What the fuck is on my neck!!

Ryan, July 2016

We are going to do this 2 different ways. First, Ryan will give you the facts of his story and his reaction, then I (Carmen) will add in my thoughts and feelings. My thoughts will always be in green. Ok, Let's go!

October 24th 5:07 AM: I'm working hard at the rowing machine next to my wife, Carmen. We had recently rejoined the Knoxville Farragut Orangetheory gym and had been enjoying it immensely. During the warmup period: the stress of the full-bodied pull on the rowing machine made me aware of a different and unusual pressure on the right side of my neck. I paused for a moment to feel the area with my hand and noted a bulge. Turning to Carmen next to me I pointed to it. She gave me the "what are you talking about" look, and I had her stop to feel the lump. After she acknowledged it, and we noted its importance, we continue the hour-long workout.  For me it was a definite, what the fuck is that moment. I knew it wasn't normal and told him we needed to get him into the doctor right away.

Immediately following our workout, we called our Primary Care Physician for an appointment. We managed to get an appointment at 2:30 that afternoon at Tennova in Turkey Creek. At our appointment, Christina Shuey (Physician's assistant) examined me. She noted the lump, which at this point was the size of a golf ball under the skin of my neck. Christina and I discussed her concerns, and she referred me for an ultrasound immediately. The lump was firm and unyielding. It literally felt like a golf ball It had grown to its current size in a matter of hours. The ultrasonic testing was completed under Carmen's watchful eye. Carmen was concerned about the fact that the mass seemed to pulsate with my cardiac rhythm. Having seen quite a few ultrasounds, I was actually noticing that there were 2 lumps showing on the ultrasound and how large they were (3cm and 2 cm). I also could see the blood flow through the carotid and jugular and could see that area being compressed.   Following the imaging and before we even got home from the appointment, we were notified that our case had been referred to a surgeon. Rather than feel comforted by the quick response from our medical team, I was concerned about their need for urgency.

Happy fucking birthday tumor!

October 26th: The surgeon requested a CT scan prior to our appointment. I had this imaging completed immediately. Once the surgeon reviewed the imagery, he deferred my case to an ENT specialist. The two masses were confirmed as 3+cm and 2+cm. At this point I'm extremely worried. How do I combat my anxiety? Humor of course. I named his large primary lump Angus. The secondary lump which wasn't as visible was named Rupert. Outlander fans will get it.

October 30th: Appointment with Dr. Hayes, ENT specialist. Dr Hayes examined my neck and throat. He conducted an examination of my throat and nasal passages. Post examination, he discussed the next course of action. The most likely causes of the mass was a non-malignant mass or a carcinoma of some sort. During this examination, I felt Dr. Hayes was extremely professional and straight forward with his thoughts. He referred me to a pathologist for a biopsy of the mass. Nice guy. He had a better name for the non-malignant mass. I just can't remember it. Something to do with an infected saliva gland. He gave Ryan some antibiotics to start right away in case the biopsy showed this as the problem.

November 1st: Carmen and I found our way to the poorly marked office for the Cytopathologist office in the Parkwest hospital center. Dr. Smithey was a very personable doctor who explained the Fine Needle Aspiration Biopsy (FNA) we were preparing to conduct. He procured samples of tissue from my neck by first numbing the affected skin with a freezing spray and then jabbing a needle into the mass repeatedly until he had enough of a sample. This was repeated 3 times, the last one being the most uncomfortable to endure. Dr. Smithey then examined the samples to ensure he had an adequate volume to examine. His initial analysis was disturbing. He had told me that he would give me his unofficial thoughts about what he saw under the microscope. Of course more testing is needed before he could say for sure. He noted there were abnormal squamous cells but was unable to make a definitive diagnosis, thereby, making an additional three samples necessary. The next day we got the official word that the tests were inconclusive making a surgical biopsy necessary. This was scheduled for Monday, 6 November. The knot in my stomach just got bigger.. all I can think about is oh fuck, oh fuck..

November 6th: Surgery day! Throughout the weekend the mass in my right neck seemed to solidify and grow. My attention was directed at every moment to its existence. The discomfort would grow throughout each day in my right jaw and ear (making him much crankier). I was very excited to get the mass removed! The plan was once the mass was removed, it would be sent out for biopsy. The process of waiting for the surgery was painful. Once at the surgical center, we had the usual signed in, paperwork, and pay the nominal fee required. Who talks like that, Ryan? Nominal fee.. we paid the co-pay.  Thankfully, they accepted TRICARE insurance. Once they took me back to surgery pre-op, it was a solid hour before the Anesthesiologist and surgeon came out to discuss the procedure. After that, things moved swiftly. They wheeled me into the surgical room. I recall the final preparations before they administered the anesthesia. My last recollection was of telling the OR staff "Ok, I can feel that".

After surgery

Coming out of the haze is, as can be expected, hazy. The OR staff were entertained by the double single finger salute I provided when asking how I felt. Upon finding a better sense of the world, Dr. Hayes came out to talk about the surgery he had just conducted. The tumor he removed from under my right mandible was about the size of a tennis ball. It was wrapped around my Jugular vein and Vagus nerve. This proximity to vital areas in my body were of concern to the surgeon. Upon my consciousness from the surgery, Dr Hayes asked that I smiled. This was a test to ensure that my vagus nerve was not damaged. He didn't know this until I told him.

Dr Hayes took me to one of the family rooms to explain what had been done during the surgery. What he had removed was actually 3 different things that had kind of fused together. There was a cyst type mass that was directly under his mandible. It had become attached to 2 of his lymph nodes which had turned necrotic. He said the overall tumor had grown little finger types and were securely attached to the jugular/vagus nerve. It was about the size of a baseball in his hand. I jokingly asked him if he got any pictures of it that we could show Ryan which of course the answer was no. He told me that he would ask Ryan to smile to make sure no damage had been done to the nerve going to his face. Once I heard about the fingers, I was pretty sure we were dealing with cancer. No time to grieve though. I know I need to maintain a stoic exterior for my husband. After taking him home and putting him to bed, I started my run to fill prescriptions and get some kind of soup for Ryan to drink. 

Post surgery November 10

Post surgery November 17

The next few days were full of the expected post-surgery pains and aches. Dr. Hayes did a marvelous job with his needlework and the incision quickly mended. I followed up with him a week later and he was mostly satisfied with the operation. There was more swelling at the operation site than he was happy with, but he was confident that the fluid under the incision would reabsorb into my body. He attributed this to not putting a drain in for normal post surgery drainage.

November 9th: The biopsy results were finally given to me when I was driving to work Thursday morning. Dr. Hayes confirmed it was squamous cell carcinoma. He said if I has to pick a type of cancer, this would be a good one to pick (WTF?). I wasn't exactly productive that day as this news dominated my thoughts. We thought we would get the biopsy results by Wednesday at the latest, but it was actually Thursday. Ryan had apparently gotten the phone call on his drive into work but didn't tell me. I had sent him a text about 13:29 and asked if he had heard anything. His reply was "Yes. We will talk about it when I get home." I thought, well, shit.....