Saturday, January 14, 2012

Six Weeks Post-Treatment Appointments Next Week - Jan. 17, 2012

Today I fly to Washington DC in anticipation of appointments next week at Johns Hopkins Cancer Center in Baltimore for my 6-week follow-up of my combined chemical and radiation therapy.  My final radiation treatment was Dec.5.  I'm very much looking forward to seeing and spending time with our daughter Raquel, who will pick me up at National Airport and take me to the house of my friend Mark Smith and his wife Bella, in Vienna VA, where I'll stay until Monday, and maybe the entire week.  So far I have appointments at Hopkins only on Tuesday, Jan. 17, so I hope to visit friends who work in USDA in Washington, some in the Forest Service and some in the Foreign Agricultural Service.  And I'm hoping to spend a lot of quality time with Raquel.

I'm also hoping that next week my doctors will approve removal of my PEG tube, which was welcome during the final weeks of my treatment and two weeks after when the sores in my mouth and throat prevented me from eating normally, but which is no longer necessary, because I'm now able to eat pretty normally.  I still have at least one sore in the back of my mouth but that doesn't seem to affect eating.  The greatest remaining radiation effect is reduced saliva production, which requires sips of water to be able to chew and swallow drier foods such as sandwiches.  Munchies such as Cheetos appear to be a thing of the past, at least until my salivary glands recover from radiation bombardment, if they ever do.  Most foods present no problems, other than very spicy food, to which my mouth retains heightened sensitivity.  At any rate, the need to daily flush the PEG tube and place split-gauze dressings around its base after showering, and the prohibition of bathing in the ocean or thermal springs, makes the PEG tube a depressing appendage to my body.  After all, it's summer in Costa Rica (verano, the dry season) and I'd hate to waste it without being able to fully enjoy the beach!  Last week I called my Hopkins radiation nurse to suggest scheduling an appointment for removal of my PEG tube while I'm there.  She alarmed me by saying that, if the G-tube was needed for nourishment during treatment, they generally recommend leaving it in place until three months post-treatment when a PET scan is performed to detect whether there is still active cancer that might require surgical removal.  Apparently the thinking is that the surgery would affect the mouth and/or throat and therefore the patient's ability to nourish him or herself by mouth.  The thought of having to continue to maintain an otherwise unused PEG tube for another six weeks makes me depressed.  I suspect that contributing to the depression is vocalization by the nurse of the possibility that my arduous treatment might not have totally killed the cancer cells.  This in spite of reading in National Cancer Institute literature that cancer cells continue to die up to a year following radiation.  I pray that Dr. Quon, Dr. Marur, and Dr. Gourin find consensus that my PEG tube can be removed.  The risk would be that if a PEG tube were subsequently needed because cancer remained and surgery to remove it would impair normal eating, that additional minor surgery would be required to put in a new one.

I return to Costa Rica from the States next Saturday, Jan. 21, so this is a short, but expensive, trip.