Decisions to make

We have to make decisions on what to do now. My sister-in-law Julie took Dave and I to see the specialist from University Hosp. on Friday. (has office in Chagrin Falls, Beechwood area, closer to where we live). She got us there 1/2 hour before appt. time. We then had to wait for an hour before the receptionist even started acknowledging all the patients that had arrived. We were wondering what the problem was. We finally got to go in and meet the dr. but before that Dave had to be weighed, BP, temp, and a million questions. We then met Dr. Rezaee, very nice. He checked Dave out, then numbed his throat. While waiting for that to take effect, he went and checked out the disks from Daves CT Scan and Pet scans. He was very pleased with the scans, they were very clear. He took a look down Daves throat, I had to turn my head, as did Julie. We couldn't bear to watch. Of course Daves throat is numb, Dr. Rezaee put this really thin tube through Daves nose into his throat. He could see the tumor. Julie and I were very glad when he was done with that part of the exam, whew!

Dr. Rezaee then proceeded to talk with us, Julie was awesome she took some really good notes. Dave and I are very happy that she was there. Talk about information overload. So here are the things that were discussed (from Julies notes) that will determine our future.

Dave has Destructive, Stage 4, Level 3 Laryngeal Cancer, all 3 levels of the larynx have cancer, including the cartilage surrounding the voice box. It does not look like it has metastasized. The Tumor board will be reviewing further on Fri. December 12, 2008.

Treatment options are do nothing, definitely not an option Dave says.

Standard and usually recommended in advance cases of destructive Stage 4, level 3 Laryngeal cancer is surgery to remove the larynx (voice box), lymph nodes, followed by radiation and chemotherapy. This would involve a permanent tracheotomy, (hole in throat used for talking and breathing). Dave would have to see a speech therapist to learn how to talk. For a short time he would have to have a feeding tube (port in stomach) and would require a short visit in the hospital.

There is a new clinical trial that is not generally recommended for stages past 2, but has been tried with success lately. The main hindrance with this for Dave is that the cartilage is involved. The chemo and radiation needs oxygen to work, the cartilage does not have circulation per se, therefore no real oxygen source for the chemo/radiation to work properly/effectively. There would be a short stay in the hospital. Will not know if effective for awhile. The complications are greater with radiation/chemo. followed by surgery.

If this doesn't work Dave will have to have surgery anyway. With radiation, tissue is burned, more delicate, more easily damaged during surgery, possibly causing more serious problems, such as sores, tissues breakthrough, seepage, etc.

Either option will involve radiation and chemotherapy. Radiation will permanently change surrounding tissues (mouth). Major dental work will need to be taken care of before radiation can start. Any dental work needed after radiation will require 30 days x ea day of hyperbaric treatments both before and after dental work is done. Dave will also require nightly prescription treatments of fluoride to keep teeth healthy. None of which general medical ins. will cover, (considered dental work, we have no dental ins).

Surgery can probably be done by the end of Dec. early Jan. with chemo/radiation following in about 6 weeks. The aggressive radiation/chemo treatment probably would not actually start till the end of Jan. 2009.

They will be making oncology appts. for Dave here in the Akron area do discuss treatment plans, options, complications, etc. Cindy or Cheryl, Dr. Rezaees nurses are getting this started. Dave will also be seeing a speech therapist to talk about his future if surgery is done. .

Now we wait for the tumor review board for there recommendations, is Dave a candidate for the aggressive radiation therapy? They may also want Dr. Rezaee to take a look surgically before deciding the treatment plan.

Dave will be getting the info. for his short/long term disability benefits from work today, I hope that he remembers. I have been on the phone already this morning. Daves dentist appt. has been scheduled, the Radiation Oncology appt. is made, the Medical Oncology appt. has been made. I have talked to the insurance company about Daves coverage, so this ball has started rolling and its moving fast.

There were some issues with Daves work last week and the possiblity of him being laid off was good, but the company got there bullsh** straight and he will not be laid off. He will be off the last 2 weeks of this month for vacation, but that time is being filled with doctors appt.

Our families and friends are being awesome and we are very grateful for all there love and support. Thank you for being there. I will update as I have time. We love you all.