This will be the informational (a.k.a. boring) post.
Since our last "conversation," Vic has had several medical appointments:
Dr. Maymani
This is the best part of the story. You may remember that Dr. Maymani prescribed a short course of steroids to see if that would help bring Vic's platelets up. Well lo and behold, it worked! His first blood test had a platelet count of 187. And while the platelets were down a bit on his second test a week later (176), they're still high enough that Vic shouldn't have any platelet trouble with the surgery.
We see Dr. Maymani again tomorrow (July 22) to find out how the platelets are this week and whether we need to do any additional platelet therapy.
Nurse Katie
Our favorite nurse practitioner at Anschutz is Katie, who we've seen many times and who even gave us her cell phone number. She does all our presurgery visits, so we saw her for presurgery last week. I have nothing to report from that visit, but we love her so much, we always want to do a shout-out in the blog.
Dr. Julie Goddard and P.A. Jeannie Doyle
Dr. Goddard is Dr. Song's partner, and she will be doing the reconstruction on Vic's tongue. Jeannie is the person we'll probably see most often for follow-up visits. We've met her before, and she's amazing. This was our first meeting with Dr. Goddard, and we really like her too. Strong handshake—confident. Just the kind of surgeon you want.
We were very impressed with her preparedness. She has a Plan A (which, BTW, sounds awful—more on that later), as well as a Plan B, C, and D—and probably more. She has given Vic's case a lot of thought, and we feel like we are in good hands.
As I've discussed previously, Dr. Song is planning on taking up to half of Vic's tongue, so he will need "a little" reconstructive surgery to help him eat and speak. It didn't seem so bad—take a little square of skin from the wrist, make a tongue out of it. Piece of cake.
But we got the real skinny from Dr. Goddard's Plan A. Yes, they take a square of skin, but they make an incision all the way to the elbow to get the blood vessels (and an artery, I think?), then each of those blood vessels has to be connected to blood vessels in the tongue, and the blood has to start flowing well (this is called perfusion). Then they have to close the repair the damage to the arm, and arm skin is not very stretchy, so they will have to take a little skin (probably from the thigh) to replace the skin they take from the arm. (This is called a split thickness graft.) Dr. Goddard said this would be a superficial amount of skin, like if you scrape your knee on the sidewalk. I didn't want to remind her how painful it is when you scrape your knee on the sidewalk. I'm sure she knows.
(Plan B would be to take the skin and blood vessels from the thigh, and they would do that if they needed more skin for the tongue. In this case, they don't have to do a split thickness graft because leg skin is stretchier and easier to repair.)
She was very positive, even when discussing the worst-case scenarios. She said if he hadn't had any radiation before, she'd classify his surgery as "easy" (as is, she classifies it as "moderate"; definitely not "difficult") and expects his recovery to be on the "high end." She said their goal is to have him well healed and feeling good six weeks after surgery, although it will probably take three to six months before he settles into what they're calling his "new normal." There will likely always be some speech impairment, but it shouldn't affect his everyday life.
It sounded worse in the office than it sounds in these words, and Vic was pretty down about it when we left. I won't get into it here, because he is working on another blog post so you can see for yourself how he's feeling.
Next steps:
- Meet with Dr. Maymani to find out about platelets (July 22).
- Get a PEG (feeding ) tube placed (not really scheduled yet).
- Have surgery (August 1).
You'll probably see one more post before the surgery. I'll try to make it as scintillating as this one. ;-)
I'll leave you with this adorable dog video my sister posted on my Facebook today. Hope you like it as much as we did!
5 comments:
That soulful puppy is too much for me. Good Lord, he's cute. Vic, the details are daunting to hear, but you're worth every bit of complicated, surgical wizardry. All the limbs' involvement. All the letters of the alphabet. A plan Z. It's not surprising you have such a dedicated team... You two are the best and you make people want to give you their best.
Again Patty thank you for sharing so much of what you and Vic are dealing with especially explaining the medical issues that this cancer has caused and what your medical team is doing to bring Vic to a "new normal". I like that term "new normal"!
You know of course that all of us will be thinking of Vic during his surgery on the 1st. Will someone be with you at the hospital on the 1st?
Hugs to both of you. Having to look forward to a new normal is scary. I still sometimes morn my old normal. It reminds me to enjoy what I can do while I can. It also beats the alternative. I’ve also found gifts in my new normal. When speech and eating is more difficult, you become a better listener. I also find it easier to savor my food. Eating quickly is not an option anymore for me. A real plus is I can continue to eat whatever I want as I get older and I don’t gain weight. When eating is so much work you get tired of eating before you over indulge calorie wise. ��
Love the dog at the piano ... our cat, Shadow, not so much, she got down from the chair by the computer, and John is laying on the futon going to sleep. Anyway, it made me smile a lot :) It's great to hear that your platelets are up in number, thanks to the steroid. Maybe you should have a second dose of that steroid to really get you going! It's nice to know that your doctor has thought out multiple options, because in life, you always need a backup plan or plans as in your case. Looks like you'll be getting a new tongue, new arm skin borrowed from the thigh, and thankfully, they don't plan on borrowing from somewhere else to put the thigh back to normal. And then, you get a "new normal", we'll all have to see what that looks like. I bet you'll be able to eat lots of ice cream!
One big hug coming your way from both John & Debbie
GerRee: <3 <3 <3
Aaaaaaaannnnnne: <3 Yes--my sister and Vic's sister will both be with me at the hospital.
Erin: We were just talking about you today when it took Vic twice as long to eat lunch as it did me. ;-)
John and Debbie: Hahahahaha! And he just finished the second dose of steroids, so I'm hoping those counts go up up up! Ice cream--mmmmm--and hugs--thank you. <3
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