I remain, alas, in the soup – thanks to a condition called lymphedema. This saga began, as you may remember, on 25 June – when I went under the knife to have my prostate taken out at the National Institutes of Health in Bethesda, Maryland. That operation went smoothly, and there were no immediate complications – no infection, in particular. The initial post-operative period was a bit grim, but I made steady progress and went home on 3 July. Soon thereafter, I learned that the cancer had not spread beyond the prostate and that I appeared to be cancer-free. All that seemed to be required for me to be fully back on my feet was caution and a bit of patience. But things were not quite so simple, and the tale may be instructive – for you, my gentle reader, may someday go under the knife yourself.
Cancer surgery always or nearly always involves a partial removal of the lymph nodes that lie in the vicinity of the cancerous cells. Nearly always, when cancer spreads beyond the organ where it originates, it spreads first to these lymph nodes. If they are not cancerous, one is nearly always home free, and chemotherapy and radiation are unneeded. If the lymph nodes are cancerous, however, chemotherapy or radiation is advisable.
When these lymph nodes are removed, the nodes into which the surgeon has cut bleed fluids. Generally, this bleeding of fluids dries up pretty quickly. Even when the flow continues, it ordinarily drains into the abdominal cavity (lined by the peritoneum) whence, if is not excessive in amount, it is re-absorbed and excreted. In some cases, such as my own, the flow does not dry up, and it flows elsewhere – into the arms, the legs, or into one of the cavities in the lower back where the kidneys are to be found. This condition, which is called lymphedema, can cause various kinds of trouble, and it requires medical intervention.
In my case, the fluids collect near my left kidney, and when the amount becomes sufficient they put pressure on the muscles that control axial movement of my left leg, producing in the end intense pain. In time, if nothing was done, they would do harm to my left kidney.
For nearly three weeks now, I have had a catheter in my lower back draining the fluid, relieving the pressure on the pertinent muscles, and protecting my kidney. The first day nearly a liter came out. Then, the numbers dropped steadily for a while, and then, alas, they stabilized at about a fifth of a liter per day.
About five days after I arrived, I came down with pneumonia, but that has passed. I feel fine. I am no longer coughing a great deal. I have plenty of energy. But the flow continues. Were it to fall to, say, one-tenth of a liter per day, the doctors in charge of my case would remove the catheter on the theory that it is functioning like a wick and eliciting to some degree the flow of the fluids into the pertinent cavity. After a few days, they would do an ultrasound to check whether the liquids were still collecting in the cavity near my left kidney. If they were not, they would send me home.
In an attempt to reduce the flow, the medical personnel at Intervention Radiology have been subjecting me to a process called sclerosis every other day. Through the catheter, they introduce a drying agent into the cavity – in my case, near-pure alcohol. I then roll around with an eye to coating the cavity, and the fluid is withdrawn. This procedure causes the cavity to pucker up, and it may even induce it to close – which would force the fluids to flow elsewhere – into the abdominal cavity, one hopes.
The sclerosis seems to be working as intended. The pertinent cavity has shrunk. But the flow has not abated. So here I remain, twiddling my thumbs and wondering whether I will be able to return to the classroom at Hillsdale on the 29th of August, which is the appointed day. My doctors advise patience. But although I am a patient, I have never in my life been all that patient.
If, in the end, this does not work, there is always the knife. A window can be opened into what I will call the left kidney cavity so that it empties into the abdominal cavity. Surgery is never, however, welcome if something else will work. It is always dangerous, and there may be particular dangers associated with this species of surgery that are as yet unknown to me.