Wednesday, November 13, 2019

Teratoma

It's October 23 at 8 AM, and I'm having an ultrasound. I tell the tech that I'm there for irregular bleeding, some minor symptoms - that I'm worried my IUD might have shifted. I've put this off for too long - for one reason or another, it's been months since I decided to make an appointment.

A squirt of warm lubricant on my stomach, and there we go. It's strange, experiencing this without a baby on board. Things look different.

“What’s that big white blob?” I ask. “Is that my uterus?”

“No,” she replied. “Your uterus is right here."

"Can you see the IUD?"

"Yep, I can. It looks fine."

"So what is that big, white blob?"

"Oh - it’s all just part of your pelvis; the doctor will go over it with you. I’m not allowed.”

Within fifteen minutes, I'm back in the waiting room, reading my book. The doctor won't be in until 9 AM for the follow-up. I'm feeling very grateful Brian is able to watch the kids and guilty that I unexpectedly have this huge block of time to do nothing but relax.

A stream of easy-listening hits plays through the exam room speakers. The Band Perry sings, “If I die young, bury me in satin...” Two songs later, Joey and Rory: “But you’ll be okay on that first day when I’m gone...” Jeepers

Finally, at 9:25, the doctor enters, shakes my hand, and gets right down to business.

“You’ve got a ten centimeter mass,” he says. “That’s the size of a baby’s head.”

My mouth drops open. I hold my hands together to form the size of a grapefruit. “This is in my body?”

He's a young guy, long hair, casually dressed, and his demeanor is something between astonishment and amusement. “Yeah,” he replies with a smile. “It’s most likely a dermoid cyst- they’re full of hair and teeth and stuff like that.”

I am still slackjawed. "Whaaa-?"

He explains they'll do blood work today for cancer markers, then schedule surgery as soon as possible. “Because of its size, we won’t be able to remove it laparoscopically,” he says. “We'll make the incision at your bikini line. You’ll be in the hospital for two days.”

My facial expression has not changed. I cannot believe I have a mass of body parts sitting in my pelvis- completely invisible externally- and now to spend two days in the hospital? “What?” I must sound like an idiot.

“Some people get out sooner.”

“How did I not feel this in my body?” I hold out my imaginary grapefruit. 

He shrugs. “You must have a high pain tolerance.”

He shows me pictures of dermoid cysts. Disgustingly fascinating. Their alternate name is teratoma, from the Greek word teras, which appropriately means “monster.” Apparently, when I was just a plum-sized developing fetus, a germ cell (one of those delightfully versatile cells that can become any type of tissue as the fetus grows) attached itself to the wrong place- in my case, my ovary- and has been riding along ever since. And as ovarian dermoid cysts do, mine had begun growing in earnest during my reproductive years- though later, it occurs to me that it must have put on all its size since Mac’s birth.

I ask more questions:
What other symptoms can this type of tumor cause? Bleeding, cramping, bloating, weight gain, nausea, localized pain. (I suppose I have had most of those.)
Will my health improve after its removal? Laughing- Yes. (This feels like good news, since I haven't even been feeling that bad. Maybe I'll emerge from this with more energy in general.)
Who will do the surgery? I will- unless it’s cancer, and then we’ll send you to a specialist. 
How long do I have to wait to have it removed? As soon as the bloodwork indicates it’s benign, I’ll get you in my books; you’re looking at about two weeks. 
Can I have a tubal ligation at the same time? Sure. 
Will you be able to save my ovary? We are having a hard time getting a good image of it. I won’t know until I’m in there. 
You really don’t think it’s cancerous? I really don’t. 

I thought of more later:
Will I experience other health issues if you have to remove the ovary?
Will I be able to see the cyst after the surgery?
Should I not be exercising? What is the likelihood of torsion? Of rupture?

Driving home, I feel astonishment and bewilderment, as well as relief, horror, and amusement. Everybody laughs about the aunt in My Big Fat Greek Wedding- “Inside the lump he found teeth and a spinal cord.” I feel confident that the cyst will be benign; still, the idea of it is so disgusting. I want it out.

This doesn't have to be a big deal, I tell myself. I've been carrying on normally. Nothing has to change. But after the appointment, true to the power of suggestion, I discover I can very much feel the mass inside me whenever I move, and it makes me positively squeamish.

-------------

Two days later, after Googling my head off, I am in a more sober headspace. The stupid mass is all I can think about. I've told my parents and Elisabeth, but I don't feel like talking about it to anyone else. I'm now aware that a dermoid cyst grows relatively slowly, less than 2 mm per year, and I find myself focused on the same stupid deduction: this doesn’t add up and it’s probably cancer. The math isn't reassuring: I didn't have this mass less than three years ago, and now it's 10 cm.

I want those blood work results something fierce.

The office is working with me to schedule the surgery. Meanwhile, I recognize how much this ordeal is throwing off everyone’s busy lives. My parents, Brian, and Brian’s parents are all figuring out how to take time off. November isn’t exactly a great time for this.  We settle on November 19th for the surgery.
Thanksgiving is November 28th. When will I get ready for everyone?
Dad turns 60 on November 17th. What are we going to do for him?
This is totally derailing Brian's hunting season. 

I want those results. 

On Friday, I’m packing to leave for a church women’s weekend retreat. I’ve been looking forward to this for months, but today, I do not feel like going. Everything in me just wants to stay home, cuddled on the couch with my kids. I walk down to the barn to close the doors on Brian’s cooling buck, and I find myself crouched down on the concrete floor, crying. I can’t leave. My kids need me. I can’t leave them.

Saturday, October 26 - I'm at the women's weekend retreat. It's the first time our church has planned one of these, and it's amazing. Robyn is teaching us about inductive Bible study when my phone lights up quietly. I grab it and run out the door and up the stairs to the lobby. It’s my doctor. 

“You sound nervous,” he remarks when I answer the phone. “Don’t be. Your tumor markers came back low risk.” I know this test is not conclusive, but he explains it’s the best result I could hope for, until they can conclusively test the mass itself. He seems genuinely relieved for me. “So you’re good to go for the nineteenth,” he says. “Take it easy until then, and call or text me if you have any questions.” 

I feel like dancing. I text Brian. I head back down to catch the end of the teaching. As soon as it’s over, I beeline for my mom. When I tell her the test results are good, I'm surprised to find that I'm crying again, relieved tears this time. I don’t deserve good results, I think. Other friends are fighting cancer, and their families need them, too. But I am so very happy

Time to get comfortable with my monster baby on board. It’s gonna be a few short weeks until he comes out. I find that the word teratoma brings to mind the musical Oklahoma! and I discover myself frequently singing that theme song without realizing it.

Initially, I expect that the mass will constantly be on my mind, but as it turns out, I often forget it's there. I keep working out - Erin, Bayda, and I are completing the Morning Meltdown 100 challenge together - but no powerlifting, per the doctor's orders. Honestly, life seems so hectic and heavy that fitness has taken a backseat in general. I'm thankful for the challenge; without their accountability, I probably wouldn't be working out at all right now. The doctor told me no lifting anything heavier than 20 pounds - he surely doesn't realize I have a needy thug two year old who lives in my arms. I keep wearing Mac around, especially when he's sick and cranky. Life goes on, and people need you. It's reassuring.




Other life issues have a friendly little way of popping up during the wait for my surgery, so my mind isn't really on it. Frankly, I find myself looking forward to a good, long, anesthetically-induced sleep. Nana and Papa are coming all the way down from Charlevoix to help with the kids for a few days, and everyone is excited to see them- although last week Barrett spontaneously burst into sobs and, when pressed, explained that he was crying because: "I don't want you to leave - Nana and Papa aren't the same as you."

Brian's taking several days back in Montana to try to fill his tag, and while he's gone, it's prep time. I need to get my to-do list checked off, and it's about as long as my arm. (I'm keeping my fingers crossed that the recovery will be shorter than predicted because man, these days are busy enough when I'm quick on my feet.) He'll be back just in time for the surgery, and I'm planning for him to find the house immaculate, the laundry - shockingly - 100% done, the boys' school lessons printed and prepped, and everyone's extracurricular bags packed.

I'm excited to deliver this little monster. 

On Sunday morning, the kids and I drive down to Royal Oak for my blood type and screen at the lab. What an adventure! We park in the second level of the parking deck (cool), take the elevator down to the tunnel (double cool) and find our way to the Imaging Center, where the phlebotomist good-naturedly lines up four extra chairs so that the kids can watch the blood draw. William and Barrett are transfixed and disgusted as they watch the tube fill up with blood. “What are they going to do with that?” William asks. The phlebotomist answers, “Oh, we’re vampires. We eat it like a snack.” He laughs at William’s dubious expression. Barrett throws his head back. “I’m never gonna, ever gonna, EVER gonna do that!”

With my hospital bracelet double-checked and snapped on for Tuesday’s surgery, we leave the hospital to get ready for Grandpa’s 60th birthday lunch. It’s a great day, to celebrate the best guy ever. 

Monday, the day before the surgery, is a very hectic day. There’s so much to do. My in-laws arrive around 7 PM bringing a car full of groceries and presents for the kids. Brian’s dad and I go over the dropoff/pickup/dropoff/pickup instructions- he’ll be handling taking the kids to school and picking Brian up from the airport while I’m in surgery. I fall into bed that night and have restless dreams- dreams that I have to bring the kids with me to the OR, that no one is there to watch them, that I’m barking instructions at them while they’re administering the gas. I dream that the surgeon tells me he can’t perform the procedure after all. I dream that I’m unexpectedly pregnant. 

On Tuesday, my mom and I drive separate cars to the hospital. We check in at 11, and it’s not long before they take me back to pre-op. My heart is beating a bit more rapidly than usual, but I feel happy to be there and excited to get fixed up. The surgeon greets me and says he’s been looking forward to this case. I imagine that pulling this cyst out is going to be immensely satisfying. 




He confirms that I’d like to do the tubal. This, surprisingly, has not been a difficult decision. There was a brief period this summer/fall when I wanted another child. Brian wasn’t sure, and he suggested we wait until the 1st of the year to decide. Then life swooped in and school started and I realized that, for a hundred reasons, our family simply couldn’t handle another member. And then I found out about this tumor, and knew it was the perfect opportunity to take care of the sterilization discussion we’d been having about who/when/why. We are all here; I’m confident of this. I’m looking ahead to experiences I’ll be able to share with the kids, untethered by nap schedules and breastfeeding. I’ve been extremely lucky to have four healthy pregnancies and four rockstar kids. So I tell my surgeon that yes, I’d like to do the tubal. The nurse reads off to me the procedure at hand: exploratory laparotomy, left cystectomy, possible left oopherectomy, bilateral salpingectomy. My mom and Becca come back to say goodbye. My mom, in true mom fashion, asks the surgeon to please make sure that the incision is nice and smooth and does not leave me with a pucker of fat. She asks the anesthesiologist if I can choose a flavor of gas. “Mom,” I groan. She prays for me, and they say goodbye. They wheel me into the operating room and we chat about children, until they give me the gas. Six or seven breaths, and I’m out.  

I wake up in post-op around 2 PM with a scratchy throat. My nurse’s name is Brian, but unfortunately my Brian hasn’t made it back from the airport yet. My first question: “Did they have to remove the ovary?” Yep. My surgeon shows up soon. Everything went well. The cyst, which ended up measuring 12 cm, came out without bursting, but since it was enveloping my ovary, they had to remove it. My tubes are gone and so is the IUD. I feel like I’ve done 100 abdominal workouts in a row. 



It takes several hours for them to procure a room for me. Brian makes it in and we chat for a while before he heads home. My mom is determined to stay with me until I get settled into my room; she doesn’t end up leaving until after 9:30. That first night is rough. Walking from the postop bed to the bed in my room is extremely painful, and it’s hard to control the pain after I get situated. Thankfully, the catheter is still in place, so I stay put all night. 

At midday on Wednesday, they remove the catheter and get me up and moving again. I’m feeling better every hour. Becca and Brian come to visit in the afternoon, and my mom comes in the evening to stay for a few hours. At that point, even though I’ve had no solid food for two days, I’m very bloated and uncomfortable. We walk, walk, walk- more of a shuffle at first, but I get stronger. That night, I sleep wonderfully, the nurses keeping my medications consistent.

Though I was hoping to be home in one day, I’m so grateful to stay for two. By Thursday afternoon, I feel prepared to go home- although a bit apprehensive about how it’ll be to manage the chaos. I’m hoping that the weekend will see me feeling ready for Monday- and I’ve learned that there’s no school Thanksgiving week, so that will be a nice break, too. My mom and dad plan to bring over a simple Thanksgiving meal; my siblings will be celebrating elsewhere. Maybe this wasn’t such a bad time for this. I’m so relieved it’s done. 



On the way home, Brian and I talk. We talk about hard things and future plans. Somehow, this feels like a new beginning, a resolution of sorts. We sit in the parking lot of the pharmacy and hold hands, expressing ourselves in quiet voices, listening to each other, pausing to get the words right. At this moment, this whole experience feels like a gift.

A couple days later, on Saturday, I'm not feeling so euphoric. My abdomen is unrecognizable. I can't hold my stomach in; my abdominal muscles are pooling below my belly button, straining at the incision. Standing, sitting, walking hurts. It's all I can do to avoid texting the doctor: "Tell me this gets better!"

Monday is my postop visit. To say I’m still feeling rough is an understatement. Brian offers to drive me to my appointment, and I take him up on it. The surgeon had said I would be able to drive by Monday, but I can hardly climb into the truck. In the exam room, I tell him that I thought I would bounce back faster than this, and he says he surprised I’m not feeling better. He checks me out and, according to him, everything looks good, and my pathology came back “beautiful.” He tells me to wean off the Norco and gives me the go ahead to start working out- “nothing over 35 pounds.” I look at him askance. Jumping jacks? Squats? “Oh yeah, you can do all that,” he says. There’s absolutely no way, I think. “The more you move, the faster you’ll recover,” he insists. 

After that, I don’t take any more Norco. Throughout that night, Mac is awake and out of bed eight times. Remembering the doctor’s advice, I am up and down the stairs with him all night long. The next day - Tuesday - sees a huge improvement. I don’t know if I was having an adverse reaction to the Norco, or if it’s simply a psychological effect of hearing that everything is fine and I need to move more, but I feel markedly better. I even do a little stretching workout at the end of the day. It feels like working out with someone else’s body. My stomach looks completely different than it did before, and I can’t hold a plank for more than 30 seconds. Still, I feel triumphant. I’m back!

On Wednesday, I try a cardio workout. It goes great! Burpees and plank-based movements are quite painful so I substitute with jump squats or other moves. 

Thursday, I work out upper body. No problem! It’s Thanksgiving and I find myself in a wistful mood. I miss people. I decide to make cornbread dressing to take to my parents’ that night, just for the smells in the kitchen to make it really feel like Thanksgiving Day. I’m hopping around the kitchen just fine. That night, I set up my phone for a family picture, time the shot, and run into the pose quickly. Ouch! I pull something pretty hard and hobble home. 

On Friday, I’m still hobbling. It’s so uncomfortable to walk. Brian pulls out our Christmas tree and it sits in three disconnected dark green lumps in the corner while the kids beg me to decorate it. I look around at the messy house and the laundry and dishes and all that needs to be decluttered before decorating that tree and I cry in frustration. So much to do and I just want to sit very still and be left alone. So I compromise. I turn on a movie at 10 AM and I sit and watch it with the kids. After that, I feel a bit better, and somehow, we get through that busy, busy day. We even decorate the tree! 

In my frustration, however, I begin a water fast to accelerate healing. I fast through the weekend and up until Monday night (80 hours). Who knows if it helped, but the placebo effect is all I need to tackle Monday and everything that needs to be done. I’m truly feeling better every day. 

The incision still hurts and the skin around it is painful, but finally I’m able to move around just fine and do what I need to do. My abdomen is still pretty puffy, and I can’t wear much more than very soft leggings or the skin above the incision becomes very irritated. Honestly, that’s been one thing that’s thrown me a bit- my puffy stomach. Brian insists it’s swelling, and I hope he’s right! I hate to be vain, but if it’s not, my stomach has drastically changed and I was not expecting that. When I find myself worried about that, I remind myself that this is likely something that would have killed me within the next 5-10 years, if I lived a century ago or lived somewhere where I did not have access to medicine. How many of our friends, I wonder, would be gone right now, without modern medical intervention? I can easily think of a few. We are so, so lucky.

Three weeks post-op, I can truly say I feel like myself again. I can work out just fine, I can run around the house as usual, and the puffiness and sensitivity is almost gone. My stomach is almost back to its normal appearance, with things settling in nicely without the monster grapefruit pushing them around. I can even wear a pair of jeans for the first time. I feel amazing. I'm still waiting for my final post-op visit at the beginning of January, to get clearance to lift heavy again, but I truly feel like I’m through this. 

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