It's Benign!

Just a quick update to let you know that, as of this morning, the biopsy results are in and the tumor removed last week has been confirmed to be a benign Lipoma.  Apparently Dr. Monson removed a small amount of fat and a lymph node sample as well from that area, both of which also came back clean.  Yeah!

On a recovery note, I went back to work on Monday (a little earlier than originally planned) and have been doing fairly well.  However, over the last day or so, I've definitely noticed much more pain and swelling in that area.  I'll try keeping an ice pack on it today as Holly swears that will help more than anything.

And man do I ever need a full shower!

A little off the top, please

All indications are that the surgery was a complete success!  So far, my pain is quite manageable, though I suspect it will likely go up a few notches by tomorrow.  My marching orders (post-op) are:

1. Take the dressing off after 3 days.
2. Follow-up with the doctor on Friday, July 9.
3. Do not drive or operate heavy equipment in the next 24 hours.
4. No alcohol for the next 24 hours.

I’m good with most all of these instructions, though I did make it clear “no promises” regarding the 24-hour moratorium on alcohol.  J  The Lipoma itself was approximately 4cm x 6cm and I'm told that the pathology results should be available within 7 - 10 days (though nobody is really expecting this to be anything other than Lipoma, which is benign).

Prior to the surgery, I got a little bit nervous when Dr. Monson mentioned, “Yeah, that thing’s in there really deep.  Removing that huge Liposarcoma on your leg was easy given where it was at; this will be a bit more complicated.”  Moments later, the Anesthesiologist followed up with the comment, “Wow – that really is an unusual location.  Surgery there can really be painful.”  All I can say is I’m just glad that I’m the kind of guy that really likes to hear people tell it to me straight!  Otherwise, a “panic attack” might have been in order.

Seriously though, this medical team is incredible!  I’ve got one of the best orthopedic surgeons in the southeast operating on me, awesome nurses, and an Anesthesiologist (named Heather) who really listened to my history of getting sick after surgery.  She described this as PONV (Postoperative Nausea and Vomiting) and told me she had it covered.  And sure enough, for the first time I didn’t get sick following surgery!  Yeah!

I’ve rented 2 movies and plan to start watching them as soon as I get something to eat.  Plus I plan on playing with my new iPhone 4, which was delivered today (perfect timing I might add).  I'm such a technogeek!

Thanks to all for your support, comments, emails, etc.  You-all are awesome!

A Cut Above

Yes, the time has finally come to get a new scar “tattooed” to my body.  At high-noon today, I will go in for that lipoma surgery that I mentioned in previous posts.  And this isn’t just any run-of-the-mill, dime-sized lipoma either (I have several of those); this one is much bigger and buried deep within my right armpit.  The main reason it’s coming out is because the location makes it difficult to monitor and we don’t want it to grow unchecked and become a problem.

I’m not really expecting this to be a big deal or anything, but I do think this is gonna hurt!  I just remember the pain that Holly was in after she had her right axillary node dissection (15 months ago) and I think this operation will be very similar.  I’m just glad I’m in the capable hands of Dr. Monson, who did such spectacular work on my leg 15 months ago.  Don’t know if I’m going to need any drains yet for this procedure (I’m hoping I won’t).  The surgery itself will be taking place at the Emory Spine Center (Executive Park) on an outpatient basis.

Once this is behind me, the exciting thing is that Holly and I will now have matching scars under our right armpits!  Now how cool is that?!?  I know that some couples like to get tattoos and all, but we (apparently) do things a little more “out of the ordinary”.  And trust me, the experience we’ve been through is just as permanently etched into our bodies, hearts, and minds as any real tattoo.  I’d say we’re a match made in Heaven!

Well, here’s to careful cutting, a speedy recovering, and a scar that’s just slightly bigger than Holly’s (for bragging rights, of course)!   J

Recent CT-Scan.  The area circled in red is the Lipoma that will be removed today.

Quarterly scans “all clear”

Just a quick update to let you know that I had scans this morning (MRI on my left thigh and a Chest CT-Scan) and both were clear.  Yeah!  It’s always such a relief to get that kind of good news, even though I typically don’t worry about it (except sometimes the night before a scan).  My next scans (CAP) have already been scheduled for August 12th.

Still to be arranged is a date for removing the rather large lipoma under my right armpit. Dr. Monson will be doing that surgery likely sometime mid to late June timeframe. I just need to sit down and look at my calendar, Holly’s calendar, the kid’s summer schedule, and then make that fit with Dr. Monson’s surgical schedule.  I’m told that the surgery will be done on an outpatient basis and that I will be out of commission for about a week recovering at home.  Holly’s axillary node dissection surgery was similar to this both in terms of complexity and location, and I know it took her a while to bounce back from that.  Dr. Monson also said that a full pathology would be ordered on what they remove (to rule out cancer).

The other thing I wanted to mention is our Gwinnett Relay for Life results this year.  Thanks to contributions from many generous friends and family members, Holly and I together raised around $3,500.  That is really awesome and it’s all for such a good cause too.  I would encourage each of you to participate in the Relay for Life event in your area.  It’s really quite an uplifting experience.

More updates in another month or so . . . once this lipoma-gone-wrong gets the hatchet treatment!

Kyle, Bryce, Holly, and Dave about to share their story at Gwinnett Relay for Life last Friday (click to enlarge).  


You might notice that I'm wearing last year's shirt.  I like purple better.  :)

Right axillary lipoma to be removed

As a follow-up to my previous post, I wanted to let you-all know that I do indeed plan to have the large lipoma (located under my right armpit) removed sometime this summer. I had another conversation with Dr. Monson (my orthopedic oncologist) about this and he was able to clarify why this particular lipoma is “special”. (Please note that I have several other smaller, more typical-sized lipomas in other easily-accessible locations, but the doctor has no interest or intention of removing those.) I also got a second opinion from another oncologist, who said essentially the same thing as Dr. Monson.

The reasons to remove this particular lipoma include:

1. It’s difficult to monitor – given its awkward location, it’s difficult to monitor this lipoma for changes. Physical examination of the area is not a reliable means of detecting change and CT-Scans are primarily focused on abnormalities of the chest, abdomen, and pelvis and, therefore, not always fully inclusive of this area.
2. It could become cancerous – though this lipoma is not believed to be cancerous, there’s a chance that it could become cancerous (in particular for someone already diagnosed with Liposarcoma). Having said that, however, I should also point out that I was told (by the doctor) that this would be “unlikely”. Even so, this motivates me all the more to have it removed.
3. Don't wait for it to become a problem – given that there are critical nerves, blood vessels, and lymph nodes in that area, it’s probably best to have this removed before it has a chance to grow and become all that more of a surgical challenge.

I should mention as well that both doctors said “no rush” on the surgery, which is why I’m waiting until the summer to have this done. All-in-all, I’m not too worried about it, though I’m well-aware that this surgery comes with its own set of risks (especially given all of the nerves in that area). Even so, I think that a good surgeon shouldn’t have any problems with it.

Bottom line – having it removed is the right thing to do.

Quarterly scans all clear, but . . .

Thursday morning I had both an MRI of my leg and the full set of Chest, Abdomen, and Pelvis (CAP) CT-Scans. These scans, of course, were preceded by a Wednesday evening “nightcap” of “Creamy Vanilla Smoothie” (a.k.a., Barium Sulfate Suspension), with the same for breakfast Thursday morning. I have to admit, the Vanilla was the best of all the flavors I have tried. That’s not to say that I liked it either, but rather that it was the most tolerable of the ones I’ve had thus far. Next time though, I think I’ll press my luck and go for the (even newer) Mocha flavor! Mmm . . . Mocha . . . I just hope I can stand the anticipation between now and then! [No, not really; I can wait. :)]

Now for the good news: my quarterly scans where all clear! Yeah!!! This leaves me sitting easy for the next 3 months. Honestly, I never really worry too much about what may or may not be going on in-between scans. Yes, I typically do get a little nervous the evening before my scans, but the truth is there’s really nothing I can do that will make my results either better or worse than what they are going to be. And that’s not fatalism or defeatism by any stretch; that, my friends, is acceptance.

So what’s the but about in the title? Well, way back in July, 2008 (when I was getting my first full set of scans), it was noted that I have a rather sizable lipoma under my right armpit (see dark area within the red outline in the scan picture on left). Though my latest radiology report describes this as “a right axillary lipoma, stable from the prior exam”, Dr. Monson (my orthopedic oncologist) recommended that I get it removed.  (Note that I also have several other smaller, more typical-sized lipomas in various locations, but the doctor has no interest or intention of removing those.)  Though his advice was couched with “no rush”, the concern is that a large lipoma could change into something cancerous. I suppose he’s probably right (he certainly has an amazing reputation and impeccable credentials). Even so, I’ll want to get another opinion as well as find out more details about the surgery itself, particularly the risks and recovery time. I think my main hesitation here is I'm not looking forward to any surgery, especially if it will take days to weeks to fully recover.  Furthermore, it's not currently bothering me or giving me any type of discomfort.  If anybody has any information or advice for me here, I’m all ears.

And there’s one more but worth mentioning here: all my scans this time were done without IV contrast. Why? Well, recent blood tests showed slightly elevated creatinine levels (mine is 1.5) and there was some concern that the powerful intravenous contrast agents (those used with the CT-scans especially) might send my kidneys “over the edge”. What’s surprising to me is that I’ve always been good about drinking plenty of water and I’ve made a point of drinking 2 – 3 bottles of water immediately after each CT-Scan in an effort to quickly flush these from my system (as suggested by the radiologist).  Even so, it's possible that the sum of all these dyes to-date has led to my elevated creatinine levels. But it's even more likely (as one comment below suggests) that in my case what I'm seeing here is a late effect of my chemotherapy drugs. Either way, I will need to avoid contrast agents going forward.

To be clear, I’m not blaming anyone for this. Dr. Monson never ordered any contrast with my scans and has long since preached against this practice, arguing that the risk outweighs any perceived benefit. Furthermore, in my case, I am told that about 80% of any Myxoid Liposarcoma recurrence would show up as “chest nodules”, which is something you don’t need contrast to see.

So why was IV contrast used in the first place? Well, it’s the radiologists who seem to prefer it. But even there, they were fine with skipping it knowing that my creatinine levels were elevated. In fact, they were very appreciative that I had my levels tested and that I brought this to their attention.

So why even mention this? The point here is that one needs to be aware that cancer treatment and/or prevention can lead to yet a new set of problems. Also, if you’re having MRIs and/or CT-Scans with IV contrast, be sure to drink plenty of water immediately after the exam to help flush these dyes from your system. Finally, make sure that your doctor monitors your creatinine levels (especially if you've had chemotherapy drugs) so that any issues are caught early . . . before they have a chance to become big problems.

OK – I’m done. I’ve rambled on long enough. Expect to hear from me in another 3 months.

My "Vacation" has started; my Chemo has not (yet)

Hi everyone! Well, I have been admitted today as expected and should get going on my chemo treatment shortly. In the meantime, I’m finally set up here in room 7120 at Crawford Long Hospital. With Holly now headed back home and the kids away all day, this feels like a vacation . . . or at least a business trip. Though don’t be surprised if I change my tune in a little bit after the chemo starts flowing.

Now to update you on some previous tests. The area noted near my right axilla was indeed confirmed to be yet another Lipoma (I have 5 of those now). The more interesting result was my MUGA scan, which indicated that my heart does not appear to be strong enough to handle the chemo known as Doxorubicin (a.k.a. Adriamycin). The scan computed my ejection fraction at 0.45 and it needs to be 0.50 or greater to undergo that more powerful chemo drug. So, as a contingency, I’m going to be getting a stronger dosage of Ifosfamide instead. Furthermore, Dr. D’Amato ordered a cardiology consult to do further tests on my heart. If those tests are normal, I may be put back on Doxorubicin.

Given that the Ifosfamide is served up in 12-hour doses for 4 days, it would seem as though I won’t be getting out of here until Friday morning. If you wanted to call me, I do have a direct line: 404-686-7120. If I don’t answer, it’s either because I’m not in my room or not feeling up to taking a call.

It’s really nice that they have free wireless here at the hospital. And of course I’ve packed my laptop and have my iPhone. So much has changed in the 8 years since I’ve last seen the inside of a hospital!

Hey – What’s happening?!?

No news is good news?
Well, I had 2 MRIs yesterday, one on my right axilla and another on my left thigh (the latter will serve as a baseline for my upcoming chemo treatments). As these were full MRIs with contrast, the two took over 2 1/2 hours to complete, which is a long time to be told “don’t move”. The right axilla was identified as a potential point of interest in my CT scan two weeks ago and the MRI is intended to rule out any metastasis. Though something is definitely visible in the scans, Dr. D’Amato last week seemed to think that it was likely just another Lipoma. But we won’t know for sure until Monday when I get the Radiology report.

Make it a Double!
This morning I went in for my port placement, which went well though is a little sore. The surgery itself took about 1 1/2 hours with more than an hour of prep time and blood work prior to the operation. It was certainly a bigger deal that I had expected. The port itself will definitely take some getting used to. This particular port device is a double port (similar to the one circled on the left), which is required in order to feed two different types of Chemotherapy drugs (as they cannot be mixed). The double port is located on my right chest with catheter extending up to my neck. The surgery was performed by Dr. Best (what a name) and a resident Dr., both of whom were great.

I also had a MUGA scan this afternoon. Quite ironically, they are not able to use the new port system as the particular medicines they inject “must go directly into a vein”. Therefore, I had to get stuck another two times for this procedure (ouch). Believe me, I’ve had enough needles to last me a while now.

Make me look like pastor Buddy
Tomorrow I go in for my big haircut, followed by a day of rest on Sunday, followed by industrial strength chemo starting on Monday.

Thank you so much for your continued words of encouragement and support. It means so much to me and my family.