Friday, October 21, 2016

Drum Roll, Please! (Written 10/20/16)

Well, folks, it's almost time for another nose-picking!

I'm back in the Big Fruit. The operation is scheduled for tomorrow morning.  I have been remiss in updating, so let's revew the events of the past few days and then get to the meat of the issue (so to speak).

On Sunday, the 16th, I stayed overnight at the home of the gracious R and H, the usual hosts for me and my family for these adventures. They live a short walk away from the F'in' Famous Cancer Hospital.

The next morning, K and I walked a few blocks to the office of Dr. Skully's partner in crime, and ENT extrordinaire, Dr. Nariz. Dr. Nariz is probably about my age. Very easy-going, but smart, and confident. He's seems to be the kind of guy I could have a beer with, although I wouldn't want to before an operation. We discussed the surgery.

K asked some intelligent questions. I've forgotten most of them. The thing that will stick in my memory is that Dr. Nariz reiterated the warning that there is a possibility that he and Dr. Skully could puncture my meninges--the bag of cerebrospinal fluid around my brain. In that case, the immense pressure of my over-inflated head I would propel me across the room like an untied balloon. He assured me that no, that wouldn't happen. I'd be pretty tightly tied to the table. I'd just make a mess.*

After we finished with Dr. Nariz, I went to meet a delightful internal medicine doc (like myself) for a preop examination. As she questioned and examined me, we commiserated about the atrocious state of electronic medical record systems. Then I got some blood tests and K and I took the train home.

After going back to work for 2 more days, I am back at R and H's home with K, B, and my parents. Earlier tonight, R and H treated us to a lovely dinner nearby. And here I am, typing in bed.

So, what's on tomorrow's menu? The good news is that I get to sleep in. I don't need to show up until 9:45 am. The bad news is that I am will not be allowed to eat breakfast.

I have a special plan. Nowadays, surgeons often mark in advance the location they are going to cut. This avoids embarrassing errors like removing the wrong limb and whatnot. I'm going to take it a step further. Taking a Sharpie, I'm going draw an arrow on the side of my face and the words, "this way is up." Other arrows, marked "enter this way," will point to my nostrils. My ears will be marked, "wrong way." This may be overly cautious, but you can't overdo safety. (This paragraph is a bald-faced lie.)

Then, we'll stroll or ride to the hospital. After putting on a stylish gown and getting an IV line (the worst part for me), a nice man or woman will give me some very special drugs, and my part will be over for a while.

Sweeping into the operating room in his special Supersurgeon disguise, Dr. Nariz will start off the nasal spelunking expedition, sticking his schnozascope into my nostrils, clearing the way for Dr. Skully. (Honestly, I can't imagine he'll have that much to do. Surgeons have been scrapig away back there for decades, and Dr. Otto Laringologo did more cleanup last summer. Is there really anything left between my nostrils and the base of my skull?)

Anyhoo, once Nariz has cleared a path to my skull base, Dr. Skully descends by ropes and pulleys through a trapdoor in the ceiling, and Dr. Nariz will drop through a chute in the floor. Dr. Skully will take up the schnozascope to scrape out some skull charcoal send it to Dr. Pokey and Dr. Droopy in the pathology department.

Here's what happens next. In addition to doing the same review on the last set of tissue I gave them, the pathologists will try to determine the "proliferation index" of the tissue they collect. This is, as I understand it, the ratio of cells seen reproducing (Perverts!) divided by the total number of cells seen within a particular part of the specimen. Normal tissue has a relatively small number of reproducing (dividing) cells in any given sample of tissue, hence a low proliferation index. Cancer has a lot more, so it has a high proliferation index. The higher the proliferation index, the more aggressive the cancer is.

If they do find cancer, they will then run the DNA tests that will show them what particular treatments might work for for it, and we're off to the races for a long run of Tumoriffic updates.

So, wish me luck tomorrow!

Be well,


* Honestly speaking, a meningeal leak is not as bad as one would think. I have had one before in 2005 when I was recovering from surgery in the neurological ICU at F'in' famous. It wasn't even uncomfortable--just very creepy. It really made the surgeons jump, though! They came in from their days off on a Sunday night and wheeled me back into the OR. Still, all they had to do was unscrew the top of my skull, push, my brain aside, and slap on a patch. No big deal!

On the other hand, if it happens this time, the surgeons will get much jumpier. This time, if there is a leak, they'll have to repair it using really long, skinny instruments and fiber optics or video to see. It's possible they'll have to open up my whole face.

Now, don't get your undies up in a bunch about this. It's not at all likely to happen. It is just the kind of thing that runs around in my head the night before surgery on my head.

And now, a puppy:

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