As we left off, my pre-operative workup was complete for the malignant melanoma under my right thumbnail; Kels and I had contracts on our new home, which would be a downsize, and our current home; and I took a day of rest in preparation for my surgery, pleasantly surprised by a visit from my 3 life-long relatives/friends, Lee Randolph, James Sutton, and Ronnie Carter, who prayed over me in my living room the night before.

My surgery date was exactly 2 weeks after I was operating on my own patients and received the call from my Pathologist between operations, revealing the diagnosis of malignant melanoma. I will say that I am extremely grateful that had I have access to such stellar and speedy healthcare. In under two weeks, I had seen 4 physicians in consultation, undergone plain x-rays, undergone MRI scans of my brain and upper extremity, undergone a whole-body PET/CT scan, and was on the operating room table! Once the diagnosis of malignant melanoma was made, it was hard to keep it out of my mind since it was so readily visible right there on my right hand. I was extremely grateful for my health care providers and was ready to move on with what we surgeons call surgical extirpation of the tumor.

For my surgery day, the plan involved partial amputation of my right thumb, clearing the margins of the tumor, reconstruction of the thumb, and sentinel node biopsy of my lymph nodes, likely being in the region of my right axilla. I was to report to the medical center around 6:30 am to be checked in by 7:00 am in the Nuclear Medicine Department. For the sentinel node biopsy, the Surgical Oncologist would identify and sample the lymph node (or two) that was the most likely to receive any tumor cells if they had spread beyond my primary tumor. The nodes would be removed and evaluated by the Pathologist to see if there had been any microscopic spread of tumor cells that would not have yet been identified on imaging studies. Localization of the sentinel node or nodes involved two aspects: 1. Lymphoscintigraphy in which a radioactive tracer, Technetium-99m, would be injected in and around the tumor prior to surgery so that it would be taken up by the sentinel nodes and could be detected with a gamma counter probe during surgery, and 2. Injection of lymphazurin blue dye around the tumor during surgery which will stain the lymph vessels and lymph nodes blue to help with visualization and mapping.

I did have some topical anesthetic cream to be placed on my thumb to help tolerate the injections of the radiotracer in the Nuclear Medicine department. Either it did not work very well, or I erred in the timing of the placement of it, but those 4 injections in and around my fingernail were painful!  After that, I checked into the pre-operative area for surgery, was prepared for the procedure, kissed Kellee, and was on my way to the operating room. For obvious reasons, I had very little recall of the rest of the day. All the surgeons told Kellee that everything went well, and the Surgical Oncologist felt confident that they were able localize the sentinel lymph nodes, the first representing most of the radioactivity, followed by a second one that had the remainder of the activity. The team felt good about the surgical margins and had to amputate the thumb back to the first joint or knuckle, but preserving enough of it that I would have the ability to use it and oppose other fingers to it.

Over the next few days, I had a large bandage on my right thumb and a healing incision in my right armpit. Basically, I had to adapt to performing activities of daily living all left-handed. I had to eat left-handed, brush my teeth left-handed, and try to bathe myself left-handed. Fortunately, although I am right-hand dominant, I am also ambidextrous to some degree. I naturally have much more upper body strength on my left side, so in my youth I taught myself to play ball with either hand. I played baseball left-handed, but I could hit both ways. I can shoot a basketball with either hand. In my adult life as a surgeon, I typically remove the right tonsil with my right hand and the left tonsil with my left hand. So, I did not find this immediate situation to be very inconvenient.

As I rested and recovered from surgery, we were anxiously awaiting the pathology on the lymph nodes. Whether or not they were positive for cancer cells would determine my final stage. How this information was revealed to us is quite the story, and I will tell it in my next blog.