Tumor is Out...10 1/2 Surgery is Over...FYI...GRAPHIC PICS from surgery below

11.11.14

Well, surgery is over. It took 10 1/2 hours...much longer than we expected but with a positive outcome.

I briefly described in the previous blog about how the surgery might go. Well, here's how it went...

After Jimmy went into surgery, the first doctor to work on him was the vascular surgeon. He placed an IVC filter in Jimmy's right leg. This filter is designed to catch blood clots before they reach his lungs. The filter is a little less than an inch long. Here's a pic...


He had to stop taking his blood thinner one day before the surgery and has not yet resumed taking it. Also, since he has a history of blood clots in his lungs and deep vein thrombosis, the doctors decided this filter was necessary.

After the vascular surgeon put in the filter, the orthopedic surgeon, who is the Chief of Surgical Oncology at Penn and in charge of Jimmy's case, she proceeded to take out the tumor. She found that the femoral vein and the femoral artery in his left leg, along with nerves were completely encased in the tumor. She had to remove an entire muscle from his leg...the iliopsoas muscle. This muscle controls the ability to lift your leg up like when you climb stairs. She did have to cut both the vein and the artery and take those pieces with the tumor (the vascular surgeon would repair them later). When she came out to talk to me after her part of the surgery, she said it was a very hard surgery and took longer than she expected because of the size of the tumor. She said the tumor was really deep and she had to remove a mass larger than the size of a softball from his groin. She sent the mass to pathology to confirm that she got clear margins around the tumor. The pathology will take a couple of days to complete. The incision is about 10 inches long.

The vascular surgeon was taking a second turn and his job this time around was to repair and/or replace any vessels that has to be taken out with the tumor. Since the main vein and the main artery in his left leg both had sections removed, he needed to repair these. They had already prepared an incision in his right leg to harvest veins from but soon found out that this was not an option due to the size. The vein and artery are both larger than the veins they wanted to harvest and would not provide adequate blood flow so the surgeon decided on a prosthetic for both the femoral vein and the femoral artery. The prosthetics are made of a material similar to Gore-tex and have ridges for flexibility. I am posting pictures of what they did during surgery...THEY ARE GRAPHIC but I think very interesting to see. Again, this is very GRAPHIC. The picture on the top is before the prosthetics were put in. The middle white thing is just gauze but you can see on the top and bottom of the incision the vein and artery where they have been cut. The artery is the one with the thicker wall. The bottom picture has the prosthetic. It kind of looks like PVC pipe. You can also see a little piece of his right leg where it had already been prepped for vein harvesting. I hope I didn't offend anyone with this pictures but there are people going through this who do want to know what to expect and that's why I'm posting them.

Before prothestics

After prothestics

Now that the vascular team has done their job, the plastic surgery team can begin. While it sounds like "Oh, they are just going to make his incision pretty and close him up", let me assure you it is no joke what they did.

They had to close up the incision on his right leg where they had planned to harvest the veins. Its crappy that that was an unnecessary incision but an easy one to close up. It is about 7 inches long. The tumor site, however, was a different story. As you can see from the pictures, the incision was really big and really deep. In order to fill up the space, they needed to insert another muscle from somewhere else in his body. Given the length and the strength of the muscle needed, they decided to take one of his abdominal muscles...the rectus abdominus (also known as the six-pack muscle). In doing so, he now has a 3rd incision down the length of his abdomen also about 10 inches long.

Each doctor told me separately how difficult of a surgery it was and the reason it took so long. Each team of doctors seemed optimistic that Jimmy will have a good outcome after he heals.

After surgery, I was finally able to see him...he was sent to the ICU. I was so relieved just to lay eyes on him and see that he was okay. He was very groggy and in an incredible amount of pain. It is so hard to see him that way since he is always so stoic when it comes to pain. He is now hooked up to several monitors, has four IVs and is hooked up to oxygen. Here are a couple of other pics I took...the second one is a picture of his 3 drains. A little gross I know but they are very necessary.






11.11.14
I went home really late last night and came very early to the hospital...only getting about 4 hours sleep but I wanted to be at the hospital when the doctors arrived to check in on him. Even though I spoke to them yesterday, now that I've been able to process everything, I have some questions and need some reassurances.

The doctors have collectively said that his incisions look good and he has had a consistently good pulse in his legs and feet. They have put him on complete bed rest for 48 hours to give the muscle they transferred time to start healing. As for eating, Jimmy was only allowed ice chips last night and this morning but he has been given the okay for clear liquids now. The big problem today has been pain. He is in horrific, horrific pain. All day long they have been trying to get a cocktail of medications that will work for him and give him some relief. They switched things around a couple of time and in doing this, the pain got ahead of him and it has taken a while to get it under control. He has also been running a slight fever most of the day as well. Finally though, it seems like they have found the magic potion. He is resting and even getting some sleep. I'm very happy to see him sleeping.

As for me, I am extremely exhausted and I need to go home and spend time with Logan. Thankfully, friends let Logan spend the night last night so he was taken care of and had a little fun in the process with an unplanned sleepover. It also allowed me to be with Jimmy and for that I am grateful. But, tonight I want to hang out with my son...I miss him.

I want to acknowledge all of you who have supported us and sent us your well wishes, thoughts and prayers. They are so meaningful and I truly believe the prayers are working. So THANK YOU! xoxo

I will update again soon.