Going Commando

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A light-hearted view of a dark process.

Dedicated to:

My doctors – for saving my life

The staff at St. Clair’s Hospital – for helping to save my life

My son and especially my adorable wife – you have saved my life – you are my life

Preface

I began writing this ten days post-op in my hospital bed. These notes are some of my thoughts over that time and about events that are happening and continue to happen.

The surgery and follow-up was difficult, but I have found not all was bad. I think events like this help us delve into our humanity.

These writings are in no way to be construed as diagnostic, therapeutic (except to me!) or as medical advice in any way. If you are experiencing neck, mouth, throat or tongue problems or believe you may have a medical problem like cancer, please see your doctor as soon as possible. Quicker detection and treatment greatly increase your chances of survival.

Cancer IS a treatable disease.

GOING COMMANDO

I don’t go ‘commando’ (sans underwear) anymore. I’m much older and wiser ( a little scarred) really enjoy foundation wear.

The zipper is a wonderful invention. It’s an efficient and ingenious device to open and close two pieces of fabric. It’s used in all types of ways. NASA uses them in space suits to hold back the danger of space. However, with only a split second of inattention that same zipper can become a 150 metal toothed and merciless monster. From just a second of distraction after finishing the ‘job’ in the men’s room, that unprotected male appendage while going ‘commando,’ can become the focus of great attention, an embarrassing trip to the emergency room and contrite explanations to our significant other when the marks become visible. Jason and the Argonauts hunt for the Golden Fleece was to find some really good underwear – they must have anticipated the zipper.

In addition to have previously gone ‘commando,’ I have also been a commando; okay at least I trained as one.

In the late 1970’s, while stationed to Canadian Forces Base Petawawa as an Air Force Medical Technician, I was selected for for promotion by being given an Air Force Junior Leadership course of instruction. But this was scheduled for a year in the future!

This “Air Force” leadership course consisted of taking some classroom work on the principles and applications of leadership and management. Normally it is delivered in a bucolic campus type setting over five weeks and ends with a small two day “exercise.” This “exercise” consists of students taking turns leading small parties to complete simple tasks such as pulling a truck from a ditch or building an outdoor shower: all very civilized.

However, I was much younger and far too anxious to wait a year for this course and promotion. So, I asked to take the army equivalent course called a “Combat Leader” course at my current base of Petawawa: home of the infamous “Airborne Regiment” and the “Special Service Force.” I could be on course in just a couple of weeks. I thought, ‘how different could it be?”

I quickly found out it could be very different. Firstly, it was eleven weeks long (not five) and I don’t recall actually being in a classroom much: other than to be told we won’t be spending much time in a classroom or even indoors for that matter.

What I do remember was lots of guys with really short hair, lots of yelling, running, push-ups, patrols, more yelling, shooting guns, no sleep, yelling, digging trenches, being cold and of course being yelled at. Amongst all that, remarkably, I do remember someone actually teaching us about Maslow’s Hierarchy of Needs – it just didn’t seem to fit with what else was going on.

Towards the end of the course, culminating in a massive four day (and four night) battle exercise, due to previous injuries of the good and ‘real’ soldiers, I found myself at the top of my section which meant I had to assume one of the main leadership roles for this exercise – which was actually a competition to find the best student leader.

This exercise consisted of four stages of a war with each stage a leadership role: deployment to operation area, initial attack and hold of captured hill, tactical withdrawal after enemy counter attack and finally our finishing and overwhelming counter-counter attack and victory!

Of course, I was selected for the tactical withdrawal. Keep in mind, the army never retreats: they only “advance.” So a tactical withdrawal is what they do when met by a superior force. They make an about turn and “advance” in the opposite direction: it is not, they insist, running away.

I could see what they were trying to tell me, “okay, if for some strange reason you find yourself the senior commander of a group of real soldiers, our advice is to get the hell outta there – and here’s how….”

In the end, I placed number four out of four on marks for leadership on that exercise. I do, however, take solace in the knowledge that I got all my men out so they could fight another day: and we didn’t run away, I swear!!!

The 'Commando' I now find myself involved with is a complicated and invasive surgical procedure to the neck, throat and chest: it is brutal. The term ‘Commando' is not really a surgical term but to refer to a range of separate procedures. My surgeon informs me that the term “Commando” is used as it was similar to a type of surgical procedure used on soldiers during WWII, Korea and Vietnam.

A solder often needs to know what is over a rise or around a corner. Unfortunately, that means he often leads with his head and face: putting it harms way. These types of injuries require extensive reconstruction usually to the face, jaw, teeth and neck. The whole set of surgeries to these ‘commandos’, was extensive and usually disfiguring – but it was better than the alternative.

The Commando in modern surgery is usually used to treat lesions of the mouth, tongue or neck: often as a result of cancer. Typically this operation consisted of several procedures: neck dissection, mandibularotomy, major pectoral flap and usually a tracheotomy to ensure an adequate airway as a result of swelling.

I will spare the reader full details, but if you are interested try googling commando throat surgery. Please be warned that these sites have both graphic text and photographs of actual surgical procedures: I really don’t advise it…. Squeamish readers may wish to pass….

In my case the reason for this surgery is throat cancer. About two months previous I went to my family physician with a feeling like I had an unpopped kernel of corn stuck on inside of my throat and I could feel a small lump just under the throat tissue.

Within two days, I was seen by an ear, nose and throat specialist (pretty fast I think) who booked me for a needle biopsy the next week that came back “inconclusive.”

The next step was a day surgery resection of the lump and a tonsillectomy of the adjacent tonsil. All to be sent for biopsy and this came back positive for cancer.

I’ve heard that two of the most uncomfortable ‘childhood’ surgeries for an adult are tonsillectomy and circumcision. Well, I’ve now had one of these and plan to take good care of the other to ensure I don’t have to that other discomfort! I expect that could “sting.”

About two weeks after recovery from that surgery I had a C.T. scan to pinpoint areas for radiation treatment. Unfortunately, that scan revealed the possibility of several lymph nodes being affected. Yet another needle biopsy came back “inconclusive.” Given that it showed the cancer had spread, there was only one option: cut them out!

On that news and what the surgery would entail (see above hyperlink – if you dare) I felt much like a deer must feel in the headlights of an oncoming tractor-trailer: an impending doom.

After the news my wife and I were left alone in the office while the staff began the arrangements for the surgery. For the first time in many years, I had a good cry: I was glad my wife was there.

Oddly, I wasn’t greatly upset about the news of advanced cancer, but more so about the surgery. I knew what was ahead and that I was going to get very uncomfortable very soon.

That the cancer didn’t greatly upset me I think was because I knew it was something I couldn’t do anything about. Usually throat cancer is due to smoking. As it happens, I’m the only one in my family who doesn’t smoke. My mother died of lung cancer and my father died of emphysema both from heavy smoking. Ironically, all my siblings, older than me and who have smoked all their adult lives, are fine. Anyway, perhaps I was just predetermined to get cancer or maybe it was from the second hand smoke I’ve been around all my life. In any event, there is nothing I can do to change this.

Anyway, I was scheduled for my ‘commando’ within the week. Probably just as well since I didn’t get much time to dwell on it.

My surgery went well I am to understand. It turned out there were six tumours and had spread to my lymphatic system -yech! The staff at the hospital were great though. However, it was a period I would just as soon forget. It seemed like I had tubes out of every part of my body. I couldn’t talk and I had to breathe through my ‘trache’. I was fed by a tube through my nose and had to have emergency surgery to remove a blood clot that was affecting my breathing. One of the highlights, though, was the morphine. It really does work well. It didn’t really take the pain away so much as it rather made me not really care about the pain.

At one point during my hospital recovery, when they were trying to teach me how to eat again, it was discovered that my swallowing was completely messed up. Anything I swallowed went both into my stomach and into my lungs. Pneumonia was now a grave concern, so I ended up getting another tube directly into my stomach through my abdomen. This would allow me to eat without needing a nasal tube so I could eventually go home. All in all because of the complications I was in hospital for over a month. It seemed like an eternity.

I mentioned that the staff were outstanding: always attentive and understanding. I don't think it's a job I could do.

I finally made it home – what a relief. I think the thing I most missed was my own bathroom! My next big adventure was radiation.

My radiation therapy lasted six weeks of daily radiation. This consisted of being strapped down to a table with my head immobilized (and since it was bolted on to the table I could not get out of on my own) and then massive doses of radiation was directed at different parts of my head and neck to destroy any tissue which may have lingering cancer cells.

Some people fly through this treatment with few problems. I wasn’t one of them. I basically spend the entire six seeks always feeling like I had a massive hangover and wanted to throw up all the time even while prescribed with three anti-nausea medications. One time while strapped to the table I did throw up. Now that was awful. I felt myself drowning during the moments it took my therapist to realize what was going on (through a video monitor outside the room) and rush in to release me. Scared the crap out of me. At this stage I just about quit the radiation. I thought, ‘what could be worse than that’.

However, I went back, taking one day at a time. I tried to block out everything during that time. I really don’t have much else to say- except I don’t want to go through that again.

The radiation might have killed my cancer (here’s hoping anyway), but it caused problems of it’s own. My swallowing and speech are worse now so they have me on speech therapy and nutrition counselling. I’m speaking better and holding my weight level. The worst thing though, I think, was that the radiation pretty much destroyed my salivary glands. I had no idea how much fun I used to have spitting. One of those things you don’t really think about until you lose it.

Now everything I “eat” must be liquid and mush. If it’s dry at all (I mean if its not mostly liquid) it’s like eating drywall chalk. Hopefully, this will improve: sometimes it does. Both my wife and son love to eat. They were always teasing me by showing me what great junk food they are eating now: Christmas was the worst. But that’s okay ‘cause I got them back by lifting my shirt and showing them my stomach tube. That always got them to run away!

I’m told my recovery will take at least a year. It is probable I will never get back to 100%. I’ll never grow my right pectoral muscle back and I may never get my salivary glands to work again. Normally, the life expectancy after five years for this type of illness even with treatment is a bit less than 50%. However, many of those people are smokers. Many of those continue to smoke and carry on with a lifestyle that may not help in their recovery. It’s my hope that by taking care of myself I can stretch it out for many years.

Currently while recovering, my day is filled with puttering around the house doing some light housework (I like to feel useful), I play World of Warcraft a bit (my son got me hooked) because when I play I don’t remember feeling any pain (there is very little time I'm not in pain) and I have started proofing books for the Gutenberg project (something I’ve always wanted to do – but didn’t have the time).

Check out my Proof-reading blog to find out about the Gutenberg “Distributed Proofreading” process and follow how I’m doing.

Just to let you know Nerill is the name of my main Warcraft character: a demon specked - level 80 – gnome - warlock. Warlocks love books!

Bye, Nerill

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