It Might Get Messy

Or it might come apart in a spectacular fractal decomposition of parts, subparts, fragments of parts, interstitial dust and liquids of varied textures, colors and origins. Which, I suppose in an existential and pointlessly metaphoric way pretty much defines “messy”. 

Maybe better to say it’s gonna get ugly. Inevitably and inarguably ugly. Here’s the deal.

Dr. H studied the PET/CAT scan output. Found several things he didn’t like. A couple spots in my left lung that had grown measurably since my last scans. First evidence of remote expression of malignancy otherwise confined to my throat and tongue. On its face, this is bad. However.

The spot on my tongue where the original tumor was has re-sprouted cancer cells. And is growing rapidly. And is pretty damned big. Big enough so that today, I can feel it, and it is starting to hurt like hell 24/7. It has to go, and it has to go soon.

And that’s the start of how things are going to degrade. Treatment options for this revived tongue tumor are limited. I’ve pretty much run through my lifetime dose of radiation, so there’s no play there. Chemotherapy is possible, but can only slow, not stop or reverse, the malignancy. I’m afraid this baby requires surgery. On the plus side, the tumor appears to be coherent and amenable to successful removal. Absent the backup of radiation, though, Dr. H says he needs to overcut to minimize chances of future recurrence. This means drastic things for my future. The surgery will damage what’s left of the functional abilities of my throat complex. I may lose my ability to keep liquids from running into my respiratory tract. Simultaneously losing my ability to swallow. Leaving me…where? Dr. H wasn’t completely clear. I’ll have a tracheotomy through surgery and after. We’ll have to make a decision whether to keep it or lose it later. That decision may depend on whether I’d rather be able to talk or swallow.

Both functions, BTW, will be compromised by the replacement of a large proportion of my tongue mass with thigh muscle. In other words, if I’m going to be able to talk at all, I’m going to have to do so after teaching a frickin’ piece of bottom round roast to produce the sounds needed for human speech! As I inquired of Dr. H: “Are you shittin’ me?!” 

Dr. H reported that he was not, unfortunately, shitting me. In fact, he said he thinks, but is not completely certain, that he will not have to remove my voicebox itself. Depends on that balance between swallowing and speaking. Which depends on the thoughts of the reconstructive surgeon who will spend the day in the operating room with Dr. H when they work me over. 

More on that momentarily. Let’s go back to those lung spots. They’re small. One is 2 mm in diameter, the other 6 mm (I need to talk to the doc about this. I thought the resolution on the PET/CAT scan was on the order of cm. So I must be missing something). Anyway. This wouldn’t ordinarily be an issue, particularly since neither of them is “PET positive”—i.e., they didn’t take up the radiolabeled sugar. But they have grown. Dr. H consulted his “thoracic guy”, and they agree that the lung spots are in places where it would require massive and serious surgery to get viable biopsies. This would necessitate delay in treating the tongue tumor, mitigated as much as possible by chemo. Together, the docs think the risks of putting off dealing with the tongue tumor exceed the risks of waiting to see if the lung spots actually manifest as malignancies. Basically, they think I’ll be recovered enough from the throat surgery and reconstruction to deal with lung surgery if and when needed.

So, at the moment, we’re simply awaiting Dr. H getting an operating room he can schedule for a whole day’s work. Part of that depends on consulting with his “reconstruction guy”. Dr. H says he “has to find his reconstruction guy” to finalize the plan for surgery. This phrasing makes me think of a bad episode of The Wire, where Dr. H is desperately searching the bars and clubs in the northern residential barrens of Baltimore for an oral reconstruction surgeon. 

The bottom line? I’m about to make a sudden transition from recovering and marginally functional middle aged guy to crippled and pathetic old man. It’s only gonna take a few weeks from now for the whole deal to go down. 

Oh, don’t worry about me going down easy. I expect to be—promise to be—sharp and sarcastic through the process, out the back side, and onto the rest of the road. Next week, absent any more real news (which I don’t expect, even if Dr. H DOES manage to find his reconstruction guy) I’ll give you the hilarious story of last Wednesday, or as I call it, The Day the Diagnosis Went Down.

Thanks for being here, everybody. Hopefully I’ll have photos from surgery, which should be in a couple weeks. Love you all!