It Might Get Messy

There is power in photographs. How much would change if a snapshot from the new Mars rover had a green blob with a little raised limb giving a peace sign? How much of human history vectored down a new course the day the photointerpreters recognized soccer pitches instead of baseball fields in the Cuban missile facilities, letting Kennedy and Kruschev face down their respective war-clamoring advisors and dodge thermonuclear Armageddon? And how much can one life be derailed by a small series of diagnostic medical photos?

Let’s find out.

Friday morning at 0700 I signed into the general surgery department at GBMC, coincidently they plopped me in the same waiting cubicle I had the last time I went through. Dr. H finished up his first patient and came in to check on my as we headed for the OR, asking me how the pain in my throat was. I told him it was gone. He said “huh”. But since the radiology showed that white-hot spot on the PET scan and the radiologist could see a coincidental lesion on the MRI (neither Dr. H nor I could see the latter very clearly, if you go back to last week’s entry the best guess is that little beanlike nugget at the center base of my tongue), we figured it was best to proceed.

Which makes much sense from a risk management perspective. If we look now and things are clean, we can be certain with a high probability that they are indeed clean, that we’re not committing a Type 2 Error (mistakenly accepting that tissues samples are similar when in fact one is tumorous). The risks of the biopsy procedure, despite the need for full anesthesia are low and well known—chipped teeth while they root around in the oral cavity, slipping and stabbing the throat wall, anaphylactic cascade from the drugs. The payoff, especially here at the end of a year and a half of cancer treatment hell, is high. Knowing I’m clean would set me up for getting back in physical condition, rebuilding my shattered professional life, catching up on all the time I’ve missed in the kitchen, and with all of you

Let’s see how it plays out. First photo following orients you to things. That round tunnel to the left is my airway, working just fine, thank you. The rabbit hole right in front of you is my gastrointestinal tract—throat-behind-tongue, place the massive tumor took up its impositional residence last year. You can see the dysfunctional shards of my epiglottis—that cream-colored ring that forms a sort of structural coping around the ring that supports that vaguely “v” or stealth-fighter shaped slab across the top of the throat opening.

Now the one below is a little closer up. See how the creamy color of the epiglottal remnants run around from left to right across the top of the “v” shape, and you get that change to the sort of angry red color right about at 1 o’clock? And in that red splodge, there’s some darker red spots and stripes? That’s inflammation. Until we talked just prior to surgery, Dr. H would have assumed that to be a tumor, making him wrong and me right about there being “something” growing in my throat these past few months. However, he says, and this is interesting, the fact that the pain subsided on its own and isn’t increasing linearly or worse could mean something more benign—maybe an infection in the beat up epithelial tissues of my throat. You know, a nice, normal microbial infection, treatable, with a beginning, an end, and a middle that doesn’t involve radioactivity and human cellular toxins.

Damn, THAT would be nice. But let’s finish out our lesson in medical methodology. Here’s a shot after Dr. H hacked out the first sliver of biopsy tissue. Now things are coated with blood, and there’s that trough up top there, right around 11 o’clock. That’s where the hunk of throat meat headed for the lab originated.

Finally, here’s a shot on the way out. The rough surface running from about 8 o’clock to 1 o’clock around the top curve of the throat circle there is where the remote-activated scalpels sliced off the tissue to go to the lab. In top-notch professional fashion, they did the exchange with the biopsy lab in real time. That is, they sent the tissues to the lab while I was still open on the operating table to make sure the lab had sufficient tissue mass to do the appropriate tests. If they needed a few more milligrams, or maybe saw something warranting additional investigation, they could phone it in.

But they didn’t. Everybody did the job spot-on the first time.

So here’s where things stand. There is definitely “something” wrong with my throat tissue. It’s in a reasonably coherent spot, and it looks like what a reconstituted or residual tumor would look like at this point following on a year-and-change after treatment for the OTHER big-ass tumors across the way on the left side of the throat there. But the fact that the pain hasn’t been consistently increasing, and my swallowing hasn’t gotten increasingly impaired, gives Dr. H at least the thought that it might be something non-malignant, like a bacterial or viral infection taking advantage of the radiation-ravaged tissues down there deep in my throat.

We’ll find out this week. The samples are all in the biopsy lab. If ya’ll decide to take up a pool, I’ll put $20 on 70:30 odds that is malignant. But I don’t know have any particular insider information. Remember I’m the guy who before I went in for the first tumor thought I was having a sore throat that needed some mouthwash treatment!

So check back next week, boys and girls. The suspense’ll be killing me. So to speak… .