surgery specifics.

For those of you who have requested nuts & bolts, here you go: Mike's transoral laser surgery will be on Tuesday, April 5th at 7:30am at Barnes Jewish Hospital in St. Louis. Meeting Dr. Bruce Haughey was a blessing and relief. We can both say "we would entrust our lives to him" ... and Mike gets to. Bruce has been doing this kind of surgery since 1996 and in his own words "it is what I do all day - and night". He does research on why & how the surgery route to remove Mike's kind of cancer offers the best results, and the largest edge for functional recovery. Dr. Haughey believes that a non-surgical route is the "non-thinking approach". We couldn't have said it better! Mike's surgery will last about 5 hours and will start with the removal of the primary cancer mass at the base of tongue / tonsil area. After creating a guard for Mike's teeth, Dr. Haughey will use a Steiner Scope which will be inserted down Mike's throat. Bruce actually trained under Dr. Wolfgang Steiner in Germany. It probably goes without saying but the beauty of using the scope for the laser surgery is that they do not have to cut through the outside neck skin & tissues to enter the throat area. An initial cut will be made with the laser to get by the normal layer to the cancer tissue which looks very different. Then Dr. Haughey will work to remove all the cancerous tissue until all the margins are gone. Tissue will be sent to pathology in layers until only "clean" tissue remains. Bruce will "ink" or mark the areas where tissues are removed during this process. Using and waiting for pathology results is one of the reasons why the surgery lasts so long. After the primary mass is removed, they will switch equipment and work to remove the affected lymph nodes. Our understanding is that Head & Neck cancers all have their own drainage patterns. Mike's cancer drains to the same-side lymph nodes which are the body's natural filtration system. The neck has 6 levels and Dr. Haughey will be removing nodes from levels 2,3, 4 and 5. The affected lymph node in level 5 is the one that Bruce biopsied on Tuesday. It is a bit "further south" than the others which is another reason for the 5 hour surgery. We memorized Dr. Haughey's comforting words that he is confident he can get all the cancer, it just takes longer when the affected lymph nodes are more spread out. He will be working around facial nerves and arteries which makes it very delicate work. Dr. Haughey's brilliant nurse, Nicole, said that in similar cases Dr. Haughey will normally remove about 20-30 lymph nodes. (In case you are wondering, there are over a hundred on each side of the neck.) He will be looking for any invasion of the cancer and how clean the margins are. If there is extra spread outside the capsules, they will grade this. Some good news is that with Mike's specific type of cancer, if he gets a negative margin (the tissues are free from spread), they are not seeing these tumors recur. Some not-as-good news is that Mike will be in the hospital an estimated 5 days and he will be "uncomfortable"... an understatement. He might have to have a breathing tube the first night, in which case they will keep him sedated. He should not need a trach tube or feeding tube, but if swelling is excessive both are options. He will have neck drains which Dr. Haughey will remove on our post-op appointment on April 12th. He will be learning to swallow on the days in the hospital. The side effects of numbness of his tongue and neck area should subside in 4-6 weeks. We should probably add that we are actually 'excited' about all of this because it all sounds much more hopeful than what we have learned about radiation. These are recoverable symptoms and like we said before, we trust Dr. Haughey explicitly and still stand amazed that in God's good providence we were guided to him. In the midst of all the scary and dark things, God has been so present and there have been myriads of blessings. We are humbled and amazed... even that we have so many loved ones reading this blog and thanking us for making posts. Amazing grace.