Surgery - What's to Come

'what's up, doc?'
On Wednesday morning, we visited Dr. Yueh at the University of Minnesota. He clarified a few things for us.

Thankfully the tumor isn't encasing Andrew's carotid artery, although it is up against it, which is perfectly fine for removal. Additionally, he does believe the tumor is against the important nerves, but it doesn't matter anymore, because he believes he has to completely remove the right side of Andrew's tongue, so he doesn't need those nerves anyway.

Also, our surgeon last year, Dr. Futran, called that night and his opinion is in agreement with that of Dr. Yueh.

Dr. Yueh will perform the surgery next Thursday, March 20th. His specialty is tumor removal, which is what is most important to us, and we feel confident he can do an excellent job. Additionally, after following us the past few months, he is most familiar with our case out of all the doctors. A woman, Dr. Lassig, whom he highly recommends, will perform the reconstructive surgery immediately after he finishes. We will check in around 5am for a 7am surgery.

There is a great range of possibilities how they may proceed in surgery, because it's really so difficult to know what's going on in Andrew's body unless they've opened him up and taken a look in person in real time. Here's a lay person's explanation of what a CT scan looks like: It's kind of like an x-ray, you know on dark paper, but in addition to your bones, muscle and everything in your general anatomy light up. When there's a bump or another mass than your normal anatomy in the un-silhouette, then it's likely cancer. An untrained eye probably wouldn't notice a cancerous tumor, because it can be as small as 1 cm (anything smaller doesn't show up on the scans). It's very difficult to discern, however, what is an unusual mass in Andrew's scans, since everything in Andrew's mouth and neck anatomy are unusual. There's scar tissue in some places and then stuff missing in other places. What's tumor and what's just scar tissue?

So they have to surmise a lot of things, based on the scans and physically feeling into Andrew's mouth and touching his neck from the outside, using a tube to look into him with their eyes. Based on his symptoms, such as increasing pain in his ear (there is a nerve that connects from the ear to the tongue), increasing difficulty swallowing, and only within the past few weeks, a bump in his neck, they do not think the cancer is just in one contained mass. In addition to a mass, it seems like the cancer spots the floor of his mouth and tongue. And so they'll have to remove all around the spotty area.

So the first thing they are going to do when they open Andrew up is a bunch of biopsies again to double-check that all the areas they suspect is cancerous. Then they will put the samples under the microscope.

If the biopsies look questionable or negative, then they will have to stop proceeding and close him up.

They cannot remove all that stuff unless they are absolutely certain it is cancerous. But it will take a few more days for the samples to come back with a definitive result. For instance, at Andrew's last biopsy a few weeks ago, when they immediately put it under the microscope, they said it just looked like scar tissue. But when the definitive results came back a few days later, it turned out to be malignant for carcinoma.

Please pray that the biopsy will be correct during the surgery.

I wouldn't want it to come back questionable, then close him up, and then a few days later they say it is positive and they still need to do the surgery, but they can't fit him in for a few weeks. We do not want the tumor growing any more and we want to get this thing out as soon as possible.

Due to the fact that Andrew got cancer at such an early age, and since surgery, radiation, and chemotherapy were not successful, this tumor is clearly very aggressive. Not in the sense of growing as quickly as some types of cancer, but in the sense that it does not want to give up easily. Thus, Dr. Yueh wants to aggressively cut out as much as reasonably possible, since chemotherapy and radiation are not liable options for treatment.

The next step in surgery are the following possibilities:

Best case scenario:
Remove the rest of the right side of his tongue. In addition, remove the floor of his mouth. Replace it all with a chunk of his forearm. The result is his speech may be as good as it is now but his swallowing may be greatly affected.

Worst case scenario:
Remove the entire tongue, floor of the mouth, and the right jaw bone. For reconstruction, again, they will use a chunk of the forearm. They will use the fibula from the leg to replace his jaw bone. Then they will use some of his thigh to cover the forearm and leg. This may cause him arm and leg pain and even a limp. He may be able to eventually talk (though difficult to understand), but being capable of swallowing is questionable.

Andrew becoming Robocop and being rebuilt sounds so surreal to me. It sounds more like a sci-fi movie then something that could actually happen in our lives.

Pray that the cancer is contained enough to only require the easier surgery.

Surgery will be much more extensive than last time. They will have to navigate through scar tissue as well as figure out where Dr. Futran had moved various nerves and other anatomy in Andrew's neck. One good thing is that at least Dr. Yueh is very familiar with Dr. Futran's work.

Additionally, reconstruction will be required, which it wasn't last year. The forearm is used as a pseudo-tongue and floor of mouth because it is the most veiny part of the body and has the most success with being reattached to a different area. Reconstruction is very meticulous, as Dr. Lassig reconnects the various veins of the forearm with the veins in his mouth. Last year's surgery was 4 hours. This time it will be a minimum of 10-12 hours.

Andrew should be in the hospital for up to two weeks and then it should take at least an additional month to heal. Of course, learning how to speak again and stuff will take months.

'what are you two laughing at?'
I'm so thankful for the sermon last Sunday (Scroll to bottom of page and Click on Prayer for Healing March 09, 2008) about what God's Word says about healing. I feel so convinced like never before that the life of a man is completely in the Lord's hands. That truth really prepared me for this last week's doctor's appointments. I mean, I would have said that before, but my anxiety, fear, and doubt would have betrayed otherwise. Of course, I still struggle, but in the moment, the Lord provided all the grace we needed to hear what the doctor's were going to do. When we go to the Lord, the weaker we are, the more strength God provides. Sometimes, I feel like God is providing so much strength, and peace, and joy, I don't even feel like myself. I feel like a totally different, hopeful person. In the days of those appointments last week, the Lord gave me such certainty that the life of a man does not rest in the hands of a doctor. And if you've talked to as many doctors as we have, a doctor doesn't even pretend to think he holds a man's life in his hands. He knows from experience that it doesn't. He can do the best job he can, but the results are unpredictable. And so it hardly mattered what the doctor said, because he doesn't have the final word.

"I know that You can do all things, And that no purpose of Yours can be thwarted" (Job 42:2).

The length of a man's life was written before time began. And Andrew's health and the various things that happen to him are also in God's hands. Yes, nothing can thwart the sovereign hand of God.

Truthfully, I was floating when they told us all this information Wednesday, because I was like, "Well I'm expecting a miracle and they're not even going to find cancer in him."

Then I thought, "But, Grace, how are you going to prepare if God says 'no' to your prayers? Are you only going to have the length of the surgery to prepare mentally when the surgeon doesn't come out to tell you the good news?"

Then I thought, "Just relax, Grace. It's good for you just to be hearing what the plan is. That's orientation in itself."

And slowly, what they told us has been sinking in as we make all the preparations. Andrew's parents will be arriving Tuesday and his mom will be able to stay with us for the next six weeks. I stocked up at Trader Joe's and we've been trying to get everything squared away that we won't be free to do in the next two months, like filing our taxes, etc.

We still had to laugh about it, though. I said to Andrew in the car. "Andrew, when they open you up, Dr. Yueh's going to be like, 'This doesn't even look like cancer --'"

Andrew finished Dr. Yueh's sentence for me: "A gummy worm? What's that doing in here?"

"Oh that Dr. Futran," I continued for him. "I keep telling him not to eat his gummy worms in surgery."

grappling
I have to say, on Friday, when Andrew mentioned in hardly a phrase the possibility that cancer could overtake him, my mind's eye raced with images. My spirit was crushed. I had never considered the possibility this time around. After cancer last year, we lived with uncertainty. But uncertainty is much better than thoughts about death. Uncertainty means we don't know what the future holds, but we do know what's right in front of us, which is Andrew, alive, right this moment. So I asked my brother-in-law/pastor last night when we had dinner with his family, what should I do if God chooses to say 'no' to my prayer for miraculous healing. He said, "We have to remember that if God chooses not to heal Andrew, it's because He has something better instead."

It was such an encouragement to hear that. Praise God because His sovereign will is always kind and always for His glory, which, when it comes down to it, is what all believers long for most of all.

He reminded me, too, that God will provide the grace to handle then what happens during surgery. But not before. His grace is sufficient for today, but not tomorrow. Tomorrow has enough cares of its own. Don't we believers need to be reminded the truth over and over? Don't we sometimes feel so weak, we just need someone to tell us what to think, we don't even have the strength to know up from down?

We are praying for miraculous complete healing before the surgery. I know God can do that. If He chooses. For as many tragic stories we've heard, having been through cancer last year, we have been a magnet for just as many positive stories. God still heals people today. Our friend, Erik Greene, is just one example of that. He survived three leukemia bouts as a child. Doctors study him because there are hardly any others like him. And then last year, the night before he was intending to meet with Andrew to encourage him, he was unexpectedly raced to the emergency room. They didn't believe he would survive the night. He fell into a coma but survived. After a few weeks, one doctor said his wife should unplug him. Well, he is living and walking around and with his wife and four kids right now! And there are many other stories of hopeless cancer cases, much worse than Andrew's, after the elders prayed for them, inexplicably going into remission. At our church, we have all been constantly repenting of our unbelief and begging God to heal Andrew miraculously. Please join us.

Please pray for HAS a tongue:

* HEALING
- MIRACULOUS total and complete healing once and for all before the surgery

* ACCURATE INITIAL BIOPSIES

* SURGERY
- EASIEST surgery would only be necessary (if God chooses not to heal him miraculously)
- SUCCESSFUL surgery completely with no mishaps

The following message is such a blessing and has changed everything for us. Please click HERE, Then scroll to bottom of page, and Click on Prayer for Healing March 09, 2008. We all need to listen to this Biblical preaching on what God says about healing.