(This is the final post in a series by Kristin about health challenges while traveling.)
Forgive me, in advance, for going into embarrassing detail about a strange topic: my spleen. If you read our blog for travel ideas, feel free to skip this post entirely. Hopefully, we’ll return to exploring exotic locales soon! But if you’re interested in what I’ve learned about spleens, splenic cysts and laparoscopic surgery, read on.
Four weeks ago, we paused our grand world tour and reluctantly returned to San Francisco. We already knew I had an enormous, fluid-filled cyst (like a water balloon) on my spleen measuring 4″ x 4″ x 5″. It seemed to be the most likely cause of my abdominal and back pain, because it filled much of the space inside my left rib cage. We just weren’t sure what we should do about it.
Upon returning to California, we visited three physicians (a surgeon, a urologist, and our family doctor) who subjected me to numerous tests and examinations. The team quickly reached a verdict: my splenic cyst should be removed via abdominal surgery.
As I mentioned before, splenic cysts are incredibly rare. One cause of large splenic cysts, especially for patients with an “interesting” travel history like mine, is parasitic worms (like Echinococcus). There was a possibility that my enormous cyst was created by — and filled with — parasites. That idea still gives me nightmares!
Many exotic laboratory tests later, we were happy to learn that my abdomen was not crawling with worms. Instead, my doctors hypothesized that I’d either been born with the cyst or that my cyst had formed long ago after some kind of minor trauma. Either way, it had been growing slowly over many years, and my recent kidney infection may have accelerated the cyst’s growth, helping it reach its giant stature.
That big dark gray sphere on the right side of this CT image is the cyst. The three white ovals bordering it are my ribs. As you can see, the cyst was outgrowing its space!
My surgeon, Dr. Norton, was confident that he could remove the cyst laparoscopically, using 3 small incisions instead of traditional open surgery. He thought it was unlikely that he would need to remove my spleen, unless it started bleeding uncontrollably during the procedure.
There was just one catch: he’d never operated on a splenic cyst before.
This is not for lack of expertise. Dr. Norton is the chief of surgery at Stanford and has been performing abdominal surgery for more than 30 years. He’s considered one of the best in the field. I knew that my condition was rare, but until that moment, I hadn’t processed just how uncommon it really was.
Since I was a medical oddity, no one could tell me what I would experience after the surgery or how long recovery might take. Seeking answers, I obsessively researched splenic cysts and treatments online, reading every medical journal article I could find. This didn’t take long: only a handful of websites offered relevant information and I didn’t see any forums for patients with my condition. In fact, that’s the main reason I’m writing such a detailed post now! (And I’d be happy to answer questions about my experience for any other splenic cyst patients).
I found precisely one blogger who wrote about having a large splenic cyst — she dubbed it “Igor.” Inspired, I jokingly named mine “Quasi” after Quasimodo in Victor Hugo’s Hunchback of Notre Dame. “Quasi” gave me a entertaining way to discuss my upcoming surgery with friends. Though I tried to maintain a casual attitude, I was terrified. I’d never had surgery before, and thinking about the details made me so nervous I’d get nauseous.
On April 17, I had laparoscopic surgery that lasted 1½ hours. During that time, as is standard for this kind of abdominal procedure, my body was fully anesthetized and my lungs paralyzed, with a tube placed down my throat to keep my airway open. I had a urinary catheter and an IV in each arm, pumping me full of drugs and fluids.
For those interested in the gory details, here’s how the surgery worked. Dr. Norton made three small incisions in my abdomen: one in my belly button, one some six inches above that, and one at the base of my left rib cage (near the spleen). Each was 1″ or smaller. Through this triangle of incisions, he inserted numerous surgical tools, including a laparoscope (a high-tech video camera) and a laser. He also filled my abdominal cavity with carbon dioxide gas, inflating it like a balloon, to create space around my organs. From there, he cut into my spleen to reach the cyst and then carved a large hole in it, in a procedure known as “unroofing.” After suctioning the fluid out of the cyst, he used an argon laser to destroy the cyst’s inner wall to prevent it from refilling with fluid. Thankfully, my spleen stayed firmly in place.
Laparoscopic surgery is safer, faster, and easier to recover from than open surgery. But laparoscopic or not, abdominal surgery takes a major toll on your body. I spent two delirious nights in pain at the hospital. The worst of the pain came from an unexpected source: the CO2 gas that remained in my abdomen after the surgery, causing constant and severe abdominal spasms and cramps. I wasn’t expecting this, and there’s no easy solution: the body must simply absorb the gas over a period of days.
My doctor discharged me once I could accomplish a few simple tasks, like holding down food and managing my pain through pills instead of an IV drip. Nauseous, lightheaded and barely able to walk, I returned home. No one warned me I’d need full-time help for at least a week, or that I’d feel like I was progressing at a snail’s pace. I’m incredibly grateful I didn’t have to go through this alone. My helpful and unflappable mom flew across the country for my surgery; Jeremy, my amazing husband, proved to be an excellent nurse, chef, waiter, social secretary and cheerleader.
Our friends visited numerous times, bringing meals, flowers, cupcakes and ice cream. Their thoughtfulness and generosity cheered me up and — in a wonderful surprise — helped me recover faster. When friends were around, I laughed harder than I had in weeks, giving my lungs and abdominal muscles a workout. I pushed myself to sit up longer than I otherwise would have, even if it was painful. They helped me finally understand the Chilean saying that I’ve referenced before: “in sickness, there is health.”
It’s been two weeks since my surgery, and I’m feeling a little stronger each day. I’m going for short excursions now, walking slowly around the block or the grocery store. Each day gets a little easier.
So what’s next? We plan to catch up with our original travel itinerary, heading to Europe in a few weeks when I’m back to full health. I’m excited to return to our wandering life abroad, but I think I’ve had enough “medical tourism.” I hope to avoid seeing doctors for a very long time!
