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Last week I traveled to Halifax, Nova Scotia for what amounts to my 17th quarterly check-up post surgery and chemo/radiation for my 'head and neck cancer'. It is always an interesting head game as the days come closer to my visit with my four specialists... surgeon, oncologist, prosthedontist and periodontist.
It is a head game because when I originally was diagnosed with squamous cell carcinoma, it was in the gum tissue where my front right tooth met the gum... call it the margin of the gum. I went to the periodontist who did a great job of identifying and then confirming my cancer the first time she saw it. I was lucky to get an appointment with a very competent periodontist; she also saw it necessary to have pathology done on the tissue... and to my surprise, the cancer was determined to have spread deep into the tissue and yes, the bone of my upper jaw. It is a head game when something occurs that you don't expect... something that could be lethal.
The game continued after my surgeon removed the cancer... including the bone of my upper jaw, right up to my nasal cavity! Initially three teeth went with the bone, later the total became five. Then I met my prosthedontist... she would design the prosthesis or obturator that would block the passage between my nasal cavity and my mouth... yes, without it, if I sipped some coffee, it came out my nose (that happened the day I left the hospital). Between my surgeon and the prosthedontist, things literally came together, I had teeth, and I didn't leak liquids.
But when I describe the head game when one goes for a quarterly cancer check-up... it is far more serious. It is like the quote on the cover of McLean's Magazine a month or so ago, which quoted the coach of the English side in the World Cup of Football in South Africa... as I recall, it went something like... "some people think winning the World Cup is a matter of life and death; I assure you it is much more serious than that!" Here's what happened on one of my check-ups... after I had lost part of my upper jaw, and by now five teeth, and have to live with a bunch of plastic and metal that reaches from my teeth to the back of my molars... including covering my much of my pallet.
At that time, I was getting monthly check-ups... it was late fall of 2005. I was feeling great, no pain, taking my courses in an EMBA program and I went to see my surgeon... he was palpating the area around the hole in my jaw... moving back and then to the lower jaw... trying to feel if something was amiss. He moves smoothly, persistently along the soft tissue and my gums, back to soft tissue... and then he stops. That starts the head game! He stopped!
He carefully moved his fingers around, and then back to the 'stop' point! Then he moved on, my mind started winning the game, it was nothing. He finished probing my jaw, then the neck and so on. When he turned off that spot light that surgeons who are also dentists use... the lights we all get used to with dentists.
Then he stepped back and said... "I noticed something that doesn't feel right, we need a CT scan" or something close to that. Here I was planning to spend time that week working on a paper for business school... and instead, CT exams and then waiting for the diagnosis. It came, there was nothing apparent!
Not good enough, my surgeon was certain he felt something, so he checked again... and sure enough, he could still feel it. "I think we need to do a biopsy of the tissue"... hey Doc... we are winning here, the CT said negative!
The first biopsy came back negative, too! But he persisted and used a larger gauge needle... biopsy requires that you actually get to the target tissue and sometimes one has to do it several times to get it right... this time, when he called me, near Christmas Day, I was losing the Head Game again... "Bruce, you have cancer in a lymph node... we need to do surgery!"
We spent a few hours on Boxing Day (December 26th, 2005) discussing the options, none of them were good. Well, the rest is history... I had a big surgery, and for four years following my radiation and chemo... I have been playing the check-up head games.
So, when I went to have my 17th check-up last week, I had my game face on... but it was hiding the real feelings inside. The Doc and me always have a great chat about medicine, family, cycling, kayaking, hockey... then, we get around to the exam... exactly the same every time. Slow, persistently working around the gums, lips, soft tissues, tongue, throat, neck, upper chest... no stopping last week... this defines winning the head game!
I intend to write about this cancer, so we can understand ways to deal with it... playing the head game... to win!