Just a Simple Biopsy

The next step in the process was to have a biopsy of the tumor in my abdomen taken so that the pathologists could pinpoint the exact type of lymphoma at the cellular level.  This is very important in determining how they are going to treat it as far as the type of chemotherapy drugs, etc.  The best surgeon in the area is Dr. Hoepp, so that's who we wanted to do the procedure. (Side note: he saved my life 32 years ago when I was 13 months old and got a penny stuck in my throat.)  He's very hard to get appointments with, but we were able to get a pre op appointment with him right away for Tuesday, March 4th with the surgery scheduled for the day after.  Unfortunately there was a huge storm in the Mid Atlantic and Dr. Hoepp was stranded in Florida until later in the week.  His office worked it out and the appointment was pushed to Thursday and surgery Friday.

The pre op appointment was uneventful, although he seemed really concerned about how he was going to do the biopsy.  He showed us the CT scan and said the tumor is covering all of the major arteries and organs, so it would be more difficult than a simple biopsy.  His plan was to start laparoscopically and if he couldn't get what he needed, he would make an incision and get the rest to avoid risk. Sounded good to us.

Friday we showed up at the Elliot Hospital at 11:30 and were checked in for surgery.  I should mention that my sister Erin has been a nurse in the operating room there for over 10 years.  She wouldn't be in the room during my surgery, but everyone was aware of my situation and expecting our arrival. It was nice having so many people come in to say they worked with Erin and offer their support.  Once I was all hooked up and ready to go, our pastor and his wife stopped by to pray with us just before I went in.  If everything went according to plan, the procedure would take about 45 minutes and I would wake up in the recovery room and be able to go home the same night.  I remember being wheeled into the operating room and then the anesthesia kicked in and it was lights out for me.

My awesome sister and her family

When I opened my eyes next I was in the recovery room and I heard a lot of people around me talking.  On my right I saw Mia, who was my recovery room nurse and also a close friend of my sister's who I've gotten to know over the past several years.  She was asking me if I was in any pain, which I then realized that I was in a great deal of, especially in my stomach.  She told me that I had a catheter in, but I didn't register at the time that a catheter is for longer surgeries and wasn't supposed to be part of the plan for this one.  I looked up at the clock and noticed it was after 5:30.  Something was wrong.  Dr. Hoepp then came over and said "you're not going to remember this, so I'm sure I'll have to repeat it, but there were complications with the biopsy."

The surgery started out according to plan and he was able to get some tissue samples through the 3 small laparoscopic incisions, but the pathologist needed one more sample.  When he went back in for the last sample, "all hell broke loose" in his words.  My iliac artery on the left side was sliced open and began gushing blood internally.  Now here is another example where God's hand was with me: Dr. Hoepp is also a vascular surgeon, so he was immediately able to take action and make the repair.  Had he not been, they would have had to page one and I could have bled out.  As it was, I lost around 2.5 liters, which is around 40% of my blood supply.  So he made about a 6 inch incision from my belly button down to go in and repair the artery (initially holding it in his hand as I was told.)  This also required another incision about 4 inches long at the top of my thigh to insert a stent into the artery and feed it up to where the damage was.

At some point after my artery was repaired, my left leg started turning blue from lack of blood supply and they realized that I had a blood clot in the newly repaired artery.  He then had to reopen it to restore blood flow to my leg.  According to another doctor who was in the room, it was "very scary."  This stent saved my leg, and I'll be reminded of it every day by the 81mg of aspirin I have to take for the rest of my life and the official card I have to keep in my wallet.

After the artery was repaired again, there was still the issue of getting the rest of the biopsy.  Going back in laparoscopically was now out of the question, but he was able to get the rest of the tissue sample with the large incision already there.  Mission accomplished, I was then stitched up and sent to the recovery room.  Throughout the ordeal, my family was provided with updates in the waiting room, including Dr. Hoepp candidly explaining that "everything that could go wrong, has." I'm thankful for everyone who stayed with them to pray and provide support during such a stressful time.

After I woke up a little more in the recovery room, Tiffany came in to see me followed by my mom and dad.  I was then taken to the Intensive Care Unit to be monitored for the first night.  I was hooked up to every kind of monitor imaginable along with oxygen to help me breathe.  Tiffany fed me ice chips because my throat was killing me from having a breathing tube in for 4+ hours and was so dry from all of the pain medicine.  The nurses came in every hour throughout the night to take vital signs and check the pulse in my feet to make sure they were getting blood.  At first the alarm kept going off and they would yell "breathe Joe!" because apparently I wasn't.  I would force myself to take deep breaths until the alarm stopped and then doze back off until it went off again.

The next morning I was deemed stable enough to leave ICU and was moved to the Fuller Unit, which is the post op floor.  That is where I would spend the next 3 days and nights on a mostly liquid diet while regaining some strength and mobility.  The first day was rough when there was a glitch in my morphine drip and a delay in getting me more, but overall they took great care of me.  By Tuesday all of my vital signs were normal and my incisions were healing the way they were supposed to.  I was able to stand on my own and walk to the bathroom and back without a walker, so I was given the OK to go home that afternoon.

I was disappointed in the setback which will delay and potentially make chemotherapy even more of a challenge, but thankful to God for carrying me through.  All hell may have broken loose, but when that happens the Bible says in Isaiah 59:19 "When the enemy shall come in like a flood, the spirit of the Lord shall lift up a standard against him."

Happy to be home with my babies

This is my song for this experience.  Warning: it's hard and you probably can't understand most of the lyrics, but the chorus "I'm not ready to die" speaks for itself and the aggressive tone is how I feel about this fight with cancer.