Are We There Yet???

A little snack while we wait for the big meal:

Today, K called Agent Skully's nurse to chat and got a little surprise. Dr. Skully had hoped that the pathologists at F'in' Famous Cancer Cancer Hospital would have identified my little surgical scraps by now. Then she could meet with other experts on Monday and give us a plan by Tuesday. However, the little bits of my tumor on the slides that we so lovingly carried to my appointment went to the inboxes of Dr. Pokey and Dr. Droopy in the Pathology Department.* This means that, until late next week or even the following week, there may be no ID on that crud they dug out of my face in mid-August.

I still don't know whether I am facing (or the back of my face is facing) a terrifying, potentially deadly tumor eating its happy way towards my brain, whether my skull is just turning to powder (which is, surprisingly, not such a big deal), or whether I need another operation to decide (which would be a real laugh riot). I realize that suspense makes for a good story, but I was hoping for a short story, not a novel.

Thus, for the next week or so, every time I get a little headache, or a tickle in the back of my throat, I will get really paranoid that something like Miss Muffet's spider is wiggling around inside my head. And it's fall allergy season.

Be well,

Tom



* Perhaps I am being a bit harsh here. Drs. Pokey and Droopy may need to use some extra special herbs and spices on my li'l' bits, but the ones from August are already too processed. Without these preparations to bring out the flavor, maybe it's hard to tell the difference between blackened Cajun bone scraps and a carcinoma souffle. Dr. Agent Skully may need to go in and nibble off another piece. Yum.

This picture does have something to do with this post:

Warning: Prostate Meds and Cataract Surgery Do Not Mix

Enough about me (at least until next week or if I pop another tumor before then).

If you don't want to read the details, here's the gist: if you or you family member, or your patient is on one of several common prostate medications and has cataracts, think hard before considering corrective surgery and make sure your ophthalmologist knows about the medications. It could mean the difference between sight and blindness.

Today, one of my patients asked me to share this story.

An eye doctor diagnosed Mr. X with cataracts. Mr. X's vision was OK. The cataracts were not really bothering him. However, he had surgery to get the cataracts removed.

Mr. X was on prostate medication. Specifically, he was on alfuzosin (Uroxatral). This medication keeps the prostate from getting too swollen and can be very useful. However, it can also cause Floppy Iris Syndrome. (And no, even though it sounds like something I would do, I did not make that name up.)

Floppy Iris Syndrome is a loss of tone in the muscles of the iris. Patients with this syndrome can have sight-threatening complications during cataract surgery. Floppy Iris Syndrome appears to be irreversible, so patients are vulnerable during cataract surgery even decades after the last pill they took.

As many as 15% of patients on alfuzosin who have cataract surgery may have complications related to Floppy Iris Syndrome (although not always severe). With a related medication, tamsulosin (Flomax), it may happen as much as 90% of the time. Mr. X was on alfuzosin, and he had the syndrome. His surgery did not go well. He may lose his sight.

With proper precautions, an experienced surgeon may be able to reduce that risk, even with tamsulosin, to 0.6% (6 in a thousand).

So, the take-home is that some prostate medications and cataract surgery are a dangerous combination that should be avoided except with serious sight-impairment. Anyone who needs cataract surgery and is on these meds needs a first-rate surgeon who knows they are on the meds and will take proper precautions.

Be well,

Tom

PS: A med school classmate provided useful corrections to this post after it was published. Many thanks.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2814568/

The Cauliflower Show Goes on the Road

I got to see two doctors in two days this time! It's kind of like a surf'n'turf dinner, or, maybe, a pasta dish and an entree.

1. Appetizer

Good evening tumor fans! K and I are on the train, returning from a worldwind trip to the Big Fruit and F'in' Famous Cancer Hospital. Brings me back to old times and my last big tumor. Oh, sweet memory!

As faithful readers will know, on Friday, September 9, Dr. Famous Squamous walked us back from sheer terror to mere concern, telling us that the cauliflower in my head is probably not the scary papillary squamous cell carcinoma, but the creepy-sounding but less dangerous osteoradionecrosis (known as ORN to cool people, or, to me, as a squeamish cell tumor). However, the pathologists at Wicked Famous Cancer Hospital continue to be coy, refusing to be pinned down on whether this is cancer or just another manifestation of the little Fukashima inside my head.

After work on the 13th, we hopped a train down south. As always, we stayed in the home of our generous friends, R and H, who live conveniently close to F'in' Famous.

2. Pasta Course

On the 14th, K and I hiked downtown for a reunion with the warm but suave Dr. The Fixer. Dr. Fixer is the reconstructive surgeon who expertly reassembled the right side of my face in 2005 only to watch it melt like a Hershey bar in the sun under the proton beam of Dr. Zap. That still irks him. He also had to repair me twice more in 2006 and 2007 when my cheek fell open.* Good times! Anyway, I am the patient that refuses to go away.

On the 14th, our question to him was simple. If the cauliflower turns out to be squamous unstead of squeamish, and if we can sucker some poor surgeon into taking the whole thing out, can he put me back together? Unfortunately, the answer is no. The cauliflower is in a really bad place, and you just can't get there from here.

The good news is that Dr. Fixer has seen a lot of ORN, and the MRI and CT of my clivus look like ORN to him. The other bad news is that I have a whole lot of ORN, not just in my clivus, but in my sphenoid bone, particularly on the right. The sphenoid comprises two big wings of bone on either side of the clivus.**

After that, we took the subway to Greenwich Village to lunch and loiter with my dear friend J, another of the ever sympathetic and helpful Tumoriffic stalwarts. On the subway, however, we overshot the meeting place. K was uncharacteristically grumpy about it since she was very hangry. Don't make her hangry. You wouldn't like her when she's hangry.

Later, K and I hiked across Central Park and cabbed uptown to have dinner with my cousin and cousin-in-law A and D at a wonderful Italian restaurant. I don't remember the name, but it was something like "The Meningococco."

Afterwards, we walked to their apartment to say "hi" to their kids, J and P, and their dog, Charlie. Charlie was so happy to see us, he peed on the floor. He never does that anymore, so we were flattered.

3. The Entree

Finally, early this afternoon, we hiked back to the main campus of F'in' Famous to meet the eminent skull-base neurosurgeon, Dr. Agent Skully. She was soft-spoken, but impressive, and her eyes bugged out only a little when we discussed my history.  She looked at my films, and I gave her my delectable pathology slides, which she promptly ate. (Just kidding.)

Not being an old friend like Dr. Fixer, and, thinking of the recent premature diagnosis, she was a little reserved, not committing to what she thought was going on with the cauliflower. She was logical and methodical. Nothing can be decided until Pathology has spoken. F'in' Famous is about 10 times larger than Wicked, so they have seen a lot more weirdos like me. If anyone can make a diagnosis with these slides, they can. It will take them 7-10 days. After that, Dr. Skully will present my case to her colleagues in a weekly conference known as Tumor Board. ***

If even the F'in' pathologists cannot come up with a firm diagnosis, Dr. Skully wants to go in through my nostrils and nibble off a bit more crud so they can subject it to more tests in the pathology lab. If, on the other hand, the crud turns out to be squamous cell carcinoma after all, she has not excluded the possibility of doing an open procedure like I fantasized. She would have to discuss it with another surgeon from ENT, and she would still have to pursuade Dr. Fixer that it was somehow possible to put me back together, but I can dream.

Meanwhile, I think I will need to be on antibiotics for a good long time. We'll discuss it with Dr. Bug, but that's my guess. Maybe I can breed my very own uber-antibiotic-resistant bacteria on my own clivus.

4. Dessert

Once again, I had fun with the pre-visit questionaire. Mostly in my head, not on paper. I don't want them to call a psych consult on me.

What is the most important thing our staff can do for you today?  Keep me from dying.

Are you unable to care for yourself and have no one to help you?  Only when my wife goes on a trip.

Where was your last fall?  I spent it mostly near home. I tend to travel more during the other seasons.

Do you use oxygen at home?  Of course I do! Where the smell do you think I live?!? Neptune?!?

Would you like to talk to someone about talking to your minor children aboout cancer?  I find that offensive. I consider no child minor! Children are major!

Who do you live with?  You mean WITH WHOM DO I LIVE. This is supposed to be a renowned cancer center! Get your grammar right, you losers!

5. Digestif

The next menu should be out in about 10 days when we have heard from Dr. Skully. 

By the way, if this story were fictional, I would consider the author to be pretty lousy. I really doubt that I have squamous cell carcinoma. We're just making absolutely sure. 

If this were well-written, the conversation with Dr. Squamous would take place far later so that I could spend more of the story in terrible fear. On the other hand, what if George R. R. Martin wrote it? Just as we thought things were going to resolve for the better, Ramsay Squamous would suddenly appear, and every knows what happens when Ramsay Squamous shows up!

Stay away from my story, George R. R. Martin. You have better things to do. Like finishing the Song of Ice and Fire series already. Seriously, man, get to it!

Be well, 

Tom

* If anyone's counting, he actually patched my up twice in 2005, once, after Dr. The Coach and Dr. Mister Rogers scraped out my osteosarcoma, and, again, two days later along with Dr. Rogers after my meninges (brain lining) sprung a leak.

** The sphenoid houses the sphenoid sinuses.  (If you guessed maxillary sinuses, you're a dummy.) The shape of these determines different degrees of resonance in singing voices such as, for instance, Luciano Pavoratti and Bob Dylan. As time passes I will sound more and more like Bob.

*** I have been the star of many tumor boards in many hospitals. In those venues, I'm like a medical version of Hamilton!

Photo with No Apparent Relationship to this Post:

Whipsaw!

I hardly slept last night. K and I had read up on squamous cell carcinoma (SCC), and it's just not appetizing literature. Today was the day I was to meet with oncologist Dr. Famous Squamous and see what was on the menu.

At 5:45, after about 2 hours of sleep, I got up with K, and we drove to Wicked Famous Cancer Hospital. We walked in, and the x-ray tech started an IV in my arm and injected me with that radioactive sugar I was talking about last night. Then, took a nap for maybe an hour. When I woke, my tumor had had time to suck up this delicious stuff, and I lay down for the scan. I don't remember that part, because I fell asleep again.

Then, K and I went home, and I slept. Shortly after noon, we drove back to Wicked Famous. In the car, I went over the notes I had taken on the treatment of SCC, guessing on what Dr. Squamous would probably have in store for me and what questions or objections I might have.

At the hospital, we were quickly put in an exam room. There, we sat for a almost an hour. (I'm not complaining. That would make me a hypocrite.) I actually got some work done, but, I mostly worried about what the next few months or years were going to bring. Those were not happy thoughts. Meanwhile, Dr. Otto La Ringologo, who had given me that distasteful diagnosis last week, kept poking his head in nervously, saying, "hi," and looking around.

Then, Dr. Squamous' very pleasant oncology fellow came in to take a history and examine me. I always enjoy sharing my medical history with oncology people for the first time. It makes their eyes bug out.

At long last, the eminent Dr. Squamous came in. I could barely restrain myself from peppering him with questions as we shook hands. I hadn't seen my him since my last cancer in 2005. He looked a little older.

His head was a slightly bowed, and he seemed almost rueful. He had a little smile on his face. Quietly, with one eyebrow raised, he spoke. "Before we go too far into treatment questions, we need to clarify some things. Did you see the pathology report?" I had. I have inside access. "Did you notice that there was a lot of description in it, but no definitive statement of diagnosis?"

I had noticed that. There were a lot of scary words like "dysplastic" and "invasive," but nowhere did it actually say, "squamous cell carcinoma."

He shook his head a little. "I'm not sure it is squamous cell carcinoma."

K's and my jaws dropped, and, suddenly, the Earth shifted.

"There are other things that could look like this, and when I talked to the pathologist, he refused to be pinned down. It could be squamous cell carcinoma, but it could be a fungal infection, or it could be osteoradionecrosis.* It's also odd that you are having no symptoms. I would expect you to be in a lot of pain with SCC at this stage. And, I looked at the films from the last few years, and there has been the same enhancement in the same place all this time. This year, it's a little bigger, but, if it's SCC, it's moving a lot slower than SCC usually does."

He told us that the PET scan showed enhancement only in the nasopharynx. That means, if this is malignant, there is no invasion of local lymph nodes, and there are no metastasis. That was kind of nice to hear, but I was barely listening by then.

The rest of the visit seemed like one long exhalation of relief as we planned next steps. I will head down to F'in Famous Cancer Hospital in NYC (a.k.a. The Big Fruit) and show my pathology slides to their experts. I will meet with a surgeon (yet to be pseudonymmed) down there to discuss whether she can do a procedure to get more tissue if the pathologists need it for diagnosis or if she is willing to go in and scoop up the dead tissue and let The Fixer patch it up with another piece of my thigh or something. That might prevent me from getting any more of those cheesy infections or from rupturing my brain lining when I laugh too hard.

Of course, we did go over the worst case scenario. If it is SCC, the only proven chance at a cure would be a big surgery and more radiation, neither of which are necessarily possible with me. Otherwise, there are some very harsh old chemo agents and some newer meds that are probably not worth trying unless I am in a lot of pain (which I definitely am not!) or having other symptoms. There are some clinical trials for newer medicines, but that would be a 'hail Mary' shot. That's what I have been sweating about for days, but, suddenly, it seems a bit less immediate now.

So, this cauliflower may yet turn sour, but it's very possible that it's only burnt. This adventure is not over, but it's starting to look like it will have one of those dumb plot twists where the protagonist wakes up only to find they dreamed the whole thing. Thank you all for coming along with me this far. Even if there is no SCC, I may end up having a big, nasty surgery in The Big Fruit, but everything just got a quite bit less terrifying.

Be well,

Tom


P.S. You would think I would have learned by now. This is the third time I have been whipsawed by Wicked Famous. The first time was in 2005, when, from the radiology, they thought my small, contained cancer from 2004 had returned and was going to kill me. It just turned out to be a silly old osteosarcoma that got all better after a giant surgery, tons of radiation, and a year of chemo. The second time was 2012, when they thought they saw a big tumor on my clivus, and it was just an infection that only required a month-and-a-half of IV antibiotics. This time, though, La Ringologo told me the pathology showed SCC. It may still be that, but wow. "Fool me once, shame on you; fool me twice, shame on me;" fool me three times, and I'm going to New York.



* a.k.a. supercalifragilisticradionecrosis! Osteoradionecrosis is death of bone due to radiation treatments. The entire irradiated area does not all die at once. More and more of the tissue in the radiation field can progressively die off.

How I Feel Right Now:

Another Big Day Tomorrow

You can skip to the main course if you just want to get the update, but I do hope you will have the salad and appetizer first.


1. Salad

First of all, before I get to the meat of recent events, I'd like to complain. Over the last few months, I have gained weight! What's with that? People with cancer are supposed to get skinny. That's the silver lining. Instead, I'm just getting one big fat cloud.


2. Appetizer

Second of all, before I get to the meat of recent events, I was prompted to make a very grumpy comment on Facebook yesterday at 1:30 in the morning. I'm not naturally a grumpy person. Quite the opposite, but I was having middle-of-the-night catastrophic ruminations (Why would I do that?), and I made the mistake of looking at Facebook. One should never do that after bedtime, but certainly never when one is feeling, ahem, a bit out of sorts.

I was in a closed Facebook group about science and health. People had been posting all sorts of nonsensical quackery on it. I had routinely posted skeptical comments, but I hadn't gotten around to taking myself out. Then came the last straw. Some genius posted something about how evil oncologists have been hiding the fact that a spoon of baking soda a day can cure cancer because cancer is caused by acid pH in the body.

This is complete hogwash on its face. Your body is quite good at maintaining a precise pH of 7.41 using the lungs and kidneys. I guarantee you that if you ingest a spoonful of baking soda, the contents of your stomach will become more alkaline, but your blood pH will not budge appreciably. If you somehow succeed in making your blood alkaline to the extent that your body cannot compensate, you will die. On the plus side, your cancer will die too.

So, I told said genius that he was full of dukey (in a more polite way). He responded that, since I am a doctor, I must know the baking soda cure and will use it myself. I was enraged. I don't get angry, generally, but I'm feeling a bit delicate right now. I didn't engage further. I did what I should have done months ago and left the group. I then made a grumpy comment about such things on my regular feed.

Anyway, the point is, unless you are well-informed about real cancer treatment, it is not wise or kind to boldly proclaim poorly researched opinions or to give medical advice to cancer patients. We are passengers in a plummeting plane. We're looking for parachutes. Don't go around telling us about the flying carpet you saw rolled up in the bin over row 7. And it is particularly insulting to me since I am a doctor. You are implying that I am a fool or a conspirator. As a doctor and multiple cancer survivor, I'm really good at finding parachutes (if I may say so myself). If there's one on board this thing, I'll find it.

Meanwhile, knowingly or not, you are steering less-informed patients towards quacks who will remove their money but leave their tumors. Then, these poor passengers may fatally delay the search for a parachute, or. in the absence of one, waste time. That time would be better spent calling home (or watching the in-flight movie).

OK. Enough of the tirade. On to the main course. It's a big one.


3. Entree

K and I (particularly K) have been buzzing like freaked out bees reading scientific articles and calling doctors in Boston and New York. First of all, we succeeded in getting my PET scan* moved from Sept. 12 to Sept. 8 (tomorrow). Then, we got them to move my appointment with renowned oncologist Dr. Famous Squamous** from September 13 to tomorrow afternoon. That way, I will not have to stew all weekend wondering about my prognosis and next steps.

Meanwhile, we have contacted members of my 2005 Dream Team in New York, neurosurgeon Mister Rogers, otolaryngologist The Coach, and reconstructive surgeon The Fixer. Unfortunately, they have broken up. The Coach as moved to Lummox Hill Hospital while the others remain at F'in Famous Cancer Hospital. I have an appointment with The Coach on September 28, and Mister Rogers got me an appointment with a hyperspecialty surgeon at his hospital on September 15.

Tumoriffic fans with good memories will note that Dr. Otto La Ringologo here in Boston did not think my tumor was operable without a high risk of disastrous complications. He may well be right, but K and I are stubborn. We are going to consult a few other luminaries before we give up on that option. It is just possible that surgery could, maybe, if I'm ridiculously lucky, rid me of this unappetizing cruciferous morsel.


4. Dessert

Meanwhile, in solidarity with my plight, Katie the Cat, hearing the word "cauliflower," vomited on the bedroom floor. Ginny the Dog then expressed her solidarity by gobbling it up.


Be well, my friends and family. Another exciting meal of mixed metaphors awaits tomorrow night.




* Despite the name, a PET scan does not involve being scrutinized by domesticated animals. The principle of the thing is that tumors consume sugar faster than nearly anything else in the body. So, I'm not eating anything before the PET scan tomorrow. That way, my whole body will be starved for sugar, especially my tumor. I will then have a delicious breakfast drink of radioactive sugar. My hungry little tumor will greedily suck it all up. I will then be rolled into a machine that will be able to detect the radioactive sugar, showing my doctors the shape of the tumor and whether it has spread to other parts of my body or my brain. If I'm lucky, this little last bit of radiation on top of the thorough cooking I have already have will finally allow me to tap into the hidden strength that all humans have. Then, don't make me angry.

** Dr. Famous Squamous is one of the leading authorities on head and neck squamous cell carcinomas like mine. It is rumored that they were named after him.

Me, in a grumpy mood.

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 http://www.tumoriffic.org/Part%20II%20chapter%203.htm, 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 (http://www.tumoriffic.org/LLC.htm) 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!

I Really Don't Like Cauliflower

Some bad stuff today. First off, the Lanes & Games, "Greater Boston's premier bowling alley" will be closing soon and will be replaced by condos. I really like Lanes & Games. I mean, in all the years I have lived up the road from it, I have only gone a handful of times, and I'm a lousy bowler, but, still, it has always been a comfort to know that it was there. Alas.

Second, the microwave. It's a brand new Bosch under-the-counter microwave put in during our kitchen renovation earlier this year. I was heating some asparagus, and, all of the sudden, smoke started coming out of the top of the microwave. I took the asparagus out, but the microwave was still smoking. As I write, the repair guy is here and recommending we replace it. Luckily, it's under warranty, and the asparagus was unharmed. I like asparagus.

But, third, there's the cauliflower. I really don't like cauliflower.


Cauliflower Gone Bad

This morning, I had my appointment with the second Clivus Brother, the ENT surgeon, Dr. Otto La Ringologo. As usual, K was there to take notes and be logical and supportive. Shortly after we entered the exam room, La Ringologo came in. He looked bad. His eyes were tearing up, and he was sniffling a bit when he walked in. Allergies, I suppose.

He was kind, but blunt. That cauliflower thing is cancer, and it's a bad one. Squamous cell carcinoma, stage T4. That means it's invading the tissue nearby. Specifically, the last bit of bone between my throat and the lining of my brain. Apparently, this is not good news.

Dr. Otto La Ringologo does not think that removing any more tumor by surgery is a good idea. It lives in a crowded neighborhood. If anyone tries to scrape it, they might knick a carotid artery or create an unpatchable hole in the lining of my brain so that all the fluid leaks out and my brain dries up like a raisin.


What to Do, What to Do?

Thus begins, not a mere pimple-popping, but an old fashioned Tumoriffic quest. In a week and a half, I will get a PET scan to evaluate the extent of the tumor and look for mets. (That's short for metastases. I don't mean the baseball team.) Then, I will visit the oncologist. There are medical treatment options. Lately, there have been some exciting new brews. But, I suspect, more radiation is right out given that the inside of my head is already deep fried.

While he is not sure it is the best idea, Dr. La Ringologo also told us that the best endoscopic (minimally invasive) ENT surgical team is in Pittsburgh. They would probably operate if I really wanted them to, but he thinks it's probably not a great idea. He may well be right, but it's worth going down and talking to them.

Also, at some point, I will make my pilgrimage to New York.  Although the prospect of going at this any way but through my nostrils makes most surgeons quail, I would like to see if any members of my dream team of surgeons from 2005 have any ideas.

I'll keep everyone updated. This may be the most exciting Tumoriffic chapter yet.


And, so. . .

Chances are, I will never bowl at Lanes & Games ever again.

A PET Scan: