Polly, (And Anyone Interested) - About my Pathology Report

[tex]

Hi Polly,

I assume you might be interested in this. While I was at the clinic yesterday, I walked over to the hospital section, and picked up a copy of my pathology report, CT scans report, x-ray report, and operative report. The operative report is very interesting reading.

My reason for getting the pathology report, was to see what the pathologist had to say about the inflammation in my colon, (the doctor doing the final check on my incision healing, had just finished telling me about the inflammation that the pathologist had supposedly examined, in the biopsy samples).


The lady at the "Release of Records" department, just threw in the other reports, when I asked her if she thought the x-ray report might have any useful information. I thought that was mighty nice of her. I never realized that there was even such a thing as an "operative report". It's almost a play-by-play accounting of what went on during the operation, (as I'm sure you're well aware).

I had always just assumed that what happened in the operating room, stayed in the operating room, if you know what I mean. Suffice to say, after reading the operative report, I consider myself extremely lucky to have escaped major problems with infections. It seems that they had leakage problems, during the resectioning process. If I had known that during my recovery, I probably would have been scared to death of infections. LOL.

Anyway, I expected the pathology report to show a reasonable amount of detail, concerning inflammation patterns, mocosal characteristics, etc., under the microscope, but it really doesn't offer much more than the most basic of observations. Here is the full text of the pathology report:

. . . . . . . . . . . . . . . . . . . .

BRIEF CLINICAL HISTORY

GROSS:
Labeled Sigmoid colon is an approximately 18.0 cm in length x up to 12.0 cm in circumference tortuous portion of colon with attached mesocolon. Both ends are closed with rows of silver colored metal staples. The serosa shows dusky red and purple discoloration, approximately 5 cm from the distal margin is what grossly appears to be an area of adherence and stenosis narrowing to 2.5 cm in circumference. Opening the specimen shows the mucosa is tan wrinkled and velvety with proximal dilatation. There are scattered shallow diverticula. Sectioning shows no grossly recognized ulcerations, perforations or mass lesions. Representatives are submitted as follows: 1A-proximal margin, 1B-distal margin, 1C-D-representatives of diverticulum, 1E-F-representatives from area of stenosis and possible adherence, 1G-proximal mucosa, 1H-distal mucosa, 1I-grossly recognized lymphoid tissue from the dissected mesocolon.

SW/sc

MICROSCOPIC DIAGNOSIS:
sigmoid colon, resection: Acute diverticulitis, focally marked with surrounding reactive mucosal changes and underlying granulation tissue.

Margins of resection are viable.

11 benign reactive lymph nodes.

Microscopic/Diagnostic Dictation performed by
Xxxxx Xxxxxxxxx MD
Electronically signed 11/15/2005 10:58:08AM
Final Diagnosis performed by
XX Xxxxxxxx Jr, DO
Electronically signed 11/18/2005 1:04:15PM
* I have reviewed the pertinent gross findings, any and all microscopic slides, and the resident's interpretation. I have made appropriate editorial changes and have rendered the final diagnosis.

. . . . . . . . . . . . . . . . . . . .

Ok, I get the impression that they couldn't decide what to call it, so somebody just decided to call it diverticulitis. Or, am I just hallucinating?

Now I'm not questioning the fact that I have diverticulosis, and I'm not denying that there was probably inflammation in the diverticula. I'm questioning the diagnosis.

Note that the exam was done only two days after the surgery, but it took an additional three days for someone to "render the final diagnosis", IOW, decide what to call it.

Everyone I've ever talked with, who had diverticulitis, assured me that it was the most painful event they had ever experienced in their life. The only tender spot I had, at the time of the surgery, was in my lower right quadrant, while the section removed from my sigmoid colon was in my lower left quadrant, of course. After the surgery, for at least three to four weeks, the only tender spot I had, (other than the incision, of course), was in my lower right quadrant. Diverticulitis might have been present there, but I'm having a problem accepting a claim that diverticulitis was the correct diagnosis in the section that they removed. Obviously, something was wrong with it, but I don't belive that diverticulitis was the problem.

The fact that the primary problem centered in a stricture in the sigmoid section of the colon, is a classic symptom of diverticular colitis. so that's where my diagnostic vote goes. Ok, so here I am making my own diagosis again, contrary to professional medical opinion. I guess I'm nutty, but that's just the way I am.

I'm glad that the report showed no signs of any malignancy, but I wish it contained information on the microscopic nature of the inflammation pattern. That might have been enlightening information.

Love,
Wayne

P S What does DO stand for? Surely, in this case, it must stand for something other than Doctor of Optometry, or Doctor of Osteopathy.

[hazel]

I think you're right on guess two--Doctor of Osteopathy.

Your report says to me that, although parts of your insides weren't looking that great, you'll make a complete recovery with no lingering ill effects! Way to go!

[harvest_table]

Wayne,

This was interesting to read! A bit confusing to me but I'm kind of with you on the "diverticulitis colitis" diagnosis. I did a quick read and found that the "stricture thingy" in the sigmoid colon is the classic symptom of Diverticulits Colitis.

It appears to me that their diagnosis was just Diverticulitis, based on what I read. Do you have any interest in following up with them and asking about that? What kind of instructions have they given you for future care and monitering of this problem?

Thanks for sharing. I'm glad your feeling better.

Love,
Joanna
Perhaps DO stands for Dr. of Operations? I dunno.

[kate_ce1995]

Wayne,

Aren't those surgery reports interesting? My first one from 5 years ago even mentions counting sponges and such (comforting).

As for the pain issue, I'll just say, both my previous surgeon and current surgeon were extremely suprised that I was not in pain as a result of the condition of my pelvis. I had almost no pain whatsoever from two conditions that cause many many women insane amounts of pain. I had some pain that was of the annoying sort, but not debilitating. I guess what I am saying is we all react differently. I think some of us just suppress pain and go on with things. Its a subconscience thing I think. Unfortunately, those of us who don't feel these things, don't always seek as much treatment as we might otherwise need either.

I take it the recovery is still going well? Are you getting your strength and stamina back? I'm working slowly at that. Had to drive some stakes into frozen ground yesterday with a 3 lb hammer...was glad I only had to do 2. Its amazing how much you loose in a short time of inactivity. Goal for this weekend is to get out snowshoeing to get some cardio going.

Katy

[Carrie]

Hi Wayne. Thanks for sharing and thank goodness for the "b" word (benign)! Having said that, I think you are right to question the diverticulitis diagnosis. The only way to be sure is to have the hospital send your actual x-rays and CT-scan pictures to another pathologist for a second opinion. If you send me a pm I will give you the name and address of the pathologist who gave me my 2nd opinion last year (and who, after a "missed" diagnosis from another, came up with the LC diagnosis). Anyway Wayne the prognosis for you looks real good. You just take care of yourself!!!

Love,
Carrie

[tex]

Hazel,

I'm afraid you might be right about the Doctor of Osteopathy, but I'm puzzled about how he would be qualified to make a diagnosis of a gut issue. True, my internal parts are in fairly decent condition, for the most part, but both the x-ray report and the CT scans report, shows my thoracic aorta to be mildly tortuous, with some calcification present, IOW atherosclerosis. And, the scans show splenic granulomata, which, I assume, means abnormal growths on the spleen. I'm not particularly concerned about that, though, since I seem to be prone to benign abnormal growths.

Joanna,

That was what caught my eye, also. Diverticula are bulges, not strictures.

They gave me absolutely no instructions on anything that I should do, concerning the diverticulosis, or anything else, except to set up an appointment for six months in the future. This is a teaching hospital, so I'm mostly dealing with interns/students, and most of them don't seem to be prone to volunteering advice. I guess I should have asked. Sigh.

Katy,

I gather that you're saying that I could have had diverticulitis, and just not felt any pain. I'm sure that's a possibility, and it may well have been the case. That still doesn't explain the stricture, but I suppose that if diverticulitis was actually clearly present, that might have dominated their attention, and they just chose to ignore the stricture. It seems kinda strange to ignore it, though, considering that it was the sole reason for the surgery, in the first place. As far as I'm concerned, it should have been the dominant consideration.

You're right about the pain, though. I seem to have a very weak response to pain. For me, a severe toothache is barely noticeable. My pain response system just doesn't work very well, I suppose.

Basesd on my experiences during the past couple of weeks, I'm predicting that after your snowshoeing outing, the muscles in your legs will ache like they've never ached before. It's a good ache, though. LOL.

Carrie,

Was it much trouble to persuade the hospital to send your samples to an outside pathologist? Is a second opinion by another pathologist very expensive?

Love,
Wayne

[Peggy]

Wayne,

You forgot to tell them about the gonorrhea!

Hugz
Pippi

[tex]

Good Grief Peg,

Did you have to bring that up. <Blush>

Ok, before you all asume the worst, here's the story:

When the lady in the records office handed me the stack of printouts, she glanced at the top sheet and said, ""Oh, wait a minute--you don't want this", and then she laughed like mad, as she removed the top sheet from the stack, and threw it away. It was from someone else's record--a pathology report, and the ruling was gonorrhea. Hahahahahaha.

She probably saved me from having a heart attack.

Hugs,
Wayne

[kate_ce1995]

Trust me Wayne, it doesn't take much to make things ache these days. I felt every flight of stairs done last weekend while helping Geoff's brother move out of a 3rd floor apartment! You are right though, its usually a good ache. My shoulders hurt today...I either slept weird, or its from being on my feet more than usual yesterday (had a site visit for work) and that is driving me nuts. Also why I'm anxious to get back into some semblance of shape.

Katy

[Peggy]

Sorry Tex - I couldn't resist

Cheeky Peg

[artteacher]

HAH! Good one, Peg!

Wayne, prior to the surgery, did you have a fever? I thought with active diverticulitis, there would be infection and fever. Or is the report indicating that you had diverticulitis, but it wasn't active at the time? And was the surgery required because of the stricture, or tissue damage due to infection? I'm really sorry if these are dumb questions. I hope you don't mind doing some teaching here. If nothing else, your "really not fun experience" could help us all learn. (My after colonoscopy reports also said possible diverticulitis, a couple polyps, and of course the chronic and acute inflammation consistant with MC) Which by the way, is now gone, so my doctor thinks I'm cured and doesn't want anything to do with me except possibly a more extended gluten challenge. Like THAT'S going to happen.

Love, Marsha

[Polly]

Wayne and all,

As usual, you ask excellent questions and draw valid conclusions. I couldn't agree more with what you are thinking. I would really love to see a second opinion, as well as further questioning of the docs who were in charge of your care (those with the ultimate responsibility, like the attending surgeon for example).

A DO is a doctor of osteopathy, or osteopath. An osteopath is cosidered to have all of the rights and privileges of a physician, and thus can enter any one of the medical specialty fields for full training/certification. I would guess that your DO is a fully certified pathologist, since s(he) seems to have the final signoff.

The best part of your report was the part about the 11 benign lymph nodes. Whew. I didn't relax fully until I saw that.

Love,

Polly

[tex]

Hi Marsha,

Thanks for mentioning the fever--I had forgotten about that, or rather the absence of fever. As far as I am aware, I never had any fever during the weeks prior to the surgery, and only a slight rise for about a day after the surgery, which was almost certainly related to the surgery.

The diagnosis in the pathology report states acute diverticulitis, which means not only active diverticulitis, but presumably, severe in degree. You're right--I should have had fever with acute diverticulitis. This just strengthens my opinion that the diagnosis was incopmplete at best, and possibly incorrect, at worst.

Still, I'm pretty sure that it's possible to have acute diverticulitis without fever, or any other obvious symptoms. In most cases though, I believe that fever is usually present.

Definitely, we should always try to learn, from each other's experiences, whenever possible. I'm pretty sure that my diverticulosis was excaserbated by my low fiber diet, during the past 4 or 5 years. I notice in the literature, that prolonged use of corticosteroids and/or NSAIDs, are also blamed for enhancing diverticular development.

Love,
Wayne

P S I agree with you. I really don't see much advantage to a gluten challenge, from a patient's standpoint, unless the issue of gluten sensitivity is truly in doubt.

[tex]

Thanks, Polly,

I really appreciate your input. I think I will try to get a second opinion on the biopsy samples, just for our further enlightenment.

As best I can recall, I only got to see the surgeon one time after the surgery, and didn't recognize him at the time, because I had been told that another surgeon had actually performed the operation. It turns out that the surgeon who I thought did the work, was only there in a supervisory, or standby, capacity, and I never did get to see him. Consequently, I never had a chance to ask the right questions of either one of them. After the initial visit by the surgeon, and the chief resident, I was always treated by someone who was not present at the surgery, usually by interns. Sigh.

Thanks for clearing up the DO question.

You're right. The line listing the 11 benign lympth nodes is definitely the best part of the report, especially since there's no question about that statement.

Thanks again, for your thoughts.

Love,
Wayne

[annie oakley]

Yeah for benign!!!!!!! You're report was real interesting. Thanks for sharing. My SIL was just diagnosed with diverticulosos last week. I,m glad you are healing well Wayne.....have you completly healed? Love Oma