Miss Diagnosis: I Should Have Seen It Coming

Saturday, April 4, 2009

I Should Have Seen It Coming

Well, I got the rug pulled from under my feet again. It felt more like getting hit up side the head with a shovel. How is it that I remain optimistic going in to these appointments? Will I never learn?

Yesterday morning Alex was feeling particularly awful. She was in a low to rival all lows. Before we could even leave the house she took 3 doses of hydro to get past the extreme nausea. A three hour drive got us to Stanford just in time for her 2:00 appointment. The receptionist told us Dr. V was running 45 minutes to an hour behind. The finally called us into the exam room at 3:40. Another hour later we were still waiting. I stuck my head into the hall and complained. They sent in a doc in training. He was completely lost and baffled; he had none of the information needed. Out he goes. A little after 5:00 (yes this was a 2:00 appointment) the doc in training along with the surgeon arrived. By then Alex and I are completely frazzled and exhausted.

Dr. V gave us a heartfelt apology for the wait and gave us his full attention. The good news? I really do like the guy and feel he is qualified to do the surgery. The bad news? He feels "considering the complexity of the case" he needs to talk things over with Dr. Friedman and some of his Stanford associates before he is willing to schedule surgery. I can't blame the guy I guess, he doesn't know Dr. F, so his caution is warranted. I know I should respect that he is not someone to jump in to life altering surgery uninformed. I just wanted so badly for this to go more smoothly.

I swear the long wait threw me off my game. I should have explained my decision making process; I thought of that in the car on the way home. This morning I sent Dr. F an e-mail to tell him to expect to hear from Dr.V, but who knows how long it might take for the two of them to connect by phone. I sent Dr. V an e-mail as well. I gave him a complete explanation of all the things I failed to mention yesterday. I just don't know what to think now. I don't know when we will hear back or if he will be willing to do the surgery once he talks to everyone.

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Transphenoidal Pituitary Surgery- From the UCSF web site

What happens during surgery?
The surgical removal of the pituitary adenoma is performed by a technique called a transsphenoidal operation. The word 'transsphenoidal' describes the path the surgeon follows to reach the pituitary gland. The word comes from 'trans', meaning 'to cross or pass through', and 'sphenoid', the name of the cavity (the sphenoid sinus) that is passed through to reach the pituitary gland. Newer techniques and improvements in technology now allow removal of these tumors without the need for an incision under the lip or within the nostril. The surgeon begins the approach by entering through the nostril on one side. The surgeon uses a brilliant fiber optic light to illuminate the internal anatomy, a microscope to magnify the area of surgery to 12 times the actual size, and very tiny microsurgical instruments especially designed for this particular operation. The surgeon guides the surgical instrument into the nasal cavity and an opening is made in the sphenoid bone. The sphenoid sinus is entered, and then an opening is made in the wall of the sella turcica to expose the pituitary gland. The adenoma can be readily distinguished from the normal pituitary gland tissue and is removed without removing the normal gland. After the surgeon removes all the tumor tissue, the small cavity that is left is treated with alcohol to destroy any tumor cells that may remain. This cavity is then sealed, sometimes with a piece of fat that the surgeon removes from the patient's abdomen. The surgeon then applies a biological 'glue' that helps seal the pituitary area from the nose and promotes natural healing. No nasal packs are used with this approach.