Pathologists Refuse to Spit or Get off the Potpourri

This morning, I had my follow-up appointment with the neurosurgery half of the Clivus Brothers. There was a hard rush to get to the appointment on time, then the 2 hour wait. (Note that I would be a hypocrite to complain about doctors being late, and I'm really not going to complain about somebody who works very hard to keep me alive.*)

I had brought along a formidable posse. Not only did I have my wife, K with me, I had the Medical Mafia. My parents drove in to observe and contribute. Unfortunately, my father had to leave for a business meeting in Ohio before we left the waiting room, but I was still flanked by the two most powerful women I know.

A while after we were put in an examining room, the neurosurgeon, Dr. Prince Clivus, arrived and promptly paged the ever-pleasant infectious disease expert, Dr. Bug, to join us.


Report on the Surgery

During the surgery, it became apparent that much of my skull is the consistency of a creme brulee, and Dr. Clivus could have pulled off bits of it the same way one can pull that yummy crust off the custard. He restrained himself, but it was quite a mess. Above, there was the cauliflower, and to the side was the bag full of runny cheese I described in previous posts. In the back, was the tattered, infected remnant of my clivus, the bone that abuts the back of my throat on one side, and the lining of my brain on the other. Dr. Clivus scooped out all he easily could.


The Bugs

As I said last week, the bag of runny cheese and the bone are growing out all manner of weird nasties. The good news is that Dr. Bug already put me on antibiotics that cover all of them last week. Even better, these are oral antibiotics, so I won't be administering IV antibiotics to myself at home and work through a PICC line (a long term IV) like last time.

Depending on final results after pathology has finished marinating my samples in their herbs and spices, I may be on these antibiotics indefinitely. This does not sound fun, especially since one of them has the potential side effect of causing tendons to rupture. (I imagine myself taking one of my usual nature walks when a loud 'boing' echoes through forest as my achilles tendon breaks like a rotten rubber band.)

But it wasn't all good news. That unappetizing mush between my nose and my brain is a magnet for bacteria. Because my skull is a house of cards waiting to collapse, and a definitive reaming out of all of the radiation-burned soft tissue and bone would be a horrendous procedure with, I imagine, potentially unpleasant aftereffects like my face falling in, Dr. Clivus would undertake such a thing only under the most dire circumstances.**

So, the next step is to watch and wait. Dr. Bug was impressed that I had lasted 4 years without a second clivus infection. He thought it spoke well of Dr. Hygeia's*** rigorous regimen of daily nasal rinses and frequent visits to her for deep cleaning. I might be able to get away with putting off the big nasty surgery indefinitely with minor adjustments.


. . . But Wait! There's More!

Just as my mom used to force me to finish my cauliflower, life forces me to face the cauliflower that grew in my head. The pathologists still haven't finished with it, and I even asked that samples be sent to pathologists at other hospital, just for spits and wiggles.

So far, though, that cauliflower looks like a dysplastic squamous cell papilloma. In other words, a great big wart. (Honestly, I have no idea how that would get there. I have had a wart or two on my fingers, but, I guarantee, that I never got that far back picking my nose.)

Warts can be scary. Just as Pap smears may reveal a dysplastic papilloma will develop malignant parts if left alone, there is a possibility that my own papilloma has some cancerous cells (papillary carcinoma), and they could, potentially, spread. This would be no fun. (Actually, it would be a little fun. I would have lots of hilarious material for blog posts.) I am certainly looking forward to more scans in the coming months if nothing else, and, from now on, visits to ENT will be like a pelvic exam for my nose (rhinogynecology).


And So. . .

I leave you with a cliffhanger. I hope that the pathology will be mostly settled by the end of the week when I visit the otolaryngologist Clivus Brother (whose full name is to be determined later). It may be weeks before the pathologists at other hospitals, having gotten their shares of the samples, make final pronouncement. But that just means there is more Tumoriffic to come.

Be well,

Tom



P.S.: I forgot to mention this. A couple of weeks ago, I got a call from the radiology department in preparation for my MRI. For those of you who do not know, an MRI uses an immensely powerful electromagnet to make atomic nuclei wiggle in just the right way so that they emit radio waves that can be converted to an image of the inside of the body. (They can also be converted to music, but it always sounds like that pretentious atonal nonsense the Boston Symphony plays most of the time.)

During the MRI, you lie on a bed that rolls you into a long, skinny, coffin-like tube. For the next 45 minutes or so, you lie there as the machine clatters around like a hundred toddlers banging on cookware. Some people, understandably, find this anxiety-provoking. I, for some reason, tend to fall asleep. Thus, I think I'll be ready if I'm ever buried alive.

Because of this John Holmes of a magnet, you have to be very careful about certain types of metal that may be in, on, or around the patient. So, for example, if you're not careful, the MRI could pull your nipple ring through your back. So, getting to my point, my caller had a long list of screening questions to ask. She did not ask about nipple rings, but she did ask about any hardware that might be in my body. I no longer bother to mention the titanium screws in my skull (which are not loose), because it just freaks them out, and I happen to know that titanium is not 'ferromagnetic'--attracted to magnets. Also, she asked if I had a pessary. I assured her I would remove them when the time came.


* This is one of my pet peeves. By definition, medicine, and especially surgery, is unpredictable. We don't control the condition of whoever happens to walk in the door or what surprises may pop up. To make matters worse, we no longer control our schedules. Administrators do, so we often work under unrealistic time constraints. In medicine, there are very few who manage to stick to the time allowed, do a good job, and not annoy the patients.

** Dr. Clivus may, someday, have to take out my clivus. Given where it's located, I would think that would may my skull collapse so that my spine goes through my brain and I become a giant bobble-head. However, the clivus actually carries no weight. It merely protects the brain and its lining from whatever goes into my nose and mouth. No biggee.

*** As pointed out in earlier posts, Dr. Hygeia is goddess of ENT who is the primary care doctor for my nose.

Photo Having Nothing to Do with Above