We met with Dr. Hoffman (surgical oncologist) and Dr. Milhem (“Mo” – oncologist) at the University of Iowa today. Kevin likes this team, both because they wanted to start everything immediately (and sent us all off to do so!), but mostly because there are so many specialists available in the same complex – oncologists, radiology, plastic surgeons, etc. Being turned down by the plastic surgeon, while appreciated, was a bit scary, since we were losing precious time searching for another.
Dr. Hoffman explained and showed photos of the wide area excision to be done on Kevin’s scalp. He also explained the steps involved, showed us surgical photos (very helpful) as well as describing the recovery time. He also thought the new baldness from the surgery’s resulting scar tissue could be easily hidden by hair. This is an important consideration. While all of us might think it’s absurd to care so much about hair in lieu of lifesaving measures, to one going through cancer, it’s one more thing to lose. I was so delighted to see this worry just roll off his shoulders.
As for the sentinel lymph biopsy, Dr. Hoffman also showed us photos and explained the process. This gave us a whole appreciation for the delicate nature of this surgery, and why experience is required. Dealing with such a tiny area, any misstep – even accidentally disturbing a nerve – could result in facial paralysis or other problems. You really have to admire the iron nerves of these surgeons. To stand that long, and be that steady while working on a live human being would be inexplicably difficult.
We were also shown what melanoma looks like in the node – I was surprised you could actually see it. These little spots we saw on from the photo of another patient actually resembled mildew. Dr. Hoffman explained that each of these must be removed if found. Apparently, surgeons would benefit from a slight OCD because from the photos we saw, there were hundreds of little spots in a very tiny area. I felt like laying an offering of gold at his feet.
He did not feel Kevin had this type of invasive melanoma, since his SUV score was low from the PET scan (this is the number assigned to suspicious areas which may have melanoma or a different cancer). However, he said you never know for sure until various biopsies are done, and a good visual inspection, so precautionary measures are critical. The human body, we were reminded, has many variables – and to add to that problem, each of us are slightly different. For example, cancer cells might dump into one node on one person, and another route on a different person, even if the cancer appeared in the same relative area.
This requires surgeons to be adaptable, quick-thinking, as well as brilliant in general. We appreciate all we’ve spoken to – Doctors Reid, Grado, Nabi, Hoffman and Milhem. We truly appreciate your work and all you do for people.
So, the next news will be the results of the MRI and CT scan. Then the surgery.
Here’s the schedule so far:
- Next week Kevin will go to Iowa City to get an MRI of the skull to rule out any brain cancer, as well as a CT scan (this is precautionary). Since I can work on my laptop I might go down if my schedule allows.
- Kevin will likely have the wide area excision the week after next – Likely around the end of Feb, or early March. This will take about 3-6 weeks to heal up. At that time they will locate & biopsy sentinel nodes to see if and where cancer has spread.
- If it has spread, he will go in for another surgery to remove affected lymph nodes. That surgery usually requires an additional 3-6 weeks to heal.
- Since Kevin is healthy and very active, they’re predicting healing times will be closer to 3 weeks.
- After surgery, we talk to the oncologist “Mo” to find out Kevin’s official stage (remember, 2C is preliminary without the sentinel node biopsy). He will discuss treatments and clinical studies at that time.