Thursday, December 18, 2008

Why Am I Having Surgery?

A few people have asked lately why, exactly, I am having surgery. Here's my attempt at describing it. It's a bit detailed, and a bit drawn out, but I think if you read it all, you'll have a pretty decent understanding.

The short answer is that I have endometriosis.

Endometriosis is a very strange, very misunderstood disease. It only affects women. What it means is that tissue that has a lot of the same properties as endometrial tissue (which normally lines a woman's uterus) is growing rampant in other places - primarily in my lower abdomen. On months when I actually ovulate, my body produces a lot of estrogen before releasing the egg. This estrogen tells the lining in my uterus to grow and thicken. It also tells all of the abnormal tissue growing outside of my uterus to grow and thicken.

If, about two weeks after my ovary releases an egg, there is no pregnancy, the hormone levels drop very sharply. This tells my uterus to shed its lining, resulting in the bleeding most women experience each month. Unfortunately, it also tells all of the abnormal tissue to shed. This abnormal tissue has no outlet, so it just bleeds into my abdomen. This, believe it or not, hurts!

The blood also contains substances (prostoglandins) which cause an inflammatory response, which also hurts. And causes me to have a fever of about 102 for about ten days out of each cycle. That makes me achy and tired.

My body, sensing that there is bleeding where there shouldn't be, works overtime to repair it. This makes a lot of scar tissue. Anywhere that there are two spots semi-close together, the scar tissue ends up connecting the two spots. This isn't so bad if it's just a couple little spots, but when it's a spot on one organ connecting to a spot on another organ, things get messed up.

Last time we did a scan and exam, we determined the following: my bladder seems to be stuck to my abdominal wall and to my uterus and left ovary. My uterus seems to be stuck to the lower right hand side of my abdominal wall. A little bit of my colon seems to be stuck to the side of the uterus. My small intestine is adhered in quite a few locations, and a loop is adhered firmly to and around my right ovary. These are just the places where imagine makes it easy to see that something is clearly amiss. It's almost a guarantee that there are a lot more adhesions (scar tissue) that we can't see with scans.

As far as places where there is the abnormal tissue (endometriosis) growing... we are aware that the ovaries have a lot of it. There is some in my bladder (yes, IN), and some on the outside of it. There's a bunch on my uterus, a bunch on my abdominal wall. There's some growing low in my pelvis over a nerve, which means that it always feels like I just hit a funny bone - inside my belly. Which is just weird. There is some in my colon, and a lot on the outside of it. There is some on my liver, and some on my diaphragm. My left kidney has a bit, as do both ureters. My small intestine has a lot.

Tomorrow, the surgeon will use a laser to vaporize as much of the endometriosis as she can. This part of the procedure could take anywhere from two to six hours. She will then dissect or remove the adhesions, which could also take anywhere from one to four hours. Once she has removed everything she can, she will spend between one and two hours covering every visible organ with a substance called Intercede. This will hopefully keep post-surgical scarring to a minimum.

She plans to do it all laparoscopicly, but I have been advised to be prepared for a potential larger incision if needed. She has promised that she will not completely remove either of my ovaries. We're also planning for me to come home tomorrow evening. Of course, there are some variables that might prevent this.

One, if they have to open things up further, I'd spend at least one night. Two, if I am unable to tolerate the post-op pain, they'll keep me in for IV pain relief. Three, if the procedure goes until seven or eight PM, they'll probably keep me over since they usually like to wait at least four hours post op before sending people home. Four, if there are any complications, I'd stay. And five, if my white count or blood pressure tanks out and/or I require a transfusion, I'll stay. In the past, it's gone both ways. So we're just going to monitor it all closely and deal with whatever we need to.

It is pretty much impossible for the surgeon to successfully remove every bit of endometriosis. Anything left inside has the potential to grow and spread and land me in this same situation in another year or so. To prevent that, I'll be going on some heavy-duty suppression therapy for a few months. This will inhibit estrogen production and literally starve out the remaining endometriosis. We can't do that instead of surgery, because there is so much endometriosis that it would probably literally take several years to work, and it wouldn't do anything at all about the scar tissue.

Now, here is where my faith comes into play. Medically, this is not a cure. According to the doctor, the condition will be back to where it is today within a few years. But I have something that medicine can't provide - a Savior. A Savior who died for my sins. A Savior who was beaten and bruised and whipped, who allowed His body to be broken so that mine doesn't have to be. I am believing that this will be the last time I need this procedure. That my healing has already been provided, and that this is the end of my endometriosis battle.

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