Wednesday, August 09, 2006
A Medical Marvel?
During my "off" week between treatment cycles 1 and 2 in the Velcade/Celebrex study, I visited my home gyn/oncologist for evaluation of an increase in my abdominal size accompanied by significant discomfort. An ultrasound the previous week at MUSC had shown fluid collections (ascites), but not enough in any one spot to remove for therapeutic purposes.
This time, my MD found a pretty good size pool of fluid in my right upper abdomen and asked if I wanted him to remove it. I gave the go-ahead, and he used a local anesthetic, then inserted a needle guided catheter in a short distance and left me with the nurse to drain out the fluid. The collection bag filled up quickly with about 1 and 1/2 liters (about 4 pounds) of yellowish fluid, then promptly stopped draining. She had me change position a couple times, but still no more drained. So she removed the catheter and placed a gauze pad over it, telling me it might drain quite a bit in the next couple days. This procedure is called a paracentesis.
The whole procedure was fairly painless, and I was breathing much better immediately. I went home and my sister and I were busy going through boxes, sorting out things to keep or give to Goodwill, when I noticed I was beginning to have a lot of swelling right next to and below the area of the paracentesis. This continued to get worse during the rest of the day and evening. By the next morning I looked pregnant on just the right side of my body from rib cage down to pelvis, and around the back on my right side.
I went back to my gyn/onc and saw another MD in the practice who said he had never seen anything like it, but thought it was probaly fluid that continued to leak after the catheter was removed, and seeped into the muscle layer. To be on the safe side, he ordered a CT scan, which was done that afternoon. The radiologist came to talk to me, scratched his head and said he had never seen anything like it, but the fluid very nicely outlined all my muscles on the right upper and lower abdomen.
Day 3 - back to my gyn/onc to see my MD that performed the procedure. He looked at it, shook his head, and said he had done 3,000+ paracentesis procedures, and had never seen anything like this! He did not seem concerned, despite my worry that now, instead of the cancer cells in the ascitic fluid being just in my belly, they were in the muscles and skin all along my upper and lower abdomen and back. His response was that since I am getting treatment for cancer, cancer cells anywhere in the body should be affected equally. Also, he mentioned that even though cancer cells leak out along the catheter line when he does this procedure, he never had a patient develop cancer at that site, so didn't think I should worry!!
I found out later this fluid accumulation has a name - seroma - and is a fairly frequent occurrence in cosmetic surgery such as liposuction where they remove a lot of tissue. They will sometimes draw out the fluid with a needle and syringe. This option was not offered to me, and I don't know if it would have been possible in this situation. I do know that it is resolving - very slowly - and that I have a good sized knot at the site where the catheter was inserted, and still have a painful collection of fluid nearby, 10 days later.
That is an example of the many things we cancer patients have to accept - not knowing and best guesses. This is just one of many such situations (land mines if you subscribe to the war on cancer theory) around every corner in the battle to keep cancer at bay, and hopefully one day banish it. But worrying about all these unknowns is unlikey to create a better situation. A big measure of faith is required. Faith that continuing to struggle to stay strong and be optimistic about the fact that I am still here and still going will at least make the quality of my life better, although it may not impact the quantity. Some days this is easier said than done and I have to dig deeper to find that calm at the center of the storm of panic, uncertainty, physical distress and wondering if I am missing a message that I should be getting.
This time, my MD found a pretty good size pool of fluid in my right upper abdomen and asked if I wanted him to remove it. I gave the go-ahead, and he used a local anesthetic, then inserted a needle guided catheter in a short distance and left me with the nurse to drain out the fluid. The collection bag filled up quickly with about 1 and 1/2 liters (about 4 pounds) of yellowish fluid, then promptly stopped draining. She had me change position a couple times, but still no more drained. So she removed the catheter and placed a gauze pad over it, telling me it might drain quite a bit in the next couple days. This procedure is called a paracentesis.
The whole procedure was fairly painless, and I was breathing much better immediately. I went home and my sister and I were busy going through boxes, sorting out things to keep or give to Goodwill, when I noticed I was beginning to have a lot of swelling right next to and below the area of the paracentesis. This continued to get worse during the rest of the day and evening. By the next morning I looked pregnant on just the right side of my body from rib cage down to pelvis, and around the back on my right side.
I went back to my gyn/onc and saw another MD in the practice who said he had never seen anything like it, but thought it was probaly fluid that continued to leak after the catheter was removed, and seeped into the muscle layer. To be on the safe side, he ordered a CT scan, which was done that afternoon. The radiologist came to talk to me, scratched his head and said he had never seen anything like it, but the fluid very nicely outlined all my muscles on the right upper and lower abdomen.
Day 3 - back to my gyn/onc to see my MD that performed the procedure. He looked at it, shook his head, and said he had done 3,000+ paracentesis procedures, and had never seen anything like this! He did not seem concerned, despite my worry that now, instead of the cancer cells in the ascitic fluid being just in my belly, they were in the muscles and skin all along my upper and lower abdomen and back. His response was that since I am getting treatment for cancer, cancer cells anywhere in the body should be affected equally. Also, he mentioned that even though cancer cells leak out along the catheter line when he does this procedure, he never had a patient develop cancer at that site, so didn't think I should worry!!
I found out later this fluid accumulation has a name - seroma - and is a fairly frequent occurrence in cosmetic surgery such as liposuction where they remove a lot of tissue. They will sometimes draw out the fluid with a needle and syringe. This option was not offered to me, and I don't know if it would have been possible in this situation. I do know that it is resolving - very slowly - and that I have a good sized knot at the site where the catheter was inserted, and still have a painful collection of fluid nearby, 10 days later.
That is an example of the many things we cancer patients have to accept - not knowing and best guesses. This is just one of many such situations (land mines if you subscribe to the war on cancer theory) around every corner in the battle to keep cancer at bay, and hopefully one day banish it. But worrying about all these unknowns is unlikey to create a better situation. A big measure of faith is required. Faith that continuing to struggle to stay strong and be optimistic about the fact that I am still here and still going will at least make the quality of my life better, although it may not impact the quantity. Some days this is easier said than done and I have to dig deeper to find that calm at the center of the storm of panic, uncertainty, physical distress and wondering if I am missing a message that I should be getting.
