update

[Guest guest]

Hi folks - I've spent most of the last few days at doctors - well,

that's how I spend almost all my days now. I had my fist visits to

UCSF, whre my radiation therapy will be done. I was screened at the

oral medicine clinic by an MD/DDS - quite a combo, that! - who tells

me that I will need two teeth pulled before radiation can start.

This is actually good news, because I knew I was going to lose the

tooth from which I lost the big filling on Christmas, which I just

had patched instead of capped because I didn't want the possibility

of a post-oral surgery infection to delay my roux-en-Y - and, of

course, they pull the matching tooth in the upper jaw to prevent

malocclusion and jaw strain. So two was the best I could hope for,

and that will happen on Tuesday.

The latest MRI and PET scans show my cancer to be growing quite

fast, with new spread to the right lymph nodes for the first time.

The primary tumor in my throat is now almost twice as large as

estimated in the first CT scan, partly because the MRI and PET scans

have better resolution, and partly, of course, because it is

growing. So, they want me to get started with radiation and

chemotherapy as soon as possible, probably around the 28th of March

(my tooth extractions have to heal before they can begin, and they

have to do measurements and simulations to aim the radiation, and

they have to make a mask to fit my face, head, and shoulders to keep

me immobile during treatment (and what a relief to have less weight

on my diaphragm when I lie flat on my back!). While I still feel

great and work out quite vigorously almost every day, my voice is

increasingly altered. The doctor at UCSF says that they call my way

of speaking " hot potato speech. " Even though my breathing does not

seem to be affected, they are seriously considering doing a

tracheotomy on me before they start the radiation, just to be sure I

have an airway.

I continue to try to slow my weight loss ahead of the radiation and

chemotherapy, to little avail. My metabolism makes me lose weight

more rapidly when I am exercising, and this is a fair tradeoff - I

may not keep the weight up as much, but I will be stronger and

healthier from the exercise. I have been trying to slow my weight

loss to about 2 1/2 pounds a week, but I am already down to 245 from

281 at my surgery date of 2/2. Lately I am thinking that it will not

be so strange to return to a more typical mode of post-bariatric

eating from my current indulgences - I'll be so happy to be able to

eat, period, that what I'm eating won't much matter. Of course, the

fact that most head and neck cancer patients lose their senses of

taste for as long as four years after the radiation, and most never

wholly regain it, will also make the issue relatively unimportant.

I have spent a fair amount of time in the last week having

conversations with friends and family - before the voice gets

impossible to understand, or before I have the tracheotomy, which

will make phone conversations very difficult. And of all the things

I am dealing with, these conversations are the hardest. It is very

emotionally draining to deal with people's reactions, and when I

have the odd duality of feeling wonderful but knowing I am about to

enter a living hell, talking about my health and prospects seems

almost unbearably self-indulgent.

Randy