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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