T2NoMo SCC Right mandibular alveolus. Surgery April 2018 No PORT
18th January 2018, I see GP to discuss what to do about a hernia, and agree that surgery was needed. Then I said “by the way, I’ve got a sore patch in my mouth that doesn’t seem to heal up”. My GP referred me to the Max-Fac unit at Westmorland General Hospital, a biopsy was taken, and on 1st February I was told that I had a squamous cell cancer. That came as a great shock as the word cancer had never passed my mind before. I was then referred to Royal Preston Hospital for treatment.
All sorts of scans, MRI, CT, Heart Echo scan, ECG, blood tests, pre-op assessment, and eventually surgery is scheduled for 4th April. Discover in the process that Royal Lancaster Infirmary cannot communicate with Royal Preston Hospital except by snail mail – different Health Trusts and incompatible computer systems. Turn up on 4th April, all dressed up in theatre gown, only to be told that surgery cannot go ahead because there is no bed in the Intensive Care Unit. Come back a week later. That is one heck of a shock when it is life saving surgery. One week later (11th April), and guess what. Exactly the same thing happens. Shock turns to desperation.
Fortuitously my MP (Tim Farron) is holding an open surgery in the local ASDA café. He immediately writes to Chief Exec. of Royal Preston Hospital, and my son gets the Clinical Commissioning Group involved. Eventually surgery goes ahead on 18th April. By this time the tumour has become aggressive and is loosening my teeth. (A footnote to Tim Farron’s intervention. Not only did surgery go ahead, but the hospital decided to invest in doubling the size of the Intensive Care Unit)
Meanwhile the reference for surgery for my hernia reaches the top of the queue, but we are forced to agree that this will have to wait until the cancer is dealt with. Come back in 3 months time.
Surgery takes 8.5 hours, but the surgeon kindly phones my wife at home to tell her when it was all finished and satisfactory. Further readmission from ICU to theatre to remove a haematoma. Tracheotomy, catheter, drain tubes and nasal feeding tube in place. My wife admits that she had made a note of the contact details for our local Funeral Director ! Six days in Intensive Care, and eventually discharged on 2nd May. Great news just before discharge – no spread to lymph gland. Virtually all of my memories of the stay in hospital prove to be delusions and I’ve no memory at all of the time in Intensive Care.
29th May, surgeon gives great news that no chemotherapy or radiotherapy is required, but they do need to remove another 2mm of jaw bone to give a 5mm clear margin from the cancer. This is arranged for 6th June and is very quick. We’re all home for lunch! The final outcome is that I lost 8 teeth and 2/3 of the thickness of my jaw bone. A “flap” was taken from my wrist, spliced into my mouth, and all the blood vessels connected up. A skin graft was taken from my leg to cover where the flap was taken (but it failed to take). All very clever stuff. I don’t think etiquette allows me to name the surgeon, but we think he is very skilful.
Adequate recovery from this surgery, and it’s time for the hernia to be sorted. Concerns about an adequate airway and the risk of fracturing my weakened jaw bone leads to a decision to use spinal anaesthesia. I really do not recommend this. Surgery takes place on 8th August in Royal Lancaster Infirmary. Of course this proves to be more extensive and takes twice as long as expected. Had to be sent home with a catheter in place – ugh!
Wonderful care from my wife, coping with soft food, and we manage a little UK based holiday. Roll forward to end of the year (January 2019) and something is going wrong. I’ve lost muscle strength and all movement hurts. I need help just to get dressed. An inspired guess and a blood test by one of the GPs in our practice reveals that it is “polymyalgia rheumatica” - what on earth is that? - and that it first started 3 months earlier. She says no direct connection with cancer or hernia surgery (really ?). Treatment with steroids (Prednisolone) sorts it, but lasts for a year with reducing dosage.
Now it’s time to think about those lost teeth. There’s a Consultant in Restorative Dentistry in Royal Lancaster Infirmary, and she’s come up with a plan of action. But first that flap in my mouth needs tightening up and trimming in thickness. That’s back to my surgeon in Preston. Surgery fixed for 24th April 2019. Shouldn’t be painful he says, nothing that paracetamol can’t cope with because there’s no nerves. Some hope! He must have cut some nerves because I needed a shot of morphine in the recovery room. I think I must be getting a bit too blasé about surgery. However there’s good news on the cancer front. Its 12 months now since the big operation and the surgeon says the odds on a recurrence of the cancer drop significantly after the first 12 months clear. I am quietly confident, but well aware of the possibility of a recurrence. As of the time of writing, the new teeth aren’t yet ready for installation, but I’m aware that they’ll take a lot of getting used to.
