Next was the pre-operative clearance where an EKG strip of the heart is needed. Flat T-Waves - I knew that and my heart has always had flat T-Waves. The doctors were not at all concerned since we chased that anomaly down a rat-hole years ago.
By this time I was starving, so I bought a fruit cup which I did not eat and went to the Vocal Cord exam on the 12th floor of Gonda. I asked there if I could eat it and they advised not to, since I would be "scoped." I was nervous about this scope - up the nose and down the throat - to look at my vocal cords. Why look? Because I'm a "re-operative" case - I've had prior neck surgery which can damage the nerves to the vocal cords. The surgeon wants a baseline on how much damage I have - if any. I told the doctor (she was lovely) that I was likely unnecessarily nervous - she said the entire procedure takes under one minute and that calmed me right down! Plus they numb your nose and throat - the worst part is the stuff tastes awful! Very bitter. So they squirted the stuff in and I also said "by the way, I have a tendency to get nose bleeds." Remember this magical statement should you ever need this done because she turned to her nurse and said "go get the pediatric scope." YAY - the kiddo scope!! Much thinner than the adult version. She showed it to me and said "see it's like a strand of spaghetti." Spaghetti MY ASS! I'm Italian - there is no Spaghetti on the planet that is that thick!! Bucatini maybe - but that was no Spaghetti. She carefully inserted it up the nose - that part I could feel, but it was not painful in any way - just odd. I could not feel it at all in the throat. She had me make a high pitched "EEEEEE" sound and then "breath in slowly through your nose as if you are smelling flowers." She said everything was working normally and looked good. I'd say it took 45 seconds, if that!! She recommended a few brand name items for nasal dryness: Ponaris - Nasal moisturizer, natural decongestant and XLEAR - nasal cleanser that is moisturizing. She prefers both to Saline and said the Ponaris has a pleasant Vicks-like smell. I bought both at the Mayo Store after lunch.
I ate my fruit cup at 10 a.m. as I basked in the sun by the window - very warm, given it was about 2 degrees F outside (that's -17 degrees C for the Celsius crowd). Off to the Endocrinologists office. He reviewed everything and answered all my questions about the diseased parathyroid and talked glowingly about the surgeon.
After a walk through the sub-way and the sky-way system in search of lunch, it was time to meet the surgeon - she entered with her entourage. My Endo arrived to introduce her, along with her resident, her visiting surgeon from Massachusetts and her nurse. The room was crowded!!
Here's the game plan:
- Call the "hot-line" after 8:15 tonight (but before Midnight) to find out when surgery is tomorrow - yup - I have no idea when it will be until I call the "automated line to receive instructions." (Update: I called and have to report at 7:30 a.m.)
- Anesthesia will be general (yay!!)
- Surgical approach will be minimally invasive
- Location of incisions (two) will be just above my thyroidectomy scar and to the left, and on my upper chest (more on that later)
- No other glands will be observed (we have 4 parathyroids, she will enter, remove the diseased one and sew me up - no hunting around due to significant scar tissue in my neck - my case is known as a "reoperative" case)
- She'll provide a photo of the adenoma (YAY for the U.K. crowd)
- She uses a vocal cord nerve monitor during surgery (cool!)
- She will remove any reactive lymph nodes she observes due to my history with thyroid cancer
She will take a piece of the diseased parathyroid and auto-transplant it into my chest, near the surface of my body - the reason is fascinating:
There are two worst case scenarios - the first is that she can't find the adenoma at all and sews me back up and sends me home. This is unlikely since we have it on a sestamibi scan and an ultrasound - so we have a "road map."
The second is that she removes my diseased parathyroid and we discover that it was the only working parathyroid I had...so, as an insurance policy she puts a small portion of it into my chest which will start to work in 4 weeks. The other parathyroids should start working again sooner than that...hopefully right away...but just in case I'll have the one in my chest as insurance. If that one, since it's diseased, continues to cause issues in the future, it can be removed in a clinic visit, right in the office. Brilliant!
All in all I was super impressed with the surgeon and her game plan. She answered my laundry list of questions before I even had a chance to ask them!! She does thousands of these operations and is an expert in reoperative cases.
So the schedule:
- Wednesday - Surgery - time TBD later (7:30 a.m. check in)
- Wednesday night - stay in Methodist Hospital
- Thursday morning - monitor blood calcium and PTH hormone (which will also be monitored intra-operatively or ioPTH) - if both look good, I will be discharged to go home. If I have any symptoms of low calcium, I am to stay in the area one more night and go home Friday.
I'll need to supplement with Vitamin D and Calcium to rebuild bone mass - the goal of this surgery is to reverse the incipient osteoporosis (as well as get rid of the bone pain and the ringing in my hears, etc.)
I'm ready!!
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