Most people don’t get the chance to see what Julian White sees. Most people don’t have the training that he has. But plenty of people may one day need his services.
Julian White is an ear, nose and throat surgeon. It’s a branch of medicine where simple procedures can make a big difference. The insertion of grommets, clearing of sinuses, removal of tonsils or adenoids – these and other common operations can have life-changing benefits for the patient. It was one of the things that attracted Julian to the specialty. “There were a number of procedures that didn’t really take all that long but were very beneficial to a lot of people, perhaps more than other specialties,” he says. “There are a lot of people who have ear, nose and throat problems.”
When it comes to the sinuses, he operates endoscopically (using video monitors) and may soon also be doing so at Braemar on the salivary glands and ducts. These are so small that the endoscopic instruments he will use are only about 1mm in diameter. Using them will allow him to do more than he can with conventional procedures, including more reliably removing stones and administering medications.
Julian White also performs more intensive surgery thanks to a subspecialty in head and neck cancer. To further his knowledge in this area after he finished his training in 2005, he spent 18 months in Canada working with and learning from leaders in the field. At Braemar, where he operates for half a day each week, he has been able to apply that knowledge with operations to remove lymph nodes in the neck. Apart from his private practice, he also develops his skills at Waikato Hospital.
It is the continuation of a career in a branch of medicine that he was first attracted to as a student. “I looked down a microscope into the ear for the first time and I remember it clearly because it struck me that this was something that most people don’t see. And that’s still one of the things that attracts me to the specialty, I suppose – you can look into dark holes and see stuff that is invisible to other people. I saw the structure of the ear, I saw the eardrum, the little bones, the ear that I’d only read about in text books before.”
The spark was further fanned early on when he was inspired by working with a “very intelligent and caring” ear, nose and throat surgeon for a year in Auckland.
Years later, his career has brought him to Hamilton, where he lives with his wife and their two young daughters, enjoying the benefits of a “great place to raise school-age children”.
That includes reviving his interest in playing music as one of his daughters learns the violin while the other learns the cello. He learned to play the violin as a youngster, and now he has an excuse to pick it up again alongside his daughters who are being taught by the Suzuki method. “What they really enjoy is the camps, that’s really what got us hooked. The Waikato branch has a camp every year at Lake Rotorua. We went there in January. It’s actually a really wonderful thing. If you go to a camp like that, the older kids are playing amazing music and the younger ones can see that if they keep going they are going to be playing like that one day.”
In some ways that’s not too different from medicine, where Julian has come a long way since he first peered at the inner workings of the human ear and launched himself on his chosen career.
5 Commonly Asked Questions
1) Are all neck lumps cancerous?
Fortunately, most neck lumps are not. There are several normal structures in the neck which can feel like an abnormal lump. The most common neck lumps which reflect illness are lymph nodes which can enlarge with a bacterial or viral infection such as tonsillitis or a cold. Cysts can be present at birth or develop later on. Benign tumours can occur in the neck as well as malignant tumours or cancers.
2) When should I be concerned about a neck lump?
As a general rule, all neck lumps should be checked by a doctor. However, if you have one or a few small (less than 1 cm) lumps which appear with an obvious infection in the head and neck area, such as a cold or tonsillitis, it is likely they are enlarged lymph nodes which will disappear once the infection clears. If they are present for more than two weeks or there is no obvious infection they should definitely be checked by a doctor.
3) What tests might be required for a neck lump?
Commonly a fine needle aspirate (FNA) is performed. As the name suggests, this involves taking a sample of the lump with a fine needle, similar to a blood test. The cells obtained in this way are examined by a pathologist under a microscope. A scan, usually ultrasound or CT, is also commonly performed.
4) What sort of treatment is required for cancer of the head and neck?
As with cancer anywhere in the body, treatment can be with surgery, radiotherapy, chemotherapy or a combination. Each modality of treatment can be tailored according to the individual patient and his or her particular cancer.
5) How often is cancer of the head and neck cured?
Skin cancers are the most common, and most are cured with simple removal, although sometimes they can be more aggressive. For other types of cancer in this area, the short answer is about 50%. However, many different types of cancer can affect this part of the body. Some types have a much better cure rate, and some are more difficult to cure. For any type of cancer, the chance of cure is higher if it is detected at an early stage.