2019 Surgery
Andy and Christine met with Dr. Pytynia and her staff in the MD Anderson cancer center in Katy. Dr. Pytynia will be the lead surgeon, and team leader for Christine's procedures. She specializes in head and neck cancers. She reviewed the biopsy and report from the remedial surgery performed by Dr. Winterstein the previous week. She proposed that an aggressive approach would be taken, which would be to remove the jaw bone and tissues, as well as some lymph nodes from the neck.
CT Scans of Head and Legs - May 13th/14th 2019
Andy and Christine met with Dr Chun, who specializes in radiology. Having reviewed the preliminary CT scan, he wasn't sure that Christine would need radiology, but still went through the process. He also felt that the cancer had not spread to the lymph nodes. He was a very deliberate and confident man
Dental/ Reconstruction Consultations - May 16th 2019
Since Andy was recovering from knee surgery, Carol-Ann kindly went with Christine to the MD Anderson medical center downtown Houston. This was probably a good idea anyway, as she was able to ask some very good questions that Andy could never have imagined. They met with Dr Chambers who is an oral oncologist, and Dr Garvey, who is a specialist in reconstruction surgery. With each doctor they discussed the planned dental work and the jaw reconstruction that would be needed for Christine to completely recover. Dr Garvey is the considered the main man for this procedure, so they felt that they were in very good hands
PET Scan and Consultations - May 23rd 2019
Andy and Christine went to the in the MD Anderson cancer center in Katy and met with Dr. Pytynia and Dr Lindquist, who is a very capable Resident Physician. They went through the final plans for Christine's surgery, and were able to answer all of our questions and concerns. The PET scan was reviewed in detail, and the tumor showed up very clearly.
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Surgery Day - May 24th 2019
Andy and Christine departed for MD Anderson at 4:15am for a 5:15 check in. Hardly any traffic, so we were there in plenty of time!
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Post Surgery Day 1 - May 25th 2019
Christine is in good spirits considering all that has been done to her. The surgeons visited first thing and they were very happy with progress. The registered nurses pop in every hour or so to check that all is OK. She is on a feeding tube, and an IV for drug medications. There are also many diagnostic wires attached. She is breathing through a tracheostomy tube and they have a Doppler blood flow monitor that shows that the rejoined arteries are working well.
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Post Surgery Day 2 - May 26th 2019
Christine had a good night, and is still progressing well, although still communicating via the white board. I think that the swelling on her mouth has gone down quite a lot since yesterday, so that is encouraging. She keeps on top of the pain meds, which makes her feel as comfortable as possible. All of the wires, although quite necessary, are a bit of a nuisance. She was able to watch Lewis win the Monaco Grand Prix, however the excitement proved exhausting, so she had a good sleep after that! 
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Christine had a bad night as she was taken off one of her pain meds, Tramadol. She was in quite a lot of pain, particularly in the jaw area. Her leg was OK though. She struggles with the production of saliva, but now has a suction tube to take care of this. The swelling on her jaw has come back again, but we were warned that this would happen.
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The Doppler monitor sounds really good, and confirms that the blood flow in her jaw is working. Thankfully he put her back on the pain meds, which she will be given every six hours. He checked to see if Christine could breathe without the trach, but the swelling in her mouth was still too bad for this to happen.
Dr. Garvey’s fellow came and checked Christine over. Very nice chappie and an excellent bedside manner! Again, very pleased with progress, and wants her to start walking around the ward to help the healing process and to prevent blood clots, etc. He expects to remove one of the drains tomorrow, and take her boot off on Wednesday.
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Up until now Christine has been fed constantly via a feeding tube. Today she will be fed with at normal times, still via a feeding tube. This means she will have one less wire plugged in for most of the day, which will be quite a relief.
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We will have to watch a bunch of training classes in preparation for going home (not any time soon). These are videos showing how to change the drains, the use of the tube feed, and a tracheostomy video. There is an on-site tracheostomy class tomorrow which I will attend.
Christine was still not well enough for visitors.
Christine had decent night, although had a dry and sore throat from the tracheostomy suction tube being administered heavy-handedly by a couple of the nurses. It seems different nurses have different methods. This is the worst bit for Christine, and we won’t be sorry when the tracheotomy tube has been removed. Although the swelling seemed less than yesterday, the coughing caused by the tube, makes it worse than perhaps it should be.
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Dr. Pytynia’s team of doctors visited and checked Christine over. They are still very pleased with her progress. She may be put on a smaller tracheostomy tube tomorrow.
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Christine was still not well enough for visitors.
You Facebook junkies will know that Christine had a bad afternoon and evening. This was caused by one junior nurse, who needed to take the trach class that Christine and I did, and the patient care partner, who failed to take Christine’s vitals, failed to get the registered nurse when requested, failed to help Christine to get to the bathroom and failed to requested pain medication. All this caused an immense amount of stress, raising Christine blood pressure sky high, and caused her to cough severely, which caused her swelling to get much worse. This morning though, there was a great team of nurses, the registered nurse, and the patient care partner, and some others who have been excellent today. The doctors came early today and changed the tracheotomy tube to a smaller more mobile one. The early report is that it is very much better than the one that Christine had before, and she is in much less discomfort. They are still talking of her coming home on Friday, but we will put our foot down on that idea.
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Another piece of good news was that Christine was able to wear her own clothes again, which must be wonderful.
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Before I get into the nitty gritty of the events of the day, I have great pleasure to report that Christine's lab analysis of the tumor and lymph nodes came back clear, and the cancer has not spread anywhere else!
The day didn't start very will with doctors showing up at 5:45, waking Christine up to change her tracheostomy tube to a smaller size. This made no sense to us, as Christine was perfectly comfortable with the size she had. Seemingly, it is a way for them to determine whether the trach tube can come out permanently. We have learnt later that this wasn't really necessary. It just managed to annoy Christine unnecessarily, and cause her face to swell up again. Seems this doctor is not capable of listening to her patients needs and pain levels. Christine is looking forward to filling out the survey.
The day perked up when the plastics doctor arrived and promptly removed the boot and two if the drainage bottles. This has given Christine a lot more freedom, and the knowledge that she will not need a skin graft at a later stage. One less surgery to worry about! Before the surgery it was thought that there would be a large hole in her leg, filled up with something called Integra. Fortunately, Christine's skin was too thin for their initial plan, so they had to revert to a Plan B.
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Since Christine still has the tracheostomy tube, open wounds, and her immune system weakened, she will very vulnerable to germs. If you have even the slightest sniffle, please do not come. Any visitor will have to thoroughly wash their hands, and wipe using antiseptic gel (thanks Lucille for this advice). I know that you all want to visit, but I hope that y'all understand my decision.
Christine had a good day today, despite being woken up quite often to be checked up. To be fair, aside from just one or two exceptions, the care that Christine has been provided has been excellent. The registered nurses and support staff have all been absolutely fabulous. It is hard to believe that it is only one week since some pretty serious surgery, and that Christine is coming home tomorrow.
With the help of the occupational therapist, Christine was able to shower. She felt so much better after this. Throughout the day, all of the home supplies were delivered, so there are no excuses for the level of care to drop…
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Christine came home today! It doesn't seem possible considering the amount of surgery that she has had to endure. The surgeons at MD Anderson really know what they are doing, and we really thank them and their nursing staff. Inevitably there have been some ups and downs, but now Christine has come home she can fully rest and recuperate. We have everything all setup, a feeding station, a drug station, and a plan of attack. Keep your fingers crossed! Follow up doctors report late next week. I'll report again in a couple of days. Thanks for all of your cards, emails, texts, and support!
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Christine has been home three full days now and we have settled into a good routine. After two good nights sleep, she struggled last night and is quite tired. She is suffering from a very sore throat caused by the tracheotomy tube. We will be visiting the head and neck surgery to have this addressed. I think once this has been removed, Christine will be in better spirits.
Today we visited Dr Garvey and his team to assess her leg and mouth surgeries. Her leg looks fantastic, and is well on the mend. The outside scar on her face is healing very nicely, especially as all of the staples have been removed. The inside of mouth, although still hurting, is doing well too. This will take a lot longer time to heal. Dr Garvey removed some extraneous tissue from her mouth (actually her leg muscle…), and cleaned around the wound. We have another appointment on Thursday to remove the last drainage tube. Then we will be down to one remaining tube!
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During the week, we have a nurse visiting daily, and a physical therapist a couple of times a week, which has been good, mainly from the peace of mind that her vitals are OK. We also had an occupational therapist visit to ensure that Christine is safely going about her daily routine, and provide her goals to aim for as her health improves. These included driving, cooking, swimming, and, of course, sewing. 
Next week, we are visiting the doctors again, and I suspect that they may take the drainage tube out providing that the improvement continues. We can’t get the trach tube out until we have done some tests to ensure that she can breathe normally for 24 hours. Hopefully, we can start this soon. 
Christine is becoming more and more mobile, walking around the inside of the house four or five times a day. She is able to have a bath and a shower, which gives her great pleasure. 
We have had some interesting experiences with her feeding tube, The antibiotics seem to block the feeding tube, so there was an incident when the safety valve blew, with all of the medicine spurting onto the wall and everything in between. The problem was that the color of the medicine was deep red, so looks like blood spatter. Seems some decorating is in my future! 
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 Christine had an exhausting day today and is cream crackered. We were up at 6am to get to the imaging hospital on Highway 6, to have a CT scan on her mouth. Unfortunately, this had to be postponed until another time as she was unable to lay on her back and stay still for enough time for appropriate images to be taken. Later in the morning, we headed downtown to meet with Dr. Dhanani, Dr. Garvey's associate. He was very pleased with her progress and to our relief, removed the last drainage tube. He has now arranged for a barium swallow test in a week or so to see whether enough swelling has gone down for Christine to move to the next stage in her recovery. We were also able to get some new pain medication prescriptions. By the time these were ready, we didn't get home until early afternoon. After a short rest, Jorge the physical therapist showed up and put Christine through her paces. He is quite hard on her, but at the same time quite convincing. Christine is now down to her last two fashion accessories, the trach tube, and the feeding tube. Now we have finished the antibiotics the feeding tube is behaving properly. The trach tube though is still causing a lot of discomfort in her throat, especially when Christine speaks a lot. We have started a course of decongestant medicine, which will hopefully improve things over the coming days. We will see Dr. Pytynia on Monday 17th, so my next report will be after this. 
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 Christine had a restful day today, still suffering from a sore throat and excess saliva. We managed to speak with the clinic and they recommended that we went full on with the pain meds again, which are mainly narcotics. Our nurse, Yanet came later and gave us a tip that if you have a sore throat and can’t swallow, stick your fingers in your ears as you swallow and it doesn’t hurt as much! It worked and Christine had a noticeably more comfortable evening. It'll make Christine a zombie, but we will also continue with the pain meds as well. 
Another bit of good news was that I went to have my knee checked out by my surgeon, and although I have to have some physical therapy, I am allowed to swing a club again. Not sure when this will be, as Christine is my priority at the moment. I have set up a hitting net and chipping green (pool) in the yard, so that should at least keep my hand in! 
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 Christine and I visited the new MD Anderson facility between Eldridge and Highway 8. It is pretty impressive! We had two appointments, one with Dr, Patel, one of the top dogs of the oncology department, and Christie Siebel the nutritionist. 
Dr, Patel, who is a really nice guy, gave us some excellent news in that he felt it was unlikely that Christine would need radiation therapy or chemotherapy. He confirmed that the cancerous lesion was limited to the gum and had not spread to the jaw bone or the lymph nodes. The final decision will be with Dr. Pytynia on Monday, but obviously, we are absolutely delighted with this news. 
We have been having a lot of trouble getting the "food" into her feeding tube. There seems to be a blockage somewhere between the nose and the stomach. We have been pumping, what seems like gallons of water through the tube to clear it. Obviously, this is not ideal. After some brainstorming and experimentation, it was decided that the best way to get the food into her system was to siphon directly into the tube, rather than use the drop feeder. So far this has worked really well. It is also a lot easier to administer, and provided we are careful with quantities it is a safe way to administer her food. 
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 Christine and I had a hectic weekend. Saturday was spent rearranging the furniture so that Christine could have a better view of the garden. I have to say it was worth the effort! We still struggled with the feeding tube but managed to have her consume her daily allowance. She is now sleeping very well now that she doesn't have to suction anymore. Big shout out to our nurse Yanet for providing the tip to help Christine swallow.
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Christine passed her barium swallow test with flying colors and is now without her feeding tube. She is now able to eat soup, ice cream, mashed potatoes without much problems. The highlight of the last few days was finding out that Christine will not need chemotherapy or radiation. This is the BEST news ever! Saturday night we will attempt to spend the whole night with her tracheotomy tube blocked off. If successful, it will be removed on Monday! As an "unbiased" observer, I am incredibly proud of how Christine has managed her recovery.
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Christine had a bit of a set back on Sunday. Out of the blue, her neck just above her trach swelled up, went very red, and started to leak. We think that whilst she was sleeping the trach cap rubbed on her wound and irritated it. We were visiting Dr. Pytynia on Monday afternoon to remove the trach as Christine had managed two nights with it capped off. Unfortunately, once she saw her neck she ordered another CT scan and told us to go home and prepare to go to the emergency room, just in case. We went back later for the results, and the diagnosis was that there was a small infection. The wound was packed to soak up the leakage, and Christine was given a course of antibiotics. At least no emergency room was needed! The downside was that the trach tube has to remain in until the infection has healed. Today we visited Dr. Garvey downtown, and he had a good poke around. He felt it was a small infection and with continual packing and antibiotics it should go away in a week or so. The only trouble is that nurse Andy has to get in there and get the packing into the wound. I have received training, in that I videoed Dr. Garvey doing it... Despite this we are in good spirits (mainly whisky for me) and are muddling along quite nicely.
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Christine is ready for visitors!!!! She has now been to sewing a couple of times, and, after trekking around the hospitals, is now becoming quite mobile. She had her first proper meal with John and Heather this evening. Andy continued with his spiritual journey and had a nice Bunnahabhain with John, and a Laphroaig later (excuse any sprelling mistrakes). Should you wish to see Christine, please send me a text (281-750-2417) to arrange a time - we still have doctor's appointments to take care of!
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Yesterday, Christine and I visited Dr Garvey and he reported that the infection and swelling in her mouth were healing well and in his opinion, the tracheostomy tube could be removed. After a call to Dr. Pytynia's team, a hastily arranged appointment was made for this afternoon. Sure enough, after some consultation, Christine had her tracheostomy tube removed. The remaining hole seemed to be about the size of a quarter, but with some glue and steri-strips was easily patched up. Christine still has to be careful when coughing and talking, taking care to cover the hole, as it can easily burst. The hole should mend in a few days, and in a week or so, be unnoticeable. This is a big relief and a huge step towards her recovery. In other news, Christine took a drive around the block for the first time in five weeks.
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Christine has had a quiet week really, bolstered by visits from Heather, Sue, Sinead, Lisa, Jayne, Doris, and Linda. We are overwhelmed by all of the support. It is hard to believe that Christine spent 10+ hours in surgery just 6 weeks ago. In terms of the recovery, Christine's infection has now healed, and her trach hole is now covered with just a band aid. We still have at least six weeks before the swelling in her mouth goes down, and then she can think about having new tooth implants. She is still on a very liquid diet, but this is a small price to pay. I cannot be more proud of how she is coping with this adversity. Our door is open if you would like to visit, and now Christine is driving again, she is more than happy to get out of the house to experience some new surroundings. Since there are no more doctor's appointments until the end of the month, I will report back then!
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It has been quite some time since I have updated the blog. The reason being is that we have been in the healing phase. Christine is doing great, although she easily gets very tired. She finds it more difficult to properly eat solid foods, and is mainly living on smoothies, and soft foods. She does manage to eat small portions of chopped up dinners. Despite this, she has resumed most activities, including driving her car, attending sewing, going to coffee mornings, and attending the odd dinner party.
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As far as the plan moving forward, we will see Dr Garvey again in early September, followed by an appointment with the dental team to determine a date to have the dental implants inserted. They will involve Dr Garvey reopening the gum, and will be done under general anesthetic as an out-patient. If everything goes according to plan this is likely to happen just after Thanksgiving.
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As far as the plan moving forward, we will see Dr Garvey again in early September, followed by an appointment with the dental team to determine a date to have the dental implants inserted. They will involve Dr Garvey reopening the gum, and will be done under general anesthetic as an out-patient. If everything goes according to plan this is likely to happen just after Thanksgiving. 
Christine and I have had lots of visitors, and we are very grateful for all of the support that has been shown. It was great to catch up with Mike and Judy McFarland. With Mike going through a similar surgery, their support through Christine’s ordeal has been fantastic. This was the first time that they have met in the flesh!
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It's two months since our last update and it's my turn to write this one (Christine). Progress has been good and I can now eat with a fork, and eat anything that can be cut into bite sized pieces. The swelling in my face has been addressed and my stiff neck now has just about full range of motion. I’m having physio on my leg to try to strengthen the muscles and make walking easier but I still get tired very quickly, although my stamina is getting better week by week. I just have to pace myself and not get too tired. 
Last week I saw Dr. Garvey, the plastic surgeon and he was very pleased with progress and thought it was time to touch base with dental in preparation for getting teeth fitted. I now have a date for oral surgery to expose the implants and begin the dental work. I’ll have a prosthetic, with 5 teeth, which will clip onto the implant abutments. Surgery date is 27th November – the day before Thanksgiving, so no dinner for me this year. However, that means I may have a full compliment of teeth by the end of the year. As. You can see above, we got to see X-rays of my jaw and all the hardware in there! I had no idea!! It seems the implants were put into the bone before it was cut from my leg – all done using a 3D computer model to get it all in the right place! 
On Tuesday I had a routine CT scan and today we saw my team leader (Dr. Pytynia) for the results. Not completely out of the woods yet. There was an anomaly on the scan but she thinks it may just be scar tissue from the infection I had in my chin. I’ll have an ultrasound scan next Wednesday to make sure, so another small hiccup but not worrying until we know for sure that it’s worth worrying over. 
I’d like to take this opportunity to thank all those people who have stood by us and supported us through the last 4 months (is that all it’s been??!) Thanks for your cards, emails and good wishes. Distance hasn’t made a difference to that support. I’ve had messages every single day from some (you know who you are) and they have been an absolute boost during the bad days. And here on the ground I’ve had super support from friends bringing us dinners, books, and things to do. Others have just been to chat and that too has made the days seem shorter. Then there were those who delayed their vacation until we were back on our feet, and those who traveled thousands of miles to spend time with us. These are the family we choose and we have chosen so well! We can never thank you enough. You have all been so instrumental in my rapid recovery and although there’s still a way to go, I know we can count on you all some more! 
There will be a small update next week with the scan results. Fingers crossed that it’ll be nothing to upset our plans to travel to UK in a couple of weeks.
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Christine received the good news that the anomaly on her cheek, was indeed scar tissue. This is a huge relief! We are heading to the UK for some well earned vacation, so our next report will be in November. 
I have great pleasure to report that Christine's lab analysis of the removed tumor and lymph nodes came back clear, and the cancer has not spread anywhere else!
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Sadly, the good news was short-lived. When we returned from our holidays, Christine had developed another tumor in her mouth, which turned out to be a recurrence of her cancer. The 2020 Surgery Blog covers the next episode.
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