Wednesday, November 11, 2015

Pre-Op Oophorectomy Appointment

Today I got to meet with my amazing gynecologist, Dr. Dharshini, as well as my overall medical doctor, Dr. Tucker, who has been the keeper of all my diagnostic information, magical appointment maker with all the best specialists in town and now my nutrition advocate.  These were the two appointments I had been waiting for with anticipation, as I'd find out the results of some important pre-surgery tests I had done last week, as well as learn all about my surgery and recovery in detail.

Dr. Dharshini...Beacon of Light, Master of Comedic Relief and Extremely Patient!

My first appointment today was with my gynecologist, Dr. Dharshini Gopalakrishnakone, who will be performing my bilateral salpingo oophorectomy (say that five times fast!).  Just Google her and you'll find out just how passionate an advocate she is when it comes to women's healthcare as well as being a mom.  I just love my appointments with Dr. Dharshini as she puts me at ease every time, just by being REAL.  She's human, not robotic, and she has a way of making everything palatable and relatable.  I don't leave feeling like I had a bunch of medical jargon shoved down my throat with zero understanding.  And I'll be honest, we laugh...A LOT.  Don't get me wrong, I take this whole process very seriously, but if I don't laugh, I'll break down into a pool of tears, and that's not going to get me anywhere when I need to pay attention the most.  So, I save the tears for the glass of wine later.

The Surgery

We first talked about the surgery and the proposed plan at this point.  I'll first relay what the ideal surgical scenario is, and then I'll relay what happens in that 1-5% chance something else is wrong.

After being sedated and pumped full of air (to open the abdomen for easier viewing and maneuvering), an incision will be made in the navel which will be the site for removing the fallopian tubes and ovaries.  And additional three small incisions will be made, one below the navel and one on each side of the abdomen.  These will all allow for the microscopic surgery to take place.  During this 1.5 hr surgery, basically the fallopian tubes are cut away from the uterus and the ovaries are separated from their blood flow.  This sounds easy, but its quite delicate being that all of this lies dangerously close to the bladder, bowel and appendix.  While the surgery is taking place, a cross-section will be frozen and sent to the lab for immediate results (looking for abnormal cells).  At the same time as the removal of the fallopian tubes and ovaries, a peritoneal washing will be given as well.  Think of it as a large protective sheet spanning your abdomen, holding back and protecting your uterus and ovaries.  This sheet has potential for carrying cancer cells as well, and thus will be "sprayed off", much like the windshield of your car.

Assuming all goes well and textbook, I'll be stitched up, sent to recovery and left to rest with a night or two in the hospital.  While it's major surgery, I won't have the same limitations as I did after my mastectomy.  I will be limited to 5kg lifting for the first month and no intercourse for six weeks, but other than that, I just need to listen to my body and take my recovery at the pace I feel comfortable.  So, here's hoping for just 1-2 nights in the hospital and a quick recovery at home lasting up to two weeks.

IF something doesn't go right, then things get more complicated.  Remember the frozen section sent off to the lab during the surgery?  That will be analyzed, and in 1% of cases, it comes back showing cancerous cells.  If that happens, I will immediately be opened up vertically down the center of my abdomen, and the uterus, appendix (because of close proximity to the ovaries) and the Omentum (fatty apron) will all be removed, and my recovery goes from 1-2 weeks to 6+ weeks.  Remember, we're praying this does NOT happen.

There are a few other complications which could arrive during surgery and would mean opening me up like a cesarean:

1) If the ovaries are somehow fused to parts of my body and the doctor can't access them well
2) Excessive bleeding during the surgery
3) Perforation of the bladder or bowel

And lastly, a few other complications would be infection or trouble with the gas pumped into the cavity.

The Testing, Before and After

What exactly happens now that I'm in surgery induced menopause?  Well, it all seems pretty simple, for the most part.  In order to prepare for the surgery, I had to have a few tests done to see how my body is performing at this stage, pre-menopause and pre-surgery.  A baseline if you will.  Last week I had three tests done, a blood draw, a bone density scan and a pelvic ultrasound.  Today I received the results of all three which lead to a few extra discussions I didn't think I'd be having.  These results were discussed with both Dr. Dharshini and Dr. Tucker.

The blood test-  There were a few scores that came back higher and lower than we'd like when it comes to overall health.  The one immediately affecting this surgery would be my CA 125 marker (ovarian cancer indicator).  This one came back slightly elevated at 36.5 (normal would be < 35).  We are attributing this to the fact that I was mid-cycle during testing, which has been seen to elevate the numbers.  We don't want this number growing as that would indicate a much bigger problem with my ovaries (which we're thankfully removing anyway). Other things I learned: I metabolize foods quickly and have a low glucose level, I need to work on my LDL number (reducing carbs and increasing healthy fats and proteins) and I have low iron (probably due to heavy cycles which will all be history after the surgery and therefore increase my iron).  I'm being sent to a nutritionist this month just to get my eating all sorted out and get my body functioning more optimally.

The Bone Density test- Sadly, my bone density test did not come back like I had hoped.  While my spine is fantastic, my left hip showed that I'm in the osteopaenic range.  This means I'll be starting weight bearing exercises ASAP as well as taking heavy doses of Vitamin D and calcium.  The bone density screen will now occur yearly for me due to the results.  If osteoporosis develops, I'll then be put on Fosamax for a maximum of five years.
Osteopenia is a condition in which bone mineral density is lower than normal. It is considered by many doctors to be a precursor to osteoporosis. However, not every person diagnosed with osteopeniawill develop osteoporosis.- Wiki
Pelvic Ultrasound- Nothing abnormal, all good.

The Other Stuff

I'll begin taking Aspirin after the surgery, for the rest of my life.  This is apparently recommended no matter who you are at about the age of 40 and it reduces risks for heart problems, blood complications, cancers, etc.  We're sticking to non-hormone therapy for now to see how I do after surgery.  If I really need it, we'll do low doses of hormone replacement therapy with a bioidentical hormone cream.  And as for the good 'ole sex drive...IF it decreases due to the surgery and hormone changes, I can use a testosterone.

And there you have it.  Surgery is scheduled for the 28th of December, so keep me in your thoughts and prayers.  This has been an exhausting and emotional day for me and I want nothing more than to sleep the rest of it away, but I'm off to be mom now.

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