Lymphedema
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.
- Comment (47)
- · Quote
- · UnfollowFollow (3)
Comments:
Dec '10
Re: Lymphedema
I'm very sorry to hear of these additional issues. My thoughts and prayers will be with you. You seem to still have your spirits about you. I'd imagine that helps significantly.
Best of luck to you. I hope your students will be lucky enough to have you in class on the 29th!
May '10
Re: Lymphedema
Dr. Rahe, take advantage of the hand life deals you and get well.
Jul '11
Re: Lymphedema
Godspeed Dr Rahe. The prayers of my family and I are with you and yours.
Jul '11
Re: Lymphedema
Patience sir patient. Stay positive.
Jun '12
Re: Lymphedema
Prayers going up for you.
Apr '11
Re: Lymphedema
Thank you for the updates and medical narratives. It is a learning experience to follow your ups and downs here, as I am sure you intended. The wonderful news is that you fended off the pneumonia, the precursor to many complications and much misery. I wish you well and a speedy return to the classroom.
Jul '11
Re: Lymphedema
Gracious! Mrs jpark and I will pray for your speedy and complete recovery.
Sep '10
Re: Lymphedema
Prayers for your recovery Dr. Rahe. In the meantime, may I suggest a little Jean Pierre de Caussade, SJ?
Mar '11
Re: Lymphedema
My prayers for your recovery continue. "Cancer free" is the brass ring here; everything else is just incredibly frustrating and hopefully brief.
Apr '12
Re: Lymphedema
Thank you for sharing as these are lessons for us all. Get better.
Re: Lymphedema
Yes, indeed, the basic prognosis is excellent, and the problem I have can be solved. In the meantime, my wife, who has joined me, and I are watching old movies. I recommend The Outlaw Josey Wales.
May '12
Re: Lymphedema
I too will add my prayers.
May '10
Re: Lymphedema
Ah, this is such a drag, Paul. I'm praying for a speedy recovery and completely cancer free. I know God can do it.
Jun '12
Re: Lymphedema
I always enjoy and appreciate your posts and I will look forward to seeing them long into the future.
Apr '11
Re: Lymphedema
Dr. Rahe,
I have enjoyed reading your posts about everything that is going on. The human body is a fascinating thing and the processes we have developed to keep it working. Thank you for your candor and we will continue to pray for you.
Jun '12
Re: Lymphedema
Prayers for the intercession of St. Rafael in your speedy recovery, good sir.
Jul '11
Re: Lymphedema
Whooped that lymph again Josie. Give it a Missouri boat ride.
Re: Lymphedema
And a fine ride it is.
Jul '10
Re: Lymphedema
I know what you're going through. I had a colon cancer removed a year ago. The stitches gave way three weeks later and a second operation was necessary. Then a third because of an infection that required removing a third of my colon. Three tubes were inserted and fluids drained for weeks. I still take two antibiotics , five pills daily, to suppress the infection. This will work until the bacteria are dead or develop a resistance. In that case I would face another surgery to remove the remainder of my colon. The radiologist, a man of heavy sighs, said I wouldn't survive that. The surgeon said I would and spoke to the radiologist, who then said he didn't really mean that if he said it, which he doubted. I wouldn't have survived this ordeal if not for my wonderful wife who never liked the idea of being a nurse but became expert at it. Imagination is the enemy, said the stoics, so avoid both euphoria and dispair. You're not in control. Pray hard.
Nov '11
Re: Lymphedema
I could tell you a grand tale about my similar ongoing experience, but it would not entice general interest. Indeed, as you are discovering, the most reliable quality of prolonged illness is . . . boredom: one becomes bored; the family becomes bored; eventually even the doctors become bored.
Becoming bored, your fellow humans beings (creatures with a finite capacity for empathy) cannot help but begin to blame you, if not for your illness, then for your failure to get well. You won't blame them because you know all too well that illness is boring.
One of the worst things about being ill, especially chronically ill, is that it disqualifies the invalid (lovely word) from dispensing health advice. Instead, you, the impatient patient, must listen attentively to everyone's health advice (and I do mean everyone!), or risk appearing to be an ingrate. But lately when someone informs me, for example, that boiled lemon marigue extract applied anally three times a day will cure my condition, I reply, "Oh thank you, but I have decided just to die instead!"
Aside from boredom, the other thing you will notice about extended illness is how it improves your sense of humor.