Unknown Unknowns

Yesterday, K* and I saw my local doctors, infectious disease authority,** Dr. Pusworthy (new nickname), and  Dr. Hygeia, Goddess of Otolaryngology.

First off was Dr. Pusworthy.  He is brilliant man, highly respected in his field.  He is also warm and funny.  Unfortunately, due to computer problems, he had not been able to take a good look and my nightmare MRI before the visit.  He eventually made it work while we were there.  His guess is that all of this may be infection.  (We know that there is plenty of infection, but there may be a tumor as well.)  That left K and me in a good mood.  I mean, wouldn't feel warm and fuzzy thinking about a massive infection nestling against their brain and carotid arteries?

Then, we rushed to Dr. Hygeia's office.  She had been able to review the MRI thoroughly beforehand, and surgeons read a lot of MRIs in their lifetimes.  She is one of my favorite colleagues, and we always enjoy each other's company when I come for my nasal checkup.  We did our share of gallows humor and banter this time, but her estimate was grim.

She walked us meticulously through the levels of the film,*** pointing out the new abnormalities of my abnormal face.  There were areas that are pretty certainly pus.  Of course, those are sweet music to my ears (or, actually, sweetness to my few remaining sinuses).  But there are great big areas of solid tissue.  She is virtually certain these are tumor.  Given her superior experience looking at MRIs, and the time she was able to spend looking at mine before we came in.

If it is tumor with a mere ragu of infection, there is a lot of it in the worst places.  It is hard to imagine that a surgeon would dare try to take it out.  That would leave chemo/immunotherapy and, possibly, even more radiation.  My head has been practically dumped in radioactive wastewater from a nuclear powerplant.  I shiver to think what more will do.****

But don't despair!  This is only the beginning.  As Hygeia emphasized, there is still much we do not know.  Where is Jimmy Hoffa buried?  What ever happened to Aria's dire wolf Nymeria, and can I have one of her pups?  And what happened to Drogon?  What are the knowns?  What are the known unknowns?  More importantly, what are the unknown unknowns!?!?*****

Then, she moved on to the main question: Assuming there is a tumor, what kind of tumor is it?  This can make all the difference. 

There are benign tumors that can be quite friendly in their tumory way.  They grow very slowly or not at all.  Generally, they can be cut back and watched.  That would be nice. 

It could be a tumor that that responds well to chemotherapy, like some lymphomas.  Those types of lymphomas can melt like butter with a little chemo.******

Then, there are the ones that can be temporarily slowed down, like the misdiagnosed one in 2016, when they said I had 2 years left to live.  In that case, it is conceivable that George RR Martin could get off his pimply bottom and finish the last book in his series.  The end of the TV show left me thoroughly unfulfilled.

But then, there are the types that really scare me.  Yeah.  Those.

Today, I'm going to meet my NY surgeon.  He's the one who will operate.  More updates  soon!

Be well,

Tom

*I often refer to K as my best wife ever (BWE).  No, I have not been married, before or since, but still.  From now on, in this blog, she will be K/BWE.

**Infectious diseases experts don't get no respect.   While they are the most frequently consulted of all experts in hospitals, their pay is worse than a primary care doctor.  This is because a committee made up mostly of representatives of procedure-oriented (vs intellectually-oriented) specialties gets to decide how much insurance companies pay different specialists.  So much for 'supply and demand.'

Nevertheless, infectious disease specialists might get more respect if they were called something else--like puswhisperers (thankyou Mark Crislip, MD).   Imagine an inpatient team, stymied by a compicated infection, saying, "bring in the puswhisperer!"

***I actually learned some things about different MRI techniques that will make it easier to write the correct MRI orders in the future!  Silver lining!

****How about a superpower, darnit?  I've earned it by now!

*****OK, Hygeia didn't actually say all of these things, but they are important.  I especially want to know if I can get one of Nymeria's pups!  Imagine warging into one of those!

******Just don't put them on your bread.

Not Time to Panic.  Yet.