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Pathology, Gross Description, Etc.

23 Apr

I had a follow up today with my surgeon and am happy to report that healing is on track.  He said my scar is still a bit puffy (I already knew that, thank you) and that complete healing from surgical scars takes 6 months to a year.  Aside from minor maiming by my Phlebotomist today, all is well.  Stabbed veins are painful!  I received the Operative and Pathology Reports, and though both were in language unfamiliar to me, they were fascinating!  Being that it’s all done and over with, it’s quite interesting to know exactly what took place while I was under.  I’ll summarize:

Operative Report:

Basically, they put me under, prepped me, gave me some drugs and put an inflatable cuff around each of my lower legs to prevent blood clots.  Then, they slit my throat 9 cm across and 2.5 cm above my clavicle, first superficially, then through muscle.  They folded my temporary neck flaps up and clamped them open.  Then they cut through more muscle, ligated several veins in my hypervascular thyroid, snipped here, snipped there.  They identified and spared my superior laryngeal nerve, identified and biopsied nodes determined to be benign.  The left upper parathyroid was identified and spared, the lower left parathyroid was not encountered and the left thyroid lobe was inspected and no accidentally removed parathyroid was seen.  The recurrent laryngeal nerve identified, spared in situ, and viable; lobe is passed off and returned finding hyperplastic (extra cells) tissue consistent with Graves’ Disease with no carcinoma seen.  Likewise for lymph nodes.

Onto more dissecting, snipping, and sewing; right lobe removed, the right upper parathyroid vasculature was compromised by my anatomy and was therefore “minced finely with … scissors” and grafted into my neck muscle.  The right lower and a third rogue parathyroid “labeled the right middle” were viable and left in situ.  My guess is that the “right middle” parathyroid was the lower left that they couldn’t find, which must have taken a wrong turn at Albuquerque.  Then, they basically burned the rest of the gland off of my trachea and stabbed two holes in my neck in order to place drain tubes.  Then it says ” Hemostasis was adequate with a valsalva maneuver,” though I’m not entirely sure what that looks like…

Pathology Report & Gross Description:

Specimen A – Pretracheal lymph node measures 1.4×0.6×0.3 cm.  It is frozen and sectioned for diagnosis by touch preparation.

Specimen B – Left thyroid lobe weighing 24.5 grams (finally, I know!)  –  Normal weight of a thyroid is 10-30 grams, so you can see that my left half was as big as a full thyroid.  It measured 6×4.8×1.8 cm while the isthmus (the middle part that I found so bothersome) measured 1.5 x 0.7 x 0.6 cm.  The lobe was reddish-tan and “diffusely heterogenous” – I think this means it was multinodular across a large region.  Consistently inconsistent, if you will.  No distinct nodules identified.

Specimin C – Right thyroid lobe weighing 15.7 grams (for a total of 40.2 grams) and measured 5.5 x 2.5 x 1.5 cm.  This lobe was “beefy red” and homogeneous.  No discrete lesion identified.  I could’ve told you the left one was the problem.

It’s weird how 99% of my physical ailments happen on the left side of my body, my thyroid being no different…

  • One reactive node tested negative for metastatic carcinoma.  That’s always a good day…  I think this was referring to my lymph node.  Both lymph node and thyroid nodule tested negative for carcinoma.  Yay.
  • At surgery the patient was found to have an enlarged, hypervascular thyroid consistent with the diagnosis.

Hemovac drains are then placed, I’m stitched up, and sterile dressing is applied.  The next thing I remember is the nurse telling me to take deeper breaths to bring my blood pressure up and they brought in my mom and then my boyfriend.  The transfer to the room is a bit hazy.  I remember coming out of the elevator on the cart and accidentally bumping into my mom, who didn’t recognize me at first.  Getting off the cart and into the bed was the hardest part.

I had to stay in the hospital overnight, but the morphine they gave me kept putting me to sleep, so for the first few hours, my mom, my boyfriend, and I napped on and off since none of us really got much sleep the night before.  That evening I told them both to go home and get some rest – only one person is allowed to stay in the hospital room overnight and I wanted both of them to get some sleep after the whole ordeal.  I knew that Anto had to work the next day at 5 and he’d gotten only 45 minutes of sleep the night before due to having to close at work and then be at my place by 6:30 a.m.  I felt fine and sleepy and wanted him to get a good night’s sleep before having to bear the brunt of working a Saturday night with little to no sleep two nights in a row.  He left reluctantly and then texted me about every 8 minutes upon returning home, making sure I was alright, asking if I wanted him to come back, etc.  All I did was watch episodes of House Hunters International between drug laden snoozes, I felt fine and told him to stay home.

As it got to be around ten o’clock, the nurses kept returning to poke me with needles, take my vitals, bring me ice chips, etc.  All I wanted to do was go to sleep and every time I started to drift, in came the nurse or the tech to make me do something.  Just when I was starting to realize that this wasn’t going to be the restful night I thought it would be, the door opened and Anto walked in!  He had come back, a blanket under his arm, to stay the night with me.  I was and still am thankful that he returned because that night would’ve been a very different experience had I been on my own.  The poor guy got woken up just like I did every hour, on the hour, the entire night.

I was supposed to be released around 11:00 the next morning, but there was a mix up with my labs – they had to monitor my calcium and the last batch of blood-work was entered under the wrong date in their computers, and it took until about 5pm to sort out.  Poor Anto stayed with me all the way until 3, and only left because he had to be to work at 5.  My mom came to take me home and faithfully crushed my pain pills up into apple juice for me for the next few days.

You already know the story after that.  How much energy I had, how I tricked myself into mild dehydration and exhaustion.  I made myself take it easy the last few days and am due to return to work tomorrow.  I feel great, optimistic, and generally lighter – even though I’ve gained seven pounds.  Blech.  I’m not letting panic get the best of me.  After all, I’ve been doing nothing but eating and laying around for the last couple of weeks with a couple of slow paced walks thrown in the mix.  I asked the surgeon today if I could start running again next week and he gave me the green light.  I think a return to routine, work, and more rigorous exercise will be effective.  I’m also looking forward to having income again.  I *think* I’m at peace with the fact that there is bound to be a little bit of weight fluctuation and that it will even out in time once I find the right fit with my Synthroid dose. I have been experiencing pretty significant abdominal distress with the slightest stray from non-processed food, so even though I already make mostly healthy food choices, this might ensure stricter adherence to them.  Not sure what’s going on, but I’m keeping an eye on things.

Still, overall, I’m feeling positive and thankful.  *Exhale…….

 

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2 Comments

Posted by on April 23, 2012 in Total Thyroidectomy

 

Tags: , , , , , , , , , ,

2 responses to “Pathology, Gross Description, Etc.

  1. Sasha

    April 24, 2012 at 12:40 pm

    How sweet is Anto?! 🙂 Glad you’ve had good support through all of this.

     
    • houffenglaarfert

      April 24, 2012 at 12:47 pm

      Indeed! He is one of the most thoughtful, genuine, caring people I’ve met in all my life. The support from all ends has been wonderful 🙂

       

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