"Aaaaand, you are holding"

If you've seen "The Way Way Back," then I'm sure you remember the scene where Nat Faxon keeps a PYT from going down the ramp by asking her for about a minute to "hold."

If not, watch this. I'll hold while you do it.

Also, if you haven't seen "The Way Way Back," go get it. Get it now. Watch it. Watch it again. Have tissues at the ready.

OK. Back to us.

So, we saw the surgeon today, Dr. Song. He and his staff were awesome, until you could tell that he had other things to do and he stopped listening to us, but I get ahead of myself.

First the nurse came in, took all his vitals and history. Then the physician's assistant and speech/swallowing therapist came in. The P.A. took more history and talked more specifically about the cancer. Then he decided he needed to do a bunch of unpleasant things, like sticking a tube up Vic's nostril to deaden the back of his tongue, then stick a camera up that to look inside, only to decide that he should have done all that on the other side. So he stuck another tube up Vic's other nostril to deaden his tongue more, then stuck another camera up his other nostril and root around in there to see what he could see. Vic didn't like this tube-nostril thing.

Then Dr. Song came in. First he reviewed the video from the tube-nostril thing. As the camera progressed through Vic's various body parts, he talked about what we were seeing. That was pretty cool.

Then he decided he needed to stick his finger in Vic's mouth to feel around. He used a numbing spray that he said would taste terrible, like a "funky banana." Vic said it wasn't that terrible. Then he put more numbing stuff on the cancer side of the tongue. He really didn't want Vic to feel anything as he was rooting around in Vic's mouth. Then he did a lot of feeling around, much of which was painful despite all that funky banana numbing. He said he didn't feel anything on the left side, and what he felt on the right was broad (2.5 cm, about an inch) but it didn't seem very deep. When Vic accidentally bit the doctor's finger, the doctor decided to stop feeling around. He said his finger is very important to him. I'm thinking if his finger is so darned important, maybe he should tell patients not to bite it before he puts it in their mouths. But I digress.

Then he reviewed the PET scan. Again, he showed how different things were "lighting up" on the scan. First, the brain, which showed normal activity. Vic made a brain joke, which the doctor did not appreciate, because he had a brain joke of his own ("So, Mrs. Love, he has a brain, and it works.") and thought Vic stole his thunder.

As he went through each layer of the PET scan, he described what it was showing--some inflammation in the back of his neck, noting in the lungs, nothing in the heart, nothing in the liver, nothing in the kidney, nothing in the bladder. We heard all that from Dr. Maymani (the oncologist), but it was nice to hear all that from a second doctor.

Based on what he can see on the PET scan, it's early-stage cancer, probably T1 or T2, for those of you familiar with the tumor grade classification system of cancer. This, too, is good news and was nice to hear.

After all this, Dr. Song started describing the surgery, which he said would remove a portion of the tongue (a "partial glossectomy," for those of you who like to look things up). (Again, this is good news—Dr. Maymani couldn't say whether Dr. Song would even perform the surgery.)

In the drawing below, there is a shaded circle on the right side—this is the cancer. (The shaded circle at the back is where the previous cancer was.) Then there is a solid line around it--this is the part the doctor would remove.

While Vic is still under anesthesia, a pathologist would examine the specimen to determine whether Dr. Song got all the cancer. (This is called having clean margins.) If he did, Dr. Song would close the wound, procedure complete. If not, Dr. Song would remove more of the tongue. This is the area shown by the first dotted line outside of the solid line. The pathologist would examine the specimen again, if it still didn't have clean margins, Dr. Song would remove more. Lather, rinse, repeat, until the margins are clean—that is, all the cancer is gone.

The next step depends on how much of the tongue Dr. Song has to remove. If he removes a bunch, then he'll also perform reconstructive surgery at the same time—taking a bit of flesh and tissue from other parts of the body to use as "filler" for the tongue.

Dr. Song also wants to remove the lymph nodes on the right side of Vic's neck. That's less of a problem—it's just an incision on the neck, remove the lymph nodes, close it back up.

Dr. Song does not believe he would need to take part of the mandible (jaw) as Dr. Maymani suggested—Dr. Song says the mandible doesn't seem to be involved at all. That is great news, because Vic was really worried about that.

Vic may also need radiation after surgery, but the dose would be much smaller.

Vic could do radiation before surgery—try to kill it that way, making surgery unnecessary—but the radiation would be a higher dose (with presumably higher side effects) and the surgery would be more difficult after radiation.

AND FINALLY (for this part of the story), Dr. Song also discussed what it would be like if Vic chose to do nothing. He said he couldn't say how long it would take to kill Vic, and it's a horrible way to die. "I urge you to get treatment," he said. We had talked about "doing nothing" when Vic was initially diagnosed, but Dr. Maymani also said it would be very painful and awful, so we took that option off the table at that point.

Then we asked some questions:

• Best-case scenario—the surgery where he takes the least amount of the tongue and Vic has no radiation after—what does that look like? He'd be in the hospital for three to five days, get some speech and swallow therapy, some follow-up visits, and he'd probably start to feel better in about four weeks.
• Near-worst-case scenario—the surgery where he takes the most amount of the tongue but Vic still has no radiation after—what does that look like? He'd be in the hospital for about a week, but he wouldn't start to feel better for months instead of weeks. He wasn't more specific about how many months.
• As for what happens if you add radiation to the surgery, we won't know until Tuesday, when we see the radiation oncologist Dr. Weeks.
• What effect will the surgery have on Vic's everyday life? None—he'll still be able to drive, walk, eat, swallow (although obvi the last two are with therapy), etc. The only problem would be if he had something go wrong during the surgery, such as a stroke or major cardiac event on the table. Dr. Song really felt that Vic has a good chance at a high quality of life with treatment. (Although his definition of "quality of life" might differ from Vic's.)

This was the point where I feel Dr. Song was starting to get frustrated with us. He kept asking if we had any questions, but he also kept looking at his watch. Vic was trying to ask good questions, but Dr. Song got a little fixated on thinking that Vic wanted to refuse treatment—like Vic was trying to decide whether he was going to even have treatment. And he kept saying "You should really get treatment." But Vic was just trying to get more information about what the recovery would be like so he could make an informed decision about which treatment to get. I get it—there are still so many "what-ifs" that it's hard for Dr. Song to give specifics, but I still feel he wasn't fully listening to Vic.

We finished the round of questions, and Dr. Song left us with Liz, the speech/swallowing therapist. She was wonderful. Here are some of the things we talked about with her:

• The base of the tongue (in the back) is the "powerhouse of swallowing." Dr. Song is not going to touch the back of his tongue, so he really shouldn't have any long-term swallowing problems. Obviously, the early days after surgery could be difficult—but long term, he should go back to normal.
• She was the one who told us that any reconstructions would take place during the initial surgery. I know we were thinking that he'd get the cancer out, and then he'd have to wait a while for reconstruction—but nope. It will all be on the same day. For me, this was more comforting.
• She also said the most common outcome is that the first piece he takes out is enough. It is uncommon that he would have to take a whole lot of the tongue.

The unfortunate thing is that we just can't know what is going to happen until Dr. Song gets in there. An MRI would make all of this more clear, but Vic can't have one because of his defibrillator/pacemaker. So at this point, we just have to make a blind decision.

After we finished with our appointment, we drove back through Denver to get home. (The doctor is in Aurora, people. AURORA.) And I thought it was kind of cruel that, in stop-and-go traffic, we had to follow this:

I mean, at one point, I thought, "I'm just gonna stop the car, run up to the van and ask if they have any cupcakes." But common sense prevailed, and I did not get out of the car on I-70.

So, where are we now? Well, we still need to gather a bit more intel first. Dr. Song wanted us to see Dr. Weeks and Dr. Maymani again, find out what they recommend, now that they have Dr. Song's opinion. We see Dr. Weeks on Tuesday next week, and Dr. Maymani on Wednesday.

So once again, we are in a holding pattern until we get the final tidbits of information and Vic decides precisely what treatment he wants to get.

Thanks for "holding" with us!

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