Month: November 2015

Today is Thanksgiving Day in the US. Between this morning’s cases I had some moments to ponder on a consultation I had with a patient a few days ago. One of those conversations that is like a glitch in the matrix, seared into my conscience.

 

Here I am In Canada, far away on the other side of the hemisphere from where I used to be in Australia. I sat with a patient in clinic. People were speaking French behind the door and there was snow falling outside. The view through the window is magical. This gentleman in his 70s sitting in front of me is 5 years away from his treatment of mucosal melanoma of the oral cavity. For a head and neck surgeon, that is significant. Mucosal melanoma is an invariably fatal disease. It’s rare and it gets less media attention compared to its deadly cousin, skin melanoma. The survival statistics is bad. The five year survival rate is about 20%, that is, four in five patients will not be alive 5 years from diagnosis. After his diagnosis, he underwent a major head and neck resection. This was a major deforming surgery that often last 6-10 hours. Some doctors call operations like these ‘horrendoplasties”. Often the question is asked if the treatment is worse than the disease. With such a poor outlook, why, bring someone through such a massive surgery? He has a bigger chance of being dead than alive in a few months.

 

Because this week he sat in front of me and said, “I am thankful to be alive.”

 

Like a ton of bricks, it hit me again. This is why I do what I do. This is why I love my job. This is why I devote so much of my time learning to treat head and neck cancer. This is why I train so long and hard. This is why I do the late nights, the incessant oncalls, the long trips to conferences. This is why I stand for 6-10 hours sometimes to finish the job in the operating room. This is why I rely on a team of head and neck cancer nurses, radiation oncologists, medical oncologists, anaesthetists, speech pathologists, dietitians, etc.

 

It is an incredibly awesome privilege to hear my patients say, “I am thankful to be alive.”

 

Happy Thanksgiving Day.

 

Be thankful.

Here’s what I’m wishing for my patients:

 

Ear

Waterproof hearing aids that do not rely on batteries.

A tablet taken in the first trimester that would eliminate the development of congenital ear malformation.

A percutaneous, image guided insertion of a cochlear implant under local anaesthesia.

A pill to eradicate otosclerosis and acoustic neuroma.

A trans tympanic suction device that would extract cholesteatoma.

A fibreoptic trans tympanic device to microscopically inspect the middle ear.

An ultrasonic lithotripsy device to eliminate otoliths and BPPV.

A once off nasal spray to cure Meniere’s.

Tissue engineered ear drum.

 

Nose

A once off injection to desensitize the nasal mucosa and ablate polyposis.

A nasal spray that would shrink the inferior turbinate.

A microscopic robotic fibreoptic device for sinus surgery, transsphenoidal pituitary and anterior cranial fossa surgery.

A small cream application to expand and stiffen the nasal aperture and eliminate nasal obstruction.

 

Throat

A once off inhaled medication to prevent tonsillitis, pharyngitis, laryngitis.

A tablet to reduce the size of tonsils and base of tongue to reduce OSA.

An inhaled medication to eradicate vocal cord polyps.

An antiviral tablet to eradicate laryngeal papilloma.

Stem cell and tissue engineered vocal cords.

 

Head & Neck

An antiviral medication to eradicate Human Papilloma Virus.

A blood test to screen for and diagnose, thyroid and head and neck cancer.

A stem cell application to re-grow a resected tongue, floor of mouth and palate.

A sculptured implantable larynx, maxilla and mandible.

Endoscopic parotidectomy.

A handheld robotic fibreoptic device for transoral tumour removal.

Injections that would kill malignant cells in the lymph nodes.

A tablet that would kill melanoma cells.

 

Paediatric ENT

A nasal spray to stiffen the larynx and eliminate laryngomalacia.

A perfectly designed and implantable laryngotracheooesophageal complex to treat airway stenosis, laryngeal clefts and tracheooesophageal fistula.

A cream to eliminate arteriovenous malformation.

An inhaled medication to eradicate upper respiratory tract infection and otitis media.

 

And many other wishes.

 

But most of all,

That the whole world would stop smoking.

 

What are your Christmas wish for your patients?

Easy. It is the most beautiful of all the surgical specialties. I know, I’m biased. Let me tell you why (and I am about to have a word diarrhea here)

It’s true that ENT does not get a lot of fanfare in Medical Schools. Most medical schools may spend 1-2 weeks on ENT teaching. ENT is often out of sight and out of mind in many curricula. That is, until a doctor does a term in Emergency, Family Medicine, general medical ward or critical care. Suddenly ENT problems are appearing everywhere: nosebleeds, headaches, dizziness, tinnitus, ear infection, hearing loss, sore throat, sinusitis, airway emergency, thyroid problems, sleep apnoea, hoarse voice, tongue lesions, parotitis, dry mouth, etc.

In ENT, we get to deal with the most urgent of all conditions (airway emergency), to the least (facial plastics and cosmetics). We deal with the most common of all surgical operations (tonsils, adenoids, middle ear tubes) and the least (open craniofacial resection, orbital exenteration, tracheal reconstruction, brain stem auditory implants). We deal with newborns (EXIT procedure, choanal atresia repair, laryngotracheal reconstructions) and the elderly (skin cancer, etc.) We deal with medical conditions (headaches, dizziness, ear infections) and surgical conditions (facial trauma, head and neck cancer). We have short ops (middle ear tubes, botox injections) and long ones (head and neck reconstruction, acoustic neuroma excision, skull base resection). We do things beyond our traditional territories: CSF leak repair, middle cranial fossa approach, pituitary tumour, orbital decompression, scapula and fibula free flap. We do some really fine procedures (vocal cord laser, stapedectomy) and some big knife ones (maxillectomy, mandibulectomy, facial reconstruction). We cure quickly (Epley’s maneuver, tonsillectomy) or we care slowly (chronic rhinosinusitis, vestibular migraine). We do old procedures (tonsillectomy) and new ones (bionic ear, transoral robotic surgery). In essence, we do way more than most people think.

And we like it that way. The variety is interesting for us, and no one else knows what we do. We keep it kinda like a magician’s secrets.

Let me list some of the exciting things we do to give you a sample:

Otology (Ears)

Otoplasty, exostosis drillout, canal atresia repair, microtia reconstruction, myringoplasty, tympanoplasty, ossicular chain reconstruction, mastoidectomy, stapedectomy, endoscopic ear surgery, facial nerve decompression, semicircular canal plugging, superior canal dehiscence repair, meningioma, CSF leak repair, acoustic neuroma (transmastoid, middle cranial fossa, restrosigmoid), etc.

Rhinology (Nose)

Rhinoplasty, Septoplasty, turbinectomy, sinus surgery, endoscopic maxillectomy, transsphenoidal pituitary resection, endoscopic dacrocystorhinostomy, sphenopalatine artery ligation, orbital decompression, endoscopic craniofacial reconstruction, nasopharyngectomy, oesteoma drillout, meningioma, CSF repair, orbital abscess drainage, etc.

Laryngology (voice)

Vocal cord microsurgery, vocal cord injection, botox, laser vocal cord surgery, papilloma shave, vocal cord medialisation and lateralisation etc.

Head and Neck Cancer

Skin excision, lip reconstruction, glossectomy, pharyngectomy, laryngectomy, laryngopharyngectomy, maxillectomy, mandibulectomy, neck dissection, tracheostomy, craniofacial resection, rhinectomy, microsurgical reconstruction, thyroid, parathyroid, sialendoscopy, parotidectomy, etc.

Paediatric

Tonsils, adenoids, ear tubes, airway reconstruction, choanal atresia repair, microtia repair, mandibular distraction, laryngolamacia supraglottoplasty, vascular malformation, bionic ears, bone anchored hearing aid, drooling surgery, etc

Facial plastics

Rhinoplasty, mentoplasty, facelift, blepharoplasty, brow lifts, fillers, TCA peels, botox, liposuction, implants, fat transfer, etc

Trauma

Head and neck trauma, skull base trauma., etc

And those are the surgical cases. There are plenty more non-surgical fun to be had in ENT.

I love ENT because of the variety that I see everyday. A good mix of acute and chronic, medicine and surgery, kids and adults., rare and common conditions, routine and creative procedures, quick and complex cases, and lots more.

We’ve found gold, and that’s a secret that we hide from the rest of the world. Best of all, we get to help some people! Every specialty within medicine and surgery is fascinating. I happened to have found something I dearly love and enjoy.