Sunday, September 4, 2016

The Other Drama on Friday, and Speculations on Next Steps

I've been cooling down a bit this weekend. Those moments when I suddenly realize you have a life-threatening illness never seem to get easier no matter how many of them I have. But, after a day or two, the thrill is gone.

I have had enormous help from family and friends. K, as always, is my rock, and I cannot count the ways in which she makes life livable. Same goes for Ben and my parents. One of my oldest friends, Talie, lives nearby and is a professional massage therapist. She has offered to come over with her massage table every so often and give me a free massage. She gave me one yesterday, and, for the first time since the diagnosis, I spent 90 minutes not thinking about cancer. Meanwhile, legions of friends and family have offered all sorts of help that we will certainly need as things progress. Dave, the chief partner in my practice, says he and the manager will do all they can to help. (I am very lucky to work where I do.) I have also loved all of the expressions of love and support on the phone, Facebook, e-mail, and comments on this blog.

1. Lost Cat
Friday was one of those moments I will carry with me for the rest of my life, just like the day NBC cancelled the A-team. And there was one more bit of drama to add to the mix.

Our cat, Katie, is an outdoor cat. We didn't want her to be, but she is stubborn even for a cat. By the time we got her from a rescue, she was already set in her ways, and when we kept her inside, she loudly and persistently proclaimed her outrage. After a couple of months, we caved.

I take Ginny the dog on long walks through woods or meadows several times a week. It's like a form of meditation for me, and it's a wonderful opportunity for Ginny to run around and sniff the urine and feces of various animals.* On Friday, I chose a route I could take without driving.

After we had gone some ways into the woods, I noticed that Katie was following us. She often does this during our short walks, but seldom on a long one. I don't like when she does this. It seems risky, and it's a long walk for a cat. But, as I said, she is stubborn.

At the top of the neighborhood sledding hill, there is a little neighborhood. As we got to a corner, a dog confined to a yard started barking at us. Katie would not pass the dog. So, we turned around. I intended to walk back home, but, at the other end of the street, someone else had put their dog out on lead, and that dog began barking. Caught between two barking dogs, Katie disappeared.

Ginny and I waited for her, but she didn't come back. Discouraged, we walked home. I felt terrible. I had lost a family pet! What a way to ruin a perfectly good day! (Sort of.) We got back home, and it was already dark. We expected the cat to come back on her own. She's very smart and tough. (She fended off a coyote once.) But, after an hour or so, she didn't come.

K suggested that we look for her, so, with little hope, we drove to the neighborhood on the hill where I had last seen her. Less than 30 seconds after we got out of the car, we heard a loud "MMMMMROWROWROWROWROWROW," and Katie ran to me. So, Friday could actually have been worse.

* I always wonder what she gets out of this. "Hmm. This is from a spayed female shepherd-golden mix, maybe 6 years old. Recently ate some Alpo and table scraps. Fascinating!"

2. Open Face Sandwich?

I'm speculating wildly here, but bear with me. So, it sounds like minimally invasive (endoscopic) surgery for my clivus cauliflower is out (or not, depending on how good a case the Pittsburgh surgeons can make). If they rupture an internal carotid artery or the meninges, I'm toast. I assume that is because there is very little space to maneuver and address emergencies when you're operating with an endoscope in my nostril. This stinks, because the best treatment for my carcinoma (assuming it has stayed local) would be surgery. But what about maximally invasive surgery?

The problems above would probably be less daunting with a conventional surgery. They flipped open the right side of my face like a door in 2005 and 2007. After the surgery in 2005, I had a hole in my meninges. They opened me up again and patched it with some fascia from the side of my head. (See, July 11 entry.)

Meanwhile, surgeons deal with nicked carotids all the time. The carotid endarterectomy is a common surgery for carotid stenosis (cholesterol plaques in the carotid), and they routinely clamp off a carotid artery, open it, ream it out, and sew it up. So, presumably, if they have room, they should be able to manage my internals.

This is idle speculation. K thinks I may a little naive. It would be very tough to put my face back together. It has been opened 3 times and fried with radiation. But, I want to hear what Dr. The Coach ( has to say when I see him in NYC.

3. Just Say Yes to Drugs!

Then there are the drugs. I admit, I haven't done my homework on this yet, but there are options. Some options are out. For instance, if I have any more cisplatin, I will quickly become even deafer than I am. Cisplatin is the one that blew my hearing in 2005-2006. I'll skip that as long as I can afford to. However, there are other drugs including new immunotherapies that specifically target mutations in some papillary squamous cell carcinomas. Some sound promising. I plan to know more about this by the time I meet the oncologist next week.

4. And So. . .

Unless, by some miracle, there is a surgical solution, this is going to be a long slog. But, even so, there are promising possibilities. Lots of fun to be had, and inspiration for many Tumoriffic updates!

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