I will write in more detail tomorrow, but this team was fantastic. I was told by the husband of another of Dr. deHoyos’ patients that he was one of three thoracic surgeons doing TV assisted lung surgery. Will fill in details soon, hopefully tomorrow. Next doctor’s appointment will be Tuesday, May 20.

Thanks again for your interest and concern.

GOOD NEWS! The nodule has been removed, Dr. deHoyos was able to laparoscopically (actually video assisted) remove the entire upper left module. This shortens the recovery time dramatically. I am writing this brief post from my bedroom at home in Chicago. And should be fully recovered in two to three weeks.

One more river to cross - tomorrow I should get the pathology report on the nodule and the nearby lymph nodes. If the lymph nodes test negative, then there will be no need for chemotherapy.

Dr. deHoyos, his team, and Northwestern Memorial Hospital staff have made what could have been a terrible experience, bearable and in fact, I’m left thinking, “What’s so difficult about that?” Of course, the actual execution required immense skill, experience, and know-how. I was just one of three patients who was treated on Monday by Dr. deHoyos, et al. Surgeries began at 7:00 AM and ended almost twelve hours later.

Now, I am very tired and will write more tomorrow.

Dr. deHoyos will perform the surgery laparoscopically, unless there is some unexpected complication. (In that case he will resort to enlarging the incision, spreading the ribs to gain access.) He will make three small incisions. The longest incision will be less than 2″ long and will be used to insert the thoracoscope, a tiny TV camera on a tube. The other two will be used for instruments. After the operation, a tube will be inserted in one opening and left in place until fluid drainage stops. The other openings will be stitched closed.

How a surgeon can complete this procedure is a mystery to me. Besides severing the upper lobe from the lower lobe, there are bronchial tubes that must be severed and closed off as well as a multitude of blood vessels. Imagine completing these very delicate tasks with all of your visual feedback coming through a video screen.

At 7:30 AM tomorrow, I will report to the “Same Day Surgery Check-in” on the 5th floor of Galter at Northwestern Memorial Hospital. The surgery begins at 9:30 and should be complete in 3 to 4 hours. After surgery, I will be taken to recovery and from there to the ICU, where one typically stays for 12 to 24 hours.

To manage pain an epidural is often used immediately after surgery.

From the ICU, I will be taken to the Surgical Telemetry Floor on 16th floor of Feinberg for the remainder of the stay (4 to 7 days). So a typical stay from admission to discharge is 5 to 8 days. During my stay on the 16th floor I will definitely be mobile and am expected to get up and walk around the halls at least 5 times a day. I will be given deep breathing exercises to do for 10 minutes out of every hour I am awake. This helps avoid pneumonia and regain pulmonary function.

I will not be able to provide any updates until I can sit up and type, and Jana can bring my laptop. Since bad news travels fast, unless you here otherwise I will be doing fine.

Thanks for your support!

The worry and stress are rising.

As it began to close down, I stopped taking the pain killer pill. The pain wasn’t bad and I felt sure that the blockage of urine was being made worse by the pain killers. (Who knows whether it was the pain killer or a delayed response to the anesthesia and pain killers administered during surgery.)

From around 9 PM until 4 AM I was basically unable to urinate. I would try for 15 minutes; dribble a few drops; go back to bed; and within 15 minutes have another urge to pee. I was considering going to the ER to have a catheter placed to allow the urine to drain from the bladder. Fortunately, by 4 AM I began to be able to urinate and conditions improved continually.

Later in the day, the recovery nurse called to see how I was. She recommended calling my urologist (Dr. Kozlowski, NMH) and discussing the issue with him before the major surgery coming up on the 12th.

He said the only thing to do is to leave the catheter in for a number of days after the surgery. He instructed me to have him notified when I am admitted for the surgery.

Jana and I arose at 4:45 AM to get to the NMH Same Day Surgery Check-in on the 5th floor of Galter Pavillion at 6:00 AM. Surgery was scheduled to start at 7:30 for two procedures. I was to be out by 12 noon.

During the preoperative consult, Dr. Woo, the anesthesiologist, described some of the complications of anesthesia during the lobectomy. The lung that is being operated on must be inactive while the other lung must continue to breathe and oxygenate the blood. He did not explain how it is done, but we were amazed that it could be done at all.

After my varicocele surgery at NYU in 1973, the recovery room staff had complained that they had a hard time waking me up. I just wanted to continue sleeping. They had to keep reminding me to breathe deeply. This time I was told that there had been a lot of improvements in anesthesiology and I would come to consciousness very quickly.

The first procedure was a bronchoscopy. A flexible fiber-optic scope is inserted down the windpipe and bronchial tubes to make a visual inspection.

The second procedure was a mediastinoscopy. A 2″ incision was made between and just above the collarbones. A scope was inserted to examine the lymph nodes and to take tissue samples. These have been sent to pathology for biopsy. Results will be available on Monday.

The two procedures required about 15 minutes to prep me in the OR and 30 minutes to complete. After the procedure Dr. De Hoyos, met with Jana in the family waiting room and reported that both the area inside and outside of the lungs, and the lymph nodes all looked healthy. He said that he would be shocked if there were any cancer.

I regained consciousness when I was rolled into an elevator for the trip from the OR on the 7th floor to post anesthesiology care unit on the 5th. Vitals were monitored. I was given a wet sponge to suck on and ended up waiting there for an hour and a half because no rooms were available in recovery.

Before leaving recovery, I had to eat something (a turkey sandwich - it’s always turkey), drink some fluids, take a pain pill, urinate, and walk around briefly.

We ate lunch in the hospital cafeteria and were home by 1:00 PM. Later, Jana and I realized that this minor exploratory surgery areas were. How to get from one to the other. Etc.

While surfing the net, I came across a report by a woman who had had a lobectomy to remove a cancerous tumor. Numerous things went wrong. Despite being told her heart was in good shape, she had a heart attach on the operating table. In performing the lobectomy the doctors found that it had spread to the lymph nodes and was more extensive than had been shown on the CT scan. Her supposedly stage 1 cancer had turned out to be stage 3, and she was having chemotherapy.

At first, the story was frightening. But then I realized why a PET scan, stress test and pulmonary function test were all necessary and was very thankful for the excellent medical care and that I was receiving. If this woman had had a PET scan, the extent of the cancer might have been determined before the surgery, and the course of treatment would have been adjusted. Had she had a stress test, perhaps a weakness in the heart might have been revealed. Yes, I was fortunate to be at NMH and have the best care available.

To avoid further delays, the exploratory surgery was scheduled for Thursday morning. Jana and I wanted to allow time to visit our house in Michigan before the lobectomy (we had not been there for over 7 weeks) and still keep the surgery scheduled for May 12.

A blood T&C (type and cross reference) test had to be completed so Jana and I went to the pre-op testing area immediately. Afterward, it was 1:30 PM and we decided to eat lunch before going home.

To keep the momentum moving, I scheduled the office visit for the next day, Tuesday.

Jana and I considered the likely outcomes and concluded that the PET scan must have identified some inflammation left over from a recent bout of viral infection that had centered in the lungs. We looked to the exploratory surgery for confirmation.