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The_Cheese_Man 01-07-2004 09:22 PM

My upcoming oral biopsies (questions)
 
Hi

I am scheduled to have two white patches in my mouth biopsied next week. I was originally diagnosed with having leukoplakia on the gingiva (gum) and buccal mucosa (inside cheek) and had a CT scan w/contrast dye done because my jaw nodes had swelled up a bit and being a chewer, I was naturally concerned about the possability of oral cancer.

The CT scan of my head and neck came back normal except for "superficially swollen mandibular lymph nodes". I finally saw an ENT last week and he did a very thorough examination, asked me several questions, listened to me attentively and his nurse and assistant were both very courteous and friendly. All in all, I would have to say that I recieved exeptionally good treatment.

Anyway, after he had finished the oral examination and noticed these spots, I looked him right in the eye and asked him if it looked like oral cancer. His response was that it did'nt look like oral cancer to him but that he would biopsy both areas just to be on the safe side. At this point I was thinking he would just go in my mouth and make a few quick snips and that would be the end of it but when it looked like he was'nt going to do that I told him that I lived quite a distance from him and asked if he could go ahead and do the biopsies right then.

He kind of smiled like "huh?..." and then told me that he had no way of doing the biopsies while I was sitting in the chair because he would have no way of controlling the bleeding (bleeding???) and because there was'nt enough time. He then told me that it would have to be done on an operating table and that he did surgeries on monday.

Then he left and this really sweet lady comes in (his nurse?), put her arm over my shoulder and starts comforting me, telling me what a good doctor he is and that they would give me something to make me very comfortable during the whole procedure.

So I leave and come home....very satisfied that the doctor did a very thorough job of looking me over, took me seriously, was a good listener, agreed to do biopsies and that his staff was very friendly and caring. Of course over the next few days (as it hit me) I began to wonder why such a big fuss was being made over a few biopsies. I mean, I figured it would just be a little "snip snip" and that would be it but then he's talking about needing to do this on an operating table, controlling bleeding, giving me "something" to make me comfortable and he even mentioned something about needing me to to be laying down so he could reach in there with the scalpal, etc.

So now, I start looking on the internet and I see pictures of people with IV's in thier arms, laying on an operating table with a piece of blue surgical cloth over thier eyes and a mouth brace in thier mouths, etc and I really started to freak out.

Ok, I am sorry this post is so long but I guess I just thought this would be a simple 5 minute procedure. Can anyone here tell me what exactly happens when they do an oral biopsy?. Do they normally give you some type of anesthesia (and what kind) or do you have to specifically request it and do they wear surgical scrubs, masks, put you under a bright light and the whole nine yards or what?.

Thank you in advance for any information you people can provide to a scared first-timer!

bassie 01-08-2004 07:44 PM

Re: My upcoming oral biopsies (questions)
 
Hi Cheese man

Nice to read your mail and it's an important one again for not being afraid to ask questions as well as highlighting how we can fear the unknown.
My reply is also a bit long but I have generalised quite a bit by way of explaining the why's and wherefore's.

You certainly did have a nice doctor and nurse but oddly enough that can make one feel like they are preparing you for "putting your affairs in order". This is definitely not the case. A little more explanation could have been forthcoming from the dr and nurse but I guess they sometimes forget how routine a procedure becomes and it does not occur to them.

A biopsy is not of necessity a long procedure and can sometimes be done in a treatment room at the dr's rooms depending on what part of the body it is taken from and the facilities the dr has there. In your case it is from the mouth which has a very good blood supply and is also a bit awkward to "get at" unless you are lying down.

When a dr wants to take a biopsy they have to cut around the lesion if it relatively small and remove it or take part of it if it is larger. (The size of the biopsy is simply a preference on the part of the dr). If all of it is removed the cut is slightly larger than the lesion itself. Being in the mouth with it's good blood supply the dr will want to have you lying down to have easier access to the area and have an assistant who can give him some small instruments to "hold" the end of the tiny blood vessels that are exposed when cut, or to dab at the site with gauze to remove the blood so the dr can see what he is doing. (Like a dental assistant).
That's what he meant with the *bleeding*.
He will also need some assistance to hold your mouth open to the side of the cheek and gum he wants exposed. The dr cannot hold it open *and* work on it at the same time. They would not put a mouth brace in if they are giving a local anaesthetic.
You can imagine that all this would be a bit messy and very inconvenient if the dr did not have a very good treatment room and the staff set up to do all this.
So they send you to the operating room to have it done and it immediately seems like the whole thing has become a huge procedure. Mostly however it is *practically and conveniently the best way*.

The word 'operating table and theatre' often brings to mind great activities and action (as in the movies) but it is really a sensible very clean place to lie down on a bed which can be raised or lowered to the dr's comfort and in a place where he has the instruments he wants, the staff who can set up an instrument trolley for him and a good light overhead. The light over the table is quite large and round containing many globes. This is so there is no shadow cast on the operating site no matter which way the people move. It all looks very scary at first but is again no more than very sensible and practical for the needs.
All the staff wear face masks (which are clean but not sterile) to reduce breathing nose and mouth bugs around the theatre. The persons who are dealing with the actual operation (big or small) wear sterile gowns and gloves. The other staff are in their theatre gear which is clean but not sterile. The instruments used for the operation are sterile as are the drapes and dressings etc.
*Sterile* means it has been through a procedure to remove all germs.
An operating theatre in itself is not *sterile* but just very clean. Antiseptics are used for cleaning the whole room and all the furniture very regularly and the theatre area is sectioned off from the rest of the hospital to prevent contamination by all the normal comings and goings.
The patient is dressed in clean theatre clothing prior to an operation.
So the *whole nine yards* when broken down is not nearly so frightening.

You should know beforehand if the dr intends for you to have a local or a general anaesthetic but because the nurse said they would " give you something to make you very comfortable during the whole procedure" it sounds like they intend to do this with a local anaesthetic and you will be given some relaxing medication before you go to the theatre.

Make a point of checking with the dr's surgery before you go to have the procedure done. Never be afraid to ask what you want to know.

A local anaesthetic is just like being at the dentist and having a needle with the "numbing agent". That anaesthetic might include a substance which reduces bleeding somewhat but there will still always be some that has to be dealt with to have good vision of the site.
When the dr is in sterile gloves and gown it means that the area around where he has his hands is *generally* covered with sterile drapes so he can move freely without "contaminating" his hands. That would account for the picture you saw of the surgical cloth over the eyes but would have been with the patient asleep under general anaesthetic. They reduce the drapes to a minimum with a local anaesthetic because of the discomfort and anxiety it would mean to the patient.

It is just possible that you will have an IV. Some dr's ask for it routinely. It is convenient if they want to give you a little added medication to relax (for example).

So you will most probably have the following done:

# You will be asked to change into a clean gown, and have a cap loosely over your hair. This is just to keep normal germs to a minimum in theatre.
# Some form of medication to help you relax.
# They will transport you to theatre on a trolley. It may seem daft and you think you can walk but it is just standard procedure.
# Once on the theatre table the dr will give you a local anaesthetic by injection into the area he requires. This will be followed by him cutting and removing what he wants. There will be an assistant on the other side of table. Just expect some general activity over your face. It will be much like going to the dentist except that you are in the operating theatre.
# It probably will not be a long procedure. I would estimate half an hour since you will have a few stitches in the area the dr has cut.
# After you are back in the ward you may have to stay a "routine few hours" or allowed to leave. That depends on the hospital's practice. Most likely you will not be allowed to drive because of any medication you have been given.
# When the anaesthetic wears off it will be a bit sore for a couple of days. You may be given a printout of what food and drinks to avoid for a short while.

Hope this has reduced your anxiety somewhat. Ask some more if you want. Best wishes.

The_Cheese_Man 01-09-2004 04:54 PM

Re: My upcoming oral biopsies (questions)
 
Hi Bassie:)

Even though I am going through a lot in my life right now and it's difficult for me to concentrate on what I am posting here, I could not, in good conscience, let your wonderful and thoughtful reply go without giving you a huge THANK YOU!!!.

You explained the way I felt better than I could have ever done myself and the way you explained it perfectly described exactly how I felt about them making such a fuss over a few biopsies. I mean, you might have thought I was about to undergo a triple bypass or something!...LOL.

Today I went in and saw my regualr doctor (not the surgeon) and he was in high spirits and gave me the CBC/Diff tests I asked for and even gave me a test for electrolytes and explained that those three tiny "finger-like things" under my tongue were just a "normal variation called papillae". He made me feel soooo much better!. It looks like next weeks I will be getting a LOT of results for various things (biopsies, bloodwork, etc) and yes, I'll be a bundle of nerves!.

Hehe, anyway, I just wanted to say thanks for taking the t ime to help me!!!:)


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