Category Archives: surgery

The Blue Nevus

When I saw my primary care physician back in November, she asked me how long I had had that discoloration on my scalp.
I said, “What are you talking about?”
Indeed, there was something there, though neither my wife or I had noticed it. My doctor wanted me to see a dermatologist. Naturally, that takes awhile.
So it was only 10 days ago when I went to the dermatologist, who said, “Ah, you have a blue nevus.”
Now does that not sound like a car or a flower or perhaps something in space?
No, the blue nevus is a variant of a common mole. It is composed of melanocytes, the cells which produce the melanin pigment, which have a spindled to epithelioid appearance. This nevus gets its name from the distinct clinical appearance because of the pigmented cells within the dermis.

So what should I do about it? I noted that my doctor saw it in November but had not seen it in my ptrevious annual visit. Its recent appearance was an issue for my dermatologist; if I had had it for 20 years, he wouldn’t have thought much about it. This not being the case, he said he thought we should have it removed.
I said when should we do that?
He said, “Now, if you’re up for it.”
He numbed the surface with a topical liquid, then gave me a shot (which didn’t hurt), then removed the nevus, needeing three stitches to patch me up. It was a bit more bloody gauze than I would have expected from such a little mole.

I was to come back this past Thursday to remove the stitches and to get the results of the biopsy. I wasn’t worried, since these are almost always benign. On the other hand, in the United States, Blue nevi are most frequently noted in Asian populations, where the prevalence is estimated to be 3-5% in adults. They are found in 1-2% of white adults and are rarely found in blacks.

So I’m atypical. “Blue nevi are twice as common in women than in men.” Also, “Rare cases of malignant melanoma have been reported arising in association with cellular blue nevi.”

I return to the dermatologist as scheduled, got the stitches out and good news about the nevus. The one down side is that it was deep, and it might come back someday, so I may undergo this procedure in the future.

ROG

Jawbone

ADD will relate.
One of the things that’s been keeping me busy lately is helping my wife prepare for the jaw surgery she had this past Monday. Evidently the lower part of her mouth is not large enough to accommodate for the teeth there. So her jaw was cut and brought forward a few millimeters. The surgery usually involves a three-to six-week recovery period, depending on the track of the procedure. If all goes according to plan, the cuts to her jaw will be clean and the shorter time will be required. If on the other hand, a piece of the jaw breaks, then it’ll be the longer scenario. Unfortunately, while one side went as desired, the other did not. Three little pins on one side, a titanium plate and one screw on the other. For probably the whole month and a half, she will have her mouth wired shut.

We’ve gotten some pretty peculiar responses to the news of her impending surgery. One person, when told that Carol needed to be eating strained foods for the next couple of weeks, shrieked “OOOOHHH, I HATE strained foods!” Not particularly helpful.

Then there are the people who think that my wife’s mouth not being big enough is a sort of punchline for something out of The Honeymooners. Guys in particular seem squeal with delight that my wife will be somehow struck dumb by the contraption that is located in her mouth. It is as though they’re thinking “to keep the old lady quiet for a while” is my desire; I find this more than slightly disturbing, not to mention insulting to my wife. Actually, she will be able to speak, albeit with clenched teeth. We have been warned that she will sound a bit angry ,even though she is not.

The worse part of this was the tremendous pain my wife was in on day one. Even with “the good stuff”, her pain threshold only went from 9 to 8. this is a woman who did childbirth without meds before and only extra strength Tylenol afterwards. I made it very clear to the hospital staff that my wife does not complain idly about pain; if she says she’s in pain, she’s in PAIN. By the next day, the pain had alleviated somewhat, but she still has a modicum of discomfort.

Ironically, the surgery is considered successful. The lower teeth ARE lined up properly with the upper teeth; the goal was met, It was merely the methodology that was problematic.

One of the good things that’s come out of this is that Carol’s finally gotten a health care proxy, which I’ve been nagging her to do for about nine years. She thought it was more complicated or required more verbiage. But when she saw my version, which I had done 15 years ago and have altered twice since, she realized it was pretty easy to take care of.

She’s recovering well and sleeping a lot.
ROG

The Lydster, Part 41: A Pain in the Butt


A couple days before we went on our trip to the Berkshires in June, Lydia somehow got a thorn or something similar through her bathing suit into her posterior. She didn’t tell the people she was with at the time, but only complained later. Carol and I couldn’t get it out, so Carol called our pediatrician.

Carol claims, and I believe her, that she heard tones of snickering and even mild mocking in the response by the receptionist when she made the appointment on the Friday before the trip. You mean these pathetic parental units couldn’t get a little sliver out of their child? I think we took some mild emotional satisfaction, mixed with medical concern, when Lydia’s doctor couldn’t get it out, either. He recommended heat and other salves to try to draw out the foreign object. If it’s not out by the end of the weekend, he recommend that Lydia see a surgeon. A surgeon for a sliver!

Well, we left for the Berkshires on Sunday, but first thing Monday morning, Carol called the surgeon’s office, and made an appointment for the next morning. We drove back to Albany on what may have been the hottest day of the year; I remember distinctly leaving a fitted sheet over Lydia’s car seat, so that the seat and the metal wouldn’t be too hot when we return.

Carol, the nurse and Lydia were in the room when I heard Lydia screaming. I assumed this was the shot to numb the area. No, it was the numbing cream used in anticipation of the shot. The actual shot went relatively easily.

The surgeon was called away on an emergency for a time. Finally, when the actual removal took place, it involved the surgeon removing the object, and the nurse and two parents holding the child.

We had lunch and soft ice cream after that, then returned to our vacation locale.

(This will be one of those posts where, years from now, she will undoubtedly chastise me.)


These are her favorite colors.

ROG

The Adenoidectomy


I’m looking for the proper analogy.

You know when you go to a really fine restaurant, and the food is really great, first rate, but you can’t find the waiter to fill your water glass or get/pay the check? Or when you order something online, and it is everything you wanted, but the shipping charge in the fine print is much more than you anticipated? Well, neither of these is exactly spot on, but I’ll leave it there.

The process for the surgery starts with the phone call to the surgeon’s office, which Carol tried several times unsuccessfully, before I called, and got the office on the first attempt. I was told by a very nice person all that would be taking place in the next eight weeks, only some of which actually happened.

For instance, we needed to have Lydia’s pediatrician do a physical and fill out the surgeon’s forms within the month before the surgery. This would mean we’d need to get the form in the mail, but that didn’t happen until we called again, three weeks before the surgery; these did arrive promptly, so that we could schedule the pediatric visit.

I was told we’d be getting a phone call two weeks before the surgery. Well, no, not until Carol called them. We did, however, get the promised sheet of paper about the pre-surgical procedure, though it was a bit cryptic in places.

Carol took Lydia to the presurg visit a week before the procedure, and that was quite positive. Carol explained would be happening to Lydia, and even got her a couple books, one with Curious George and one with Madeleine, about hospitals. I wonder if they were too intense, for Lydia had a couple nightmares during that last week. She did, though, like playing with the doctor kit; she particularly liked giving me a “shot”.

A couple days before the surgery was scheduled, we were concerned that her coughing might preclude Lydia from having the surgery that was desired so that she would be less susceptible to colds. That would have been ironic, but as long as she didn’t have a fever, and she didn’t, she was good to go.

The day of the surgery:

The procedure is scheduled for 10:40 a.m, and we’re supposed to be there at 9:10. Lydia can’t eat anything the day or the surgery, and we think this will be a problem, since what she usually wants to do is go for yogurt and/or cereal first thing. She also can’t drink anything three hours before the surgery. She wakes up at 7:40, and we try to encourage her to drink something, to no success. Perhaps she’s internalized the no food or drink rule.

We get to the place at 9:17, and we were already missed by the surgical team, apparently. So we waited a few minutes and then I met with the young woman who would take the insurance information. She was very nice. In her office were 8 by 10 pictures of Jon Bon Jovi, one with Richie Sambora, and, hanging prominently on another wall was a huge framed pic of JBJ. Somehow, I thought it was sweet that she could personalize her office so.

We get led upstairs by a nice woman named Lydia, as it turns out. We go into another waiting room for a short time, then to a pre-op room, where the very nice nurse and the anesthesiologist both check her out. I met the surgeon, who I’ll call Jason, because that’s his name, a very affable man, but how old IS he? I think I have socks that are his senior.

Lydia was given a nasal spray administered by machine to clear her air passages, then an inhaled drug to relax her. The latter made her really loopy (read: stoned).

So after we read her some stories, another nurse came by, introduced herself. Then, contrary to what Carol was told – and what Carol told Lydia, that Carol could accompany Lydia into the surgical room – the nurse carried off Lydia to surgery. Lydia was screaming, Carol was crying, and I was bewildered.

We went to the waiting room, where my parents-in-law were sitting. That was 11:20. By 11:40, Dr. Jason came out; the surgery was very successful. Her adenoids were “a mess”. By noon, Dr. Jason was out again, telling another family that he’d removed the tonsils of their family member; he is very efficient, but one didn’t feel rushed, as he answered any and all questions.

Carol and I go to recovery. Lydia is conscious, but crying uncontrollably, even when Carol holds and rocks her. She settles down with a Popsicle, but the waterworks begin again when we go to post-op. Eventually, she becomes more like herself. Around 1:30, I get Carol and me some food, with my mother-in-law helping to dress Lydia. We got a couple prescriptions, one for pain, one was an antibiotic. Then the in-laws bought some Boston Market meals for all of us, which served as comfort food. Carol and I were exhausted, as though we had done heavy manual labor.

So, the surgery went well. Most of the folks were great, including the surgeon and most of the staff. But at the pivotal point, the experience was…disappointing. More so, because that night, Lydia asked her mother, “Why did you leave me?” As parents, bumbling through as we do, we don’t always get it right, but we do try to be honest with her. That nuance between being mistaken and telling an untruth isn’t entirely clear. Another in one of those highly overrated “life lessons” is to never promise what you don’t control, and probably not even then.