Since I never really believed I was going to get cleared for surgery, I really didn’t think too much about the surgery itself or what was going to follow. But this shit is real now! So the day after my appointment with Gandalf, I had my final pre-op CT scan and then started reading in earnest to try and make sure I asked all the right questions at my consult with thoracic surgery the following day. I read up on all the different ways a thymectomy can be done and the pros and cons. I read up on surgical management of thymic neuroendocrine tumors and what to expect during and after the surgery. In case you are interested in reading more yourself, this article was a particularly informative one for me:
Reading this stuff in black and white both scares and reassures me. It really underscores the need to have this surgery. There is no doubt in my mind, but it helps to see it in writing, from a source I trust. I need to know this. I need to do this. That is all there is to it. It is ok to be afraid, as long as fear moves you forward and doesn’t paralyze you. Someone as a joke once told me that “Scared But Determined” should be on my tombstone. It is certainly the motto I am living by today.
I made a list of questions and circulated it to M, The Coven (a dear group of friends that have been with me through this every step of the way) and some very informed and helpful family members so they could add their own questions to the list. Knowledge is power, as they say, and given time was of the essence their input was very helpful. The more people thinking about your problem the better, in my books.
My cramming on Thursday left me with a lot more questions than answers by the time my appointment with the thoracic surgeon rolled around Friday. She was very no-nonsense and forthcoming with information. My CT scan was consistent with the others – no obvious surgical target but a few lumps and bumps that could be a tumor. As we looked at the images together, she was of much the same mind as Gandalf: *maybe” this is something? *Maybe” that is something? For certainty, my symptoms and the Octreoscan ARE something, but as the surgeon said, none of us really know what we will find until they get in there.
The surgery itself is quite interesting. The surgery will be conducted by two thoracic surgeons who work as a team. The thymus is in a tough to access spot, nestled between the heart, the breastbone, lungs and major veins, arteries and nerves running through the chest. Cozy!
To get my thymus out, the surgeons have decided to use a robot assisted surgery. Four robotic arms are placed into one side of the chest. One of the arms has a camera and the others have surgical implements. Together, the surgeons control the arms of the robot from a console in the OR, using images from the camera as a guide.
The plan is to remove the entire thymus as well as the bed of fat between the thymus and the heart. If anything else looks suspicious while the surgeons are in there, it will get removed as well. I also have a small nodule in my lung that I have known about for about a year now. It is difficult to characterize the nodule from the CT scan – it could be a lymph node, it could be a tumor, it could be benign or not. It is anyone’s guess. The plan is to remove the thing in my lung as well if it is easy for the robot to access. Since the surgery is minimally invasive, if all goes according to plan, my recovery should be relatively easy, with only a day or two in the hospital after the operation. Not so bad!
The second half of the thoracic surgery team was out of town and will be gone all of next week as well. He still needs to review my case and sign off before we can move ahead. I am hoping this is just a formality, since Gandalf and the first thoracic surgeon have already signed off. We have a few pre-op details to take care of after that and there will be several details to work out with anesthesiology due to complications introduced by my pituitary surgery last year and complications introduced by this current tumor. But knowing what problems to prepare for is 95 percent of the battle.
I won’t have a firm surgery date until thoracic surgeon #2 is back, but I was told to plan for either the third or fourth Wednesday in June as Wednesday is “robot day” for the surgeons. In the meantime, we will all continue preparing for the surgery and for what will follow.