Well hello again! It certainly has been a while since I last wrote.
I have a bunch of updates, some good, some exciting, but unfortunately some stressful as well.
Let's start with the good: I've finished my orthopaedic surgery residency at Albert Einstein, which has been quite a happy milestone. My "Decade in 'da Bronx" is now officially over. Unfortunately, the excitement of finishing residency is very much tempered by the fact that the American Board of Orthopaedic Surgery Part I Certifying Examination looms right at the end. For the last several months (heck, for the last four or five years!) studying for this test had slowly taken over my life. But remember, this is the good news paragraph, so I'm here to report that as of last week, the exam is now behind me! (at least until I get the results in a few months...)
Continuing, many of you know that my post-residency plans have been for a fellowship in Hand & Upper Extremity Surgery, at the University of Pittsburgh Medical Center. Well, as of this week, I have landed in Pittsburgh. I have a fabulous new apartment that I'm taking my time unpacking into, and I start fellowship August 1st. All very exciting!
Anyway, on to the little bit of troubling news that I have to report...
Regular readers will remember that since the disappearance of my alleged T-cell lymphoma last year, I had been getting regular "surveillance" scans, in the form of a PET/CT every 4 months or so. They have all been negative, the most recent in February. (yup, check the date of my last post here :-)
About two weeks ago, I called Dr. H of Sloan-Kettering to ask him what sort of follow-up I should plan for the future, given a year of negative scans, and my plan to move to Pittsburgh. He said that he thought I only needed the minimum of oncologic follow-up, if at all. He recommended an annual exam and CT scan of the chest, abdomen, and pelvis, in lieu of continuing the full body PET/CT's. So I had the CT scan two weeks ago, then went off to Chicago to take the boards, with plans for a follow-up visit last Friday for the check-up and scan results with Dr. H.
Everything OK so far.
On the flight back from Chicago on Wednesday night, I was doing a little bit of pleasure reading (woo hoo! no more studying for the boards!). At one point I think I was sitting with my left palm under my chin, and I probably then adjusted my position, running my hand around my neck and through my hair. And that was when I felt it. A firm, large swelling, on the left side of my neck. It took about one-tenth of a second for that sensation at my fingertips to translate to the words ENLARGED CERVICAL LYMPH NODE = LYMPHOMA flashing through my medical mind. Yes, in retrospect that's a bit simplistic, but hey, you always fear the worst, especially when it's your own lymphoma.
I was a total wreck at that point. I put the book down, and was basically shaking in my seat for the remaining 45 minutes or so of the flight. I started completely expecting the worst--This is it. It was lymphoma last year, we missed it, and now it's really back. Yikes.
By the next morning, I had composed a very long email to Dr. H, outlining the situation in even more detail than you have read here. I wrote that while I already had a follow-up appointment with him in less than 48 hours, I was too panicked to figure out if there was anything I needed to do in the interim. He wrote me back fairly quickly--A reassuring one liner:
Hi Sam, We've already dealt with scarier worries - we'll assess it tomorrow. PH
The next day I saw him, and in person he calmed me down even more. He reminded me that lymphoma was only one of several things that could be heralded by enlarged lymph nodes. And he added that frankly, as far as he was concerned, it wasn't even among the highest things on his list. "I wasn't convinced you had lymphoma last time, and I'm not sure we have to assume that's what you're dealing with now..."
But nonetheless, we agreed that this must be dealt with fully, and any of the above is possible.
The lump, which I describe as about walnut-sized, is deep--meaning it is covered by other stuff, in this case the sternocleidomastoid muscle. For this reason, I had to get a CT scan of the neck to localize where it is:
(click on image for larger view)
This is an axial cut of my neck. Viewed as if you chopped someone's head off and looked at the resulting cross-section. But left is on the right, and vice versa. The gray lobule with the green marks on it is the lymph node in question. It's about 2.5 centimeters in diameter, which fits my walnut description. The gray sausage-like shape just to the right of that is the sternocleidomastoid muscle. The white thing in the center is one of my neck bones (4th cervical vertebra), and the assorted white dots are mostly blood vessels, filled with contrast. The white arch at the top is my hyoid bone.
The plan now is a surgical biopsy. We have to take it out, examine it, and deal with whatever it is. We're hoping it's not lymphoma, but it's just wait-and-see.
I wasn't sure how to proceed. I told Dr. H that I was very much in need of guidance--in just a couple of days, I was about to move, sign a new apartment lease, pay a lot of money to have my stuff transported to Pittsburgh, and start fellowship. I was second-guessing everything at this point.
He poignantly told me that I should just proceed with my life. Go to Pittsburgh, get my apartment, move, unpack, settle in.
Just be prepared to come back to New York in a week or so, so that we may deal with this.
--
And that, my friends, is where things stand now. I've been in my snazzy new place for about four days now, at this point fully surrounded by half-opened boxes. Just now, I finished unpacking all of my kitchenware, and it's really starting to feel like home. I've also bought a lamp that is almost nine feet tall, and starts to fill out my 14-foot-high living room.
On Monday, I'll be driving back to New York. And on Tuesday, I have an appointment with a head & neck surgeon at Sloan-Kettering, as well as another for a new PET/CT scan.
By the end of the week, I'm hoping to have had the surgery. And if all goes well, I'll be coming back to Pittsburgh in time to start fellowship on July 31st.
I keep reminding myself, "we don't know what this is... It's not necessarily lymphoma."
We'll know next week. I'll keep you posted.
I sure hope your doctor is right. My gut says he is.
Posted by: V | 25 July 2007 at 01:08 AM