How many doctors does it take to treat a patient?

Another day, another doctor. This time, another ENT, who is my age.

His first comments were those we’ve come to expect: how rare it is to see someone our age, female, nonsmoker, with this type of cancer. Yes, it is indeed rare. I always thought that if I were to be afflicted with cancer of some sort, it would be breast cancer, since that runs in the maternal side of the family. Then again, I have always charted my own path, so maybe I just had to be different.

More poking and prodding. The doctor runs his finger up the side of my tongue, which is excruciatingly painful. He also feels my gums, around the bottom of my tongue, feels around the back of my mouth, which makes me gag a little, and apologizes the whole time for the pain he’s causing. What a guy.

He then spritzes a vile topical at the back of my throat – the label has the funniest claims on the front of the bottle, one of which says “reduces gagging”. I was wondering what that particular claim was for. Until the doctor put a mirror all the way in the back of my mouth and used a wooden depresser to push my tongue down so he could also have me say “eee” and look down my throat. I’ve made a note that “reduces gagging” means that it will take three seconds instead of one to gag when someone starts messing around back there.

The doctor says for something like this, he’d recommend surgery, with radiation to follow if surgery did not get all of it. He also wants a CAT scan.

Since everything we’ve read about this sort of thing says surgery, and based on the side effects of radiation, we elect for surgery.

The doctor says he’ll need to check his schedule, since he’s leaving town for a week, but that he’ll give us a call and in the meantime, we’re to go ahead and schedule the CAT scan.

A couple of hours later, we get a call from the doctor. He leaves a message with his cell phone number (which shocked the hell out of me), asking us to call him as soon as possible, even if it is after hours.

So we do. He says he checked his schedule, and he would not be able to do the surgery until the first or second week of August (we’re in the first week of July at this point in our story). However, he has spoken to another doctor, for whom he has great respect, and discussed the case with him. They are in agreement that we probably should not wait that long for action. The other doctor is not leaving town, can see us that same week, and can likely do the surgery the following week. He has also been doing this sort of thing for about 30 years and is highly knowledgeable and respected. We agree that we’ll head over to the next doctor after the CAT scan and get things rolling there.

The mask of doom

The first ENT, who did the biopsy and also broke the bad news, recommended radiation followed by surgery if necessary. As I mentioned, the reasoning behind this was because surgery can be so disfiguring.

While we were doing our research, we went ahead and got a recommendation from my primary care doctor for a radiation oncologist, and headed over for an appointment.

The doctor is a local boy – went to school here in town, then headed to Harvard, and came back after finishing a residency at Stanford. Very, very nice guy. Young, too.

Like all the others, he poked and prodded the lesion on my tongue, then stuck a tube down my nose into my throat to take a look around and see if anything looked off. Fortunately, after peeking in there and making me say “eeee” while he looked at my vocal cords, he said things looked fine there.

His question, though, was why radiation first in this instance rather than surgery. We explained the answer given by the first ENT. He told us that in this case, since the lesion is accessible (i.e., on the oral tongue, the part that’s mobile, rather than the base, which is at the back and doesn’t move), his first inclination would be surgery. He spoke to the ENT, and they didn’t really come to any definitive answer, since they’re both experts in their fields but not the other’s.

So we asked for the name of another ENT, and made an appointment with him to get yet another opinion.

In the meantime, we went ahead with the mask of doom.

The mask is one made for patients with head and neck cancer. It’s a form-fitting mesh apparatus used to keep the head in one place during treatments. The form is heated slightly, then pressed down across the face and shoulder area while the patient (me) is lying flat on a table.

For those with claustrophobia – like me – this is an anxiety attack inducing experience. The mask tightens and goes solid as it cools. It is not a fun procedure for people like me, and I thought I might hyperventilate myself into unconsciousness at one point. The techs were very kind though, kept talking to me, and tried to cool it faster by placing cold rags on it. I am convinced that if I do have to undergo radiation treatments, I will need to be slightly drugged while I am in this mask. Did I mention that it bolts to the table right about the ear area on either side?

The radiation oncologist ordered a PET scan. This uses a glucose formula with a radioactive substance contained within it to “light up” areas that may have cancer activity, since cancer cells tend to use more energy than normal metabolic functions. All of this would be more fascinating to me if it weren’t for the fact that I had to wear my new mask during the procedure.

It took three tries and a compromise to get the mask in place – the compromise being that I would only need to wear it for about six minutes rather than 30, because I was having too much trouble having the mask in place. With a little help from one of the techs, though, I managed to get in the most comfortable position and the calmest state of mind I could, and was rolled back and forth through the scanner. With the mask off, and with me being almost motionless, they also did a longer scan of about 20 minutes.

And then I was freed from the mask, and once again, we waited for results and our next appointment, this time with the new ENT.

How in the world did we get here?

So how in the world did we go from point a to point b?

A little of the past before a little of the present is in order.

Back in April, I had noticed a small sore on the left side of my tongue. It looked like a regular old canker sore, which I’d gotten before from time to time (although rarely on my tongue). I hadn’t had any for quite some time, but figured it would go away on its own.

It didn’t. In fact, it got a bit bigger, and the area around it became red and inflamed as well. Since I was headed to the dentist to get a cracked filling replaced, I asked him about it. He told me it looked infected, gave me some antibiotics, a dental paste (sort of like liquid gauze), and told me to alternate rinsing with salt water and Peroxyl. Not better in a week? Go to the doctor.

Well, it wasn’t better in a week, so I headed to my primary care doctor. I had to go anyway to get my cholesterol rechecked, so had him take a look at the sore, which had grown a bit bigger. After looking at it, he suggested a trip to an ENT. He did point out that my risk factors for cancer in that area were quite low (which I knew: never smoked, never used any other tobacco products, not a big drinker, and no history of oral cancer in the family, although breast cancer runs through), but they worry about things that don’t heal as they should.

So, off we went to the ENT. He took a look, and decided that we should try a topical antisteroidal to see if that would help. None of us, of course, considered cancer as a primary factor. If it wasn’t better in a week, I was to return for a biopsy.

It wasn’t better. In fact, it continued to grow, and the ulcerated part also grew larger. So, biopsy time.

If you’ve never had the joy of having needles stuck directly into your tongue, you’re not missing anything at all. First, a small topical gel was applied to the affected area to numb it a little. He then injected novocaine directly into two different places in my tongue – two different areas of the sore, I should say.

About five minutes later, he took several small samples from the area. Even with the novocaine, the pain was still quite intense. They sent the samples off to the lab for the pathologist to review, and told me to hang tight while we waited for the results.

Four days later, they called me into the office.

“The pathologist says it doesn’t look good.”

The pathologist, in fact, wanted another set of samples, deeper into the tissue, to confirm what he saw in the first sample. So we went through the procedure again, this time with a pain level five times the first time, as the doctor dug out a core sample from about the center of the sore. They then sent me home, told me to hang in there, and we waited for the results to come back.

And that, my friends, is how we ended here, with a diagnosis that surprised every health professional we’d seen to that point (plus all the others we’ve seen in the meantime) and shocked the hell out of me and my family.

The Big C

“The latest biopsy did come back as cancer.”

Those are definitely not the words you want to hear. Now, admittedly, after dealing with a sore on my tongue that wouldn’t heal for about three months and that was surrounded by a reddish area that kept growing, this was in the back of my mind as I made my way from my dentist to my regular doctor to an ENT (ear, nose, throat doctor). But oral cancer, in my tongue? Me? A lifelong non-smoker who had never taken a puff of anything, legal or not, and who had never used any other types of tobacco products at all? This is the sort of cancer that most often strikes older men with three pack a day habits, not females under 40 who have never adopted that habit.

“The doctor recommends radiation, followed by surgery if necessary.

When I asked, the reasoning was that surgery on the tongue or in the mouth is disfiguring and can have a large impact on things like speech and eating, especially given where the tumor on my tongue happens to be (left side, about in the middle from front to back). Radiation can shrink tumors to the point where surgery afterwards can have less of an impact than initial surgery can.

However, conventional wisdom is surgery first, then radiation if there are areas missed by the surgery. Ever hear that phrase “the margins are clear”? That’s what post-surgery pathology is looking for: no evidence of cancer cells around the perimeter of the removed tissue, which generally indicates radiation is not necessary, although consistent, regular followups are.

Besides, my speech had been degenerating for a couple of months since the tumor continued to grow and is ulcerated in the middle, making it very painful to talk. And swallow. So I sound like someone who might be a little mentally challenged, and the only way my speech could be any worse would be if I couldn’t speak at all. I can’t speak on the phone at all right now, and it’s getting pretty tough for people to understand me when we’re face to face.

So, off we went for a couple of other opinions. I haven’t written about this previously, because I’m a fairly private person, all things considered. But there’s a dearth of sites about oral cancer compared to things like breast cancer, so I thought I might give people like me, who are searching for others’ experiences, anther place to land if they, too, are given the news that there’s something growing on their body that shouldn’t be.

Primo guacamole

Years ago, I never cared for guacamole. That’s probably because every version I’d had was processed into something resembling the stuff that could be found in a baby’s diaper after a particularly bad intestinal bout.

However, I sampled some made by one person that wasn’t quite so processed, and found that it could be quite tasty. I’ve modified it a bit, as hers tended to be a little too watery if it sat for awhile, and I like mine a bit stronger, so I use more red onion and garlic. This is a great taste as you go kind of thing, and the amounts can be adjusted to suit whatever tolerance you have for the various ingredients.

Primo guacamole (serves about half a dozen, or 2-3 hungry people, or 1 person who doesn’t like to share)

6 slightly soft Haas avocados
1 lime
2 medium tomatoes
4-6 cloves of garlic, finely minced (depending on your tolerance)
1 – 1 1/2 cups diced red onion (ditto)
Fresh cilantro, minced (to taste)
Freshly ground black pepper (to taste)

Place the avocado meat in a good sized bowl, and mash it a bit with a fork. Personally, I like my guacamole a little chunky, so some diced-sized pieces of avocado are always welcome. Squeeze lime over the avocados immediately to prevent browning.

Quarter and seed tomatoes (this will keep it from getting watery on you). Chop roughly and add to avocado mixure, stirring gently to combine. Add remaining ingredients and stir a bit more. Give it a taste, make any spice adjustments, and enjoy.

Chewy Chocolate Cookies

Because sometimes, you just need some chocolate.

1 3/4 cups (unbleached) all purpose flour
1/3 cup unsweetened cocoa
2 1/4 teaspoons baking powder
2/3 cup powdered sugar
1/8 teaspoon salt
3/4 cup plus 1/4 cup semisweet chocolate chips (minis)
3 tablespoons canola oil
1 cup light brown sugar, firmly packed
2 1/2 tablespoons light corn syrup
1 tablespoon water
3 egg whites
2 1/2 teaspoons vanilla extract
Cooking spray

Preheat oven to 350.

Sift the first five ingredients into a bowl and stir well.

Combine 3/4 cup chocolate chips plus the oil in a small saucepan and heat on low, stirring constantly, until chocolate melts. Pour the chocolate mixture into a large bowl (preferably the bowl of a Kitchen Aid or other mixer) and let cool for five minutes. Add corn syrup, brown sugar, vanilla extract, and egg whites* to chocolate and stir well. Add flour mixture and remaining chocolate chips to the wet ingredients and stir well. The dough will be slightly dry, but should stay together if pressed in your hand.

Drop by level tablespoons about two inches apart on baking sheets coated with cooking spray or (better) onto Silpats. Bake at 350 for 8-10 minutes. Let cool for 2-3 minutes, then move to wire racks to completely cool. Do not store these cookies in the open air.

If you use an ice cream scoop (dip) to drop the cookies, use a smaller one, as otherwise you will get uneven cooking and the outer eges will be crispy while the center is raw.

* Egg whites: I used a carton of egg whites (All Whites) for this recipe. Three tablespoons equals about one large egg, so I added five tablespoons to the mix initially. When adding the flour, my mix wound up a little dry, so I added a bit more egg white while the KA was mixing for me until the dough was moist enough to stay together but still dry enough to retain the chewy factor after baking. The total egg white addition was probably about seven tablespoons. Your mileage may vary, so adjust according to your needs.

Reflections on gardening, cooking, and life