Throat Blog — A Tale of Three Doctors

Ok, to start, a short story. Before I tell it, though, I must say that I wrote the story before I met 2 of the 3 doctors I saw today. Any resemblence to any doctor, living or dead, is purely coincidental (and, in my case, actually there is little resemblence…but don’t let that detract from the story itself).

A Medical Oncologist (i.e. chemo doc), a Radiation Oncologist, and a Surgical Oncologist all go in together on the purchase of a fixer-upper. They all three go to check it out and decide on the best course of, well, fixing it up.

The Medical Oncologist looks around a bit and says, you know, if we just strip the floors, put in some aromatherapy, and set off a bug bomb or two this place will be just fine.

The Radiation Oncologist looks around and says, you know, all this place needs is better lighting. Lets just put up some strategically placed high-intensity spotlights.

The Surgical Oncologist looks around and says, well, I think we are just going to have to take everything out of here. And, while we are at it, we should move the front door closer to the bathrooms.

Ok, now for my real tale which really didn’t go as the above might suggest.
First off, still elated that I kept my larynx, yesterday. I’m a little sore swallowing, but that is rapidly getting better. Took a vicodin to sleep last night, but Tylenol was fine for today. As to the doctor visits:

The Medical Oncologist was first. He went over all the options from his perspective, including his thought that ultimately the major surgical option might be the best way to go, but that he was open to starting with a more conservative therapy. We spent the rest of the time discussing the roadmap in the event we went more conservative. Basically a chemo cocktail every 2-3 weeks while simultaneously getting radiation therapy every week day. He didn’t expect that nausea would be any issue for this kind of chemo, but that the radiation might start making me feel bad after the first month or so.

Next up was my Surgical Oncologist who did the biopsy yesterday. He also said that long term, a complete laryngectomy was more than likely, but that he would completely understand and support starting with chemo-radiation while still watching to make sure that there were no issues that would take that option away.

The Radiation Oncologist actually spent more time talking about the risks of not having the surgery in general in terms of long-term prognosis. However, the increased risk, in the aggregate of patients, is not huge (like in the 5%-ish range). I have one bad thing feeding this: the tumor is large. However, balanced against that is that my general health is excellent, I have no breathing issues, I have no issues swallowing, I’m not obese, diabetic, or a present or past smoker. All of those would make chemo-radiation virtually a non-starter.

They all asked what my outcome desires were. I gave them all a hierarchy of outcomes. Overarching all: life. Beyond that, in order of best-to-worst outcomes:

  • Restoration of voice and continue to have a mouth/nose airway.
  • No natural voice (beyond whisper) and continue to have a mouth/nose airway.
  • No natural voice and no mouth/nose airway (i.e. a stoma in my neck for breathing)

The first two are only possible without a full laryngectomy. The third would be the result of the full laryngectomy. Even without the laryngectomy, my voice might never restore. The anchor point of my vocal ligament on the thyroid cartilage seems to be missing. But, maybe not. It is not easy to tell.

A total laryngectomy would be a huge quality of life issue. It would restrict my activities quite a bit in ways that I really, really don’t want to be restricted. I know that this is creating a big bias affecting the decision to take a bit more risk. In the end, I’ll either regret this or not. I’ve decided to proceed with chemo-radiation. I should be able to return to work, but will be out at least 2 hours a day every day for treatment (chemo days I’ll be out all day, as it is about a 5 hour process). Two-three months of treatment, then we’ll see where we are. We might be right back to laryngectomy.

Meanwhile my chemo doc told me to fatten up. Later on, if I am queasy, I’ll need that energy. So, trying to eat 3 squares a day.

I should add that the above is a really condensed and biased synopsis of 3 meetings, each of which lasted 45 minutes to an hour. Which was pretty phenomenal considering I was basically a “walk-in” to all three. All the doctors said much more than what I’ve decided to relate, above, and I am sure I’ve skewed some of the details a bit. I recorded the meetings so that I could go back and review them (in lieu of notes), but didn’t have 3-4 hours tonight to do that. So, trusting to untrustworthy memory based on biased listening for this post. I might have gotten some of this wrong…blame it on me, not on the doctors. They were all great.

Tomorrow I go in at 7:30 am to be fitted for my head shield (cat scan of my head and upper torso so the shield can be prepped to my exact size). I’ll also meet the Radiation Oncologist’s research team (I agreed to participate in a trial that reduces the exposure of surrounding tissue to the radiation while keeping the same concentration of radiation on the diseased tissue). A possible benefit of the trial methodology would be less damaged tissue in the irradiated area in the event a laryngectomy is still necessary.

We’ll also have to see what happens as the tumor retracts from the areas of the thyroid cartilage that is affected. It could recalcify, develop hardened scar tissue, or just leave a hole. Hoping for one of those first two, as the third points back to laryngectomy. Also, the thyroid glands themselves are going to be, in the doctor’s words, toast. I’ll need to take thyroid supplements, but he said that is a well-developed protocol.

Even with all of the above, I’ll say again that all three doctors said that total laryngectomy is still quite likely even with successful chemo-radiation. No minced words. My hope does not equal either diagnosis or prognosis. So, I’ll whistle past the graveyard while I can still whistle.

Ok, enough for now. I need to finish my dinner before it gets cold. Tomorrow is another doctor day.

Throat Blog — A Good Nap Spoiled

Ok, my nephew (posting as my sister, reposting on FB as me) gave you most of this, but there are a few additional details.

First, this is the best mental day I’ve had in a couple of weeks. Why?

When I first got checked in and the anesthesiologist came by to tell me what he’d be doing, the procedure was still a total laryngectomy. 15 minutes later, after the surgeon reviewed the PET scan results, the procedure was radically changed for the better. I ended up getting basically a through-the-mouth biopsy. They knocked me out (I lost about 3 hours), went down my throat with their tools … oh, wait…not a good choice of words. They accessed the tumor through my mouth both above and below the vocal folds (ah, much better) and took samples.

I woke up sharp, but don’t know if I had awakened a few times not-so-sharp before that that I cannot remember…I suspect so. Just soreness in my mouth and throat. They gave me a Vicodin let me go home after. My sister and brother-in-law brought me down to my “home” restaurant in Mansfield. I finished almost all the grilled chicken fettuccine alfredo. Going to eat a Klondike bar now that I am back home.

Oh, and the PET scan showed absolutely no metastases. The tumor might be very slightly larger, but that could also be accounted for by the difference in resolution between the CT and PET scan. So, it is not rapidly growing like it did over the Labor Day weekend. We have time to look at treatment alternatives.

So, no metastases + still mouth/nose breathing + back to my own bed tonight = a good day.

I still do have bad things (squamous cell carcinoma, likely total laryngectomy, long hospitalization and rehab) but for the first time in a couple of weeks, I think I won’t sleep like a baby. Because, anyone who has been around sleeping babies know that “sleep like a baby” really means waking up every 3 hours crying.

Tomorrow I meet with a radiologist, oncologist (chemo), and my surgeon to go over options. The surgeon says total laryngectomy, but that he is open to having his mind changed based on input from the 2 other doctors and the tumor forum they have every Wednesday. My doctor was skeptical about any temporary return to work, as he seems to think immediate radiation and/or chemo which would not be conducive to driving, high-level functioning, or keeping food down.

I was concerned that all the life and work planning I had done for a long convalescence would make me look like the “Chicken who Cried Wolf” but he assured me that those preparations would still be necessary. Even if he is swayed to something less than total laryngectomy, there is still substantial damage to my larynx that needs to be addressed. We’ve not had that discussion yet, though. Perhaps tomorrow.

Oh, and the only thing that really spoiled the good nap was the sore throat…but that, at least, shall pass.

More Fact Finding, No Surgery Today

(Posted by Paul’s Nephew)

I know we are all sitting around refreshing so here is the latest update.  

Today turned out a little different than we all thought.    The procedures completed today include a microlaryngoscopy and bronchoscopy.  Both of these are accomplished with a scope and are non-surgical.  They took  approximately 1 hour and the purpose is to take some biopsies and visualizations.   

Tomorrow there will be a meeting with the “tumor conference” to work on next steps.  The diagnosis officially changed from sarcoma to squamous cell carcinoma.  Sounds like surgery is still a possibility for removal.  Additionally, chemo and/or radiation treatment are anticipated.   The PET scan showed no sign of metastasis which i believe is a good sign (even though I am far from being a doctor). 

Paul will go home today as well. 

Throat Blog — The First Day of Forever

Ok, I just titled this entry like that because it sounds deep. In reality, as I told a friend a few days ago, the closer I get to surgery, the more I want to keep to shallow waters. There is a raging torrent just below the surface, and I am fighting to keep from dwelling there.

Throat Blog — What Insurance?

Well, I have insurance through work. But, they have not yet approved the surgery. So, assuming this is still the case, tomorrow, I’ll have to sign a waiver saying that I’ll take full responsibility for the bill. Yikes!

My office stepped up and contacted folks to get a  # for expedited approvals. Either way, I’m having the surgery. I just might go from ER to ICU to room to rehab to the poor house. I’m not that worried…we’ve just been moving faster than the speed of insurance bureaucracy the past few days. They’ll catch up.

Throat Blog — Would You Like Some Isotopes with Your Barium?

Well, I wasn’t actually given a choice about that, but I did get to pick between Berry Barium or Mochacino Barium. I opted for Berry. Meh. The isotope injection actually had more flavor (I could taste it about 5 seconds after it started going into my arm).

So, now I sit for 45 minutes waiting for them to put me in the donut. They had gotten me a scrip for Valium, so I assumed this would be one of those closed machine procedures that people get claustrophobic in. The donut machine is nothing. Plus, I drove myself and Valium takes about 6 hours to get down to a safe-to-drive level. So, I can save this one for later. 🙂

Next up, paper pants!

Throat Blog — Got some Time?

Well, I got the time, anyway. Go into prep around 10:30 AM. Surgery starts at 12:34 PM. Ok, so that sounds really overly precise at first glance. It is like saying 47.834% of all statistics are made up.

But, upon a little reflection, that should mean that they actually have a minute-by-minute plan of action (even if I don’t have that plan to see for myself). I can imagine it, though.

  • 10:30:00 AM: Remove Patient’s Shirt
  • 10:30:15 AM: Remove Patient’s Shoes and Socks
  • 10:30:30 AM: Remove Patient’s Pants
  • 10:31:00 AM: Remove Patient’s Underwear
  • 10:34:00 AM: Fully recover from previous step
  • 10:35:00 AM: Lay Patient on Gurney
  • 10:35:30 AM: Start IV Line
  • and so it goes…

Throat Blog — Last Day at Work for a While

Well, finishing up my last day at work before hospital fun starts. Still haven’t heard specific times for the surgery, so I plan on leaving early before my PET appointment so that I can stop by the surgeon’s office (assuming I haven’t made contact before then).

I seem to finally be at a loss for words. So, now you know what it takes. 🙂

Throat Blog — Where There Is a Will

So, no updates yesterday (Saturday) other than a couple of FaceBook posts.  Had a downer Friday afternoon and wasn’t too motivated for the kind of thought this post takes. The downer was writing out a will (which I hope isn’t needed for 50 years, but can’t leave things just floating if it is sooner). Not going to say who gets what, here. Not the time or place. Again: time 50 years from now and place Mars is what I’m shooting for.

But, even 50 years from now there are a few things about “final arrangements”  that I don’t see changing so might as well get it out there, now.  Can really sum it up in two words: Cremation and Celebration.

First word pretty much speaks for itself, I think. No need to have a place in dirt to come see me. If you remember me, you’ll remember me without all that.

Second word I’ll take a bit more time with. I do not need or want a religious service. Not because I don’t have beliefs (I do) but because I know we don’t all share the same beliefs. I believe there is more than one answer, and that answer is personal for each of us. So, if you need to seek solace with God, Jesus, Jehovah, Allah, Buddha, Shiva, or Vishnu please do that. But first (or after) come and celebrate with my friends and family.

I don’t know where that will be 50 years from now. There are no restaurants on Mars, yet. But if it is significantly sooner, that celebration will be at a restaurant I go to a lot, where I have made many good friends, and sat listening to music (or reading my Kindle book at the bar) many, many times. La Gondola in Mansfield. Take the day off. Come down for some good food. Music by David Paul and Doug Bullard (jointly or as individual soloists). No downer music…ok, maybe just one. Eat, drink, enjoy, and remember.

So, that’s out of the way. Last night I went to my two favorite downtown Fort Worth venues. Reata (no pictures, but had chicken fried quail with cheddar jalapeno grits and elk sausage). Finished most of it. Then on to Scat Jazz Lounge for some good jazz. Nice night. Probably my last time to have a chance to do that until next year, when I’m up and able to drive myself around.

Today I’m going to have coffee with a friend and lunch with a couple of others. No more of this maudlin crap. 

Note: I accidentally posted this under my sister’s account. I’ve made her an admin here so that she can update posts during/after surgery. Was showing her how to login to the system and left her logged in, I guess. It was really me (Paul), though, on this one.

Throat Blog — How Much Will It Cost?

Well, finally got a call from the hospital…but just about the upcoming costs (assuming my insurance pays and I have no idea why they would not pay). Pretty much the price of a small home freeze dryer. I’d used up a lot of my out-of-pocket expense cap leading up to this (2 CT scans, ultra sound, doctor’s visits, plus my annual physical and blood work back in January).

Still awaiting a road map, which is top of my mind and which is what most people ask me. How long will I be in the hospital? How long will I be in Rehab? How long before I can eat? How long before I can go home? How long before I can drive?

I know that many of those answers are the standard answer given by any good economist…”It depends.” (Most people don’t know that most of my elective  business degree courses were economics…Money and Banking, primarily…they think I’m some kind of engineer or lawyer or bohemian geek.) Some general ballpark idea would be nice, though.

Well, back to waiting for the next call.