Patient Experience: How David Kelly discovered a 12mm-wide stone in his throat
IN BRIEF - 10TH AUGUST 2016
How David Kelly discovered a 12mm-wide stone in his throat - and how having it removed changed his life for the better, despite forcing him to miss on of the biggest days of his career.
Up until a year ago I didn’t even know salivary stones existed, although I’d had a bit of an issue with my glands swelling at meal times since I was about 12 years old. By the time my parents ever got me to the GP, the swelling had gone down. The GP checked for mumps, and told them to just keep an eye on it; there wasn’t much they could do, they said, and it only happened about once or twice a year.
Then, about a year ago, it started happening more frequently. I’d be eating, then my jaw would swell up painfully until eating became uncomfortable. One day it happened when I was having lunch at work.
I work at Manchester United Football Club, where I’m the first team’s sports scientist, so I went to see the club doctor. He alerted me to this condition called salivary stones, in which one of the tiny calcium balls that are produced by salivary cells all the time and are normally just washed out in the saliva gets stuck on a duct wall or bend. There, it acts as a nidus for calcium dissolved in saliva to precipitate out, causing the ball to grow in size at about 1mm a year.
Eventually this ‘stone’ ends up partly blocking the duct, so at meal times, when saliva is stimulated, it can’t flow into the mouth. The gland inflates with obstructed saliva—hence the swelling in the lower jaw and cheeks—until the dammed saliva slowly finds a way around the stone into the mouth and the swelling recedes again. It’s called mealtime syndrome apparently. It’s the major symptom of salivary stones—and when I went to my local hospital in Barnsley as the doctor at Man U recommended, the x-ray revealed a large stone, about 12mm wide, deep inside my neck.
I have to say, I was surprised to see it. A week before, I didn’t know salivary stones existed: now I was looking at a large calcified mass inside my submandibular gland. They told me the only way I could have it removed was to take out the whole gland, through my neck—a big operation, which comes with a big risk. The submandibular gland sits very close to a major facial nerve, and trying to dissect the gland without affecting this nerve is difficult—like a needle in a haystack, apparently. If it was damaged, it could create a paralysis— like I’d had a stroke.
I was adamant I wasn’t going to have that done. It would leave a big, visible scar on my neck, and if the nerve controlling the face was affected, my face would droop. This makes me sound vain, and I’m not, but the last thing you want is a drooping face. I did some research on the internet to see if there was an alternative way to remove the stone, and came across this leading expert in salivary gland surgery, Professor McGurk. I went back to Barnsley, told the doctor there that I’d discovered this surgeon who had pioneered the use of minimally invasive surgery for salivary stones—known as the Endoscope Assisted Submandibular Gland procedure—and he said immediately, “You must mean Mark McGurk? I worked under him, years ago. However, looking at the scan of the x-ray, I think you’ll find this salivary stone is so deep even his surgery won’t work.”
"I woke up Saturday morning to find one side of my face had swollen up quite badly."
Of course there was some discomfort when I came round after surgery on Thursday night: after all, they had cut through the floor of my mouth to reach the gland via the duct using a micro endoscope to find the stone before releasing it. Also, in order to ensure the important lingual nerve was not affected by surgery they had had to isolate it, which leaves a tingling sensation in your tongue. Come Friday afternoon, however, it seemed everything was back to normal besides the tingling sensation, which was similar to that you get after a visit to the dentist. There was no swelling, no pain, and they allowed me to go home to my nephew’s. I was really overjoyed, if a little tired—so as soon as I got in I went to sleep.
I woke up Saturday morning to find one side of my face had swollen up quite badly. I realised I was having difficulty swallowing—then, difficulty breathing. It felt like a ball was trapped inside my windpipe. So far, my sports science background meant that I’d found the stone quite intriguing: I’d read journals and papers, and really got very interested—but this experience of being infected and feeling so ill was entirely new. I’d never really been ill before, because of my job. I have to stay fit and eat healthily to keep up with the team. The most I’d had was the flu; now it felt like my neck was closing in. It wasn’t very nice really— so I rang Mark McGurk, who told me to come straight to the hospital. My nephew lives in east London, so it’s a 45-minute tube journey to King Edward VII’s Hospital—and it felt like the longest 45 minutes of my life. I was really struggling to swallow by then, so I had to take an empty water bottle with me and spit in it during the journey. I don’t know if you’ve ever tried not to swallow, but it is very unnerving—and I was pretty embarrassed, spitting in this bottle— but I thought people on the tube had probably seen worse.
As soon as I got in, Mark McGurk put me on antibiotics and a bit of pain relief. I’d got an infection, he said, which can happen in a few cases because when you disturb the stone bacteria can get in. I had to stay in the hospital for 24 hours so they could keep an eye on me, and I continued with antibiotics for the rest of the week.
It turned out the Barnsley doctor was right not to be too hopeful— because when I did initially see Mark McGurk at King Edward VII’s Hospital he told me that in 96% of cases he could feel the stones in the neck, so he could get at them easily. My stone, however, was so deep he couldn’t feel it at all. I was in that unlucky 4%. The stone had been there for 12 years at least, and probably much longer. If I cut the stone open, he said, I’d see rings of calcium like the rings of a tree. I remember asking him at that moment what would happen if I just left it, and didn’t proceed with any treatment. He said it would almost certainly get bigger, until eventually bacteria found it and started causing infections. The more infections there were, the more damage would occur to the gland—and it would ultimately make me very sick. Although it would be tricky, we decided to go ahead with the Endoscope Assisted Submandibular Gland procedure.
I still think I’d have lived with it had there not been the possibility of having it removed via this procedure. As it was, I decided to work until the end of the football season at the end of May, then have my op. The club were happy for me to have it earlier, but I wasn’t in agony and I was happy to wait until it was best for the team. The surgery was booked for the evening of Thursday 19th May: the FA Cup Final was that Saturday at Wembley, and the plan was to stay with my nephew, who lives in London, and then take him to the game.
It was terrible. I ended up watching the FA Cup Final, where Manchester United beat Crystal Palace, alone in my hospital bed with my IV drip. But the way I was feeling at that moment, I just wanted to be safe—and I felt safe where I was. I sorted my nephew out with some workmates so he got to see it, which was good—and I’m happy with the outcome. Now when you look at me, you’d not know I’d had an operation. Within a few weeks the stitches dissolved and disappeared, I didn’t feel sore and while my tongue was still a bit tingly the swelling had gone and I could eat normally—even sour foods, which used to be the worst because they stimulate your glands the most. I’ll see Mark McGurk in three months, just for peace of mind, but he said the chances are he will take one look at me, ask me how I am and I’ll tell him I’m perfectly fine. I’m so glad I went to see him.
After reading so much about this condition, I don’t think many surgeons could have got that stone. He’s an interesting guy. We had good rapport. He’s done a lot of work around mouth and neck cancers too, and works for a charity called Project Harar, treating facial deformities in Ethiopia. I’m going to get Wayne Rooney and the lads to sign a shirt for him, so he can auction it. I’d like to help in some way.
I’m devastated I missed the FA Cup win, but at the end of the day it’s out and it’s done, and that’s the main thing. Besides, there’s the new season, and training starts soon. I’ve already told the lads they have to do the same again, because I missed it—and I’ve taken in the stone to show them. It’s pretty gruesome-looking, and really hard, like marble. I can’t believe it was inside of me for so long.