CDC Symptom Diary Card

Monday, September 03, 2012

Taken Off The Field, my surgical report


Here is a copy of my surgical report.  I was blessed to have such an excellent surgeon in California. I am not sure how that all worked out because every step of the way up until I met him was one error after another.  

I had a hematology oncologist who was smart enough to override my gynecologists referral to a regular OBGYN surgeon.  Had he NOT done THAT, I would not be here. I am so thankful for both of those great doctors, for I did not know how significant that referral was until later.

After you read this you will understand why I was so angry for so long.  You will also understand my wardrobe.  I still cannot wear anything fitted, like jeans or regular pants.  I do need a makeover though.  I will save that for later. 

I am no longer angry.  

Love,
Denise

ALWAYS get a referral for a gynecological oncology surgeon if you are suspected to have ovarian cancer.  My surgery took over 4 hours hours.

(Editors note: I used PDF converter to apply this to my blog)
INDICATIONS / FINDINGS:
On opening the abdomen, the patient was found to have bilateral malignant ovarian masses with the right ovary that was stuck in the pelvic cul-de-sac. These were removed and frozen section pathology revealed malignancy. She had extra-ovarian disease with tumor masses primarily involving the pelvic peritoneum with smaller masses involving the peritoneum over the small bowel mesentery and the pericolic gutter as well as the right hemidiaphragms although minimally.  The patient had a tumor mass adjacent to the rectosigmoid colon which was excised. She had tumor involving the appendix and she had significant periaortic lymphadenopathy. She had no evidence of a bowel obstruction. At the end of the procedure the patient was optimally debulked with no tumor masses greater than a few millimeters in size. Therefore, an intraperitoneal Port-A-Cath was placed for subsequent intraperitoneal chemotherapy.

DESCRIPTION OF PROCEDURE:  The patient was brought into the operating room and placed supine on the operating room table.  She had a general anesthetic induced. She was placed in lithotomy position on the operating rating room table using Allen stirrups. SCDs were placed on the legs to prevent DVT. She received preoperative antibiotics and heparin. She was prepped and draped in normal fashion for an abdominal procedure. A surgical pause was performed. The patient's identity and surgical procedure were confirmed by all the surgical personnel.

After the patient was prepped and draped, we proceeded with a laparotomy incision. This was started at the pubis, taken to the right of the umbilicus and carried cephalad. This was taken through all layers into the peritoneal cavity.  On opening the abdomen, the patient was found to have turbid ascites of approximately 500 to 1000 mL.  This was aspirated.  A general exploration then ensued with the above noted findings.  A BookWalter retractor was used for retraction. The small and large bowel were packed into the upper abdomen and held in place with retractors.  We proceeded first with a BSO. The uterus was placed on traction. The round ligaments were transected with cautery and the retroperitoneum was opened. The infundibulopelvic ligaments were then isolated separate of the ureters, divided between clamps and ligated. The utero-ovarian ligaments were then divided between clamps. The right tube and ovary were then mobilized by incising the broad ligament.   It was then delivered out of the pelvis and sent for frozen section pathology.  On the other side a similar procedure was performed. The left tube and ovary were similarly sent fresh.

We then proceeded to complete the hysterectomy. The patient had tumor masses over the bladder peritoneum.  The incisions were made to include the tumor masses on the bladder peritoneum adjacent to the uterus.  The bladder was sharply and bluntly dissected off of the lower uterine segment and upper vagina. The uterine vessels were skeletonized. They were then cross-clamped, divided and suture transfixed. Similarly the cardinal ligaments and uterosacral ligaments were cross-clamped, divided and suture transfixed.

The upper vagina was cross-clamped. The uterus and cervix were then excised from the upper vagina and taken off the field. The vaginal angles were sutured, transfixed and the remaining vagina was closed with interrupted figure-of-eight sutures. Hemeostasis was secure.

The patient had multiple tumor masses involving the pelvic peritoneum. We systematically either excised these or fulgurated them. Tumor masses over the bladder peritoneum were excised by excising the peritoneal implants.  The patient had a. tumor plaque involving the left pelvic sidewall. The left  ureter was mobilized off the medial leaf of the broad ligament extensively. We then made a peritoneal incision to excise the entire left pelvic sidewall tumor plaque. The patient had tumor in the back of the vagina which was excised. She had a large tumor plaque in the right pericolic region and this was removed by making a peritoneal incision and excising the tumor intact. The remaining tumor masses were fulgurated or excised. The patient was noted to have a tumor mass adjacent to the rectosigmoid colon on the mesenteric side. This was similarly excised intact. Homeostasis was obtained with figure-of-eight sutures and cautery.

We then carefully inspected the small bowel. The patient was noted to have tumor on the appendix and therefore an appendectomy was performed. The appendiceal mesentery was  coapted with the Ligasure device and then divided. The base of the appendix was crushed, doubly ligated and then the appendix was excised from the stump and taken off the field. The base was fulgurated. Hemeostasis  was  secure. We continued to look for tumor implants over the small bowel mesentery and as these were encountered, they were systematically fulgurated. Similarly the patient had tumor implants over the right pericolic gutter which were fulgurated including a tumor mass adjacent to the posterior inferior aspect of the right lobe of the  liver next to the superior pole of the right kidney.  This was fulgurated. The patient had miliary implants over the hemidiaphragm and  there was no need to remove these since they were so small.

An omentectomy was performed. The omentum was mobilized off the transverse colon and then the lesser sac was widely developed. The gastroepiploic vessels were then serially sealed and divided using the Ligasure device. The omentum was taken off the field.

The remaining tumor involved the right and left periaortic lymph nodes. The peritoneum overlying the right common iliac artery was incised and the incision was taken cephalad to the third part of the duodenum which was mobilized and retracted cephalad. There was extensive malignant lymphadenopathy in the right precaval area and these tumor masses including the right common iliac region all the way up to the left renal vein going over the aorta. The right ovarian artery was encountered, clipped and divided as part of the resection of the malignant lymphadenopathy. The patient also had lymphadenopathy in the left periaortic region. These were excised off of the aorta. The patient also had malignant lymph nodes just in the left periaortic region just below the left renal vein. We similarly dissected these areas and sent them for permanent pathology. During the process we encountered the left ovarian artery which was similarly clipped and divided as part of the resection of the malignant nodes. The abdomen and pelvis were copiously irrigated. The patient had scant bleeding around the left renal vein and this was controlled with placement of Fibrillar Surgicel.

Because the patient was optimally debulked, we decided to place an intraperitoneal Port-A-Cath. The patient had the skin overlying the right subcostal region infiltrated with 1% lidocaine with epinephrine. An  oblique incision was made in the skin. The dermis and subcutaneous tissue were divided. A subcutaneous pocket was developed over the fascia overlying the ribs. Using a tunneler, the intraperitoneal catheter was brought from the subcutaneous pocket into the abdomen. It was attached to the hub. Stay sutures of 2-0 Vicryl were then placed to secure the hub to the underlying fascia. The catheter was flushed with heparinized saline. The subcutaneous fascia was closed with a running 2-0 Vicryl and the skin was closed w1th running 4-0Monocryl. The catheter in the abdomen was cut to about 8 cm in length.

Again, the abdomen and pelvis were copiously irrigated and hemeostasis was secure. All instruments and lap tapes were then removed from the abdomen. The abdominal wall was then closed in the routine fashion using a mass closure technique of #l PDS from the superior and inferior aspects and median mid portion. Subcutaneous tissue was irrigated, hemeostasis secured and skin closed with staples. A pressure dressing was placed.Sponge, needle and instrument count were correct times 2. Estimated blood loss was  approximately 300    to 400 mL. The patient received no blood intraoperatively. She was allowed to wake up in the operating room and taken to the recovery room in good  condition.


Preliminary Report - if not signed by author

Sunday, September 02, 2012

Ovarian Cancer Feels Like This


From Wikipedia, the free encyclopedia

Prometheus depicted in a sculpture by Nicolas-Sébastien Adam, 1762 (Louvre)
Prometheus (GreekΠρομηθεύς) is a Titanculture hero, and trickster figure who in Greek mythology is credited with thecreation of man from clay and the theft of fire for human use, an act that enabled progress and civilization. He is known for his intelligence, and as a champion of mankind.[1]
The punishment of Prometheus as a consequence of the theft is a major theme of his mythology, and is a popular subject of both ancient and modern art. Zeus, king of the Olympian gods, sentenced the Titan to eternal torment for his transgression. The immortal Prometheus was bound to a rock, where each day an eagle, the emblem of Zeus, was sent to feed on his liver, only to have it grow back to be eaten again the next day. In some stories, Prometheus is freed at last by the hero Heracles (Hercules).

I post this image because this is what it feels like to have Ovarian Cancer. 
The irony is that Ovarian Cancer is also a trickster.  Our ovaries are necessary for life, without them, mankind would not be able to duplicate. We cannot feel our little gems.  They are protected.   As ovarian cancer grows, everything around the ovary is displaced, and that displacement is what causes our symptoms. Tricky little (expletive), isn't it!
Ask any woman who has been diagnosed with ovarian cancer and she will probably tell you that she had strange abdominal pain.  She may say that she had a poor appetite.  She may say that her doctor gave her antacids and to keep an eye on it, maybe it is IBS.  And then out of nowhere she has to go to the ER because the pain is so bad, she feels like she is going to die, and they do a CT scan.  The doctor says she needs surgery and results show ovarian cancer.  
Our surgery is radical, the chemo ravages through our bodies to kill the cancer, leaving behind permanent damage.  Often our abdomen becomes a permanent stomping ground for never ending pain and suffering.
Maybe find the time to go to http://www.whyteal.org/ and learn about it.  This month is Ovarian Cancer Awareness month and our color is Teal.  
I hope every woman learns more about it just so that they have a better say so in how their doctor listens to her concerns if sadly she has unexplained problems, and her inner voice says that something is wrong.
I love you all,
Denise

Saturday, September 01, 2012

Presidential Proclamation -- National Ovarian Cancer Awareness Month, 2012


Presidential Proclamation -- National Ovarian Cancer   Awareness Month, 2012


NATIONAL OVARIAN CANCER AWARENESS MONTH, 2012
BY THE PRESIDENT OF THE UNITED STATES OF AMERICA
A PROCLAMATION
This year, thousands of American women will lose their lives to ovarian cancer.  They are mothers and daughters, sisters and grandmothers, community members and cherished friends -- and the absence they leave in our hearts will be deeply felt forever.  During National Ovarian Cancer Awareness Month, we honor those we have lost, show our support for women who bravely carry on the fight, and take action to lessen the tragic toll ovarian cancer takes on families across our Nation.
Sadly, women are all too often diagnosed with this disease when it has already reached an advanced stage.  Because early detection is the best defense against ovarian cancer, it is essential that women know the risk factors associated with the disease.  Women who are middle-aged or older, who have a family history of ovarian or breast cancer, or who have had certain cancers in the past are at increased risk of developing ovarian cancer.  Any woman who thinks she is at risk of ovarian cancer    or who experiences symptoms, including abdominal pain, pressure, or swelling -- should talk with her health care provider.  To learn more, visit www.Cancer.gov.
Ongoing progress in science and medicine is moving us forward in the battle against ovarian cancer, and my Administration remains committed to improving outcomes for women suffering from this devastating illness.  Through agencies across the Federal Government, we are continuing to invest in research that paves the way for a new generation of tests and treatments.  Through the Centers for Disease Control's Inside Knowledgecampaign, we are working to raise awareness about the signs and symptoms of ovarian cancer.  The Affordable Care Act already bans insurance companies from dropping a woman's coverage because she has ovarian cancer, and from placing lifetime or restrictive annual dollar limits on her coverage.  Beginning in 2014, the law will also prohibit insurers from denying coverage or charging higher premiums because a woman has ovarian cancer -- or any other pre-existing condition.
Ovarian cancer affects the lives of far too many women every year, and the tragedy it leaves in its wake reverberates in communities across our country.  This month, we stand with all those who have known the pain of ovarian cancer, and we rededicate ourselves to the pursuit of new and better ways to prevent, detect, and treat this devastating disease.
NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim September 2012 as National Ovarian Cancer Awareness Month.  I call upon citizens, government agencies, organizations, health care providers, and research institutions to raise ovarian cancer awareness and continue helping Americans live longer, healthier lives.  I also urge women across our country to talk to their health care providers and learn more about this disease.
IN WITNESS WHEREOF, I have hereunto set my hand this thirty first day of August, in the year of our Lord two thousand twelve, and of the Independence of the United States of America the two hundred and thirty-seventh.
BARACK OBAMA

Thank you kind readers for receiving this important information: