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what do I know?

Posted Oct 12 2005 12:00am
Since I have a serious -- treatable, but still serious -- medical condition, I tend to relate everything that happens to my health to either the condition itself, or the medications I take to keep everything under control.

Lately I've had a sore throat and trouble swallowing, and since I know that there is a mass on my thyroid bed (or there was on June 2), I just figured that was it, you know -- the Persistance of Cancer. It's hard to completely eradicate, and if you leave even a little bit in there without whacking it with radiation or chemo, it will come back and haunt you.

Today I saw my ENT, Dr. O, and let me just take a moment to gush: He listens. Really! And he doesn't talk to me like I am an idiot, which is way cool.

Dr. O looked at the red spot on my tongue, which is still around even after that course of Nystatin. (Ick) He declared that it doesn't look fungal to him and in fact it looks exactly like something that is in the process of healing on its own, and he advised just letting it go. He did take a sample so it can be cultured, which is nice, and of course he'll call me if anything shows up that I need to do anything about, but he said it really was missing several of the key characteristics of a yeast/fungal infection and he would be very surprised if that's what came up.

So that was cool, and then he asked me about the thyca situation, and I filled him in on going to MDA. Then I complained about my sore throat and he took a look -- this is always bizarre, you know: mouth wide open to accomodate the dentist-style mirror that is stuck waaaayyyyy in the back of my mouth, and then having to sing/say "A" in a sustained note, or take a deep breath, or say "E". But it is also very cool because so many of the structures are visible if you do these simple things, so good docs like Dr. O can actually see what's happening.

He didn't see any signs of infection but he did see signs of chemical irritation on my lower esophagus. It's the dreaded acid reflux!

I should have known. Really, I should have. I have been through this a few times before, usually around stressful times -- stress? who has stress? -- and yet I never seem to connect the heartburn or gurgling stomach or just bad digestion with needing to take a proton pump inhibitor.

Dr O has me on a 3-month course of Prilosec (we're giving it a try first, since it's OTC and inexpensive) to settle things down and let my poor throat heal.

The bad news is I may be someone that has to take this more or less forever. My mom has a hiatal hernia and is on a ppi of some kind, has been for years -- and it provides her a lot of relief. I've long believed that adhering to a controlled carb diet (not necessarily low carb, but way lower than that Standard American Diet allows -- say 75 to 100 g carbs per day) would keep my acid problems in check and for the most part, that has been very successful. However, sometimes I just stress out and all of a sudden, I'm pumping out more acid than I can properly metabolize. Eww.

The good news, however bizarre that may sound, is that being diagnosed with GERD was a profound relief. Maybe now I won't need surgery! I thought my throat was sore because of the cancer, but it's not -- or at least, not entirely. Thinking about it a little more clearly now, that makes sense. My suppressed Tg was only 1.7 last time, after all, that's pretty low, certainly not reflective of an out-of-control, growing cancer. Yes, there are indications that something's still there, but the somethings are still very small. And who knows, by the time I get to Houston they may be smaller still, as the RAI has an effective period of up to 6 months. It's entirely possible, although I have no idea how probable it would be. But it's nice to have another possible pathway for my thoughts to wander down.

Dr. O agreed that a positive ultrasound was not definitive enough evidence on which to recommend surgery, and was pleased to hear that they would be testing me at MDA. Dr. O also knows the guy I'm seeing, and has a high opinion of him. Everyone is so encouraging, but Dr. O in particular focussed on one specific thing: positive outcome. He told me about a patient he had consulted on who had even more significant local metastases than I had, and whether or not he was a candidate for surgery to remove some junk that had adhered to his recurrent laryngeal nerve. We are very grateful that we have the option of the RAI treatment for the well-differentiated cancers. This patient, he told me, has had an excellent outcome, and he also told me that my age is working in my favor to insure that I have one, too.

This happens from time to time, I get the "I have a bad feeling about this," vibe -- but I'm wrong. Oh, how I love it when I'm wrong! Well, maybe I'm not entirely wrong -- I mean, I do have something that needs treatment, and I'm on a new round of drugs, but hey -- it could have been a lot worse. This, I can deal with. I don't feel in the least bit embarrassed or annoyed over "why didn't I think of that?" I'm not a doctor, after all -- that's why I pay these guys the big bucks. Believe me, with a $40 co-pay, it really does amount to big bucks pretty quickly. Visits like today's are totally worth it.

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