Malignant: Overload

Finally, A Field General

Phew. I just came out of a three-hour session with my new medical oncologist, Dr. Allerton.

The best thing to come out of today’s huddle was learning that Allerton will now be the “quarterback” — his word — throughout the upcoming treatment program designed to rid my corpus of the olive pit(s) in my neck.

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Believe me, that’s progress. Big progress. I’ve been pinballed from doctor to doctor for two months now ever since it was suspected my main olive pit is a cancerous tumor. And it’s not that they didn’t like me, nor I them. We all get along famously. One big happy family. Then again, family is too teensy an aggregation term. I need a word that can accurately convey the sheer number of humans who’ve now been enlisted in this game of chess with carcinoma. Treating cancer takes…, well, a village.

Here, to the best of my recollection, is the trail of doctor bouncing I’ve been subjected to ever since my primary care physician felt up my neck, said Hmm, and furrowed his brow.

1) Dr. Behney, my primary care doc, referred me to the otolaryngologist, Dr. Pugh

2) I underwent a preliminary exam by Dr. Pugh’s Physician’s Assistant, Cheryl Pittsford

3) P.A. Pittsford referred me to a cytologist whose name I forget for a fine needle aspiration (FNA), a type of biopsy

4) Upon receiving the result of the FNA, I was granted an audience with Dr. Pugh

5) Dr. Pugh ordered a throat sonogram, a neck CAT scan and a thorax CAT scan, and surgical random biopsies of my throat and the base of my tongue

6) Dr. Pugh then referred me to the gastroenterologist, Dr. Selo, for an endoscopy

7) Upon receiving all these results, Dr. Pugh referred me to Dr. Wu, the radiation oncologist

8) Dr. Wu referred me to the dentist, Dr. Baker, for a pre-treatment exam

9) After examining, x-ray-ing, sensitivity testing, and otherwise digging around my mouth with a number of sharp instruments, Dr. Baker referred me to Dr. Wittrig, a periodontist

10) I’ve yet to convene with Dr. Wittrig; she likely will refer me to an oral surgeon

11) Upon receiving the result of a full body PET scan he’d ordered, Dr. Wu referred me to Dr. Allerton, the medical oncologist

I haven’t even mentioned my primary cardiologist, Dr. Shenoy, nor my electro-cardiologist, Dr. Strobel, both of whom must give their okays before my chemoradiation therapy begins.

All of which led me to ask Allerton today: Who’s the boss around here?

See, that’s a grand total of ten croakers (my father’s word — he acquired much of his colorful lexicon during his seven months in the US Army at the tail end of World War II). The total doesn’t include nurses, phlebotomists (I’ve been stuck more than an aging spinster’s pin cushion in the last couple of months), LPNs, radiologists, nuclear imaging technicians, surgical assistants, operating room technicians, medical records technicians, and all the other collaborators and adjuncts so necessary to the running of a modern medical outfit. I can safely estimate I’ve been poked, prodded, interrogated, and viewed semi- to fully-naked by no fewer than 75 people thus far. The next couple of weeks promise oral surgery as well as a pair of operations to insert a drug port in my upper chest and a feeding tube into my stomach.

Yeah, that’s a village. At least I know who the mayor is now.

It’s A Piece Of Cake

Another good thing to come out of my meeting with Dr. Allerton today? He says my brand of cancer is among the easiest to cure. Yay!

The War With Drugs

I learned a lot about chemotherapy today. I’ll be given three megadoses of cancer-cell-killing substances over the six week period during which I’ll undergo radiation therapy. The drug, a platinum-based substance, can cause sever nausea and even horking, either of which can be endured were I of the tough-guy ilk, but would be absolutely unbearable — even dangerous — once my throat becomes severely sunburned by the radiation.

The chemotherapy begins the day radiation does. I’ll go get beamed in Dr. Wu’s garage and then dash over to Doc Allerton’s place where I’ll be hooked up to a pump that’ll send copious amounts of drug-laden fluids into my bod through the drug port in my chest. The infusion process lasts four to six hours. Nice recliners and beds are provided, along with magazines, TVs, and WiFi. I’ll go for radiation Monday through Friday for the next six weeks and I’ll go back for more chemotherapy in three weeks. After each chemotherapy session, I can expect several days to a week of extreme nausea and possible horking although I’ll be provided very effective anti-nausea, anti-hork drugs. If I play my cards correctly and dose myself the nano-second I feel a bit of an upset stomach coming on, I shouldn’t have to bear much discomfort, if at all. Three weeks later, I’ll go for a final chemotherapy session.

I think I can do it. I hope. Okay, I promise I’ll give it a try at least.

Details, Details

A few more things. Dr. Allerton assures me Dr. Wu indeed has an IMRT machine in his garage. Cool. Intensity-Modulated Radiation Therapy, the latest in nuclear-zapping techniques, is said to reduce damage to healthy tissues by 70 percent. That makes me more than happy considering I’ve been worried I might never taste my own homemade spaghetti sauce again.

Also, surgery, Dr. Allerton explained, is now a last resort in cancer therapy. In the old days, he told The Loved One and me, doctors just hacked out huge divots of meat from cancer patients, leaving gaping caverns and terrifying scars behind, and after which the patients probably would have to undergo radiation and/or chemotherapy anyway. If chemoradiation doesn’t work in my case, Allerton sez (a long shot, BTW), only then would he and the gang consider applying the blade to my throat.

Finally, I learned the roadmap laid out for me so far is the standard recommended by both the Via Oncology Pathways program of the University of Pittsburgh Medical Center as well as that of the National Comprehensive Cancer Network, both of which have formulated the very latest treatment options and whose guidelines are followed by every accredited cancer treatment center in the nation. So, were I to seek a second opinion, the next oncologist would prescribe just what the Wu/Allerton team is calling for.

I guess this is it. Fingers crossed, babies.

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