• Shared a glorious dawn at 1300m altitude with Maree and Mia at Sunrise Hut in the Ruahine ranges.

• Represented the Gillies McIndoe Research Institute at The Goat Tongariro in January, then in the Wellington Round the Bays run in February, and the Tararua Mountain Race ‘Field Dash’ in March. In that race I took a spectacular tumble 200m from the finish line (but finished).

• Thanks to some very good physio, I recovered in time to compete in the NZ mountain running champs last weekend - where I was comprehensively thrashed: by the driving rain, the 80kph winds and the lightning fast competition. It was my NZ mountain running champs debut, and I was happy to be there - and took the chance to sport the singlet of my Centre of Origin: Gisborne Harriers, home of Young Nick’s Head.

• I also started a new full time job working within the health sector in nz, with plenty of potential, and plenty to do, to make things better.

All of which has been a good way, as someone wise once told me, to Enjoy Life.

p.s. my checkup today went well ;)

This was the device (and screen) used for my checkup at hospital today, where a long fibre optic cable & camera is moved down and up my throat. The surgeon and I watch the monitor, looking for realtime evidence of dysplastic cells / tissue, or any other areas of concern. Today: no worries!

The extraordinary team at Hutt Plastics - 3 life saving surgeries and closely watched recoveries (so far - and yes, I know you all keep telling me to never come back!).

The whole team at Wellington Blood & Cancer centre, who guided me from the outset. My compassionate and expert chemo oncologist Anne. My inspirational radiation oncologist Jamie, and all the caring and careful RT’s.

My exceptionally skilful and always energetic, always encouraging ENT surgeon Stuart and his registrars and team at Wellington ENT. The vascular and emergency surgery teams, and their radiology staff, who have diligently investigated all my concerns and pains, long into the midnight hours on several occasions.

The ICU nurses and teams at Hutt ICU and Wellington ICU who’ve kept watch on me, breath by breath, over many long shifts.

My longtime life-saving and brilliant GP Dr Dave P.

My speech and swallowing therapists over many hurdles: Kate, Lou, and Liv. My clinical nurse and a guardian angel, Ruth. My oral and dental surgeons Barb and Rose. My many dieticians, doctors and nurses. My cancer rehab physio Jo. And the wonderful paramedics in the Wellington free ambulance who have several times calmly, swiftly whisked me off to safety and help when I’ve needed it most.

Throughout it all, the incomparable Swee, who has taught me more about persistence over the last 15 years than I could ever have imagined. Swee now inspires a remarkable group of young scientists at the Gillies McIndoe Research Institute to work with equal persistence, to find new and drastically better ways for treating cancer, for those who follow us.

These people are the real heroes of my story, up and over those many mountains!

Overview

• I'm on a life-long thin-liquid diet due to an inability to swallow solids; caused by surgeries and radiation treatment for head & neck cancer. Was first diagnosed in June 2009, had radiation, chemo and surgical treatment (semi-glossectomy), and multiple surgeries since a recurrence in Dec 2021.

• I cannot eat solid or even pureed food (my last meal was Feb 2022).

• My primary nutrition is from powdered Ensure (approx 2,300 kcal per day, when not training; more when training).

• I have had a PEG previously but currently do not require it - I can swallow thin liquid /water without aspiration, if careful and not excessively fatigued

• I have a high metabolism, high cholestoral (hereditary) and my remaining teeth are susceptible to decay due to radiation damage to my saliva glands (I do not have saliva), and surgical removal of all my left-hand side teeth and lower jaw.

• I do mountain running - races & training, including high intensity, high energy up & downhill running - which I find burns a lot of energy during & after, with fatigue

• Aside from Ensure, I occasionally supplement my energy needs with: 1) Up & go, 17g protein post-run (diluted slightly, so I can swallow it) and 2) Fruit juice, if fatigued at work or home and believe I need quick blood sugar

So to keep me alive, I consume a lot of Ensure (which I am very thankful for). I collect a car-boot full of tins every few weeks from the pharmacy.

Nutritional Analysis of Ensure

Here’s a summary of the nutritional analysis from my Ensure tins, translated into how much I consume typically per day at home.

Many of the great adventures in my life would not have been available, or even possible, had it not been for the hard work of a small, committed group of volunteers and friends.

This was brought home to me on last Saturday afternoon, as I approached the half-way point in the Tararua Mountain Race. The TMR is one of New Zealand's oldest mountain races, having first been raced in 1990, and winds its way 32km up and over the east of the mountain ranges to the west. Last weekend was my debut. On the day, I had climbed to about 1,000 metres altitude with my race team-mate Dan, to approach the first station at Alpha Hut. We were mid-pack in the race wave, but for me it had felt like a long, slow haul up the mountain - and I had developed a pain in the neck. Given the myriad of medical complications I carry with me these days, I have to be cautious. Dan called out to ask how I was. A pain in the neck, I said - about 2 or 3 out of 10, so I’d better slow down. So much for our race position - but Dan stuck with my slower pace, asking every 20 mins or so for my pain-scale and heart-rate level.

We reached the Hut. I plonked down on a patch of moss and slurped a flask full of electrolytes. A marshall spotted me and walked over. He scanned my face, narrowed his eyes and after a pause, asked how I was. OK, I said - just need a sit down for a bit, a bit of a pain in the neck. I sat for 20 minutes or so until I felt better.

As I got up the Marshall asked: Do you feel ok to go on? I did. Have you got someone with you? Dan said yes, I’m running with him - we’ll take it easy. The marshall nodded, satisfied, and off we went: a cautious but continuous pace through the alpine forest and its bog-patches, rambling over the tussock, past the tarns and up the scree to the summit of Mt Hector, at 1,500 metres, meeting several more safety Marshalls and LandSAR volunteers along the way.

At Mt Hector, we stopped for a check-in and a photo beside the memorial cross at the summit. I was on back on familiar territory; I could see out toward Kapiti and home. My heart rate had calmed and I was feeling good. It was all downhill from here. Dan and I both knew the route down well. Let gravity do the work, I said. We skipped down through the alpine rock trail towards Kime Hut, where I took on some more fluid, and after another precautionary pause we strode off to the next station at Field Hut.

After Field Hut, the slope pulled us down, winding quickly towards the finish across the bridge at Otaki Forks. Going with the flow, and feeling decidedly upbeat, we reeled past numerous other runners. We crossed the line at 7 hours, 44 minutes and 52 seconds - not record pace, but enough to win the team pairs event overall, by a margin of 2 seconds. Race director Andy Carruthers sat me in a chair and offered to fetch me a sports drink. Yes thanks, I said - I’ll need that.

It wouldn’t be possible for me to enter, tackle and get through these sorts of things without the knowledge that my back is covered - by all the Marshalls, the aid stations, the well-drilled organisers and network of safety personnel.

It felt especially fitting to win the teams race with Dan. For each major race we have prepared to run together over the years, he has received the kind of run-down from me that lesser mortals would shy from: what my plan for handling choking and aspiration would be; to not be alarmed if I cough, splutter and stop; the steps I’ll take if I start choking or bleeding from the mouth, the criteria for which he should summon a helicopter; which surgeon he should call for what complication - these have all been part of Dan’s pre-race briefings over the past few years. Undeterred, he has had my back.

The tub was purchased during my previous stay in hospital, in July. During several days in Ward 5 contemplating the meaning of life, love and the Bristol Stool Chart, I decided to pass time with a round of online shopping. Which led to the swift purchase of a wood-fired hot tub. It was on special, after all.

The only problem was, where to put it? At 2,000kg with 1700 litres of water, it would need a solid, level platform. Our seaside cottage is situated on a lightly-grassed sand dune. Fortunately, my life-long friend Wade offered his considerable experience and expertise in deck-building. After much researching and consulting on engineering and construction, followed by some very kindly provided supplies from Kapiti Placemakers (timber) and local concrete factory Firth Dricon (30 bags of concrete mix), I built a deck with stronger foundations than our house. The tub was placed on site last week, just in time for my recovery programme.

I discussed it all this morning with Sarah, one of my anaesthetists, as we worked our way through my surgical consent form. I paused at Clause 4, the section which advises making no important financial decisions within 18 hours of undergoing general anaesthetic. At this point, I had to confess my previous post-surgical shopping spree. To her credit Sarah felt the purchase of a wood-fired hot tub was actually a very good Local Ancillary Recovery Facility, or LARF, and a worthy investment for the enjoyment of life. From my position, I thought, it was much superior to a Bedside Ancillary Recovery Facility, and well worth it.

So, today I’m looking forward to a very good treatment in theatre and an even better recovery. Onwards!

Above: Bathrobe thoughtfully provided today by Wellington Hospital

Above: Hot tub in the snow in northern Sweden, 2003: the inspiration for my Local Ancillary Recovery Facility.

It all began a couple of weeks ago, with a mysterious Saturday Night Fever that fell to a Sunday Malaise, then flared up to a Forty-one degree Temperature by the Monday night, leading to a Tuesday morning ambulance ride to Wellington Hospital to be treated for sepsis.

Initially, the source of my infection was a mystery. Despite being pumped with fluids, my temperature stayed swelteringly high, my blood pressure stubbonly refused to come up. A phalanx of flummoxed physicians sent in a flurry of phlebotomists to sample my blood.

Eventually, by the third day, I was diagnosed with gastroenteritis (specifically, Campylobacterosis). Insisting that deploying a course of antibiotics would escalate the conflict, my doctors instead laid out a plan of appeasement: to ride out the infection’s attack and “let my body do the work”. No reinforcements would be sent in. Instead, we would simply measure the advance and hope for an eventual retreat. Nurses would measure my blood pressure, temperature and oxygen saturation and of course scale of pain; phlebotomists would regularly sample my blood to measure kidney function, liver function and immune response; and I was tasked with measuring output, using the Bristol Stool Chart.

In an age of pervasive, sophisticated biometrics, the Bristol Stool Chart boldly goes where no Fitbit dares to go, introducing a scientifically validated classification of your poo. Armed with The Bristol Stool Chart, the patient observes and dutifully records the frequency and type of fecal excretions, guided by a table of seven evocative illustrations on the Chart. No poo is equal. A hierarchy of poo quality is implied by this scale but is not stated on the sheet, presumably to avoid patient despair (or indeed, alarm).

By the way, I do not know why the designers of the Bristol Stool Chart named it in dubious honour of England’s eighth largest city. Perhaps something reminded them of home. Here is the chart:

In any case, over the next few days I dutifully diarised my defecatory output. With all aspects of bodily function now tracked, we lay back and waited.

What should have been a fairly straightforward recuperation was unfortunately confounded by a second infection, a phlebitis of the IV site into my right arm, leading to fever and sepsis again. Which is why I'm still here in hospital, now on antibiotics, waiting for this second infection to dissipate.

Thankfully, my original infection has now retreated and all but disappeared. My temperature is normal, my blood pressure healthy and my Bristol Stool Chart now makes for dull reading, for even the most enthusiastic gastroenterologist. So we wait for the second infection to pass. All of this hasn't made for the most pleasant time in hospital, but sometimes you just have to flush the dunny, and move on…

Last week I gave a presentation at a function for the Gillies McIndoe Research Institute. I’m an Ambassador for the Institute, and we had been planning and preparing for the function for several years, as a way to acknowledge and thank our supporters, and encourage further support. In particular, philanthropic support - to fund our clinical trial to develop an innovative new treatment for glioblastoma (an aggressive form of brain cancer).

So it was an important occasion and my role was to give the keynote presentation.

The pandemic, and its subsequent restrictions on hosting in-person events in New Zealand, meant we had to defer the fundraiser event in 2021 and 2022. Like many event organisers around the country, we had our fingers crossed for hosting our event this year.

It was personally important to me to give the speech. After my cancer recurrence in 2021, and the subsequent rounds of surgical treatment in 2022, I needed to retrain my ability to speak, and compensate for the various impairments that came from several of my surgeries.

While those impairments, and the uncertainty of whether I’d be capable of delivering a speech at all, obviously made keeping the commitment more difficult, giving a speech became more meaningful, for several reasons.

Firstly, the idea of giving the presentation was an important goal, to keep me focused on rehabilitation in the past year. I mention that in the presentation.

Secondly, the occasion represented a very important opportunity to acknowledge all the help and skilful treatment I had (like many other head & neck cancer patients around the world). It was also a way of telling the story of what modern head & neck cancer treatment can be like, the types of difficulties that must be navigated, and why it is important we invest in a much better way of treating all types of cancer. The Gillies McIndoe Research Institute is pioneering that work.

Finally, my speech impairments forced me to make choices about brevity, simplicity of word selection and use of video on the night - all of which benefited the clarity of the presentation, I think.

So, this was a unique and rare opportunity which needed to be seized as best I could. I decided to give it the works, by telling the story of my cancer treatment and journey from hospital to Mt Fuji, back into treatment last year, and then ultimately into The Ring Of Fire, New Zealand’s toughest alpine ultra marathon.

Here’s the video below, of my presentation on the night (a special thanks to Erin from the Institute for recording it).

There are many, many people who helped make this speech possible. Some of them include: my medical team (particularly my surgeons and my SLT Liv, and my Steel cancer rehab physio Jo); and of course my friends and family (particularly Maree who helped review the draft version and make crucial edits to improve it). Aleks, Hannah, Paul and Dot listened to my first rehearsal (after which I did another 10 rehearsals, that week, including one with Mia). My friend Garr, whose work I am longtime student of, many years ago inspired me to choose to run up Mt Fuji in Japan. Garr’s work over the years taught me some important principles about the way to present the story.

It was a very, very important opportunity to give the best presentation I could on the night - so thankyou all!

“Oh, let’s go up the hill and scare ourselves,

As reckless as the best of them to-night,

By setting fire to all the brush we piled…”

— ‘The Bonfire’, Robert Frost; Mountain Interval, 1916

I’m still gathering my thoughts several days after one of the most fulfilling experiences of my life, after finishing a 74km volcanic ultra-marathon surrounded by family and close friends, to stand at the foot of Mt Ruapehu.

It’s a privilege to be able to race among the volcanoes. Ruapehu (2,797m high), Tongariro (1,978m) and Ngauruhoe (2,291m) encircle a cratered, dramatic landscape that rumbles with the fire inside.

Before the race, all competitors and supporters were welcomed by Ngāti Hikairo with a powhiri at Otukou marae. After an exchange of speeches, our race director Jason asked me to place our koha or offering as a warrior on behalf of the manuhiri. We were given a generous morning tea of sandwiches, fruit platters and refreshments, then sent on our way with a blessing and good wishes.

We spent the rest of the day with registration and final preparations before gathering on the mountainside at 4am for race start.

Into the ring of fire we went, striding into the icy dark, over the rugged alpine course. We traversed 74km around the mountain through bogs and scree, over boulders and up a waterfall, through mountain forest, across vast valleys and lunar-like landscape - slipping, scooting, clambering and finally reaching for the finish line, safe and sound.

I’m looking forward to giving a presentation including highlights of that, and of course a story or two, at our fundraiser dinner & charity auction in Wellington in May, for the Gillies McIndoe Research Institute.

The Ring Of Fire is greater than just a race. Its personal challenges and success are so much more than a measure of the distance or time taken. Journeying across beautiful, extraordinary mountain course with my lifelong mate Dan was epic. Crossing the finish line to hug close friends and family felt like coming home, in the fullest sense.

On Sunday, the competitors and event team gathered for the the award ceremony, back at the Otukou marae. Jason, our race director, has become a close friend ever since I ran my first Goat race (over 20 Goats ago!). He spoke to us about how much it meant to him and his team to put the event together after several years of cancellations, local business and facility closures all due to the pandemic. I felt happy for him, as I know he pours his heart and soul into making the race possible, and delivers it with the highest commitment to operational excellence and safety.

The culmination of the event for me was to be presented with the Steven Neary Memorial Award. Steven Neary was a much loved trail runner who died in a car crash in Auckland in 2016. I found it especially humbling to receive the award after moving speeches from Jason and then Dan (neither of whom warned me in advance). This felt like an award earned by the support and hard, skilful work of many people over the past 12 months.

My medical team weren’t there at the marae, but how great it felt to be able to give an acceptance speech, to thank my family and friends, and acknowledge the very special team of people that made that speech possible.

No one climbs a mountain alone. I felt that all of you were on the mountain with me, into the ring of fire and out. Thankyou all for your generous donations in the fundraiser and for all of your support!

Why I’ve chosen to run this event

I’ve raced sections of the course around Mt Ruapehu more than 20 times over the past 15 years, but I have never attempted a full circumnavigation.

Last year in hospital, I decided to set myself the goal of running this race, as a fittingly difficult and worthy challenge to raise awareness and funds for the GMRI in 2023.

In particular, I want to raise awareness and funds to support the work of the GMRI’s phase 2 clinical trial for glioblastoma, an aggressive form of brain cancer. I know several patients with this type of cancer, and the GMRI has been making excellent, rigorous progress innovating a new treatment for it. They now need more funding to expand their clinical trial and reach more people.

I have been preparing through a series of mountain-based adventures since late 2022. I’ve had help in my preparations from a range of specialists: Jo, my Steel cancer rehab physio; Liv, the SLT from my head & neck multidisciplinary team at hospital, some consulting and a training plan from an ultra-running coach, and several of my close friends and family are enlisted to help on the day too.

I plan to run the race on Saturday March 11th 2023, followed by a presentation about my experience, and why I support the GMRI, at a fundraiser evening in late May 2023.

How to support

If you’d like to sponsor or support me, thank you. Here’s a link to my donation page for the event. All donations go directly to the GMRI itself, a non-profit, registered charitable trust.
https://givealittle.co.nz/fundraiser/into-the-ring-of-fire

About the ROF course

Starting and finishing on the lawn outside the historic Chateau Tongariro, the race commences at 4am in the dark, running along on the Silica Rapids Track before branching onto the Whakapapaiti Track adjoining the Round the Mountain Track. The course runs across volcanic boulder-strewn country, glacial fed river and stream crossings, ancient lava flows, and boardwalks in places. Then ascend the magnificent twin cascade waterfalls up to the Ohakune Mountain Road descending to rejoin the Round the Mountain Track on the section dubbed “The Missing Link’.

The course then traverses the southern side of Ruapehu through stunning native beech forest before embarking on epic crossings of the Wahianoa and Whangaehu Valleys before arriving in the Tukino Desert and the Tukino Area. The final section begins through the Waihohonu Track junction near the base of Mount Ngauruhoe before making your way back to the Chateau.

From dark, through light and into the night

Competitors spend between 3 and 6 hours in the dark on this course. The race begins with a 4am start with sunrise not until 7.11am. In the evening (if still on course) runners will have sunset at 7.45pm and a course cut-off of 11.00pm.

People often ask me what the distance is. It’s twenty kilometres, as the crow flies, but that’s if you have wings. No crow would be mad enough to go on foot, over twenty kilometres at 1600m altitude; scampering, clambering and straining along volcanic rocky paths, down into alpine bogs, up the side of a waterfall, claw over a martian lava-scape and crawl up a final mile-long extra hill-climb to the finish.

So, it would seem to take a special kind of madness. Partly, this is the call of the wild, but for me now, it’s the call of the soul - a chance to spend time with special friends I’ve made over the years because of this race; to share time in an inspiring environment, swap a few stories and laughs.

This time, as with one or two previous times for me, there were complications in the preparation and the now familiar dollop of uncertainty about whether or not I’d make it to the start line. Best to think of what might be, rather that what might not, I reckon. I signed up in hospital last year, knowing that with a little help from my friends, I’d make it.

Of course, there’s a difference between ambition and ability. I had, and am, a complex collection of problems to navigate. Aside from the extraordinary medical team who in the past year have guided me through life-saving surgeries, pneumonia, sepsis and for good measure, Covid-19; and along with the critical of support my family and friends - there are several important people to thank in particular. These people have been crucial for me to get back in the mountains and to be able not just be at the start line, but also at the finish.

Jo, my expert cancer rehab physio from Pinc & Steel, put me on the path, working with me on cardio and strength, cross-checking through out with my surgeon and medical team for safety; consulting others at the boundaries of her own specialist expertise.

Liv, the SLT from my multidisciplinary head & neck cancer team, worked with me over months to experiment, figure out and practice drinking water from a bottle. At first, I was unable to even fit a bottle nozzle in my mouth, let alone swallow anything without choking - but we persisted, I practised different techniques, and it all worked out.

Phillipa, my dietician, helped me manage my daily health and went the extra mile, helping me figure out how I could manage my training and endure a race like The Goat without being a food eater like most humans. I haven’t eaten a meal since last February; I live now on powered drink - so with help from Phillipa, I’ve learned how I manage preparation and recovery for mountain races on a liquid diet, without compromising my health or daily life with family.

It’s all proof, I think, that no one summits a mountain alone; many, many people help us find the right path.

Actually, rather than seeing it in, I’m more likely to snooze it in, due to an early mission this morning in search of Christmas snow, on the top of Mt Taranaki. A fitting finale to a tricky year, and finishing in pretty good shape, thanks to the hard work and support of a lot of doctors, nurses and family and friends.

It is not easy to find a White Christmas in New Zealand, but if the stars align, it can be done…

Progress was rudely interrupted by a dose of The Covid, for Maree & I. We are on the mend now. Mia was spared altogether, seemingly immune to the virus. No one, however, was spared the 7 day at-home lickdown, immediately instituted by Fred. Our dutifully sanitised household surfaces were systematically pawed, slobbered on or chewed by our 35kg furry force of nature. At times, it was hard to know whether to laugh, cry or just cough, but it was also comforting to think that no known virus could survive this onslaught of enthusiasm. And we were grateful for it.

Antiviral medicine also helped. I was fortunate to be quickly prescribed the tried and true medicine Paxlovid. Each day’s dose was treasured in a gold and regal-blue foil package of two cryptically labelled pills. Their names, “Nirmatrelvir” and “Retonavir”, sounded like a concoction from Tolkien’s Lord of the Rings. Possibly descended from the line of Boromir and Faramir, the two drugs in this modern wizard’s potion defeat the body’s attacker by working in tandem (one does not simply take nirmatrelvir; one must also take retonavir). It worked, like magic.

Of course, it wasn’t magic, it was science; the culmination of thousands of hours of diligent experimentation and collective endeavour across the globe. One day, I hope that cancer will be similarly treated. There’ll be a simple, freely available little pill that will stymie, dissipate then dispel the cancer wherever it might lurk, without invasive treatment. There isn’t such a cure yet, but we the humans are closing in. Close to home, the good scientists at the GMRI are working on it, persisting their way through the unknown. They will not be giving up, and nor should we.

The past couple of weeks I’ve stepped up my cancer rehab work, after the preparation for my next surgery was rudely interrupted by a chest infection, pneumonia, another ambulance ride to the Emergency Department and a very unwelcome stay in Intensive Care being treated for sepsis.

Recovering from all that, let alone cancer treatment, is a complex business. I’m fortunate to have the expert help of Jo, my Steel Physio.

Steel is a non-profit physio rehab programme for cancer patients, whether in treatment or after treatment, first developed in NZ and now delivered by hundreds of specially trained physiotherapists in 30+ countries.

I first tried out the programme in 2010 to help recover from my radiation, chemo and surgery; and have since done a little bit of fundraising and promotion of its benefits over the years (from representing Steel in an off-road triathlon in Wanaka, to paddle-boarding in Takapuna, for example).

This year, I’m back as a patient, and a substantially more complex patient to boot. Now presenting with a history of radiation scarring, surgical grafts, neck dissections and multiple tracheostomies, I’m the hospital pass personified, with a set of medical discharge notes sufficient to make the most seasoned physiotherapist gulp and wonder where I’d come from and where to start.

However, Steel physiotherapists are trained to deal with people who’ve had the various gruelling forms of cancer treatment. Jo knew exactly how to best navigate my radiation scarring, graft and various surgical sites to accelerate my recovery and prepare me for further treatment.

In June and July, Jo liaised directly with the speech & swallowing specialist in my medical team and with guidance from my surgeon, to target the crucial ability to open my jaw, so that I could have further surgery at the back of my throat. Without that focused rehab and exercises, I was at risk of not being able to open my jaw the necessary minimum of 15mm for the surgeon to operate.

Following treatment for sepsis in early September, and at the recommendation of my medical team at hospital, we’ve shifted focus to rehabilitate my cardiovascular and lung health, using a progressive programme of careful assessment, strength and cardio training.

Sepsis patients can face a recovery period of three months or more for recovery, depending on the damage done. In my case, the sooner I fully recover, the sooner I will be able to have my next surgery for cancer treatment. So I need all the help I can get, and I’m very fortunate to have access to the best in the business.

Pinc & Steel physio cancer rehab is a programme that every type of cancer patient or survivor will benefit from, and often via a fully funded referral. So if you know of someone who has struggled physically following any type of cancer treatment, in NZ, Australia, UK, Canada, USA, Europe or anywhere else, tell them to check out the Pinc & Steel programme here.

Laser ablation of the surface tissue is a process that my surgeon Stuart likens to “mowing the lawn”.

The idea is to systematically crop back a layer of pre-cancerous tissue from my upper palate, so that only the good grass grows back.

It’s a carefully managed process leading up to an operation of micro millimetres.

After checking in to hospital I am PCR-tested, issued a theatre gown, theatre booties and some very breezy theatre undies. Once changed, I shuffle down the corridor to sit outside Theatre and wait to be called in.

I’m kept gently warm under a large bright blue electric blanket called a Hot-Dog Warmer (I am not making this up. This device was first invented for regulating the body temperature of dogs undergoing surgery at the vet).

After a few chats and consent form signings with the always-friendly anaesthetists, I am escorted into theatre, settled down, hooked up, plugged in and eased off to sleep under general anaesthetic.

Next, holding a pen-shaped high-watt laser connected to an oversized laptop, surgeon Stuart directs the ultra-hot tip back and forth in my open mouth, vaporising the layer of offending dysplastic tissue.

A tiny special-imaging real-time video camera scope is used to help Stuart identify the target tissue in my throat and mouth, and direct his laser cutting.

During the surgery, biopsy samples are taken from sections around the margins of my jaw and throat, and sent for analysis to confirm if clear of cancer or not. Based on the results further ablation surgery is done to mow it further back. We’ll review in a few weeks, but it’s highly likely I’ll need another round.

Ideally, this mowing experience would be as with the patient English groundsman and his village green, gently nurturing new grass into a healthy lush pasture.

However the reality of my healing process has been several weeks of persistent bleeding and clotted post-op detritus in my throat and mouth. The field of my palate is somewhat charred, scarred and cratered. It bears a closer resemblance to our real lawn at home, which this year has been attacked , fouled and holed by our 30kg Labrador “puppy” Fred, as he enthusiastically buries and recovers multiple bones and the occasional gumboot (stolen from me).

I am not complaining; I am fortunate to be able to have the is the ablation treatment as an option. I’m well looked after and the recovery is tolerable enough. Most importantly, in my case the ablation mowing treatment is deferring the need for more radiation treatment to my head and neck, which would compound the damage from my radiation dose in 2009, and introduce some unsavoury risks. Much better to dodge that while I can.

For now, thanks to a dedicated medical team and a very supportive family & friends, all I have to do is be patient, recover carefully and look after the small things that help me prepare for the next round of mowing the lawn.

I’m writing from my bed at Wellington Hospital, in the post theatre recovery unit.

Today I had a surgery to eliminate some precancerous tissue in my jaws and palate regions. Due to some of the complexities I present, it was another exercise in Special Ops, involving some trickery with a camera through my nose, some clever breathing tube placement, and a laser. More on that later.

For now, this is a brief update to let you know the procedure went as planned, and I’m recovering well in a comfy bed in post-theatre. I’ll be here one or two nights, probably (we’ll see in the morning).

It was lovely to have a visit from Maree, after I woke up from the general anaesthetic. As expected, I have a fair amount of blood in and around my mouth from the surgery, and a little in my lungs to clear as I cough. Maree says I look like a vampire that has just enjoyed a juicy meal. I can feel the colour returning to my veins…

For the past few weeks I’ve had a series of scans, tests and assessments to check for any spread of cancer.

Histology results showed some dysplastic, pre-cancerous tissue around the margins of my jaw and palate. Left alone, it would almost certainly form another tumour. So, I’m booked in for another surgery, to remove the offending tissue, in a couple of weeks time.

Meanwhile, to be thorough in the search for the areas of cancer, further testing has continued.

Today for example, I had a neck biopsy at Wellington Hospital.

While I’ve had many biopsies over the years, I’m an increasingly complex patient to operate on these days, and accuracy is important.

A trio of doctors were tasked with carefully inserting a hollow needle into the right side of my neck, searching for hotspot of cells to extract tissue samples for lab testing.

Like a Special Ops SWAT team equipped with night vision cameras, they used the guidance of a high resolution, realtime ultrasound image to probe my neck, navigating through its jungle of nerves, radiation-scarred tissue, re-plugged veins and arteries, past several surgical clips floating in suspension from a previous operation.

Lying on the bed with my head turned away, I couldn’t see the action, but I could sense it. The mood was tense, focused and positively Situation Room.

“I can’t see the target, said the young doctor. “Can you see it?”. A pause, a shuffling of feet, and the older doctor stationed himself alongside at the screen.

“Target is two clicks lateral, posterior”, said the older doctor.
“I see it now,” said the young doctor. I’m going in”.

Having been numbed by local anaesthetic, most of the angling and movement of the needle felt dull and distant. Occasionally, one of my nerves would be brushed by the needle, triggering a forceful shock through my neck and right arm - like that time I used a knife to try to pry a burnt piece of crust from inside the toaster, while it was still plugged in.

“I’m at the target,” reported the man on point. “Doing the extraction now.” I felt him work the needle back and forth 10-20 times, to draw the tissue cells up inside the needle.

This process was repeated several times over, to extract different samples that would be sent away for lab analysis. “All done now,” said the younger doctor, wrapping up. “Results in about ten days.”

So, with that side mission completed, next up is my surgery - where the degree of difficulty will go up a notch. More on that soon, in Special Ops: Part Two…

Good flow

On Tuesday, I had a follow-up appointment with my vascular surgeon, who summarised his team’s part of my February surgery as a success. It was my first opportunity to talk with him since. He told me that the endarterectomy procedure itself had been more complex than standard, due to the damage from my previous radiation treatment, but my recovery has gone well and with normal blood flow restored, I can now reduce some of the medication I’ve been on. And no need for further follow-ups; a phone call in October will suffice. So another crucial part of my system is sorted for now.

A naked neck (look! no tubes or dressings!)

On Thursday, at my dressing clinic at hospital, my tracheostomy wound was assessed as sufficiently healed to lose its dressings and go naked. At times in the past month, my doctors and nurses would describe the wound as “fragile”, “delicate” or “angry”, so going naked was a significant graduation. With the temporary airway completely sealed & healed, I’m cleared to go swimming. While I was lying in ICU in my March hospital stay, I would close my eyes and imagine myself swimming under the waves, as a means to stay calm and focused on my breathing. So it was a fitting celebration yesterday to go for a 20 minute run along the beach, followed by a deep breath and a dive into the waves.

Some other aspects of my post-surgery recovery have been slow, but steady enough. I’ve had some marginal gains in my swallowing skills: I can now drink a smoothie without coughing it up, and I’m now able to hit my target of one yoghurt a day. It isn’t clear how much improvement is left, but I’ll put that to the test over the next couple of months working with my SLT specialist.

A lap around the sun

I also had my birthday, marking 47 times around the sun. Every lap is significant; this one especially so. No-one is more excited about birthdays than 5 year old Mia, who demanded a celebration with the works. Maree got up early to bake a cake. It looked delicious cooling in the morning light on our kitchen bench. However the only one from our household to actually enjoy the cake was Freddy - who while we were out of the room, disgraced himself by hauling the cake to the floor and pawing it to pieces. He ate a solid third of it in three seconds flat, and he would have eaten the lot if he hadn’t given himself away with all his greedy growling as he gorged himself. Was it too much to ask, to have our cake and eat it too? Sigh.

A sneaky peak

To complete my lap around the sun, I slipped in a sneaky peak, with a run to the summit of the Paekakariki escarpment track. It was tough, slow going, but important to do. The run was my part of a virtual charity fundraiser in support of Kerry Suter, an elite runner and coach, who broke his neck in a mountain biking accident in late February. We have several mutual friends, so I had heard news of his accident quickly, while I was in hospital. Kerry is now a tetraplegic, receiving specialist treatment at NZ’s spinal unit in Auckland. Reading Kerry’s progress updates reminds me how fortunate I am; to freely walk, to return to running (however slow!) and to play at the beach with Mia.

A few pics below from April…

To suit my medical requirements, I’ve annexed part of our bathroom as a medical base, stocked with a small arsenal of pills, potions, lotions and medical supplies. From here I conduct my daily ablutions, exercises and medicine-taking, nutrition-drinking and dressing changes. After all that, I unlock the door and emerge for a rest, or more likely a wrestle, with Mia and Fred.

Dressing down

Gradually, my dressings are lessening. My arm donor site, from whence my new palate was grafted, now has a slim-line dressing about a quarter of its size and mass of a month ago. After the first surgery, my forearm dressing / cast looked like the one they use for Police Dog Training for apprehending armed offenders. At home, Fred took a little too much of a liking to it.

So I’m less dressed, but with the essentials covered. I still have a hole in my neck, from the most recent tracheostomy, which needs a patch dressing changed every day or so. It’ll be healed in a couple of weeks, I’m told. Thankfully I no longer require the hole for breathing. Much easier for coordinating a cough, too. Up until a week ago, I needed to press the patch and pinch my nose in order to clear my throat. Leaving any of these outlets uncontrolled would led to messy results.

Stats extra:

Home is where the heart rests

An indicator of my home healing, and the ‘work’ being done since surgery, is the data on my resting heart rate. I’ve tracked this data daily for the past two years, for fitness tracking and training. When I’m fit and race-ready, my resting heart rate is approx 40-44 beats per minute (eg in Jan-Feb 2022, prior to racing The Goat). When I have an infection or have recently done a tough run, my resting heart rate spikes five to ten beats higher, a sign of the body working hard to repair itself. As I recover, over a period of days, the resting heart rate falls back.

You can see the relative impact of my surgery on Feb 23rd, shown in the far right of the chart below. My resting heart rate rose by about 25 beats per minute, or more than 30%, a much greater impact on my body than any mountain run I have ever done. It stayed around 67bpm for a few days, then slowly began to fall. You can also see that in terms of recovery, I’m on the down hill section now!

While I’m not quite ready to resume mountain race training, I did start this week with some daily stairs, and by taking Fred out for an evening trot along the beach. He’s an enthusiastic trainer but completely incapable of travelling in a straight line, racing off to waves or dunes, and sniffing out each half-buried stick on the beach as if each was a fresh bone. So, a straight 2km walk involves about 6km travel, as the dog flies. Still, as the All Blacks say, Champions do Extra.

This week I struck a hiccup in my home recovery, featuring an ambulance ride back to hospital for an unplanned surgery to the roof of my mouth, and a return stay in intensive care. I’m now recovering in the familiar friendly territory of Plastics Ward and if all goes well I should be back home mid next week.

I’ll save the detailed description of it all until after I get back home. For now I’m focused on my rehab, rest and exercises to regather the progress from the past two weeks. Onwards!

I’d like to say a very special thanks to my first responders on Tuesday morning: Mum, Bron and Maree, who were absolute champions and life-savers for me, doing exactly the right thing, under high pressure.