So Many Appointments

Hi everyone – 

Physically, I don’t feel that much different – I need a bit more sleep, my throat feels kind of “thick” with just a bit of difficulty talking sometimes. The hard part is yet to come. 

Emotionally, I’m coming to terms with what’s coming down the road. I’ve learned a ton in the past week, and all of the information has helped turned a big scary mystery into a big scary plan. But I no longer have “fear of the unknown.” I know it will be uncomfortable and then painful and I just have to be here for it. 

On a boat in Kauai, 2022. I miss feeling this healthy – time will come again. Photo by Ward Ruth.

The number of appointments and scans involved in planning for cancer treatment is just ridiculous (but everything has a reason – no complaints). Trying to fit all of this into my work schedule has been a challenge, but work has been really supportive – no one is complaining that I’m missing half the time. I’m keeping a log of appointments I’ve had or that are coming:

Feb 11 – GP first appointment with throat concerns 
Feb 27 – ENT specialist who did the biopsy
March 4 – CT scan, Oakland
March 6 – Scan follow-up with head cancer surgeon
March 9 – Start diet/exercise/fasting for PET scan
March 10 – Blood panel
March 11 – PET scan with radioactive tracer to see whether there was further spread
March 12 – Video visit with oncology specialist
March 13 – Radiologist meeting – general info
March 14 – Medical leave arrangements mtg at work
March 18 – Audiologist – Radiation could affect my hearing
March 18 – Cancer dentist – radiation will affect my teeth
March 19 – Final more CT scan – the mapping/planning one (super detailed)
March 24 – Speech pathologist – like PT but for speed

I’ll have a start date after the mapping scan on March 19 – probably the 2nd week of April. From that point, I’ll have one 4-hour chemo session per week, which will wipe me out (exhaustion), and five 10-minute radiation treatments per week. The whole course lasts 7 weeks. Then I need a full month of recovery. The effects of radiation discomfort will actually continue for the first couple weeks of recovery. 

Then more scans and checkups for quite a while, tapering off over time. If after five years there are no further signs, I’ll be considered clear.

For the radiation, they’ll be making a mesh mask of my face. I’ll lay down, they’ll put the mask on my face, bolt the mask to a frame, and bolt the frame to the table. The target markings will be on the mask. That’s how they’ll keep radiation directed at precisely the right spots, and have a consistent reference from visit to visit.

I’m supposed to be trying to gain weight right now – if I lose more than 10% of body weight, I’ll have to go on a feeding tube they’ll implant in my abdomen. 

I have to see a special radiation dentist to prepare to deal with damage to teeth (which already aren’t great). And I have to meet a speech pathologist to minimize effects on my speech. 

I asked whether there was a possibility I could do some of it from my parents’ house at a different clinic and they said no – it’s important to have the same gear and the same care team for all sessions. I’m sorry. 

My medical leave at work – I’ll have job protection and stay on benefits for 3 months, but California SDI will pay 90% of my salary. That squares well with the expected amount of time for treatment. If it goes longer, there are other options, but I may have to rely on insurance or just go without pay for a while. But I don’t think there will be. 

I’ve been so impressed by all of the doctors and caregivers – everyone is super sharp and friendly and it’s clear they’ve all been doing this for a long time. I have total confidence in all of them. 

Amy is amazing – such a great researcher, and getting ready with special recipes, a new blanket and pillow, house supplies, preparing to take off work to drive me to chemo, etc. I am so lucky to have her here for me. 

The doctor insisted I go on the work ski trip next week so that’s what I’ll be doing! Doctor’s orders, you know. :)

That’s all I can think of for now. Feel free to ask me anything. 

Love,
Scot

Treatment Ahead

Hi friends – 

Today the doctor told me to try and get through my hot sauce collection quickly, because I probably won’t be able to enjoy it after the radiation treatments begin. That gives me a few weeks to get through ~20 bottles. Not going to happen.

A few weeks ago, a persistent “thickness” in the throat and a visibly swollen tonsil led me to see the doctor, who felt suspicious and sent me to a specialist, who surprised me by doing a spontaneous biopsy on a lymph node in my neck and an order for a CT scan. A few days later, I got the call – I have Stage 2 Squamous cell carcinoma of the throat. It was the last thing any of us saw coming, and suddenly things are moving really fast. Yesterday I met with a surgeon who delivered a mix of good news and bad. 

The good news is that the marker I have — P-16+ — is the good kind, which responds very well to radiation and chemo, and which will allow me to avoid surgery which would probably have life-altering side effects on speech and swallowing. He gave me a 100% chance of survival (not 80-90%, as the first doctor had reported), which immediately lifted a huge stress load. 

The bad news is that I’m about to embark on a really rough treatment path – 7 weeks of daily radiation treatments, which will accumulate over time into pretty harsh discomfort / pain swallowing and eating (“the worst sunburn of your life, but in your throat”).  That will be interspersed with chemo treatments that will make the cancer cells more susceptible to radiological bombardment. During the worst part, I’ll probably just live in bed, and may have a feeding tube. So… lots of fun ahead. 

All told, it could be a six-month journey, but in the end I’m going to be fine. I may permanently lose some taste sensation, and my hotsauce funtime is probably over for good. But I’ll be able to get back to all the other things I love doing, and will stick around for a while. Treatment will probably start the last week of March, right after this year’s work ski trip, which doc strongly encouraged me to do! (One last hurrah).

The cancer started in a tonsil, as a result of the dormant HPV virus that almost all of us carry flaring up for inexplicable reasons (because cancer is cancer).  Nearby lymph nodes then also became cancerous while trying to filter toxins. 

I have an amazing support network. Amy is so attentive to every detail, an amazing researcher, and is all-in and on my side. And Energy Solutions has already offered up to six months of medical leave (I can optionally work whenever I feel capable – incredible). I’ve updated the rest of my extended family and everyone is so supportive. I’m so appreciative of all of the early support.

Just wanted to let you know what’s going on. 

Love,
Scot