Thursday, May 05, 2011

Pre-Op Visit

It's about a week out I guess and the scheduler, Sarah, called to set up a pre-op appt (this happened a couple of days ago), so here I am again, in the doctor's office and of course there's a problem with AHCCCS and my other insurance and the bills and I think I'm going to die of stress related brain embolisms before I can be cured of cancer. Apparently since I don't have a Primary Care Physician I can't use this doctor with AHCCCS because I didn't get a referral from my Primary Care Physician that I don't have. That would be fraud, ya know, to go to a Specialist without getting a referral from a Primary Care Physician. I guess Tank forgot to port-load that program for me cuz I didn't get that training. All I know is I've been coming here for two months and now they tell me that the thing I told them day one (no primary physician) is now going to keep me from getting the surgery. Oh but wait, I have other insurance. Yes, yes I have Pizza Hut's meek little tic-tac of a health plan that seems poised to save my life, literally, simply by the fact that they can be considered my Primary Health Insurance Plan and the ADCCCS becomes my Secondary Insurance Plan, thus solving the dilemma of who referred me to Dr. Rothman. I think. No, as Kevin would say, "everyone's God willing". We figure it out by saying, "here, call this number tomorrow."

So it's not long of a wait and Marsha sits me in the scary dental chair in room 4. Rothman shows up maybe 5 minutes later, smiles and shakes my hand warmly, which is so not like his previous meetings with me.

So he pretty much starts out by saying that this should go about as smoothly as my biopsy, as far as I was concerned. I'd meet him for a few minutes about a half hour before surgery. I'd meet the anesthesiologist. The nurses would give me an IV and ask me a bunch of questions, then they'd wheel me out and down the hall and the next thing I'll know is I'm waking up in ICU. I won't have any tubes or hoses in my nose or mouth. I will have a breathing tube installed, along with a feeding tube, as I won't be able to swallow. I imagine the breathing tube is for the swelling in my throat from the surgery which probably wouldn't allow me to breathe normally.

This all takes place on my right side, left if it's your point of view. He explained again how normally he would go in through the mouth with robotic surgical tools, but my kind of tumor prevents that. So he has to take apart my jaw on that side, which will be repaired with titanium. He indicated the chin area when speaking so I would think that's where the bone is broken so that half of my jaw can just be kinda moved out of the way. This also includes slitting me from collarbone to above my ear and probably up my chin to, and maybe including, my lower lip. It's called Radical Neck Dissection. Do not google that.

Once he can get at the tumor from all sides he'll remove it, the idea of course is he'll remove all of it. This will leave a tumor shaped hole in my face which must be filled. Tissue and muscle will be taken from my chest, which I described before, but what I learned today makes it cooler. The tissue and muscle will be moved under my skin. They kinda snake it up under my skin, past my shoulder and up into my neck and jaw area, with all the original attendant nerves and blood vessels still intact, so that it is my own live tissue being used to rebuild my neck. If they had gone with the other procedure, the one I really wanted, they would have had to painstakingly rebuild the circulatory network, I guess by matching veins with veins and arteries with arteries and nerves with nerves and so on. If he'd explained that the first time I totally would have gone with the chest method.

Then it's sewed back up and into ICU. Day 2 they'll get me out of bed and walking around. I told him all I cared about was being able to pee standing up. None of those bedpans. He said I'll spend 7 days in the hospital. Day 3 they'll probably start me on physical therapy for my chest, shoulder and neck.

I ask him if I should start looking for an oncologist and he says no, he's an oncologist. This is all he does. When the time comes, if we need to add a little radiation or chemo to the plan, he can take care of all of that. Arranging for a Radiologist or a Chemotherapist(?) He's said it like that a number of times; "If we need" radiation or chemo after surgery. It's encouraging. He tells me to call him if I have any questions, that he will call me back if he's not able to talk at the time and I believe him. Very reassuring. In fact, the whole visit was more encouraging than any previous one. More than all rolled together. And I still could barely keep from falling apart when I left. I think it's the holding it all in while we're calmly talking about breaking my jaw and swinging it out of the way like a gate on a fractured hinge, right after my neck has been cut open like a frog tied down with pins, so they can scoop out a golf ball sized piece of my neck and then pull some chest meat up under my skin to fill in the hole.

Sat in the parking garage and called dad to tell him about the meeting. Find out that my kid is now employed. Woot!

I forgot to ask about the blood stuff - my mom and dad want to try to donate blood if it's needed, and Kaia's friend Alix did too, but I forgot to even ask if it's even an option, if it's needed.

Overall I feel much better emotionally than I have for the last few days. Sorry if I've been grumpier than usual.

Oh yeah, sorry Kevin, I shoulda told you that I was going to get some awesome food. It was kinda spontaneous. I couldn't really help myself, Mikado was on the way home and well, tuna tataki! I'm not going to get my hopes up too high, but if I don't have to have radiation, then my fear of losing my sense of taste might not even happen.


Colleen said...

Glad to hear you are feeling more secure with your doctor. Are they going to have a cranio-facial surgeon on hand?

Guy said...

Dr. Rothman is the man. I don't know who he plans on having assist, if any, but I was left with the impression that he's the guy who's doing it all. He would have had a plastic surgeon to help with the 'arm tissue' method, which he was coordinating with when we found out that guy won't take AHCCCS. He had said in the first meeting that if it was the chest version, he could take care of it all himself. He's a surgical oncologist specializing in head and neck cancer. He says this is all he does, all day every day.