Surgery 1 Pre-op Visit

Dec '07, Roughly about a week before my first surgery...

My mother and I visited Brian Machida one more time before the surgery. This visit is basically to go over what will happen, and to make sure I'm physically fit for the surgery, which isn't a huge one. The surgery will take 3 hrs, and be an outpatient surgery. Meaning, I'll go home right after. No need to stay in the hospital. The surgery will take place at the Queen of the Valley hospital in West Covina. The process seems simple enough, cut from the inside, attempt to scoop out the tumor, and close up. The nurse begins to explain that there is the possibility of having a drainage hose/tube that will come out of my neck after the surgery. This drainage tube will collect fluids and blood after the surgery in an attached bulb-like container. She then went on to instruct me and my mother as how to empty and clean the drainage collection unit.

Obviously the thought of a hose/tube coming out of my head/neck was quite horrifying.

The doctor, Brian Machida, comes in, right as she is going over some of the hose/tube issues, and he tells her and us at the same time that there shouldn't be a need for a drainage tube. Whew! Dodged a freaking bullet there. The reason is because he is going to go from the inside and not cut from the outside.

With all the pre-op stuff done, all I can do it wait till the surgery date.

12.12.07 Curettage @ Queen of the Valley Hospital in West Covina

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CT Scan for Curettage

Immediately after recieving yet ANOTHER insurance authorization to get a CT Scan of my face, I schedule the scan and go in a couple days later. 

After arriving at the Radiology department of the Concourse Medical Center, the one on Gale Ave right by 99 Ranch Market, I found out that the lady from Brian Machida's office requested a CT of my sinuses... I immediately tell the technician that this is for a growth in the jaw, and to please also include the jaw area. She thinks about it, considering the insurance authorization for a couple minutes. After she says that she'll include it, relieving me a huge amount of pressure, due to the fact that I'd have to get ANOTHER insurance authorization, specifically describing the jaw area, if she didn't help me out. 

As I laid there motionless, I started to contemplate what I've gone through...

Is it possible this is just a regular cyst? I really hope it isn't a cancerous mass. As up to this point, what the growth was exactly, was still up in the air. According to the doctors they were pretty decisive on the growth being an Ameloblastoma, which is benign, but I was hoping for some kind of miracle, that the growth wasn't even a tumor, and could some how easily be taken care of. 

Roughly 15-20 minutes after jumping in, the technician pulled me out to change my "form". She made me bite down on some sort of plastic doohickey. It was pretty similar to the doohickey that my dentist uses when taking x-rays. 

After about what seemed to be like an hour of scanning, and loud noises it was finally over. She told me to wait outside, and that my films would be ready in about 30 minutes. 

After grabbing the CT films, I immediately call Brian Machida, to see if he has time to look over the films, and give the green light for surgery. Somehow, I hunted him down at his Rowland Height office, which he wasn't supposed to be at, and showed him the films. He briefly looked over them, and said,

"Alright... Looks like it hasn't penetrated the bone to spread to the soft tissue. We'll go in there and try to get it all out. I'll have my receptionist request the authorization with your insurance. "

After that brief talk with Brian Machida, I felt a huge weight lifted off of me. "I'm going to have my surgery." And possibly have this problem dealt with. At the end of the week, I recieved my authorization and talked to the lady who scheduled Machida's surgeries. Surgery 1 scheduled...

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Brian K Machida...

After all the formalities of insurance pre-authorization and approvals, I finally sign-in at Brian K Machida's office a couple weeks after my visit with Dr. Chen.

Not too long after sitting down with Dr. Machida, previous records and x-rays reviewed, Dr. Machida concurs with Dr. Ho that it is vital to remove the mass. But Dr. Machida suggests a curettage instead. Basically, he just wants to go in, and remove the growth, specifically, not all the bone.

After much research, I discovered that there are generally two ways to go about removing an Ameloblastoma.

First, being the curettage. This option is generally less invasive and less risky. This involves going in and cutting out the growth. The problem is that it is generally extremely difficult to remove 100% of the growth. This is due to the method of which the tumor grows and has been documented to have little spires that extend up to 8mm from the main mass. In documented cases, there is a 75% chance of reccurance. And continuous monitoring is required, and also subsequent surgeries are probably required. Dr. Machida's plan...

Second, is the invasive resection of the growth and surrounding 10mm of bone. This is the most effective method of removing Ameloblastomas and has a 95% cure rate. Whereas 95% of cases where the tumor and surrounding 10mm of bone was resected, showed no reccurance of the tumor. Dr. Ho's plan...

Thinking back and forth, and trying to take everything I've heard and researched into account, I figured that I could go with the less risky surgery first, and see how that goes. So Dr. Machida says that he'll need a CT scan to get a better picture of what is going on inside my jaw, before we go into surgery. Off to get authorization for a CT scan and such... Insurance is a pain in the ass, but vital... kinda like women... j/k j/k

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A 2nd Opinion...

After my "Reality check, slapping you in the face" doctor's visit with Dr. Ho, I go home and deliver the news to my parents. Showing them the x-ray, regurgitating what I could remember from my conversation with Dr. Ho.

My parents suggested visiting my regular doctor for a second opinion, so I made an appointment, and waited...

A couple days later...

Arriving at the Concourse Medical Center on Gale Ave, right next to the 99 Ranch Plaza in Rowland, I immediately enter Dr. Chen's office, sign myself in, pay my $20 co-pay and sit myself down in the waiting room.

Dr. Chen calls me in and gives me the once over, while she proceeds to ask me why I've come in today.

"Hi Sherman, How are you feeling today? What is your reason for coming in?"

I start to think about how I'm going to tell her what I learned only a couple days ago. I then proceed to tell her that I have a huge tumor in my lower left mandibular area, and that I need extensive surgery to remove it. She replies,

"Why would you want to do extensive surgery? There are MANY risks involved... You could end up looking like a stroke victim! I suggest we try to find a Ameloblastoma specialist and get another opinion."

I then asked her for a Oral and Maxillofacial surgeon to refer me to. Dr. Chen referred me to Brian Machida, an otolaryngologist. Basically a head and neck specialist. And so the journey continues from one doctor to another.

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It's just an impacted wisdom tooth, right?

11.08.07

I get to Dr. Ho's office in Rowland roughly 1pm in the afternoon. Waiting in the small/mid sized waiting room. Evidently Dr. Ho is quite popular for wisdom teeth extractions. So, after a slight wait, first order of business, larger panoramic x-ray of my jaw then to the consult room where I was shown a short video on tooth extractions and out patient surgeries. Keep in mind, I was thinking,"Stupid cyst, you shall be out of me in an hour or two." A couple minutes later the doctor came in with the x-ray film and showed me exactly how large this cyst had grown. He immediately told me,

"Sherman, you have what appears to be an Ameloblastoma, but we won't know for sure until you do a biopsy. that large dark area in the lower left area of your jaw is the growth. It also extends up the side of your jaw. I cannot handle something of this magnitude on my office. I'll have to refer you to UCLA. I have a friend currently in the Oral and Maxillofacial Surgery program at UCLA Medical. An Ameloblastoma is a benign tumor derived from a tooth cell. For an Ameloblastoma, the most effective form of treatment is removal of the tumor and the surround 10mm of bone. This is due to the fact that it has been documented that Ameloblastoma cells have been found as far as 8mm away from the main mass. Also, due to the size of your tumor, you'd have to remove the a large portion of your lower jaw."

My response,
"HOLY SHIT...."

Well.. not exactly.. but that was basically what came out... So now.. from "Psh.. I'll be fine.." it was.. "I have a friggin' HUGE tumor in the side of my jaw.." Immediately the doctor shot out a disclaimer to me, "No more contact sports, and/or bar fights." So, I talk to the doctor for a tad bit longer, and try to remember everything to bring the news home... doctor's visit, over.

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No one likes going to the dentist...

"You have a growth in your lower left mandibular area.", the dentist said to me after reviewing some X-rays.

That being said, he showed me my X-rays and I indeed saw pockets of gray (empty) areas around my left lower molars where bone was supposed to be. This was somewhat shocking, as I didn't really feel any abnormal pain, other then what I thought was my wisdom tooth. But then again, I could have been wrong, interpreting the slight pains as tooth pains, as opposed to "growing pains". My dentist then explained to me that this is a cyst or possibly a tumor. Immediately a cold chill went through my body..."Tumor", What?! That's impossible! Those were the thoughts going through my mind. I proceeded to brush it off, and just thought, "It's a small cyst that can get taken care of easily."

My dentist then recommended me to a oral surgeon down the street. He usually removes wisdom teeth and such. Average customers being small outpatient surgeries. One slight problem was that the X-rays were some what inconclusive of how large the growth actually was. The reason for this, was because the Dentist's X ray machine was only meant to X ray 2-3 teeth at a time.

Nothing could have prepared me for what was to come next...





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An Unnerving Discovery...

It begins...

Roughly around September/October of 2006, my wisdom teeth grew out and were impacted. Having impacted wisdom teeth is no fun. Especially since all four were impacted. Having the unfortunate misunderstanding that such extraction, of those aforementioned wisdom teeth, would put me out of commission for a week or two, I opted to delay removal, and fight through the pain. These went on for a while, as more and more things came up. School was quite important, work (helping out the parents) wasn't any better, and my cousin was getting married in a couple months. I just figured, the pain would go away and I'd be fine... Boy was I wrong...

Roughly in August/September of 2007, I was randomly starring at myself in the mirror obsessing about my weight and looks, I noticed a slight bump in the lower left region of my jaw. First thoughts were, "Hmmm... Did I bump myself on something?", "Did I hurt myself somehow?", and "Oh well, It'll go away on its own. No need to worry." Wrong again...

One day at work, I propped up my head on my left hand reluctantly doing work, resting my head on my hand right where that bump was. Suddenly I felt a pop, and tasted something foul in my mouth.

Sidenote: Due to my impacted wisdom tooth there was a slight cut/hole in my gums in the affected area.

After feeling some of this liquid come into my mouth, I rushed to the restroom, and applied more pressure to the area of my jaw, and spit out these yellowish fluid.

This was very disturbing. In fact, it was actually really disgusting... Immediately after that, I filled in my mother about what just happened, and we scheduled an immediate dentist appointment for the next day.

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