Throat Blog — Round 2 Begins

Well, busy doctor week this week. First, I fired a doctor. He didn’t do anything wrong…its just that I don’t really need a cardiologist. He had checked me out to ensure that the clot I got in my small intestine last year didn’t start in my heart. It didn’t. So, I told him it was best if we parted ways. Seriously, we spent the entire visit talking about bicycling and guitars. Oh, and he confirmed no a-fib or other heart issue that needs constant followup. So, our breakup was amicable.

To keep the universe in balance, though, I’ve also taken on another doctor. During my visit with my ENT/Surgical Oncologist, I repeated a constant plea: Find a way to make my voice louder. As a reminder, the tumor in my neck last year destroyed the thyroid cartilage, which is what the front of your Adam’s Apple comprises. The vocal cords each have a tendon that connects to your thyroid cartilage, kind of like how guitar strings are anchored down by the bridge. In looking down my throat while I made pitiful mewling noises on command, he said that the side ligaments that are supposed to tighten and loosen my vocal cords to produce pitch and volume are working. But, since the “tensionors” aren’t in place, the vocal cords don’t come close enough together to vibrate properly.

Drawn in ascii, my vocal cords look like \ / instead of || when I try to talk. So, he’s sending me to a different ENT / Surgeon to have filler injected next to one of my vocal folds so that my vocal cords will be more like |/ all the time, pressing one cord over close to the other one. The hitch is that it will also mean that my airway will be half-closed all the time. So, will have to balance getting them close enough together without actually affecting my ability to breath.

Next up was a quick visit with my Medical Oncologist where we pondered 2B or not 2B. The cetuximab rash is graded on a 1-5 scale:

1: Less than 10% coverage over entire body.
2a: 10-30% coverage, but few or no pustules.
2b: 10-30% coverage, but mostly pustules.
3: 30-50% coverage w/pustules
4: >50% coverage typically with secondary infection
5: Death.

Each grade has its own treatment and I’m at 2b, which indicates either topical or oral antibiotics. Really want to stay away from 3 (3-week break from chemo) and definitely staying away from 5. So, started some antibiotics and either coincidentally (these rashes usually go away after about a month) or due to the antibiotics the rash immediately got better. No more itching in my head hear or back, so sleeping a lot better. Still looks bad, but feels so much better.

So, Friday I started Round 2: cetuximab and carboplatin infusions then fitted with the 4-day fluoruoricil pump and sent home. Well, actually I went to work. And, Saturday I headed out on my annual sojourn to Nashville for guitar, guitar, guitar. Expect my next few posts to be less health related and more guitar related. A relief for us all, I’m sure.


Throat/Guitar Blog — Trip to Nashville

Well, Saturday week ago I headed to Nashville for an annual event I’ve been going to for several years. Guitar Gathering brings a group of beginner to advanced to performance-ready guitar players together for 4 days of intense guitar experience. Days are filled with master classes in music theory, fingerstyle, blues, rock, and more. Then, evenings feature a concert given by some fantastic talent. Watch here and on my Youtube page, as I take plenty of videos of the main events and post them as I get them edited.

But, not getting too far ahead of my self, first I have to get to Nashville. I normally take 1 or 2 days. It is about 9 hours of driving, which under normal circumstances, would not be a problem. But, as I headed out I was connected to what I lovingly refer to as my “poison pump” which gives me continuous doses of Effudex for 4 days. Effudex tends to knock me down a bit. So, first leg was to Hot Springs. By the time I got there, I was really having to fight off falling asleep. Got a hotel, got unloaded, took a nap.

In Mansfield, there is a restaurant I go to 2 or 3 times a week: La Gondola. It is a jewel of an Italian restaurant, serving up incredible Italian food hidden cleverly in a strip center. It was started by Sal, who had previously partnered with Jamal to run the Italian Villa in Arlington. When they sold Italian Villa, Sal started La Gondola, but Jamal moved to Hot Springs and opened J&S Italian Villa, there. So, while I was in Hot Springs, I decided to check it out. Jamal’s son, Sean, now runs the restaurant…I sent him regards from Texas and sat down to Pollo Rolotini (aka “Roly Poly Chicken”). Chicken breast wrapped around Italian sausage. Yummy.

Back on the road, I made it to Memphis on Sunday. It was a pretty short drive, but enough for one day. I wandered up and down Beale street, had lunch at B. B. King’s, and bought a hat (it matched 3 of the shirts I’d brought on the trip).  Beale street is a hopping place on a Saturday night…Sunday noon, not so much. Still, some live music, some good barbecue, a nice stroll, then I was ready for the hotel.

Monday I made it into Nashville and got checked in. Actually stayed down in Mt. Juliet…hotels closer in get really expensive. Didn’t do much on Monday other than rest and recover from the drive. Tuesday I got up and noticed that the bag of Effudex looked really flat. It wasn’t due to actually stop running until a little after noon, but I was pretty sure it had pumped all it could. I ready for a while, at the same time watching a few little bubbles that were in the IV line. When the pump hummed, they’d move about a quarter inch toward me, then immediately return to where they were. After watching this for an hour, so I was very certain that there wasn’t actually any drug still pumping, I disconnected everything, unplugged the line from my chest, and headed out to the meet and greet.

The event is primarily held in the music building at Trevecca Nazarene University. Said hi to some previous attendees, met some newcomers. At about 4pm, things broke up and I headed back to the hotel, intending to take a short nap then go to dinner. Well, the short nap ended up going from 5pm to 4am. So much for dinner.

Wednesday through Saturday were filled with all things guitar. I’ll talk a bit about each event as I post the videos.

Saturday we met at Columbia Studio A. This is where Marty Robbins, Patsy Cline, Elvis Pressley, and more recorded hit after hit in the 50’s and 60’s. Actually much of it was recorded in a studio called the Quonset Hut (which, oddly enough, was built in a Quonset hut). Got a great tour of the facility, which is now part of the Belmont University campus. Then student showcase, where 16 of the folks here for the event got to play and, in some cases, sing in the studio where magic had happened. I’ll be posting those videos, later (but some may be private, at the request of the performer).

Drove an uneventful drive home. Took two days…and I felt good enough that I could have probably made it farther each day than I actually did. Stopped overnight in Lonoke Arkansas then finished the trip on Sunday.

So, now, here I sit connected to yet another poison pump (just for a couple of hours, today). Then, into the office. I completely disconnected from work email on Wednesday…too busy during the day and really ready to crash after each night’s concert. So, I expect there to be a pile of emails to handle (well, I peeked and I have 90 unread work emails), a gazillion forum posts to read, plus whatever my bosses put off for “until Paul gets back from vacation.”

Throat Blog — Chem-on Down!

Ok, I’m about 66% through treatment and it is starting to wear on me a bit. Pretty evident from my weight chart, above, which plots from beginning of treatment to today. Rounds 1 and 2 (each round is 3 weeks, starting w/a 3-drug combo the first week, then a single drug each of the next two weeks) I got by pretty good. Appetite was a little affected (especially during the first week of each round), but recovered by the end of the round.

The first round, just had a little queasiness for a couple of days, the rash from the Erbitux, but not much else. The second round, the rash was still pretty bad (especially on my head) and I did get pretty tired by the end of the day during the first week, but the 2nd and 3rd weeks I had plenty of energy. Well, round 3 and I still have the head rash (a bit on my chest and back, too, but it doesn’t itch there, so doesn’t really bother me). But the two things most affected now are my energy levels and my appetite.

Even in the 2nd week, my energy levels were pretty low. I went to work every day, but also left early every day. I got into the early afternoon and realized that if I hung around until 5 it would not be safe for me to be driving. So, early in the week I took off around 3. Later held on until about 4. Got home and crashed in front of the TV and tried not to go to sleep too early. On the plus side, I was able to catch some great documentaries (making of National Lampoon’s Vacation…I never knew that Lindsay Buckingham did the “Holiday Road” theme song…rockumentary on The Doobie Brothers, and another on Brian Wilson).

Appetite, though. That is the worst, as not eating also affects energy levels/fatigue. I’m not nauseous, but food is unappealing when I look at it, tasteless (mostly) when I eat it, and I quickly fill up…long before the plate is empty. I can feel my appetite slowly recovering (the week 1 combo is really what drags down my appetite), but not enough to keep my weight up. As you can see from the graph, the last two weeks my weight has fallen off the cliff. Overall, about 10 lbs lost, but 5 of that has been in the past week or two.

So, I am trying to pick higher calorie (even if it also means higher sugar) options. Instead of black iced coffee in the morning, grabbing a latte. Most sweets and coffee still taste OK (but potatoes taste like sawdust, as do many other foods). I was eating oatmeal for breakfast, but it tastes so bad, now, I’ve switched to yogurt. Lunch I’m trying out a variety of soups (Udon noodle is best, but Phó is also pretty good). Dinner is the toss-up. Sometimes just a smoothie (homemade from freeze-dried then powderized banana, strawberry, kale, and broccoli). Sometimes I can manage 1/2 of an entree like lasagna or other pasta.

Even typing the above makes me feel like I want to have nothing to do with food. Ugh. I’m not even going to re-read it for typo’s and grammar tweaks.

Anyway, I really don’t feel bad. Just get tired early and often. I’m able to mostly keep up at work. My guitar practicing has suffered. The couch looks so much better than my practice area. And, keeping up this blog has suffered, as well. But, I can tell that next week will be better. I’ve already warned my office that the week of the 30th will likely be my worst week (the beginning of my last round).

So, back to editing videos from the Nashville trip. Or, maybe a nap. Well, definitely a nap.

Throat Blog — Just Add Water

After mulling that dramatic 5 lbs in 6 days weight loss, I realized that that could not have been body mass loss. I was eating some, if not enough. So, considered the other probability…hydration. I am not in a habit of drinking a lot of water in-between meals unless I’m doing physically active things.

Sitting at my desk. Driving to/from work. Sitting on the couch. Sleeping. Hmmm, none of those are really falling into the category of “physically active things.” And not eating as much also means (to me) skipping some meals entirely. Which means skipping my main time to drink fluids…mealtime.

So, yesterday I made it a point to keep sipping on water throughout the day. I probably put down a little over 2 liters of fluids. And, this morning, right out of the shower, I weighed a little over 3 lbs more than I did yesterday morning. So, instead of 5 lbs weight loss in 6 days, maybe 1-2 lbs, which is still not great, but also not alarming or entirely unreasonable.

My appetite yesterday was better, and today I also feel more like eating. So, I suspect that during the coming week I’ll be able to pack in more calories (and water!) in preparation for the 4th and final 3-week round.

Throat Blog — End of the Last Week 1

Ok, I made it through my last “Week 1” 3-drug combo week. As expected, I’m more fatigued than the previous three rounds. After the dehydration of the previous round, I’m making a real effort to stay hydrated and fed, but still going to get a full bag of hydration on Monday along with my Week 2 chemo.

Fatigue, though. Bleh. Headed home very early afternoon this week, and barely hit the couch before completely zonking for 3 or 4 hours. The only one enjoying that is the cat. Until he gets bored and starts grooming me. Tiny cat licks on the face. Must be time to get up and eat something. Oh, and drink another glass of water.

I can’t really complain of feeling bad. No nausea (but little appetite, either). No real weakness. Just hard to keep my eyes open after about 2pm. Skin on my face and head looks pretty bad, today, but should slowly heal up this week.

Big thing to look forward to this week (other than naps) is a CT scan on Wednesday. This should give a very good read on whether this chemo protocol has taken care of things. Considering how bad the rash has been, everyone really thinks that it should be doing a number on the tumors, as well (generally severity of rash is positively correlated to effect on the tumors).

I realized that I don’t currently have any followup appointment scheduled for an oncologist to actually tell me the results of the CT scan…and don’t want to have to wait 8 days for the lab to release the report to me. So, emailing the Dr’s office today to set up a follow-up (or at least ask him to send me the summary as soon as he gets it).

I also want to see about getting the raw CT scan data. I don’t have the chops to be able to read it as far as the tumors go, but I can make a 3D picture that images things like cartilage and bone…if you go back to an older post, you’ll see what I was able to do with a previous CT scan (oh, I’ll just make that image the featured image for that post…no need to look for the old post). It would be nice to know what the structure of my larynx looks like, now…it feels like there is more cartilage in the front, but I really don’t know for sure. CT imaging will show it clearly.

So, forcing myself to stay awake past noon. Been working on the last of my Nashville videos (uploading now, post about that should happen later this afternoon). Planning a new video shoot of a guitarist friend, but want to wait a few weeks so that I have the stamina to get it done.

Throat Blog — Good News/Bad News

So, I’ve been (im)patiently waiting to get the read from the CT scan last Wednesday. Looks like I’ll have to wait until next Wednesday to get the actual reports. But, the doctor did review the reports and gave me a summary that boils down to: “Well, I’ve got some good news, and I’ve got some bad news. Which do you want to hear first?”

So, start with the good news. No new nodules since the last CT scan 3 months ago. And, more good news, the nodules that were there 3 months ago have not gotten bigger. Untreated, they would be expected to double in size about every 3 months.

Now, to kill Pollyanna, the bad news. The nodules that were there 3 months ago have not gotten smaller, either. So, while this regimen is working, it doesn’t seem to be working quite well enough. But, that assessment is real borderline. So, I’ll do a 5th round of the current set of chemo, then will get another CT and determine what to do from there. If still no shrinkage, will probably switch to Keytruda or Opdivo.

Not looking forward particularly to another Week 1. I’m just getting over the last Week 1. I did not really realize how out of shape I’ve gotten. Mostly, I walk or sit. My most strenuous two activities are carrying my laptop into and out of the house and office and walking up the stairs to the chemo lounge on Mondays. But, yesterday I needed to review some wall art at work. These are 3×6 foot prints on a plastic film that we use at trade shows. They might weigh 1/4 pound each. Need to roll out about a dozen. This activity involves squatting down, pushing the roll so that it unrolls, then standing up and sliding the prints apart. I had to sit down to catch my breath twice. I’ve never been in this bad of physical shape. I basically did nearly nothing and it wiped me out.

So, during this week 3 I’m going to try to do some work on the exercise bike, just to get some aerobic capacity back…or maybe just keep it from getting worse. I can’t commit to doing anything next Week 1 or 2, though. On the one hand, the rash and skin effects from the Week 1 chemo have gotten progressively better (I think there isn’t much sun-damaged skin left to burn off). But, on the other hand, the added fatigue gets worse and lasts longer each time. I would have never imagined that I would actually get tired of napping.

And, with that…I think I’ll grab a small lunch and take a nap.

A Wreck (and a Wreck)

Driving home, Tuesday, driver behind me gave me a little bump from behind. No major damage, we were both able to drive away after swapping info. He wants to pay out of pocket and keep his insurance company out of it…OK by me, but I still got his D/L and insurance info as backup. Looks like he was wanting to change lanes and checked his mirror at the wrong time…when traffic stopped, he didn’t.

Repair estimate is nearly $1,200. Which is actually less than my first thought, but the bumper piece that would be very expensive is repairable without replacing. So, mostly paint and buff labor expense.

Now to the second wreck…which is me. Wednesday I helped set up a trade show booth in Dallas. My plan was to sit and point. Instead, I ended up doing a lot more physical stuff than I had planned. Plus, any time I gave any direction, I had to repeat myself 2 or 3 times, as only one person at a time could hear me, and had a crew of 6. Got pretty frustrated and very tired.

Thursday, I was still wiped out. I did come to work, but left early and napped for several hours before heading to bed.

Today, Friday, woke up feeling mostly OK. But, when I got to Starbucks and started trying to eat my breakfast, I got my very first bout of nausea. Didn’t eat much, and didn’t toss my cookies, but was worried about it for a bit. Came on into the office, as it is only 15 minutes away from the clinic and I have to go there to get my chemo pump disconnected, so no point in driving back home until after that is done. Think I’ll head there very shortly then head home. Not enough energy to be very productive.

Tomorrow, I had tentatively planned to assist with booth teardown. I’m pretty sure that ain’t gonna happen…hopefully everything will get packed back into the correct crates without me being there.

Throat Blog — Update to CT Results

Ok, this post updates the results of the last CT scan to almost entirely good news. After talking over the results with my oncologist, he really believes that the 4 nodules that show as getting slightly bigger aren’t cancer. They are more than likely inflammation caused by aspiration. If they were cancer, they would be doing like the 5 definite tumors are doing…dying. And, cavitation in tumors this small have absolutely no significance other than indicating that the tumor is dying. So, rather than move to an immunotherapy after this round, he’s proposing we do “maintenance chemo” using only one of the drugs (cetuximab/Erbitux) every two weeks. Erbitux’s main side effect on me is the acne-like rash, but it really fades during weeks 2 and 3, so I expect that it will be a non-factor during maintenance.

The one shadow in the results is that I have a brain cloud. Well, he didn’t actually call it that…there is a small something (actually smaller than a BB…it only shows up in one “slice” of the CT) in my left prefrontal cortex. The oncologist thinks it is either a scan anomaly or something benign, but the radiologist recommended a MRI followup, so I’m getting that this evening at 7:15pm. Hope I can stay awake that long. Even if it is a tumor, the oncologist said that it can easily be knocked out with Gamma Knife technology with no hospital stay, no side effects, and no trouble.

Meanwhile, as I predicted, the Week 1 treatment is hitting me harder this round. Just worked a couple of hours each on Monday and Tuesday. Last night, I couldn’t get to sleep until after 3 AM. The skin on my head and face is pretty raw, and I couldn’t seem to find a comfortable position. I intended to sleep late, but between the cat and my normal circadian rhythm, woke up at my normal time, then kind of dozed in and out for a couple of hours before getting up at 8:30AM and coming on into work. Will be nearly a full day (I didn’t get here until about 10AM after stopping for breakfast), as I have to hang around on this side of the world for my MRI, anyway. Might need to close the door and nap…should have brought my binky. My mouth is extremely sore…been having to use the expensive “Magic Mouthwash” w/lidacaine. I think that is also starting to get better, now. Difficult to say…because my voice, such as it is, has reverted to mostly a whisper.

But, I expect to be back on an upswing by this weekend, and will only get better after that. I need to set up a regular mild workout to start getting my stamina back. Getting winded from standing up and walking across the room is not something I want to have hanging around for long. My appetite is still pretty minimal, but I also expect that to start turning around later this week. Managing a full (for me) breakfast, but then only have appetite for a very small lunch and/or (usually “or”) dinner. Got some Udon noodle soup staring at me right now that I should start working on…no way I can go until after the MRI tonight without eating some more.

So that is the update for the week so far. Mostly good news and possibly entirely good news. I’d better get started on that soup before it gets too cold.

Throat Blog — Brain MRI

Well, they did an MRI of my brain and they didn’t find anything. Explains my thoughtlessness, I suppose.

Actually, the meat of the report is:

1. No evidence of intracranial metastases.
2. No MRI correlate for the left frontal lobe lesion suspected on CT neck, suggesting that this was artifactual.

So, on the plus side, complete false alarm. On the down side, I have no excuse for my behavior.