1st Neck Surgery Day Over

On Monday, Jan 24, 2010 Carl had a surgery at Froedtert Hospital to de-bulk the tumor in his neck. The surgery goals were to remove as much of the tumor as is safely possible, stabilize the neck, and relieve the pain that Carl has been experiencing recently. The surgery and procedures went well, started about 7:30 AM, and ended about 3:30 PM. Carl went to the recovery room, and at about 6:00 PM he was wheeled into his hospital room on the 5th floor of Froedtert, where I first got to see him since 7:20 AM in the morning. He was groggy, in pain, and very still, but otherwise doing well. By 8:30 PM he had walked half the length of a hall, taken some steps and was back resting in his bed for the night.

Carl recovering

Below are the bloody details only for people interested. Don't read below if you are the sqeamish type, the summary above should tell you enough.

Carl was scheduled to show up at 5:30AM for a 7:15AM surgery. Carl was in the hospital already, recovering inpatient from Friday's angiogram with embolization procedure, so 'early arrival' was somewhat easy (for Carl). The surgery was scheduled to start at about 7:15AM, I left him at about 7:20 AM as they wheeled him in to surgery. Carl was out under general anesthetic at about 7:30AM.

First the surgery team "installed" multiple IV's (including one called an arterial line), a breathing tube and a foley catheter. At some point after the IV's and breathing tube and catheter were in, Carl had to be carefully lifted off the portable hospital bed (where he was laying on his back) and turned over and placed lying on his stomach on the surgery table, with his neck position immobilized the entire time. This procedure alone takes a fair amount of time (and coordinated teamwork between many people), because head can't be rotated independently from the body. (The operating team does this type of positioning roll with people with broken necks from accidents, so they are used to the procedure, but that doesn't mean it is easy.) The length and positioning of IV lines are carefully thought out in advance so that lines don't get crossed, pinched, or end up getting in the way of the surgery personnel or equipment. Carl hasn't been able to lay on his stomach for about a year because of his port, which sticks out from his chest. Padding and positioning of sponge like O-rings takes care of this, but again, it all has to be thought out in advance.

It is my understanding that the skull was locked into place with screws through Carl's skin into the bone of the skull, and X-ray imaging photos (and MRI?) were made so the surgeon could "see" precisely where the tumor lay before the first cut. I am guessing that these steps were done after Carl was rolled onto his stomach. Throughout the operation neurological functions where checked with monitoring impulse signals being sent and received from the head to the limbs, this functioning being entirely monitored by a neurological Doctor and his team. At points throughout the operation progress was checked with more X-rays.

This preparation, monitoring, imaging and other setup steps took until about 9:53 PM, when the first cut was made and the "surgery" officially began. The surgeon made an incision into the back of Carl's neck, 4 to 6 inches long, (I haven't seen it yet) and started the process of carefully removing the tumor through the back of Carl's neck. The surgeon did not try to remove all of the tumor, particularly the tumor that lay along Carl's main vertebral artery. Accidentally harming this artery could be fatal. The tumor that lay next to the spine seemed to neatly "peel away from the dura", which was a nice turn of events. It is my understanding that the surgeon cauterized the edges of the blood vessels that fed the tumor, hoping to prevent them from regrowing and resupplying tumor growth.

The tumor in Carl's neck had invaded and eaten away some bone in Carl's neck. There are 7 neck bones, called vertebrae, labeled C1 to C7 from top to bottom. The neck vertebrae C2 and C3 had lost bone material to the tumor, mostly the spiny pointed part on the the back of the neck bone. (The 'ring' portion of the vertebrae was still intact, but weakened). The tumor was removed here, along with some bone, and the neck was then fused with titanium metal hardware from the skull, through C1 to the intact C4 vertebrae. The fusing will stabilize the spine, but will result in some loss of movement in the neck. However, in the proceeding weeks, Carl has been in so much pain that he already stopped turning his head much. It is possible that he will have more movement (in several days) then he did immediately proceeding the surgery.

Carl received two units of blood, about 1000 ml, as blood transfusions throughout the surgery. (Thank you to all who have ever donated blood. Its not fun, but it is important.) The surgeon indicated that five years ago he would have expected Carl to lose about 5000 ml of blood in a surgery of this type, and he was surprised at how little blood was used. This was the reason that they did the angiogram with embolization procedure on Friday, and it was very successful in minimizing the blood loss. I expect it helps lower the surgeon's stress level as well - I looked at my pyrex measuring cup and thought of 500 ml of blood spilling all over my floor. Then I thought of 5000ml (more then a gallon of blood) spilling out of someone's neck as you are trying to do a careful job of identifying healthy cells from tumor cells, removing the tumor cells, and then building a superstructure of titanium in a living person's neck, and I was grateful for Friday's procedure.

They were closing Carl's surgery from about 2:00PM on until the surgery ended about 3:20PM. Carl was then taken to the recovery room. I met with two anesthesiologists at around 3:40PM, after they had stopped the anesthetic and removed the breathing tube and left Carl in the recovery room, (where visitors are not allowed). At about 3:45 PM I talked to the neck surgeon on the phone briefly before he went in to his next surgery. The neck surgeon indicated the surgery went well and he was pleased with the results.

Carl was in the recovery room until about 5:45 PM, and before 6:00 PM he was wheeled into his hospital room on the 5th floor of Froedtert, 5 South East room 25, where I first got to see him since 7:20 AM in the morning. It felt great to see Carl after all that time. My brother Tom stopped by within 10 minutes of Carl arriving at 5 SE room 25, which is in the 'Spinal Injury' Center.

Carl was groggy, thirsty and in pain, able to talk but only in a pained whisper, and was occasionally quietly agitated and anxious. His eyelids were very puffy (from having been laying on his face for hours), and he used his fingers to open his eyelids now and then, but mostly kept his eyes closed. He was very thirsty. As soon as the nurse 'read his orders' (instructions from the doctors), I was allowed to feed him ice chips. Carl was mumbling about water rights, and how people should not steal water. (This may be funny in the future, but at the time it just told me he was still pretty out of it.) My brother Tom kept saying "what?" every time Carl made some remark, and I kept making weird eyes at Tom effectively saying "I have no idea". It was nice to have Tom there at that time. Tom recently helped my brother Paul after a spine surgery, and he saw some of the similarities of the situations.

The neck surgeon stopped in to 5 SE room 25, and answered a few questions before leaving to arrange for more pain medication for Carl. Eventually pain medications were given and Carl settled down into a barely alert dozing state, waking to try to turn and find a more comfortable position. Tom left around 8:00. Carl had a neck draining blood from his neck (ok, yuck...) and woke up at around 8:30 PM when they emptied it. He wanted tubes out. The catheter could come out after he walked, and this motivated Carl. At around 8:40 PM he had walked half the length of a hall flanked by 2 nurses, with me pushing his IV 'tree' behind him. The nurses had to keep telling Carl to open his eyes. As soon as he was back in bed, he was asking them to take out things. The catheter came out, and arterial IV was removed, and the pain medicines were kicking in, and Carl fell asleep by about 9:15 PM, (after numerous times of shifting around his position, and Carl having me and the nurse change the incline of the bed, and location of pillows, etc.) He fell asleep, and his pulse below 60, which tells me that he wasn't in pain. (Of course, I had to first go and checked with the nurse to make sure the pulse rate that low was OK.) Carl didn't stir at all after about 9:20, and I left a little after 10:00 PM to drive home to my sleeping children, who had been fed and cared for by a team of friends that day on Monday alone. Thank you all.

Please pray that Carl recovers quickly and well, and that the tumor is mortally damaged and unable to grow back.