Ganglioneuroma: Rarest and most benign

Despite scant information on ganglioneuromas (many just repackaging the NIH blurb in a different style sheet), I wasn’t losing sleep while waiting for the pathology report.  However, it was still great to get the official phone call confirming it was, in fact, the most benign of -omas.  Because this sort of thing is pretty rare, no fewer than four pathologists were involved in “Dude, check this out.”  Hey, I would have done the same.

Since all of the earlier indications were an adrenal adenoma, I was curious how this fares in the -oma pecking order.  I found two studies on pubmed that focused on laparoscopic removal of the adrenal gland.  Of the 174 operations studied by Zografos [JSLS. 2010 Jul-Sep;14(3):364-8], three were ganglioneuromas.  Another, more recent survey by Kulis [J Laparoendosc Adv Surg Tech A. 2011 Dec 13] considered 306 cases, of which three were ganglioneuromas.  Youtube (of all places) has a video (the rest shows snippets from an operation – again, not safe for lunch.  The patient also had some complications.) from a lecture where Drs. Edward Pucci and Fred Brody cite incidence of 1:100,000.   Very rare, but still better than lottery.

On a completely different topic, since coming home, I’ve had some interesting conversations comparing surgery experiences that fall under the “Things I would have liked to have known” category.   As I hadn’t seen any discussion of this, I infer that it other people are too polite to discuss in public.   I’m not, especially if it’s potentially helpful information.

Apologies in advance to anyone who’s not had the sense to go read something more interesting and with 100% more bacon-scented airplane prawns right now.

As I was leading up to surgery, the aspect I was most apprehensive about was (cue the Imperial March)…

the urinary catheter.  I knew there was a 100% chance that one would be installed – because that’s what they do for patients undergoing surgery.  Furthermore, I understood the reasons: even though I’d be unconscious, my body would still metabolizing.  The lactated ringers needs to go somewhere.

For dudes, this device of choice is a Foley catheter.  It’s like the Internet: a series of tubes within a tube.   One’s used as a balloon to keep the assembly from popping out.  Another is used for safe urine passage.  There may be a third to allow flushing of the bladder.  After reading the first one, I was just grateful that I was sedated during its installation.

The nice thing about a catheter is pee just flows into a bag hanging on the bottom of the bed, close to the floor.   For someone just out of surgery, it’s a better alternative than having to get up every hour, stand in a cramped room, and add a few drops into the toilet.

The downside is every time I noticed it.  The tube dangling out of the second most sensitive part of my body picked up all sorts of wacky vibrations each time I moved that were mostly mitigated by having part of the tube taped to my upper thigh,.  It feels pretty uncomfortable in a “hello, WTF” way.  When I was lying very still, the weight of the urine-filled output tube causes one’s penis to lie on top of the testes, leading to sweaty balls.   When I could, I tucked my robe underneath to give it some space.

One thing I wish I had done differently was consider slipping on some underpants when they were changing out the bag o’rine the first time.  It’s near impossible – and potentially disastrous — to do so otherwise and thread the various tubes in.  In addition to providing more comfort to lying in bed commando, underpants would have also been one less thing I needed to worry about before walking up and down the hall.   Hospital gowns expose half of your body at any given time.  Even though Bryan scored me another to wear on my reverse, I nicked one of the IVs every time I slipped it on to go walking.

When it appeared I was going to be healthy enough to go home, the catheter was removed.  This didn’t take long, nor was it painful, but oh-my-fucking-god was it a weird, not-good over-sensation.  I’d best sum it up as being glad I had an hour of reserve bladder capacity.  Too much stimulation!!

 

During laparoscopic surgery, they use CO2 to inflate the abdomen, giving them more room to work.  After surgery, the remaining gas needs to exit wherever it can.  One method is burping.  Whenever I stood up, I’d emit sounds I haven’t heard since college.  Burping was a joyous relief of abdominal pressure!

CO2 should also work its way through the other side of the digestive tract, aka “flatus.”  Unfortunately, while my digestive system was making noises like a V8 with three bad cylinders, and I could belch the national anthem, I was unable to pass gas.   For a brief period, it seemed this would be a reason for the nurse to veto my going home.  Fortunately, Kevin decided I had enough other positive signs.  Unfortunately, I wouldn’t actually be able to pass gas until a couple of days later, during the Packers-Giants game.  Read into that what you want, but when I could finally rip a few, I had a wondeful relief from the cauldron of discomfort brewing in my gut.

 

I have noticed that it’s pretty common for multiple prescriptions, where one’s intended to treat the primary symptom, but the rest deal with side effects.  For example, they gave me Percocet for pain relief from the incisions.  One of its primary side effects is constipation.  Quite honestly, when you’ve had work done on your abdomen, you really don’t want to be straining to poop.  Thus, they prescribed docusate sodium to soften the stool.   Because my digestive system was full of mostly a small thimbleful of sugar-free Jello (still the best Jello I’ve ever had), there wasn’t much potential output.  Number Two didn’t return until late Sunday, during the Pittsburgh-Denver game.  For the record, I wouldn’t mind if Tebow toned down the over-religiosity down a notch or two, but I don’t have any specific problem with him.  For a Bulgarian shot putter from accounting, that was a beautiful TD pass.  (He has his receiver to thank.)

 

No Pain, No Brain.  During various points of this experience, I was asked to rate my pain on a scale of 0 to 10.  In the engineering sense, I just kind of have to guess that my pain scale works out to be something like this:

• 9+ Being digested by Sarlacc?   I’m glad to have not experienced either.
• 7 – A kidney stone.  I think this is the worst pain I’ve felt, and it was combined with feeling very bloated (as plumbing was backed up), nausea and occasional vomiting.  I wasn’t thinking clearly when I biked home that day.  (And then later, driving myself to the ER?)
• 6 – Coughing up a phlegmball the first time I tried using the deep breath exerciser after surgery.  It was relatively brief and subsided quickly.   In anticipating of the next round of breath exercises, I pre-loaded requests from the PCA.
• 5 — Sitting up after surgery.  This was less quick to simmer down.  My abdominal muscles were really weak after surgery (duh, guess why?), and I felt like an upside-down turtle at times.  Once I was up, I didn’t want to lie down again.
• 3 – 4 — General pain level the first few days after surgery, usually exacerbated by changing position.  Once I was up and walking around, I felt *much* better.   Talking walks outside felt great.
• 2 — Sore knees/ankles after a 12-mile hike on Tiger Mountain with friends.  It’s usually localized pain, relieved by Ice and vitamin-Ibuprofen, and ladled with the satisfaction of having done a 12-mile hike all day with friends.
• 1 — IV, blood draw, or stitches after the Percocet kicks in.  I think I did a pretty good job minimizing the pain medicine intake, but dang, it was so effective to take a pill a half hour before bedtime.  Pain.  Gone.
• 0 — Orgasm.  I’m forty-something, and there are always things snapping, crackling, popping and/or slightly achey.

 

At today’s two-week follow-up, the doctor asked me what the hardest part of the whole surgery experience was.  Without hesitation: the time in the hospital.  I was pretty lucky to have a half-occupied double room with a glorious view of Seattle and Mt. Rainier, but it was a very noisy, disruptive environment.  I knew this going in, and was thus motivated to get up and walk around to demonstrate that I’d be okay enough going home, where I could actually rest.   When they moved the second patient in, I was doubleplusmotivated to not endure another 24-hours of extra interruptions, translator, or the dude’s wife’s ultra-obnoxious ringtone jacked up at full volume.   I wouldn’t want to spend a few days (as would have occurred with an open.)