An unexpected development

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When I was 50 I had what is known in the business as a Big Surgery. It dealt with the issue I had, but recovery did not go well. Far from blaming the surgeon for my problems, we became friends. And after we became friends he shared this bit of surgeonly wisdom with me:

“The reality of surgery, Chris, is that we cut you and then wait to see what happens.”

I can see the switchboard light up with angry calls from surgeons worldwide, so please allow me to interpret. Obviously, there’s a lot more to surgery than the employment of sharpened tools and patience. What surgeon friend was referring to is recovery.

You can perform the same surgery on two patients who match the same profile, and one’s recovery can be wholly different from another’s. Or as Robert Burns so aptly put it: The best laid schemes o' Patients an' Surgeons, Gang aft agley.

And agley is exactly what happened to my treatment plan after surgery.

In a follow-up appointment with my swallow therapist, I mentioned that when I drank “thin” liquids (water, for example), I felt like I was inhaling the stuff. This is not an expected or welcome outcome.

And so in went the numbing spray that elicited memories of the 80s and, after an appropriate interval, down my gullet traveled the nasoscope.

“Ah, there’s the problem,” she said as she peered about. “Huh, I’ve seen this only once before.”

Special as you may feel when someone comments that something about you is almost entirely unique, this is not a thing you want to hear from an informed medical professional. In fact, you’re almost always better off when your innards look exactly like everyone else’s. 

After extracting the scope, she explained.

“You probably recall from playing Operation as a kid that when you swallow, the epiglottis closes to prevent solids and liquids from passing into your windpipe. Your epiglottis is currently functioning normally, but since your surgery, it’s been accessorized with a small hole at the base. That hole is always open and allows liquid to pass through, which is why you feel like you’re aspirating. As I said, I’ve seen this only once before in 20 years of practice.”

“That sounds bad.”

“Well, it’s certainly uncomfortable, and radiation may make it worse. I need to talk to the team.”

And talk they did.

Time passes

Everyone agrees that radiation with the hole extant is not a good idea because it may never heal, leading to bigger problems down the road, such as routine bouts of pneumonia. 

Cool.

The surgeon has never seen this before, but asks around to the cabal of head and neck surgeons who perform this kind of surgery. It’s extremely rare, but it happens. The hole can’t be stitched closed because this tissue is likely to tear rather than mend. However, given time, it will probably heal on its own.

Cool.

The radiology oncologist agrees, with the caveat that if I’m going to have the preventive radiation that completes my treatment, it needs to be started in the next few weeks. Otherwise, its effectiveness diminishes to the point where it’s not worth doing.

Cool.

So we’ll give it two weeks to heal. If it does, radiation ho. If not, we’ll talk risk/benefit.

Coo… uh. Hmm.

Two weeks worth of time passes

The surgeon, radiology oncologist, swallow therapist, one resident or another, passel of support staff, and I cram into a small examination room to take a look and talk it over. Spray, wait, and down goes the scope. Breath bated.

It healed!

But not enough. 

And not in time.

Risk: 

  • If you start radiation treatment, that hole may get worse or stay the same and never heal, which means lifelong swallowing challenges.

  • If you don’t start radiation treatment, any remaining cancer in the region (if there is any) has an opportunity to grow.

Benefit: 

  • Radiation sucks, even the lower-dose radiation I was slated to receive. When people talk about battling cancer, enduring this kind of thing is what they’re talking about. If you can safely get away without having it, you win.

  • You can have radiation treatment for this just once in your life. There may be a benefit in waiting to use it until you know you really need to rather than nuking the area just in case.

  • Stanford is conservative in its treatment. Under their protocol, I was just this side of requiring lower-dose radiation. My niece is a specialist in this disease at another well-respected cancer center and under their protocol, I wouldn’t be given radiation, hole or not. As far as her institution was concerned, my pathology was sparkling and I was cured. My surgeon agrees as he’s pretty damned sure he got it all.

So, in order to benefit the swallowing of future Chris, the current plan is to forego radiation, let the hole heal completely, and keep a very close eye on me—monthly appointments to have my throat scoped and an MRI every three months for the next two years (which is the period of time that the cancer’s most likely to recur if it’s going to). Should it recur, radiation and chemo remain in the treatment toolbox because I haven’t used them up in this round.

Collegial elbow bumps, see you around, and end of meeting.

Huh.