Friday September 7

      Another wild day at JFK ! Today we did 13 cases, bringing us to 51 cases in 4 days which is amazing and gratifying. I cannot praise the OT team enough for their willingness and desire to work hard all day to get all of these cases done. This morning Dan and I did a thyroid which was a surprise: the pre-op ultrasound reading was the she had an enlarged homogeneous left lobe of the thyroid, but on exploration we found a number of enlarged lymph nodes making cancer a likely diagnosis unfortunately.

     In Tuesday's blog I described a 14 year old male with a mass in his axilla; it turns out that he is 21 years old. I told him that I needed to do some research and that he should come back on Friday, so today he appeared at the OT. To refresh you, he has a huge mass in his axilla, and then several more masses going down his arm to the elbow. We biopsied one of the arm masses in March, and pathologically it appeared to be a schwannoma, which is a  benign peripheral nerve sheath tumor. When I saw him on Tuesday, the axillary mass was significantly bigger than it was in March, raising in my mind the possibility that we are dealing with a malignant rather than benign condition. The major problem is that he is in a lot of pain; today he was in tears. I had several people look at him, and we aren't sure what we can or should do for him. The fact that he has multiple areas of swelling running from his armpit to his elbow makes the situation even more complicated, because any one of the swelling could be causing his pain.  Today I told him that he might require amputation of his arm, and he readily agreed to that course if that is what is necessary to give him relief from the pain. From what I have read, that shouldn't be necessary, but I don't know what else to do.
       Tomorrow 9Saturday) we have 10 cases scheduled, so we will again be busy. Time to get some sleep.