Angie Mezzetti met a survivor of cancer of the jaw who now helps others to get through the disease
We use our jaws for so much - eating, smiling, breathing, drinking, kissing, talking and spitting.
Even to get a full-bodied "F" word out, your lower jaw has to work at full throttle.
Coping without most of his lower jaw presents Jamie Brydone with challenges every day but he feels lucky to be alive and has developed his own unique ways of dealing with life now on a physical and mental level.
"They used to call me Popeye," he says - the handlebar shaped lump on Brydone's jaw was so big that he looked like a cartoon character.
"I had been putting off going to the dentist as it was a busy time in work and we were changing premises. It was like a bad toothache with a lot of swelling," he says.
Eventually, the constant pain made him go to the dentist, then the dental hospital which referred him immediately to the head and neck cancer clinic in the Mater Hospital in Dublin.
There he was diagnosed as having a tumour in his jaw.
"We had to operate on Jamie to remove the cancer which went from under one ear almost to the other," says Tadhg O'Dwyer, consultant head and neck surgeon at the Mater Hospital.
Brydone is back to visit where he was first diagnosed over three years ago when he was 35.
There are no signs of cancer anymore, although he had a recent scare which turned out to be benign.
He needs to have the all-clear before beginning on a new reconstructive phase of his treatment.
The highly specialised team of plastic surgeons and specialist cancer surgeon is going to take bone, muscle and skin from Brydone's back and, over the course of about 12 hours in theatre, give him back a chin.
"We will tack on bone to the existing bone that is left and allow the face to come out further," says O'Dwyer.
"Three teams will be working on him for the day from 8am until midnight. We do this kind of surgery almost every week."
Brydone wasn't well for a long time after surgery and his recovery was complicated because he got a clot on the brain.
"His smoking habit would have been a contributory factor to him having the clot," Margaret McGrath, specialist nurse at the head and neck cancer unit, explains.
Brydone remembers not being able to communicate or to read in the way he had before the operation.
"Faces and things that had happened, I remembered in a different way.
"I made so many mistakes that I am now more cautious about what I say, I double check everything. I am still improving and am back to 70 per cent of where I used to be."
According to McGrath, "Jamie's veins were like what you see in the advert where they're all clogged up," and this made the initial surgery difficult.
The surgeons used the fibula bone from his leg to give him some structure in his lower jaw but this wasn't very successful as the radiation treatment meant that healing was very slow.
Brydone describes how one day "I rang up and told Margaret I literally had a screw loose in my jaw".
According to McGrath: "Jamie is typical of many patients who put off going to a doctor or dentist when there is something wrong with their mouths as they just don't think of cancer there, but assume it's a toothache or mouth ulcers."
She is full of admiration for Brydone who has not only come through very difficult surgery, radiation and chemotherapy treatment in Saint Luke's Hospital, but has helped other younger and older patients with encouragement and reassurance as they face into their treatment for the first time.
He had no hesitation in posing for photographs either, as he will do anything to try to discourage others, particularly young teens, to stop or not to begin smoking.
"I feel that if I had not been smoking, I wouldn't have got the cancer," he says.
He says he smoked anything he could from the age of 13.
"I was addicted but I stopped instantly the day I found out I had cancer. End of story. Smoking was the biggest mistake I ever made."
He says if he can just persuade one person not to start smoking or to quit by telling his story, then he will be happy.
His mental attitude has helped Brydone to get through this ordeal. "Initially I was told I had two months to live if I didn't have surgery. Everything comes in on top of you. I was just shell shocked."
A turning point was when he looked in a mirror after the first surgery. "When I saw myself I knew I didn't look normal. That was pretty scary. One of the nurses said to me 'you are going to look better' and at that point I said to myself 'I am going to get better'."
He highly recommends going into a field and screaming and crying when you are feeling down. "It helps you to get yourself straightened out," he says.
"Just stand there and get it out of your system. If you hold it inside and start blaming other people, you just start feeling sorry for yourself and say 'why me'.
"You take it out on someone who does not deserve it. I don't blame anyone for what happened to me."
Having a date to focus on for his reconstructive surgery is really helping him cope, particularly if it can improve his quality of life. Brydone's strong sense of humour has also helped.
"Eating out with me is not a pretty sight. I have to carry a towel for spills and dribbles. But there is one or two things I can do that are unique - I can eat and drink at the same time."
He has a feeding tube leading into his stomach which allows a high-calorie nutritional supplement to be run in directly.
"I can also drink and talk at the same time because I can pour water into the tube while I am talking," he says as he demonstrates.
He also shows a cage-like structure which is like the one that was fashioned for him.
This mask is moulded to the individual patient's face and clipped to the table so that the patient cannot move during radiotherapy.
McGrath explains, "Before we had these, the patient would have to have their face marked directly so that the radiation could be given to the exact spot, and these marks would stay on their face for weeks.
"Now the mask is marked and protects parts of the face that don't need radiation," she says.
Radiation changed Brydone's taste buds. Cancer cells are burned away and the mouth can be very sore; he couldn't talk or drink water for two-three months. McGrath says it can be particularly hard on mothers who are cooking a meal for the family but cannot eat themselves.
"Jamie had to re-learn to talk and to swallow," she says.
"We have a team-based approach here in the unit, so patients are seen by speech therapists and dieticians as well as the doctors and specialist nurse."
Brydone has become an expert at self-care and has learned to be very methodical about his life, always being prepared with nutrition packs, having a towel with him and thinking carefully first about what he has to say.
Brydone even does some carpentry and IT work now and is grateful for a supportive landlord and good friends in Rathangan.
He is also aware of how lucky he is: "There were lots of others who were diagnosed at the same time as me who didn't make it. They were older. I was lucky that they could give me high doses of radiation."
At the moment he cannot close his mouth which is often very dry and he has a tracheostomy tube. Food is a challenge because without bottom teeth he cannot chew properly.
"Occasionally I have some mashed potatoes which I eat slowly and I can drink.
"Sometimes I go down to the local and have two pints as it is good to get out of the house. People in the area get used to seeing you," he says, laughing when he recalls how a person in his local asked that Brydone be given his own "special glass" so that no one would "catch" what he had.
He is quite comfortable in his appearance but other people can feel very awkward. "Kids are funny, they say things like 'does that hurt mister' and that doesn't bother me. Their parents will tell them to look away."
Adults have also asked him "who did that to you?"
While he is okay with how he is now, he cannot wait to have the reconstructive surgery which should improve his ability to eat and close his jaw.
"If it can be improved, great. Every time I wake up I am happy to be alive. I can't remember the last time I was in bad form. What I would really love is a nice juicy steak."
McGrath says a high percentage of their patients are or were smokers at some stage - 80-90 per cent. Alcohol has a big part to play too.
"It is not uncommon for us to have patients who would drink up to 200 units of alcohol a week, both men and women."
She believes the smoking ban has helped. "Most patients are reporting that they are smoking less. Quite a few just can't give up and there is a high rate of depression in our case load."
The survival rate from head and neck cancers is not great and McGrath believes this is because people present so late.
Facts and figures
•Head and neck cancer is a term used to describe those cancers occurring from the upper third of the oesophagus up to but not including the brain areas, such as wind pipe, oesophagus, voice box, neck, mandible, floor of mouth, tongue, tonsil, palate, sinuses and salivary glands.
•People don't realise they can get cancer in the mouth. They often dismiss sores in the mouth as being mere ulcers.
•These cancers are largely preventable. Up to 90 per cent of head and neck cancers are related to lifestyle or environmental factors.
•Smoking is a big factor. Some 80-90 per cent of head and neck cancer patients engage in or previously engaged in tobacco usage.
•Drinking alcohol - especially spirits - also leaves the body more prone to these kinds of cancers. Alcohol is a significant risk factor and when it acts in synergy with tobacco usage, the risk is higher again.
•Mortality rates are among the highest of all cancers. Within a five-year period, at least one-third will die of the disease worldwide.
•Large numbers of patients present very late.
•The high death rates with these types of cancer are usually because of presenting so late when the cancer is well established.
•Earlier diagnosis means the surgery is less severe, less radical.
•The smoking ban has helped patients smoke less.
•The average patient is male, a heavy smoker and drinker and over 50. They are usually smoking for more than 20 years.
•GPs who are concerned about a patient can access the head and neck cancer clinic in the Mater by contacting any head and neck cancer team member.
•Signs and symptoms include persistent sore throats, hoarseness, painful non-healing mouth ulcers. If the patient is a smoker and/or heavy drinker the situation is more worrying.