The subject of this issue’s Office Visit, Dr. Manu Dua, was diagnosed with oral cancer in July 2019. Here, he shares his innermost thoughts about his journey: receiving his diagnosis, his extremely complicated surgery, and how he’s handling his road to recovery
We spend most of our professional lives diagnosing, treating and healing other people. However, sometimes in constantly treating others, we become immune to the fact that someday those conditions may affect us. When that day comes, we realize not only are we not immune but also that our lives are fragile and precious, and we need to stop and appreciate what we have, for soon it may be gone.
My oral cancer diagnosis
I had until this point convinced myself to live in constant fear—fear of failure, fear of rejection, fear of staff issues, fear of clinic issues and fear of life in general. The irony is, I didn’t understand what real fear was until I was faced with one of the most frightening prospects—my cancer diagnosis. I had just poured the best part of three years building a startup and surviving a recession and slow economy. Just when things were looking great for me, I got devastated in the worst possible way.
It started with an innocent sensation: I woke up feeling as though I had bit my tongue. I spoke to my colleague and best friend about it, because the feeling did not go away. Over the next few weeks I noticed an ulcer form, and eating had become painful the minute any food touched it. Concerned, I booked an appointment with an oral surgeon to look at it.
To add some context, I’m a healthy 33-year-old with no history of smoking or chewing tobacco, and I rarely drink alcohol. The first thing I asked my surgeon was if he thought it was malignant. Based on the symptoms and my great health history, we both thought it highly unlikely.
We tried a round of prednisone, because the symptoms were very close to erosive lichen planus, but that did not resolve. The lesion progressed, and I was getting earaches and constant pain in my lower jaw; I found it hard to sleep and focus at work. I tried my best to put on a brave face as we biopsied the lesion soon after the round of prednisone had no effect.
I won’t forget the Thursday afternoon in July when my friend and oral surgeon Dr. Lee Darichuk surprised me with an unexpected visit. He had come after work to personally give me the results of the biopsy. Until this point, I was very confident that it would be some form of autoimmune disease, because until this point, all of my training from dental school had heavily skewed my opinion toward a sense of arrogance that it couldn’t happen to me because I didn’t smoke, chew or drink. Also, the lesion was painful, and we’re taught malignancies are rarely painful. Imagine my surprise when he sadly informed me that I had squamous cell carcinoma of the left side of my tongue.
I would like to say that at this point I was completely devastated, but that wasn’t the case because I had watched one of my close friends battle a rare form of non-Hodgkin lymphoma for more than a year. Watching him go through multiple rounds of chemo and struggle with the effects of a bone marrow transplant really hardened me. I was there for his 30th birthday when he was in the hospital hooked up to IVs. There’s a sense of sadness that’s hard to explain in watching someone suffer for no fault of their own.
I had learned a long time ago that life was neither kind nor fair, but the unjust suffering of good people is hard to bear for even the strongest of people.
I scrambled to find a locum to bail me out, because I was a single dentist in a growing clinic with six staff members. I was living the nightmare every single owner dentist has, especially younger dentists with big bank loans and fledgling startups to take care of. My concern was also for my staff, many of whom depend on the clinic for their livelihoods, and for my patients who have been kind enough to honor me with their trust, which is hard to replace. The ENT surgeon had rushed my case, so I had less than two weeks to find a locum to entrust my life’s work with while I was recovering.
With the help of a friend who’s involved in the local dental community, I posted a locum position and soon I was blessed with a response from a dentist who had recently sold his clinic and was looking to locum. Turns out I had worked with him before, and not only was he a great and kind person, he was an excellent dentist. During this whole process, my locum, Dr. Jeff Bilodeau, has been amazing in keeping the clinic going and taking great care of my patients and staff. Most importantly, he has provided me with a huge sense of relief because I could focus on recovery and not worry about my clinic.
Left: Four days after surgery. Right: 11 days after surgery.
The next steps
My surgery was booked for eight hours. They had to remove about half my tongue and send each specimen to a pathologist for examination. They then removed a flap from my left arm and transplanted that to replace the removed tongue section. To keep the flap healthy, they transplanted the radial artery from my left hand to the tongue area to provide vasculature, then removed a section of skin from my left thigh to cover the left-hand area.
Because of a suspicious CT scan, they suspected lymph node involvement. They completed a neck dissection and removed the lymph nodes from the entire left side of my neck. To prevent the swelling from affecting my breathing, they performed a tracheostomy, an insertion in my neck to allow me to breathe. However, I was unable to speak while it was inserted. It took two ENT surgeons, two plastic surgeons and one vascular surgeon to take care of me, and I am eternally grateful to them all.
The (difficult) road to recovery
The entire hospital stay was a roller coaster of emotions and scares. They woke me up every hour for the first five days and every two hours for the remaining six days, so I basically didn’t sleep for more than a week.
On the fourth day, I developed a severe facial infection. My face was so swollen I couldn’t close my mouth for three days. They did an immediate CT scan, put me on IV antibiotics and rushed me back to the OR to drain the area, but because it was so spread out, all they could do was wait for the antibiotics to kick in.
At this point, I was unsure if I’d come out of the hospital alive. I hadn’t slept in days and I had a respiratory tract infection from the trach and a fever, and had somehow developed asthma. These were some of the darkest days I have ever experienced.
As the antibiotics kicked in, my condition started to improve and I made a promise to myself to come out stronger than ever. As I sat there sleep-deprived in a hospital bed unable to speak, I learned that the greatest wealth in life is the love and care of our loved ones. My friends and family stood by strong and gave me the courage and will to heal. No amount of money could have saved me from this predicament; no amount of practices, houses or cars would have rescued me. It was the skill and dedication of a team of surgeons and nurses and the love and strength of my family and close friends that gave me the will to survive.
Not being able to speak for two weeks teaches a person many things about the value and importance of words. I learned how to listen, how to appreciate things far more. Often we are too busy trying to get the last word in before even listening to our fellow humans. We need to speak more kindly to each other.
The first month after the surgery was the toughest for me, because I had to learn how to speak again, practice swallowing and eating, and learn to use my left hand again. Despite all the pain and nerve issues from my hand, I was focused on making the best of my second chance in life. Often we take what we have for granted until it is cruelly taken from us. I have taken this opportunity to slowly heal and work on myself.
Despite all the pain, emotional turmoil, and the cruel and unnecessary nature of cancer, I have come out of this experience strong and extremely thankful and grateful for all that I have and all those around me. It has given me a sense of perspective I would never have had, and has given me the strength and fortitude to live in the best possible way—full of kindness and without fear.
I wish this experience upon no one, and the most positive thing I can say is that it has given me the ability to truly appreciate what I have and a burning desire to make the best of my second chance in life.
My sincere hope, if someone has taken the time to read all of this, is that you shouldn’t have to face death to understand the meaning of life. No matter what circumstances you have in life, stay strong and embrace all that life throws your way, because living in fear is no way to live.
Refuse to let your life be defined by your circumstances; rather, find the inner strength and courage to respond and thrive amidst the most difficult of times, because we are all much stronger than we could possibly begin to imagine.