Day 60 - Discussion with the Surgeon

I'm sitting in the hospital cafe. Coffee and anchovie toast.

I just finished my appointment with the surgeon lady. She talks straight. I like her.
She looked, poked, and felt my leg. She looked at all PET pictures, and made special photocopies.

She has a fellow surgeon that is an angiosarcoma specialist. I asked her how many angiosarcoma operations she has done. She guessed 20. Her fellow surgeon has worked overseas, and done hundreds. She said there are so many options, and possibilities.

One thing she is pretty sure of, is that the muscles in my leg will be severely reduced. They will not grow back. The one muscle that lifts the foot will probably be completely removed. We have to weigh up having a very reduced mobility leg versus amputation.

I asked if that decision can be made on the operating table. She said that she would probably want the orthopedic surgeon there just to make sure she doesn't damage any chance of a prosthetic mount. If that was the case then yes, they could make that decision real time.

Her preferred scenario would be to remove all the cancer, see how much of the leg muscle had to be removed, then wait a few days for the lab report, and only then decide about amputation.

I asked her when she would want to operate. She squeezed my leg, and said she needed to talk to my oncologist first, but, sooner rather than later. This week would be best. If the oncologist thinks the tumors can be reduced even farther with chemo, then I may continue chemo for a few more weeks. The smaller the tumors, the less muscle to cut away. She will talk to the oncologist today.

I then asked if she needed another PET scan. She said no, but the oncologist may insist.

I asked if she would do the Mohs procedure. The Mohs procedure is where a thin slice of the tumor is removed, then checked with a microscope to see if any cancer is present. If so, then another slice is taken and checked. They keep going until there is no sign of cancer in the slice. That way the minimum amount of tissue is removed. She said that the Mohs procedure doesn't work with angiosarcoma, because angiosarcoma is spread via blood vessels to surrounding tissue, and can be present up to 5 cm from the actual tumor.  That is why she has to remove so much muscle. All tumors, plus 5cm (2 inches) of surrounding tissue.
She said it would be stupid to operate, and remove only 99% of the cancer. She wants 100%.

 She explained that one patient had a large growth in front of his ear. it turned out to be angiosarcoma. She was unable to remove the required 5 cm in all direction, and a month later he had a large growth inside the scull behind the eye.

If the operation goes as she wants, she would put on a "vacpac". That is a huge band aid that is hooked to a vacuum pump, and keeps sucking on the wound. She says that helps prevent infection. I would wear the vacpac for 2 weeks. She said it would need to be cleaned every 3 days by the wound care lady. It would be painful, but there are drugs for that she said with a smile.
Then if they decide to keep the leg, she would do a skin graft. She said at that time I would probably need assistance. It would be very painful, and I would be drugged up most of the time.

She will contact me on Thursday. She will see her surgeon friend Wednesday. She wants to show him the PET pictures. I told here I was willing to go see her on Thursday if it would be better.

It is a big decision, when amputation may be the lest painful and best option. The Surgeon seems to be more concerned with quality of life after the operation, than whether I will be alive in 2 months. So I guess that is good news.

I wish I knew what I wanted regarding support. But I don't.
Once again, more questions than answers.
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