Jeff Lukye has pushed many limits - his own and those of modern medicine.
The 30-year-old from Estevan has endured 55 hours of extreme surgery in the past month.
"He's been through so much having multiple operations, one after the other," said Dr. Eric Dozois, the lead physician on Jeff's surgical team at the Mayo Clinic in Rochester, Minn. "It's extremely difficult on him physically and psychologically. Not only him, but his family."
Jeff's wife, Keri, is amazed her husband feels less pain now than he did before the three gruelling operations.
Jeff consistently rated his pain an "8" out of "10" prior to the surgeries. Now he ranks his pain at "3" or "4," said Keri in a phone interview from Jeff's hospital room on Friday.
"It really put it into perspective for me," she said. "I knew he was in pain, but after what he'd gone through with the surgery, I didn't realize he'd be in less pain. He's uncomfortable at times, but he's doing well."
The Lukyes went to the Mayo Clinic desperate for a cure.
Diagnosed with colorectal cancer in 2008, Jeff had chemotherapy and radiation before a tumour was surgically removed along with most of his colon. Following chemotherapy, he was cancer-free until August when he was diagnosed with cancer again.
Jeff's only treatment option in Saskatchewan was chemotherapy, so the Lukyes turned to the Mayo Clinic. Specialists there told them that his only option for survival was extremely radical surgery.
The first operation at the Mayo Clinic was Dec. 17.
During the 14-hour exploratory surgery, surgeons assessed if the second operation could be performed as planned. They found the tumour had spread beyond what they had expected, so they had to redesign the second surgery. With the redesign came greater risk.
The major blood vessels had to be manipulated to the point where the risk of Jeff bleeding to death on the operating table was significantly higher.
Dozois left the operating room to explain the heightened risk to Keri and family members.
Keri turned to Jeff's twin brother for guidance.
"I said: 'You know him better than anybody in the world. What do you think he would do?' He said, 'Jeff didn't come all this way to stop now.' "
A day before the Dec. 20 surgery, Jeff was well enough to discuss the risks with Dozois and told the surgeon to "keep going."
During the 27-hour operation, surgeons removed the tumour, half of the pelvis, the lower spine, the pelvic organs and the right leg.
The third surgery to reconstruct the young man's body was performed Jan. 17 and lasted 14 hours.
The surgeons began by taking bone from the amputated leg and positioning it to act like a strut from Jeff's lower spine to the half of the pelvis that will stabilize his remaining leg, Dozois explained.
"Then titanium rods were bent and moulded to his anatomy and to his particular shape that reinforces the structural integrity of the lower spine to the remaining pelvis to give stability when he is weight bearing on his leg," he said.
Imaging studies and precise measurements dictated the placement of screws and other hardware.
"The orthopedic spine surgeons are just like magicians when it comes to this stuff," Dozois said. "They get it all plotted out and then they put it in and make sure it's secure. Then they take some crushed bone and pack it around the screw holes to try to get new bone growth to occur there."
He moved the intestines away from the hardware and plastic surgeons modified the flap of skin covering the hardware.
Dozois said the surgery required incredible collaboration between the colorectal surgical team, the orthopedic spine team, the plastic surgery team, two anesthesia teams and three nursing shifts with three nurses to each shift.
"It's an amazing sight to see quite honestly," Dozois said. "It still impresses me after all these years to see all of these people working together."
The teamwork continued outside the operating room and involved other health-care professionals such as physical therapists.
"You can't have one piece without the other," Dozois said. "If you don't have good anesthesia, if you don't have a good intensive care unit - all your efforts start to be compromised. It's a tremendous effort of many, many people."
He described the multiple operations as a marathon.
"You just keep on going through different phases of procedures and then recovery and then another procedure," Dozois said. "Jeff is away from home so that part is difficult, but the good news is that he's avoided major complications such as pneumonia or major wound infections, which is a relief."
However, the risk isn't over.
"With the hardware that is in his body and attached to his spine and his pelvis, that's a heightened concern for infection," Dozois said. "But as the body sort of recognizes it as its own and starts to build tissue around it, it gets protected. That can take several months for that to happen."
Dozois expects Jeff will be at the Mayo Clinic for at least another four weeks while he undergoes rehabilitation.
He stressed the importance of Jeff continuing rehabilitation therapy when he returns to Saskatchewan.
"That will be a critical, critical piece for his continued recovery," Dozois said.
Jeff is considered cancer-free right now, but he will return to the Mayo Clinic for periodic CT scans and imaging studies to assess tumour recurrence. On those return visits, the orthopedic surgeons will also ensure the hardware hasn't moved within his body.
"Early on with this kind of complex case, we like to be heavily involved," Dozois said. "But with time, transitions of care will take place and it'd certainly be easier for him to have care locally - if that's available. We work very closely with teams all over the world to help keep folks closer to home if that's appropriate."
In days, Jeff will start physiotherapy.
"He's very motivated to get home and get back to life," Keri said.
The couple appreciates the support they've received from family, friends and complete strangers.
"We do want the world to know that we're not going to forget about everything they've done for us," Keri said. "Their prayers and positive thinking are what helps keeps us going. I don't think we could ever say thank you enough for all of the support we've got."
On Friday, the couple was anticipating the weekend arrival of Keri's mom with their four-yearold daughter Maya, whom they haven't seen since Dec. 22.
"Having Maya here is going to be a motivator for him and it's going to fill in that part of my soul that's been missing since she left," Keri said.
Over the past months, the Lukyes have faced many difficult decisions.
Some have questioned their decision to go ahead with the radical surgeries. Dozois has also dealt with naysayers - some in the medical profession.
"This is an extreme case," Dozois said. "This is what I would call pushing the limit, but we're never going to make progress if we don't do that. We really need to be always thoughtful and mindful of what we're doing and reflect on what we're doing to make sure that we're doing it for the right reasons and collect as much data as we can.
"But there is a point where you have to have some faith that based on the best available information and knowledge that we have an opportunity.
"Jeff represents one of those very extreme cases that many people will criticize and say, 'What are you thinking?' But we can't make progress unless we extend ourselves in a thoughtful way. We don't want to be cavalier or do things without the appropriate planning and forethought.
"He represents one of those cases that could ultimately change our impression of how we manage these patients in the future."
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