and we are hanging at Brian O’Neill’s.

MMmmm…..beer.

I just want to crawl back into bed.

Man… I think I ate too much. Tons great great food, football and 42.

Highlights of the food: smoked turkey, deviled eggs, spinach dressing, scallop potato and ofcorse the chocolate pecan pie.

The 2 pics of plates full of food were both Zack’s.

Some fire fighters smoke turkeys every year smoke turkeys the day before thanksgiving. Good time with food and beer.

I am so readu for turkey day.

Relaxing, enjoying coffee and some tones before the boss gets here.

Sidenote: Its the week of Thanksgiving, wow!!! where did the year go?

More on Ian, two email from 2 different days:

I just talked to Christy and Ian. 9 PM Monday in Houston He is in recovery.

Ian seemed to be in pretty good sprits, though a bit groogy.

The surgeon told Christy the surgery went as expected. They removed a spot very near the spine that they were concerned about.

i forgot to ask if he goes home tonight or spends the nite at the hospital.

So far so good. That’s it for now.

and then this one:

Latest – excerpts from Christy’s last 2 emails

Concerning radiation:

“They didn’t say definitely but they said they were leaning that way. Her thought is that if it comes back it has a good chance of metastasizing in the lungs, lymph nodes or liver. That makes the odds of beating it on round two much lower. Because it is aggressive in that it returns over half of the time, they want to wipe it out the first time. Also because the radiation is being given to the soft tissue of the neck, there are no risks of affecting his lungs, stunting his growth, affecting mobility or harming the mouth and throat. Low risk.”

Hi

Jerry [Ian’s father] spent the day at the hospital. He left about 6.. Ben called to say ‘hi.’ When he called Ian was on a mission to pee. After having surgery, I guess it is very important to pee or else you may have to have a catheter put back in. That got Ian motivated. He was drinking tons of water and dragging his IV pole over to the toilet. When Ben called he was still unsuccessful.

Greg, Des and Sean came up to the hospital last night. They stayed til about 10. I stayed til 11. There was a bed and I could have spent the night, but Ian didn’t think it was necessary.

Guess what? Talk about adding insult to injury, you’ll never believe this. Ian got called in for a Deer Park city job. Golf course custodian, can you believe it? He was like, man you have got to be kidding me. Two week days and Saturday and Sunday and of course with the radiation he wont be able to take it. He was bummed but he told me to give it to Ryan. I called the lady and explained what was going on. She told Ryan to call her. He did and now Ryan is supposed to go there tomorrow for an interview. Ian thinks he is a shoe in now that he has the sympathy brother with cancer story going for him. Ryan is looking for cancer scholarships for Ian. LOL

Nice sunset after the much needed cold frount.

I know a lot of yall been asking, so here is the lastest.

Christy,

Hello and thank you for the e-mail.

I am glad you have been looking around at the options.

Moh’s surgery is an option for patients who have skin cancers (primarily basal cell and early squamous cell carcinomas). The principle of Moh’s is to take a skin lesion and resect around it with very narrow margins. Then, take it to the pathologist and have the margins checked.
If there is tumor at the margin, then the Moh’s surgeon goes and takes a little more, etc. etc until the margin is clear.

This technique works well for non-invasive skin cancers with a very obvious tumor margin. Moh’s surgery is not a good option for Ian’s cancer. He never had a skin lesion, so there was no way to have done Moh’s as the initial surgery. Also, he has a positive deep margin in the soft tissues, so there is no telling where that may be so a Moh’s excision would have the potential of completely missing the concerning area.

The only way to “clear” the margin is to re-excise the entire area again with deep and ample margins. We will have the pathologists look at the margins at the time of surgery… so the re-excision procedure does have some of the same traits as traditional Moh’s.

In regards to the conference, it was cancelled at the last minute due to a meeting in NY which 50% of the Head and Neck physicians had to attend.

So, I have discussd Ian’s case with Dr. Frank, the radiologist, and the pathologist.

The pathology reveals that there was definitely positive margins, meaning that there is probably left over cancer in Ian’s neck. The CT scan reveals that there are a lot of changes from the prior surgery, but that there is suspicious looking tissue deep in the back of his neck along the muscles.

He has reported that the CT scan is suspicious for residual disease.

In regards to the radiation, we will be awaiting to see what the pathology shows us to decide for sure. However, after discussing with Dr. Frank, we talked about the possible long-term outcomes. There is not a lot of experience reported about this kind of cancer. There have been a few reports of siimple removal and no further problems. But, there are also a few reports of patients having very aggressive disease going to the lymph nodes or to other places if the tumor comes back.

So, we feel that the first time to cure this disease is going to be our best chance.
And, if there are features on the pathology that increase the risk of the tumor recurring, then we should reduce the risk by using radiation.\

We will be removing the residual cancer from Ian on Monday. And, will probably have the results back on Thursday. The plan for Dr. Frank and I is to present Ian’s case in the conference on Thursday. At that time, we will have all of the surgical information as well… so we can discuss the pros and cons of radiation at that time.

I hope this is helpful.

Thanks again for the e-mail

Have a nice weekend.

See you Monday.

Amy

Amy C. Hessel, MD
Assistant Professor and Associate Director of HNS Fellowship
Department of Head and Neck Surgery
The University of Texas MD Anderson Cancer Center

fatness

isn’t it ironic, don’t ya think?