was visiting her, I was hit with the worst part of the pain from a kidney stone I was suffering through and was sent to the Emergency Room where they did a CT scan to look at the stone.

In addition to finding a small but terribly painful kidney stone, the scan found a mass/tumor in or near my small intestine which was "suspicious for carcinoid" given its size and location. A carcinoid is a type of neuro-endocrine tumor which produces high levels of serotonin. They tend to be slow-growing but often aren't found until they have metastasized (spread to other parts of the body) and pose a serious threat to one's life.

The good news in the original CT scan, although it was done "without contrast", was that it did not see any "mets" in my liver or anywhere else, so it seemed there was a good chance that the problem was isolated in one spot.

I met with a surgeon and scheduled surgery for as soon as possible, which happened to be on January 4th.

In the intervening period, I had several other tests including, in order of sophistication, a chest x-ray, a blood test for Chromogranin-A (a marker for serotonin breakdown, and therefore a decent but not flawless test for carcinoid), a PET scan (nuclear medicine test which looks for increased metabolic activity such as found within many types of malignant tumors), and an Octreoscan (another nuclear medicine scan which is very specific for carcinoid).

The chest x-ray, blood test, and PET scan were all normal/negative.

The Octreoscan is a two-day test and the results of the first day seemed to show the mass as positive for carcinoid. But the second day's scan came back negative! I got the first day's results in 24 hours, but it took several days to get the second day's results, so I was laboring for days believing the mass was indeed carcinoid.

In any case, we went into the surgery as confused as when we first learned of the mass in my abdomen except that we had the modest comfort of a negative PET scan, implying that if the thing weren't carcinoid then it was probably not worse than carcinoid.

In the pre-op room, they started an IV in the top of my left hand, to be used in the operating room for sedative and later in recovery for fluids during the time when I would be unable to eat.

An operating room nurse came in and asked me if I am allergic to anything. I said "I'm slightly allergic to socialists." Another nurse in the room said "You should be careful...she might be a socialist." I said "You're right...I take it back. I'm VERY allergic to socialists." That was my favorite moment of the day.

I was rolled into the operating room, and I moved from the gurney on to the OR table. The anesthesiologist gave me some Versed (a relaxant like Valium) by IV, and that's the last thing I remember until waking up. My surgeon told me that I was awake for quite a long time after that, including telling them how little respect I had for Jimmy Carter. When he told me that I said "OK, you were definitely operating on the right guy."

Here's how the surgeon described the procedure to me:

They found the mass which looked something like an oblong golf ball attached to my small intestine by a stem, almost like a big white cherry. He cut a small "V", with the tops of the V just on either side of the stem and the point down in the small intestine. They sent the mass to pathology while I was on the table for a quick guess as to what the thing was.

It came back as possibly being an unusual type of tumor called a GIST. So, in order to minimize the chances of leaving any nasty cells in me, the surgeon cut another much bigger "V", about two inches on either side of the stem, going through the small intestine, into the mesentery (the wall between the small intestine and the back).

Also, since many tumors metastasize into the appendix (and since an appendix is generally not useful and can cause trouble), the surgeon removed my appendix. He also repaired a small umbilical hernia I had. I suppose, in typical Ross style, I got a bargain...three procedures for the price of one.

I was brought up to my hospital room where I stayed for three days. I ate nothing the first day, had some juice and a little oatmeal the second day, and started eating small amounts of solid food (french toast for breakfast, a little pasta for lunch) on the third day. Starting on the second day, I did occasional walking laps around the ward in order to try to encourage my digestive system to get up to normal speed. It was fairly painful, but it did help...I won't get into the details of just how one knows that one's digestive system is adequately restarting.

On the first evening in the room, a nurse came in with a questionnaire. One of the questions was "What is your greatest fear?". I presume they're looking for medical answers about a surgical complication, infection, etc., but I answered "My greatest fear is that our next president will be a Democrat." I was pleased when another nurse came in the next night to tell me that she read that and thought it was great. I think that was in part because I wasn't in Boulder and in part because there are few people who understand the risk to our health care system posed by the Democrats.

Anyway, we spent the next 4 days after the surgery waiting for the final pathology results which would tell me just what it was that was taken out of me. At least I had two days of playoff football to watch just after the surgery. That was an excellent distraction despite the fact that the Redskins finally ran out of gas.

I have to say I wasn't especially nervous waiting for pathology because of the PET scan result and because the surgeon said the mass was "well-encapsulated" and he saw no evidence of any other problem. Had it been a GIST tumor, it still would likely be benign...although it's never good to have any sort of tumor.

The following Tuesday, my surgeon got a verbal report from the pathologists that the mass was benign, and when I saw the report on paper it had the temerity to call it not only benign, but "bland". Basically, it was almost like a lump of chalk that had previously been a collection of a few cells of unlimited origin. In other words, it's not cancer and we have no idea what it was or where it came from. The appendix, resected intestine, and 4 local lymph nodes which had been removed were all normal.

On Wednesday, I made one of the best phone calls I've ever made...to cancel my appointment with an oncologist (cancer doctor).

At this point, I'm still home recovering, but doing quite well. I will get the staples out of my three incisions today. (Two small incisions and one large one going from about 2 inches below my belly button, up and around it, to about 3/4 inch above it.) I feel like I've been punched repeatedly in the stomach, but the recovery has actually not been as bad as I'd feared.

It was interesting to think about the possibility of something killing me younger than I had been planning on. I really didn't think about myself as much as about Lili (now 2 years old) and our second child who is due later this month. I didn't want to think about leaving them prematurely.

And now I know I won't...at least not from a mass in my small intestine.

I'd also mention how excellent my quality of care was. My surgeon and everyone I dealt with at Kaiser and Exempla were friendly, caring, professional, and exceptionally competent. I was treated very well from the moment I arrived until the moment I left...and actually on both sides of that as well given the excellent communication I received pre- and post-surgery.

As Don Boudreaux recently reminded us in a note, the plural of "anecdote" is not "data". But if my experience is any gauge, I would be hard-pressed to say there's a health care "crisis" in America. I should emphasize that as far as the "system" knew, I was simply another insurance-covered customer. I am not (and was not to them) some sort of cash-paying high-dollar private client. I believe any patient at that clinic and that hospital (Exempla Good Samaritan in Lafayette, CO) would have been treated as well as I was.

All in all, although the experience was somewhat painful and fairly expensive (I have a high-deductible HSA insurance plan), the outcome could not have been better and the process could not have been more patient-friendly.

I am (and apparently always was) free of cancer. Now I'll have the scars to prove it.