Back to Duke

[By Susan]

We've had some great guests lately - last weekend Peter's college friend Jeffrey Johnson was here and helped me coax Peter out for a meal at Thai Cafe in Durham.  Peter's side-effects through this ordeal have involved food aversions and nausea.  For me-- I can't seem to get enough curry in my system.

Peter's oldest friend (from first grade!) Evan Rashkoff and his wife Clare were here this past weekend.  We had some great times together that included cycling the American Tobacco Trail (Clare was on her in-line skates) and celebrating our 31st anniversary with Evan and Clare plus friends Joe Coates and Geri Dawson.

Evan is an orthopedic surgeon and accompanied us to Peter's appointments on Monday.  Evan will write a "guest blog" soon, but in the mean time I'll tell you a little bit here.  We have a lot to decide.

One appointment was about Peter's voice loss, which is the result of damage to the left vocal nerve due to retraction during surgery (which can't be avoided).  The left cord is paralyzed, and stuck in the slightly open position.

 One option was a short-term fix of a collagen injection to the vocal cord, which would "plump it up" and allow the right cord to make contact, and therefore make sound.  They didn't offer vocal therapy (coaching) but apparently this is a standard part of the package, so we have to ask about that.  This short term fix could be done with a very brief general anesthesia, or with local numbing in the office.  That's a choice to figure out.  We forgot to ask if Peter could get his lips done at the same time.

Often the nerve will regenerate/repair over several months so that the second option isn't necessary, but it is there if Peter needs it - a "remedialization" of the left vocal cord, which is basically "shimmed" into place.  Our anesthesiologist friend Bret Stolp  said that this is done with the patient awake, so that they can try out the different positionings until they hear what sounds like their own voice.

I am not going to say much about the oncologist visit because I am pretty emotional about it...the offer of more chemotherapy despite the fact (and the doctor said this several times) that there is no evidence or proof that taking it would be helpful at all.

It is a drug used for metastatic breast and colon cancer (Xeloda).  It is a series of pills taken at home...two weeks on, one week off, times 5 rounds for 15 weeks total....nearly four more months of...a long list of side effects.  I think, but am not sure, that Peter would be part of a clinical trial.

Offering this just when Peter is exercising (cycling, swimming, and weight-lifting) and starting to feel strong and gain weight really knocked me for a loop.  After seeing how well Peter is doing the doctor said that his current regimen might be just as or more effective than the chemo, but once you offer it, the "what if" factor looms large and taunts us.  And there is just no way to know.  It might do more harm than good.

WWHD - What would Hippocrates do?

First, do no harm.