This past Tuesday, December 4, 2012, I had my fourth post-treatment PET scan at Johns Hopkins Hospital.  The first words from Dr. Shanti Marur, my medical oncologist with whom I had my first appointment after the scan, were "Do you want to hear the good news?"  She had just talked with the radiologist from Hopkins' PET Center who had reviewed the scan.  She went on to say that the scan detected no sign of cancer in my treated tissues, nor in the rest of my body down to my legs.  My blood chemistry results were also good, with recovery of normal levels after the effects of chemotherapy that I had received both prior to and during concurrent chemo-radiation therapy.  My PET scan was a full year, 365 days, following the last day of radiation treatment on December 5, 2011.  Dr. Marur told me that with these results, I wouldn't need to see her for six months.

Later in the day I saw my head and neck surgeon on my treatment team, Dr. Christine Gourin.  Dr. Gourin was the first doctor that I saw at Hopkins on August 5, 2011, following the fine needle biopsy of my swollen left high cervical lymph nodule in Costa Rica, the lab results of which, "findings compatible with metastasized squamous cell carcinoma" (translation from Spanish), prompted my wife Damaris and me to fly to the Washington DC/Baltimore area on August 2 for the best further diagnosis available and treatment if necessary.  Dr. Gourin gave me a copy of the preliminary radiologist report of my PET scan (not yet reviewed and signed by the attending radiologist) and examined by mouth, throat, and nose, stating that my tissues had healed well from the treatments.  She, too, said that I didn't need to return as early as three months, but recommended I return for follow-up in four months.  Because she was the first doctor on my treatment team who examined me in August of last year, she's considered my primary doctor for my treatment team, so I suspect that I'll follow her recommendation.  Dr. Gourin took a good look at my teeth and commented on the importance of special dental care because of my reduced saliva production caused by radiation effects on my salivary glands.  Saliva plays a vital role in maintaining dental health.  Finding a dentist in Costa Rica who is thoroughly knowledgeable of dental care for patients who have had radiation treatment of their mouth and jaws is a top priority for me upon my return to Costa Rica on December 13.

My final appointment on Tuesday was with my radiation oncologist, Dr. Harry Quon.  Dr. Quon also examined me, and marveled again, as he had on August 28, how well the tissues of my mouth, throat and nasal cavity had recoverd from radiation.  He commented to his resident, Dr. Shibaja (Hopkins is a teaching hospital, and Dr. Shibaja inserted and manipulated the endoscope in my nasal cavity as Dr. Quon coached him), that the still-palpable left high cervical lymph nodule had shrunk since August, and that my treatment team had opted against radical neck dissection (surgical removal of neck lymph nodules, once standard practice for level-IV metastasized head and neck cancer) and that my case was included in a research paper by him and others on the topic currently under review.

Once again, our daughter Raquel drove me to Hopkins and accompanied me through the day.  It's been great to be able to spend some time with her again.  Returning less frequently for follow-ups at Hopkins has a down side--seeing Raquel less frequently.  Maybe I can spend some of the money saved by traveling less frequently to Hopkins by paying for Raquel to go visit us in Costa Rica.

This Saturday, December 8, I'll fly to Chicago to visit our son Tim and daugher-in-law Bret in Skokie.  Bret's due date of our future grandson Oliver was December 2, and Damaris flew there on November 15 to help Bret in the final days of her preganancy and first days of motherhood.  I hope that Ollie is born between now and my flight back to Costa Rica.  I miss Damaris, and Tim and Bret, so I'm looking forward to seeing them in Skokie, but as might be imagined, the prospect of getting to see and hold my first grandson is totally awesome!