About two weeks ago, I went in for another ENT follow up. My surgery to remove George, my sinonasal tumour, was just over a year ago, but I’m still not fully healed: there’s still some inflammation — for some reason, it’s not going down, and I’m just not healing normally. During the routine exam, which involved some numbing spray and an endoscope jammed up my left nostril, my ENT doc, Dr F, noticed something “suspicious” growing along my septum. He’d already discovered a bit of something in February, but it wasn’t anything to worry about — everted, not much more than a wart. This time, the thing he saw was a little larger, and a little deeper. He took a sample and told me to come back in two weeks for the result.

Today, I went to get the results. As is normal, before I saw Dr F, one of the residents he works with (he’s an assistant professor at a local University as well) came in to administer the hideous spray, ask the typical “no swelling, blockage, loss of smell, etc” questions. I mentioned that I was there for biopsy results, and this resident proceeds to say “Oh, that, yeah. The results came back as Schneiderian papilloma, so he’ll have to talk to you about scheduling a surgery date.” Then he walked out, and I wanted to slam my head against the wall. There are three types of Schneiderian papillomas, and one of them is — wait for it — inverted papilloma, aka George. The thing I’d had removed. So, he’d just told me it was back. Again. FUCK.

And then Dr F comes in. I tell him what the resident said and he shakes his head and laughs. The resident had been right and he’d been wrong: yes, the biopsy had come back as Schneiderian, but this new tumour was an exophytic papilloma (also called fungiform and/or everted papilloma), not inverted. I had managed to get another type of Schneiderian, but the inverted (George) had not returned.

No George. Yay! But new tumour. Boo. And another boo: this new cluster of glorified wart was in a bad spot, and it was growing. It wasn’t growing inward, as does inverted papilloma, but it is growing outward, in a way where it can block the choanae, which is more or less what George did. Dr F said it was up to me: I could either choose to have surgery soon-ish, or wait until it actually started to block that choana. I’d rather not deal with that kind of blockage again, so I opted for door number one. He agreed it was the better of two evils and said he’d want to see me again in January, to confirm that it is still growing (if it hasn’t grown, it could wait, but he’s already seen growth since last month, so it’s unlikely to stop now…), at which point we’ll schedule CT and MRI scans and then a surgery date — likely in early February.

So… not at all what I was expecting. I’ve always known I’d need surgery again — there’s still a good change George will come around again — but I had no idea it would be for anything other than the inverted papilloma. Surgery to remove another type of papilloma — another tumour?¹ That I did not foresee. Thankfully, this is an everted papilloma (which is unlikely to recurr and does not become malignant), little more than a wart and only needing surgical excision because it’s decided to set up shop in a bad spot, but still. Another tumour, another surgery. I’ll almost certainly not need to stay overnight again, but it’s another dose of general anesthetic — which is unnerving and strange every bloody time — and another few weeks of healing. I haven’t even finished healing from the last surgery!

But, at least it’s not George… yet. At least it’s not George.

1. Because yes, a papilloma is a tumour. [↩]

(Non-health related stuff is at the bottom, if my Tumour Saga bores you.)

I had a one-week post-surgery follow-up with my ENT doctor Wednesday. It was less than fun, to say the very least. He removed (read: yanked out with special tweezers) the scabs in my sinuses (sorry for grossing you out! ) and even though he numbed my sinuses with spray, it still stung — and bled. Oof. Fun times. I also asked for (and got) a prescription for Tylenol 3s (Tylenol w/codeine, for those unaware). I usually handle Vicodin (which Dr F had prescribed when I left the hospital, and which I’d gotten after both the first and second surgeries) without a problem, but what with the blood loss and general not-yet-working-at-full-capacity feeling, they’re making me sleep way too much. The T3s work just as well for the ache and don’t make me sleep 18-20 hours of the day. Yay?

At the same appointment, he told me that the patho report came back on the tumour. It was all benign, and the cells in the margins he took (extra non-tumour skin and tissue around the tumour) were all normal, with no signs of dysplasia. Both things are ideal, fantastic, and yay-worthy! Given that my tumour had grown against the skin, Dr F admitted that he’d been a “little worried” that the tumour might have been malignant, but thankfully, it wasn’t. I hadn’t really been worried about that; had it come back malignant, I have a feeling Dr F would’ve had someone call me sooner.

Dr F also told me how exactly he removed bone. He had warned me before surgery that he might have to remove my inferior nasal concha/turbinate, but wouldn’t be sure until he got inside. I forgot to ask after surgery, and he forgot to tell me, so I didn’t have a chance to ask until Wednesday. He did, unfortunately, have to remove it. Apparently, that was one reason I lost so much blood — sawing (SAWING!) out bone is a messy affair, after all. If you’re not sure what a concha/turbinate is, see this photo for a side view and this photo for another view. In the second photo, the structure marked “7″ is what was removed. I still can’t get over the “sawed” part. They took a surgical saw, stuck it in my sinus cavity, and sawed bone out of my skull. I don’t mean to harp on it, but it’s so… surreal.

As I was leaving the appointment (which I went to with my mother — elevators are still making me woozy, and I wasn’t sure I could get up to Dr F’s office through two elevators without her), my mom told me that she’d like to kill my previous ENT doctor, and I… agree. My previous doc, Dr W, partially resected the tumour twice. Partially. The first time I had the surgery in 2003, he removed most of the tumour, but didn’t even attempt to remove it entirely. He did the same thing in 2006 when I had surgery the second time: partially removed by design. Just before I scheduled surgery the second time, I asked him if he’d be attempting to remove it all this time. “No,” he said. “To do so, I’d need to remove a bone in your head, and that would result in some disfigurement. Besides, it’d probably just come back. Having a partial resection every two years for the rest of your life sounds like a chore, but it’s the best and easiest way to go.”

That? That was a lie. When I switched doctors (Dr W stopped accepting my insurance, and I kept putting off finding a new ENT) to Dr C, he seemed surprised that Dr W had never even attempted total removal. After I had a CT scan and returned for a follow-up with Dr C, he told me he’d run into Dr W (they both do surgeries at Oakwood Hospital in Dearborn). “I told him I’m treating an old patient of his. He remembered you, but said he thought he got it all out.” I was, understandably, a bit livid. Had Dr W lied to Dr C, or had he lied to me about the possibility of total removal? When Dr C sent me to Dr F (C didn’t have enough experience with inverted papilloma to feel comfortable with total removal, so he sent me to F, who specialises in my and other tumours and has much more experience), Dr F also seemed surprised that Dr W hadn’t even attempted total removal. “It’s possible,” Dr F said, “and by not doing it before, he’s kind of put you behind the eight ball.” Had Dr removed it all the first time, the chance of recurrence would’ve been 10%. Had he removed it all the second time, it would’ve been about 35%. Since it wasn’t removed until the third surgery, the chance it’ll now come back? 50%. A one in two chance that I’ll have to deal with this again, all because… why? That’s what I can’t figure out. Why didn’t Dr W try? Did he not know how? Did he just want to bilk my insurance once every two years forever? I can’t figure it out, but it makes me angry to think about. In short, here’s a lesson, kids: treating athletes and other famous people does not a good or trustworthy doctor make.

Dr F, on the other hand… I can’t say enough good things about him. Besides being more knowledgeable and experienced (comparing their credentials is hilarious), he’s vastly more compassionate and much friendlier, and puts Dr W’s version of “follow up” to shame. With Dr W, after surgery, I saw him one week post-surgery, and then once every six months. With Dr F, I saw him one week post-surgery, have another appointment in two weeks (three weeks post-surgery), then another appointment two weeks after that. Then he wants to see me every month for three months, then every three months for a year, and finally every six months onward. For the first 1-2 years, he says, he treats benign tumours as if they’re malignant. One wouldn’t see their ENT every six months if they had a malignant tumour, so why would they if they have a benign tumour with the potential to become malignant?

Between Dr P (my primary, non-nasal doctor), Dr R (lady-stuff doctor), and Dr F, I have three incredibly awesome, talented doctors, and I ♥ them all. This is the first time I’ve actually had doctors I feel totally comfortable with, and it’s pretty awesome.

Other Stuff

There’s no way to tie the rest of this in with the above, so… have a list of stuff.

• I won two domain credits from NameCheap via their Twitter Trivia Contest, and I have no idea what to do with them. Sure, I could transfer AndRobots and Winterish to NC from their respective registrars, thus renewing them for another year, but that’s a pretty boring use of free credit, no? I’ll still likely do that with one of the credits anyway — probably on Winterish, since the renewal rate for NS will skyrocket next year (the downside to the awesome $1.95 code) — leaving one credit for a new registration. The question is: what do I register? And what do I use it for? I’d first wanted to register WhenIAmQueen.net (from a Jack Off Jill song of the same name, tied with “Nazi Halo” and “Star No Star” as my favourite JOJ song) and use it as a site collective. Imagine my disappointment when I discovered that WIAQ has already been registered. The .org is still available, but it’s not the same. I wanted the .net, dangit. I’ll probably still go the site-collective route, but now I need to think up a new name. This shall prove difficult, methinks.
• I watched part one of The Alzheimer’s Project this morning on HBO before leaving to get bloodwork done. It was incredibly depressing. Alzheimer’s Disease runs in my family, and the thought of one day talking to a woman in the mirror or seeing snakes crawling up my wheelchair scares the shit out of me. I couldn’t help but cry — something I very, very rarely do — during the scene in which one of the profiled sufferers dies, because it mirrored the recent death of my 93 year-old Great Aunt Alma so closely. Alma died this past November 22nd, after suffering a massive heart attack. She had been battling Alzheimer’s for several years, and had been living with my Aunt L. Alma had her moments of clarity, and most of the time at least knew where she was and with whom she lived/etc, but sometimes she’d space out and ask things like “Now where am I buried? I forget…” And that’s not even getting into her habit of seeing dead strangers and relatives. It’s just… frightening. My maternal family is a strong bunch, and aside from a predisposition toward cancer on my mother’s father’s side, we’re pretty healthy — except that Alzheimer’s is unusually common. My mother watched the documentary with me as well, and at one point, I said “Please don’t ever make me dig rocks out of your mouth.”¹ She, true to form, laughed and said “I promise nothing. If I’m going to go out like that, I’ll go out driving you insane by eating rocks and saying ‘Oh oh oh oh oh’.”² Oof, my mom.
• I need to buy some new scarves. I have to cover my nose when outside — cold air + healing sinuses = OW — and I hate-hate-hate those full-face hats, so scarves it is. I have several, but I can always use a few more! Any recommendations? I love big, thick, soft scarves, but any recommendations are appreciated. I especially love scarves with pockets near the ends, but those are increasingly hard to find lately, for some reason. Halp?

At some point, I’m going to have to post my insurance rant (nothing against my own insurance specifically, mind, just insurance in general), but this entry is getting long enough, so I’ll save it for another day.

1. If you’ve ever seen the doc, you know what I’m referring to. [↩]
2. Again, if you’ve seen it, you’d get it. That scatting thing would’ve driven me batty. [↩]