Facing the future

Thousand Oaks couple try to restore normalcy after husband battled two often fatal diseases

By Colleen Cason,
ccason@VenturaCountyStar.com
January 15, 2006

Kathy Cavanaugh examined her husband's new face.
It was the third one that Scott Cavanaugh has had in less than three years of marriage.

There had been the handsome, 23-year-old version that now exists only in their wedding photographs. By their first anniversary, that face was gone, replaced by a gaping wound in the left side of his head.

And last summer, in a narrow, mirrored hallway of a Van Nuys medical office, Scott stood before her wearing a synthetic face with skin and nose sculpted from silicone and an eye made of acrylic.

As Kathy waited for Scott's reaction, he placed a finger on either side of her mouth and gently pushed her lips into a smile.

She gave him a peck on his mouth.

"It's nice to have a nose there when I kiss you," she told him.

This face was another attempt by the Thousand Oaks couple to restore normalcy to their lives after Scott battled two often fatal diseases in 2003.
Already immune-compromised by chemotherapy for leukemia, he contracted the fungus mucormycosis. It attacks the sinus cavities and, if left untreated, will destroy the brain.

To save his life, surgeons removed his eye, eye socket, all of his nose -- except his nostrils -- his sinuses, the roof of his mouth and six teeth. His remaining eye lacks bone support and slants at a 45-degree angle.

Nine surgeries later, Scott Cavanaugh remains severely disfigured. For more than a year, he has worn a 4-by-4-inch white gauze bandage over half his face. His appearance draws stares and occasionally unwelcome comments when he goes out in public.

He has not been able to work as a software designer since he was diagnosed with leukemia three months after his July 2002 marriage. Kathy supports them as a third-grade teacher at Rio Rosales School in Oxnard.

It put their newlywed plans of children, homeownership and further education on hold. They have accumulated at least $50,000 in medical bills that their health insurance does not cover.

By all accounts -- and against all odds -- it strengthened their marriage.

After two months of living with the prosthetic face, the Cavanaughs say it is far from the perfect restoration that they had hoped for.

But it is a beginning. For Scott, 2006 will bring more surgeries and, before the year is out, Kathy will see at least one more face.

'My Scott'

Scott Cavanaugh was ready to face his battle with leukemia within minutes of being diagnosed in October 2002.

On Kathy's 27th birthday, in the emergency room of Los Robles Hospital & Medical Center, the doctor told him that he had a blood cancer.

"Is it curable?" Scott asked.

When the doctor said it was, Scott replied: "All right, then."

Seven months into his chemotherapy, around Memorial Day 2003, he developed facial pain. An orange discharge seeped from one tear duct -- both symptoms of mucormycosis.

Although this fungus is a particular danger to leukemia patients, seven days passed before he was diagnosed, according to court records filed in the Cavanaughs' suit against USC/Norris Cancer Center.
Only surgery could save his life. The surgeon told Kathy that they might have to take Scott's eye, but with plastic surgery, he would regain his looks, she recalled.

Scott emerged from the operation with his head wrapped in bandages; he could neither see nor talk.

On their first wedding anniversary, Kathy said, doctors told her that Scott probably would die and she should prepare him.

She refused. Instead, she read Harry Potter books to him by the hour. She slept in a bed in his room and gave him a bell so he could summon her.

Eventually, he battled back. But at the same time, Scott's mother, Irma, was hospitalized at City of Hope, recovering from a bone-marrow transplant. She, too, had developed leukemia.

Scott wanted to delay telling her about his crisis until she was stronger. So Scott's sister, Jenny Cavanaugh, and Kathy became cheerful actresses, assuring Irma Cavanaugh that all was well.

Finally Scott wrote his mom, telling her what had happened.

"Three paragraphs into it, I broke into tears," said Irma Cavanaugh, who has survived the cancer and lives in Camarillo.

Scott recovered enough to leave the hospital but plunged into an abyss of depression.

"I felt like I was at the bottom of an empty swimming pool with no ladder or stairs. Each time I tried to climb out, I slipped back to the bottom," he said.

He confided in his sister that Kathy would have been better off had they not married.

Tapping a pool of strength

But there was a pool of strength in their marriage that he had not fully tapped.

Jenny Cavanaugh shared with him the words that Kathy spoke when she saw Scott's devastated face after the surgery.

"That's still my Scott," she had said.

In early 2004, the Cavanaugh consulted with William Clearihue, a Los Angeles anaplastologist who creates artificial facial features. With Scott's leukemia in remission, they believed that plastic surgery to restore his face finally could begin.

Clearihue broke the devastating news to the couple. It came down to the bone, he explained. Too much bone and cartilage, especially around his eyes, were missing to make Scott a candidate for reconstructive surgery or even an experimental face transplant.

The best that could be done was a prosthesis.

It took days for that to sink in for the Cavanaughs. Finally, Scott came to terms with it. "Life is not ideal. I get what I get," he said.

But at that first meeting, Clearihue was more concerned about Scott's remaining eye. It was red and dry because his eyelid failed to close completely.

Scott underwent three more operations to stabilize his good eye.

The land of almost

With the swelling down from the eye surgeries, the process of creating Scott's prosthesis began last summer in a low-slung building beneath a runway at Van Nuys Airport.

The office of American Medical Prosthetics & Orthotics is the land of almost. Almost natural, almost normal. Almost, but not quite, Clearihue admitted.

"They want to look the same as before," he said of the legions of disfigured that he treats. "Reality is it will never happen."

Scott's prosthesis is the second largest that Clearihue has created in his 30 years in practice. Scott is only the fifth mucormycosis patient Clearihue has seen in the past three years.

"No one used to survive it," he said.

A facial, as Clearihue calls it, takes high-tech materials, old-world craftsmanship and a dash of artistry. Clearihue is a medical MacGyver, using a creme brulee torch and precision ophthalmology scissors -- whatever it takes to re-create what disease and disaster destroyed.

As the final session began and the moment of truth neared, Clearihue rested the silicone facial on the table beside Scott.

"It looks like a pastry," Scott quipped.

In the land of almost, a compromise had to be made. Scott's remaining eye slants downward from the inside corner. When Clearihue positioned the artificial eye in the prosthesis at a normal angle, it looked awkward. Scott decided to split the difference and skew the artificial eye at a slight angle.

This session, as the other five did, lasted several hours. Restless, Scott played with a hand-held video game and made conversation.

He said he is grateful he lost only a nose and an eye. He still has his hands. Since his illness, he has become an avid musician.

"I can deal with what happened to me," he said. "But if I had lost my hand, I don't know what I'd do."

As he spoke, a technician in the hall behind him carried a prosthetic hand into an adjacent examining room for an unseen patient.

Meanwhile, Clearihue attached the prosthetic to Scott's face and told him to look in the hall mirror.

"Beautiful," Scott mouthed, as he observed his face with contours for the first time in two years.

But before the session ended, the elation had dimmed.

The skin tone is off. The color that had matched Scott's coloring when Clearihue began painting now appeared too pink.

"Scott has that chameleon kind of skin," Clearihue said. "Some day, I will make him one for when his skin is ruddy and one for when it's pale."

Clearihue, who had invested 70 hours in the prosthesis, admitted disappointment in its pigmentation.

In the weeks that followed, Scott, too, developed mixed emotions about the prosthesis.

To wear it, he must first douse his face with rubbing alcohol. He then applies Liquid Bandage and a strong adhesive. The chemicals smell bad and sting. And despite these harsh measures, the adhesive can weaken and the prosthesis can gap.

Nobody would mistake it for his real face, Scott pointed out.

Recently, he and Kathy attended a concert at a Ventura nightclub, which has a rule against patrons wearing hats and sunglasses. Scott uses shades and a cap to camouflage the margins of the prosthesis.

When he removed them, the bouncer politely told him that the rule did not apply to him.

But during a meal at a Newbury Park breakfast house, few appeared to notice Scott's face.

Kathy encourages him by noting that the white gauze he once wore attracted stares from a distance. People only notice the prosthesis when they are very close to him.

Facing forward

Already hidden beneath the prosthesis is Scott's next step.

Almost a year ago, Dr. George Rudkin, a professor of plastic and reconstructive surgery at UCLA, embedded five screws in Scott's skull. Eventually, magnets will be attached that will allow Scott to have a snap-on prosthesis.

With the magnets, Scott will no longer need noxious chemicals to attach the face. The snap-on face also can be made thinner and look more like skin, Clearihue predicted.

Later this month, Rudkin is scheduled to open Scott's face to make sure that the screws have fused perfectly into his skull and will stand up to the magnetic force.

For Kathy, the attraction she felt for Scott when she saw him the first time is still there, she said.

"If Scott had died, we wouldn't have had this time together and hopefully have children and continue with our dreams.

"What is it? Mucormycosis is a fungal infection of the sinuses, brain or lungs that occurs primarily in people with immune disorders.

What causes it? A common fungi frequently found in the soil and decaying vegetation. Most individuals are exposed to these fungi on a daily basis, but people with immune disorders may be more susceptible to infection.

Symptoms: Acute sinusitis, fever, eye swelling and
protrusion of eye orbit, dark nasal scabbing, redness of skin overlying sinuses, coughing blood and shortness of breath (pulmonary), abdominal pain and vomiting blood (gastrointestinal), flank pain and fever (renal).

Who is at risk? It should be suspected if symptoms
appear in individuals with diabetes or those with weakened immune systems such as transplant recipients or leukemia patients undergoing chemotherapy. Symptoms of rhinocerebral mucormycosis are most likely to occur among people with suppressed immune systems.

How is it treated? Early surgical intervention to
remove all dead and infected tissue, along with intravenous antifungal therapy. Surgical removal of involved tissue may be disfiguring because it may involve removal of the palate, nasal structures or eye structures.

Is it fatal? Mucormycosis has an extremely high mortality rate even with aggressive surgical intervention. Death rates range from 25 percent to 80 percent depending on the site involved as well as the underlying immune problems.

How can it be prevented?

Because the fungi that cause it are widespread, the most appropriate preventive measures are improved control of the underlying illnesses associated with mucormycosis.

Source: MedlinePlus http://www.nlm.nih.gov/medlineplus/

To help

An account to cover some of Scott Cavanaugh's medical bills has been opened at Washington Mutual. Should you wish to contribute, send donations to the

Scott Cavanaugh Fund,
c/o Washington Mutual,
148 W. Hillcrest Drive
Thousand Oaks CA 91360.

Karen Quincy Loberg / Star staff

Scott Cavanaugh, 26, of Thousand Oaks, is fitted with a prosthetic face to cover the gaping hole left after the fungus mucormycosis caused the loss of his eye, eye socket, nose, sinuses and part of his mouth.

Karen Quincy Loberg / Star staff

William Clearihue an anaplastologist, uses earlier photos of Scott Cavanaugh to help build the prosthetic face, sculpted from silicone, for him. Clearihue attempted to perfectly match Cavanaugh's skin, but had trouble with the color.

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