Throat Blog — Neck Breathing

After making my previous post, I emailed my doctor that my airway seemed continuously restricted and that it might be getting slowly worse. He immediately replied back that I should go to the ER for evaluation.

Hopped in the car around 4pm and drove back to UTSW ER at the Clements building. Unlike my previous visit, this time I was taken to a room within just a few minutes. I explained the situation to the ER doctor who then called in ENTs to further evaluate.

The ENT scoped my throat and found that the airway was at least 10 times smaller than normal. Ordered some antiinflammatories, but also contacted my Surgical Oncologist. Everyone felt like I would need a stoma (neck breathing hole) put in very quickly.

Was admitted to the hospital with a room in ICU for the overnight (or longer) stay. Antiinflammatories didn't seem to do much overnight. Around 5:30 AM this morning the parade of doctors started. Surgery for lanyngoscopy was scheduled for around 8AM.

By the time the wheeled me into the OR, it was closer to 9AM. The procedure was done under local anesthetics…they needed me to be able to breathe on my own during the procedure. That said, they did give me some kind of happy juice. I really don't remember the surgery…the next thing I knew I was being settled back into my room in ICU.

For the next half hour or so, all I could do was cough. Had a "tickle" in my airway thay no amount of coughing would clear. But, this pretty much eased on its own after a while. Now I have only an occasionnal cough.

I can force air into my mouth by covering the hole in my neck, but haven't really tried this too much. I am supposed to get a better mechanical solution for that tomorrow. This will let me continue to whisper-talk.

I should be camped out here in ICU for 5 days, then they'll send me home with few restrictions (driving is OK…have to be careful not to get water on my neck when showering).

I had really wanted to avoid this. If all goes well, this will be just a temporary bypass until the swelling goes down. Worst case, though wiil see a complete tracheotomy (removal) at some point. That, of course, has always been a possibility, but this step really brings the probability of that course nearer.

Don't get me wrong, though. Having this done is much better than having the small remaining natural airway close up on me and then face this as an emergency procedure (or worse). I think I read somewhere once that getting air was a pretty important life function.

So, here's to breathing a while longer. Cheers!

Throat Blog — Day 11 Post Treatment

My last radiation treatment was 11/17. All the doctors advised me that I'd feel worse for 10-14 days, then would start to rapidly feel better. Well, today is day 11 post treatment…and I am definitely still in the "feel worse" phase. Its all in the throat, too. Throat is very sore. A lot of difficulty swallowing…and if I try to drink any water some of it goes down the wrong way and triggers a coughing fit. Really, just about anything can trigger a coughing fit right now. And, my airway is a little bit constricted all the time. Not enough to panic me, but I can feel the air forcing around probably my vocal folds both when I inhale and when I exhale.

Sleep is fleeting…I have to wake up enough to cough or the mucus builds up too much and gurgles in my airway. So I find myself sleeping fitfully at night and then dozing off a lot during the day.

I skipped going to the office on Monday, but did go in, today. Really would probably have skipped today, too, but I had a doctor's appointment this morning and the office is only 15 minutes away. Not going to stay until 5…probably will head home around 2pm.

Today's appointment was with a hematologist. We are trying to determine if/when I can go off the blood thinners. To determine that, I'm getting scheduled for a CT angiogram to see if I have a lot of plaque build up in my arteries. Also another battery of blood tests. Might know something in early January.

It seems that I have a few blog addicts reading these posts. If I don't post to the blog at least every 3 or 4 days I start to get texts and emails asking if I'm OK. So I'll try to keep posting every few days, even if not much is happening.

Throat Blog — All Choked Up

Wednesday I went to the swallow/speech therapist. But, the day's drama actually started at my house as I was getting ready to leave for that appointment. I've mentioned that I have a bad cough that sometimes turns into a gag. What I've not dwelt on is sometimes I gag hard enough that I get a mouthful of whatever is in my stomach…which is usually very acidic. Well, a brand new bad effect from this arose.

I had a coughing fit, gagged, got a mouthful of crud…and then started having trouble pulling air in. Oddly, exhaling was no problem, but inhaling felt like I was working against a vacuum. I was already agitated and this caused me to panic a bit…which made me want/need to breath faster, which just exacerbated the feeling that I could not get enough air. I was moments away from dialing 911 when I talked myself down. I was getting air in. I just needed to calm down and try to breath normally. It took about 5 minutes, but I was able to finally get it under control.

So, then headed out to the speech/swallow therapist. The session was not the x-ray swallow study that I was expecting. This was a consult where the therapist went over exercises designed to maintain/improve my swallowing abilities. I told her about my episode and she advised that the next time this happened to do a controlled slow breathing in through my nose then out through my mouth.

Well, I've had two more similar incidents, today, and both times I was able to keep my breathing (and panic) under control. Still a very uncomfortable feeling that I want to avoid.

Today was Thanksgiving. I spent it at my house, reading, listening to some music, watching some TV, napping, and feeling thankful that I'm still around to post to this blog. That pretty much sums up my plans for the rest of the 4-day weekend. Just want to get through it with the least amount of drama.

Even though treatments have ended, I still have doctor's appointments. Next week I'll go to a hematologist to discuss how long I need to keep taking the blood thinner and I'll also meet with my Medical Oncologist as a followup consult. After that appointment I'll also go get some IV hydration. Dcember, though, has only one scheduled appointment as of today. Next major appointment will be the PET scan that is scheduled for January 31st.

I'm not sure, yet, whether I'll go into the office around those appointments next week. If this cough eases, then I'll likely book some office time. Otherwise, I'll do what I can by remote from my house. Expecting to be back in the office full time in early December, but my actual condition will dictate when that actually happens. I did manage to make it in to the office most days during treatment…but as promised by my Oncological team, I feel worse now than I did at any time during treatment. Not terrible (except for the cough/gagging) but certainly noticeably more fatigued…which is just a good excuse to take another nap.

Throat Blog — Treatments Over

Well, last Friday I finished up radiation, so now just counting down to the end of January, when I'll have a PET scan that will tell us if any live tumor is left. Meanwhile, all of my cancer care team have told me that I'll continue to feel worse for about 10 days and will then rapidly start to feel much better.

This weekend my cough got much worse. Even being on scopalomine and Sudafed, I have to frequently clear my throat, which entails me making a horrible throat noise and sometimes results in me gagging. Not a sound I want to inflict on anyone else, so I skipped a friends birthday dinner on Saturday and basically sat around the house all weekend.

Monday, upped the ante by adding an extremely raw throat to the mix. I did go into the office for a little while, but really only because I had a 1pm appointment to get IV hydration and it is easier to go from the office than drive from the house.

Tuesday my throat was a little better pain-wise,  but got very little sleep so I worked from the house. Same thing, today, except the sore throat is very sore again. I'll leave in a little while to go to swallow study…and I have no idea how I'm going to swallow anything. Even just taking my nightly meds caused me to choke and gag.

I'm really hoping that since the sore throat / cough was one of the last side-effects to appear that they will be one if the first to disappear. No scientific basis for that, thought…just a really intense hope.

For Thanksgiving I'm invited to several places to go watch other people eat turkey with all the fixings. If my throat will cooperate, I'll go…but if it is still this bad, I'll spend it in self-quarantine at my house.

So, I'm really looking forward to November 28 (the 11th day after treatment ended). I'm expecting to able to really eat starting in early- to mid-December. My nutritionists have given me a transitional diet…I'll start with clear liquids for a while before transitioning to fully solid foods. I've never looked forward to Jello quite as much as I am right now.

Throat Blog — The Future is Uncertain

Well, not much clarity from today's meeting with the doctor. He is still very encouraged by my progress, but we really won't know if the tumor is completely gone until my PET scan…about 2 months from now. However, he is seeing recalcification in the area of the thyroid cartilage which sounds good.

Overall, he feels strongly that chemoradiation was the right thing to do (the alternative was immediate radical neck dissection with complete tracheotomy).

He really wants me to try to eat ASAP. So, I'll start trying a few small things and see how it goes. I don't see how I can get much down…still gagging if I cough and even getting pills down takes some time. The Sudafed has really helped clear up the mucus (but radiation treatment seems to increase the mucus even with the Sudafed in my system, so not as effective as it was on Sunday). It also hurts when I swallow. Not excruciating, but maybe level 4 pain on a 1-10. Well, I'll just have to see what I can do.

In my early 20's I took a road trip with some friends to Padre Island. We camped all week on the beach. Amazingly, I did not sunburn at the beach. I was pretty good about keeping sunscreen on. However, driving back the weather was great, the sun was out…and I spent hours driving with my elbow propped out the window. And that is what burned…my left arm got thoroughly toasted. One of the worst sunburns I've ever had…until now. Over the weekend a lot of dead skin peeled off my neck where the radiation has been being applied. Now, my neck is bright red, raw, itching, and painful. In three days, I'll be able to put some better healing ointments on my neck, but for now I'm stuck with using basically petroleum jelly mixed with lanolin. It does lube up my neck and ease some of the symptoms, but also leaves me greasy, sticky, icky, yucky. Another reason to be glad only 3 sessions left.

Throat Blog — Gag Me With a Spoon

Actually, this weekend it doesn't even take a spoon. I've had a pretty continuous cough (throat irritation generating a lot of phlegm). Several times this weekend my cough has triggered gagging. I've managed to not totally lose it, but when it happens it takes several tense minutes to settle things down. This is not nausea at all. Really looking forward to seeing this phase go away.

Other than that, I'm not noting any other substantive changes. The tumor does seem to be smaller, but with other swelling that is really difficult for me to judge. I'll get a better read on this on Tuesday when I meet with my Radiation Oncologist. We are still hopeful that this week will finish off the tumor.

This will be my last treatment week. Chemo on Monday, then radiation Monday – Friday, then done. Well, my medical team says that I'll have about another 2 weeks of downslope after the last radiation before I start to really feel better. That said, other than the gagging, I don't really feel bad. I don't have a whole lot of energy, but I don't feel particularly weak.

Assuming the tumor is gone, the next thing on the worry list will be what can be done about the structure of my trachea. From what I can tell (and, again, I'll get a better read on this on Tuesday), there has really been no regrowth of the thyroid cartilage. That is a major tracheal structure, and I'm not finding much on Google in regards to surgical restoration. Hopefully I'm just not finding something that exists. Without restoration I'm afraid the only option will be tracheotomy, which I really want to avoid.

I've been able to make it into the office most days (well, except for Mondays which are totally taken up with treatment). I'm certainly not at my most productive, but it feels better to go in and do something…even if I could do most of those same things from the comfort of my living room. Plus, my treatments are about 15-20 minutes from the office, so it is really more convenient to leave from there instead of from my house, which can be 45 minutes to an hour away from treatment.

I am ready for the treatment break for so many reasons, not the least of which is the anticipation of taste, swallowing, eating coming back. I really, really miss food. My transition to eating goal is December 10…and I want to be eating most of my food by Christmas. I'll be sure to take some foodie shots as I move in that direction.

Throat Blog — Shrinkage

Good news from the Radiation Oncologist, today. Last Friday he noted a significant shrinkage in the tumor. I had also noticed that the tumor seemed smaller from the outside, and several others noted the same.

As of today I'll have 8 more radiation treatments and one more chemo, then we'll see what is left of the tumor. He's very optimistic that these last two weeks will be a very good two weeks as far as tumor eradication goes. It is unfortunate that I missed two weeks of chemo due to the intestine issue, as the chemo is really important for priming the tumor to die from the radiation.

I still can't swallow food very well…hits my gag button (and, of course, still tastes like crap). Oncologist believes that my sense of taste will come back quickly, as most of the radiation has been targeted well below my mouth. Much of the taste issue is likely also from the chemo…and after next Monday no more chemo so perhaps a few weeks for that to clear up. Hopefully with the tumor shrinking the gag button issue will ease up and I'll start to be able to eat normally, again.

Meanwhile, on the nutrition front…my weight is up, which is good. However, I found out today that my insurance does not cover my tube feeding at all. So, I need to call the supplier and negotiate to an uninsured rate. My first two weeks were billed to insurance at $2,300. Compare that to what I would have paid through other sources ($550-750) and it is still expensive, but manageable. Unfortunately I did not find out I wasn't covered until I'd ordered another 1 month supply. All of those boxes are sitting in my living room, unopened. If I can't get a reasonable cost, I'll drop it all off at their Irving office and seek other sources.

Today I'll meet with my Medical Oncologist (manages the chemo). Since my surgeon has released me, the Medical Oncologist will now manage my blood thinner prescription. I'm hopeful that I'll only need to stay on that for another month or two, but we'll see what he says.

And, finally, the sewer line issue is fixed, and didn't break the bank (just dented it a bit). I'm back home from my mini-vacation at my sister's house. Everything flushes and drains as it should. And, since that had to have been #3 on the bad things come in groups of 3 chart, just looking forward to better things from here on out.

Throat Blog — Wherein “Sewer Line” is not a Euphemism

I've been told often enough that bad things happen in threes that I've been holding by breath waiting for the third biggie to hit (all these small nuisances don't count after 1) Cancer and 2) Blood Clot in Intestine). Well, yesterday morning I went to flush toilet #1 and it mostly didn't…but did stop filling the bowl just short of disaster. I assumed this was just a problem with toilet #1.

So, later in the day, flushed toilet #2. Same result. Uh-oh. This is not a toilet problem.

Went out front and checked the sewer down pipe (I don't know what it is actually called, but it is a capped PVC that goes down to the sewer outflow pipe). The cap had popped off…and it was full to the top, which should never be the case. It means that there is a blockage between the house and the street.

So, called Rescue Rooter who came out in the afternoon and spent a couple of hours trying to clear the line, to no avail. The line is collapsed about 2 feet from the curb. The only way to fix is to dig down to the line and look at it. Which can't start until Tuesday.

Fun fact: A house is not considered habitable without sewer service. Well, I pretty much had come to that conclusion myself. Packed a bag, called my sister, and am now camping out in her spare bedroom. Estimate is a few thousand $ for the dig…but it could go much higher if the entire line is compromised. Just won't know until they dig down and look.

Spending money is no fun (well, unless you are spending it on something fun). But, this isn't really a do-it-yourselfer project (not that I do much do-it-yourselfer stuff). So, biting the bullet, tightening the budget, and hoping for the best.

Throat Blog — A Night at the ER

Ok, gotta spoil the lead. No major issue. But, I've been dealing with the watery side effects of the antibiotic I'm on since shortly after I started on it. It was annoying, but not frequent and no cramping. Until last night. Around 7pm I started having to step down the hall every hour. Still not too worried, though. Until about 9:45 when bad cramping started.

One of the common causes for this kind of symptom is a bad gut bacteria called "C. Diff.". It is normal for some of that to be in your gut, but sometimes it can basically take over. When it does, it can cause some pretty bad things. So, lets look at the typical warning signs:

  • Recently discharged from the hospital — check.
  • Recent start on a broad-spectrum antibiotic — check.
  • Watery diarrhea three or more times a day for two or more days — check.
  • Mild abdominal cramping and tenderness — check.
  • Fever — check.

So, at 9:45 last night I packed up a few things and headed to the UTSW Clements ER so that they could check things out.

Arrived about 10:30p and hung out with all the other sick people until about 12:45, at which time they got me into a exam room. In which I mostly slept. Well, there were samples taken, blood drawn, and a 1000ml bag of fluids added. But, mostly I just dozed and awaited test results.

Test results came in around 6:30 am. Negative for c. diff. So I was cut loose and told to just keep taking the antibiotic until they were out (which will be Sunday morning) and then take probiotics to try to get things running right (or, well, not running) again.

Back to the house, I took a little 8am – noon nap. Then got some calories in, cleaned up, went back for radiation and then came right back home where I was really tempted to just fall into a coma. But, I resisted (mostly). Managed to get in my calorie quota for the day while sitting on the couch (been doing way to much couch sitting) watching TV.

Tonight, a little sore abdomen, but no cramping. Looking forward to catching up on rest this weekend and hopefully my throat (which has been improving) will also lose a little tenderness. Might finally try that oatmeal I've been promising to eat this week.

Throat Blog — A Couple of Changes

Well, what would a week be without something else changing. Some for the better, some not so much. So, I guess this should be pretty neutral.

Last week, they did a re-image scan of the tumor and adjusted my radiation treatments this week based on that scan. This is a "for the better" part…previously the irradiating machine would make 4 passes of about 1 minute each. This week, the protocol changed to only 3 passes. Active portions of the tumor have reduced enough to warrant the reduced dosing. That scan also allowed for revised/better targeting. So, all in all, that is good.

But (ok, there had to be a but). On Mondays when I go in for chemo, the first thing they do is run labs. Well, this week my white blood cell count was high. not enough to skip chemo, but enough that they had some concerns. I had no symptoms, though. No other indication of infection, no fever, etc.

Monday was a very busy day…I had to get up before 6AM to make my first appointment and didn't get home until nearly 7PM. So, I was beat. So beat that it didn't really register that I went to bed shivering a little. When I woke up at 2:30 AM, I felt hot/sweaty, but not the night sweats I'm used to. So, I checked my temperature. 102.1F. Yikes. I took a couple of Tylenol and slept until around 5:30 AM. Rechecked and fever was down to 99.7F. Still too high. So, instead of heading into work, I went up to the Dr's clinic to see what I should do.

Despite all the medical drama the last few months, I'm still a newb at being sick. So, was quite surprised when they said what I should have done was go to the emergency room. Well, guess I'll know for next time. This time, though, they put me on a strong broad-spectrum antibiotic and sent me on my way. I have noticed a bit more of a cough has developed, but it is not getting worse. The antibiotic should knock whatever bug has slipped in out.

Now, though, one of the side effects of strong, broad-spectrum antibiotics is…diarrhea. Which I had just about kicked. And which is now back. Not the 15-times a day kind I was having in the hospital. But, annoying enough. So, back on Imodium to try to get that moderated. I'm just on the antibiotic for 5 days, so hopefully after that clears my system things will start going back to normal, again.

Other than that, though, I'm in several ways feeling better. I had been at a point where I could not really lay down on my back…pressure in my throat would cause me to cough/gag. That pressure is relenting. I pretty much slept flat on my back all night last night w/o any issues. Flat on my back is good, as it allows my throat to lubricate a bit better while I'm asleep. My throat was still pretty raw this morning, but this morning was much better than the last few days.

With the easing of the pressure on my gag button, I'm hopeful that I will be able to start taking in some more food by mouth. I've not choked, exactly, on food. Everything pretty much goes down the right pipe. But, if I swallow any volume, it has been gagging me a bit. Never totally lost it, but came close. And I do not want that to happen. So, I've been very careful this week, and 98% of my nutrition has been through the feeding tube. Tomorrow, though, I might try some oatmeal in the morning. I know it still won't taste good, but it will at least keep those swallow muscles in practice for when things do start to taste good, again.

And, my Radiation Oncologist assured me yesterday that my sense of taste would come back. I think he was referring to eating and not to the aloha wear. In any case, he seems pretty upbeat about my progress.

Tomorrow afternoon, staples should come out. This will be my first post-op appointment with the surgeon, so more could come of the visit than just that…but if it is just that, that will be enough. They don't really hurt, exactly. But, they do catch on my clothes (especially the ones that go below my belt line) and zing me every now and then.

And now, it is nearly time to head to my afternoon neck tanning session. I've been putting this entry together for a couple of days, but didn't have the energy to get it Publish-ready. So, one last read-over, then I'll hit Publish and be outta here for the afternoon.