Wednesday a specialist surgeon came to see Jared. He said CT findings, such as indicated in Jared’s scan, is nonspecific and are generally “not recommended to rule out the presence of a neoplastic process such as lymphoma. A surgically obtained biopsy is required to confirm the diagnosis of lymphoma.”

Jared asked the doctor exactly what he meant. The doctor tried to avoid answering Jared.

Jared repeated his question: “What do you mean doctor?”

“We have to eliminate lymph cancer.” the doctor said.

He continued to explain to Jared that due to the position of the para-aortic lymph nodes the surgical biopsy is major surgery. A large incision has to be made to allow access to the lymph nodes situated near the aorta, right in front of several lumbar vertebrae. Jared said “Doctor I had major surgery with my Nissen Repair and it was keyhole surgery…Now you want to make a large cut for a biopsy?”

I thought it was a rather intelligent and rational question and even in the scary moment I was proud of my grandson.

The surgeon said Jared would go to theater on Thursday morning for the biopsy. He asked me to be there by 6 am so we could have a further discussion before Jared went into theater.

Jared’s eyes, when he registered what the doctor said, will haunt me until my dying day. He simply said “Oumie can we phone Mom?”

Vic’s first reaction was “Mommy I am just too sick…..” I told her Jared wanted to see her and that her dad would bring her to the hospital.

I took Vic aside and broke the news to her first. Then we spoke as a family. We went to the cafeteria and had a cup of tea. Nobody had an appetite.

Wednesday night I Googled the results of Jared’s CT scan and found the following:  “The paraaortic lymph node is lymph tissue located near the aorta, right in front of several lumbar vertebrae. Another term for the paraaortic lymph node is periaortic lymph node. As part of the lymphatic system, a paraaortic lymph node helps drain dead cells and immune system-neutralized foreign bodies. In particular, a paraaortic lymph node helps drain the organs in the pelvis and the lower part of the digestive system.”  http://www.wisegeek.com/what-is-a-paraaortic-lymph-node.htm

Five broad etiologic categories lead to lymph node enlargement, as follows:[1]

  • An immune response to infective agents (e.g., bacteria, virus, fungus)
  • Inflammatory cells in infections involving the lymph node
  • Infiltration of neoplastic cells carried to the node by lymphatic or blood circulation (metastasis)
  • Localized neoplastic proliferation of lymphocytes or macrophages (e.g., leukemia, lymphoma)
  • Infiltration of macrophages filled with metabolite deposits (e.g., storage disorders)

http://emedicine.medscape.com/article/937855-overview#a0102

Paraaortic lymph node

From Wikipedia, the free encyclopedia

Lymph node regions

 

.

We left home at 5.30am on Thursday morning.  It was raining and freezing cold.

At the hospital the surgeon spent a lot of time talking to us.  He discussed the results of the CT scan and said that the most common reason for lymph nodes to enlarge is infection.  The blood tests, done on Monday and repeated on Wednesday, however showed no infection levels.  The CRP levels were perfectly normal.  The problem with Lymphoma is that bio-markers are not enough evidence for a diagnosis…

The surgeon was concerned that he had a very long theater list and that Jared had already had four anesthetics this year.  It was a long procedure….  Furthermore he had to go back to theatre in two weeks time for the removal of the stent.  We agreed that the biopsy would be delayed for two weeks…

Jared came home on Thursday.  He is on very strong antibiotics.  His kidney is still sore.  He is scared.

We are all scared.