01 November 2006 First meeting with Oncologist

First meeting scheduled with Virgina Oncology Associates, Dr. Daniel Atienza.

Fortunately my Mom and Dad flew in from Tucson Arizona to be with me and help with things around the house till my wife Marjie could return from her deployment in the Mediterranean Sea. Marjie is stationed on a ship that is currently deployed and not scheduled to return till December 6Th.

Here are Mom's notes which is a 100 times better than I could have done. Thanks Mom!

Wed., Nov 1. David Jr. and I accompanied Dave to the appointment with Dr.Daniel Atienza, a short, genial Filipino doctor. He started in to explain the rationale behind chemo/radiation therapy.tumor site only – radiation; tumor + metastasis to a lymph node – chemo. Chemotherapy will (1) enhance the effect of radiation on the tumor and (2) prevent further metastasis of the cancer cells. There is concern about metastasis to the lungs and bones; however, Dave's chest X-ray is clear which is very good. Side effects will include increased sensitivity to sunlight.

The combination of chemo AND radiation enhances the effects of both.

Chemo has the effect of bringing down the white blood cell count (white cells fight infection) so they will keep a close check on his blood chemistry. There is also the potential for hair loss (head, eyebrows, beard, everywhere). Unfortunately the best drug for the treatment of head and neck cancer also had an increased potential for nausea; Dave will be given pretreatment medication of Dexamethasone (Decadron) and Emend for nausea and joint pain. A side effect (of this medication??) may be numbness and tingling in the fingers and toes. This should subside when treatment is complete although there could be some lingering and possibly permanent numbness/tingling. Another side effect is possible loss of high frequency tones in hearing (something the Vigal boys already suffer from!!)

Side effects to the kidney will be monitored – the kidney tends to flush salts from the body (apparently the chemo meds are salts), and yet some salts are critical to maintain…..need to research this a bit more.

He may experience mild anemia, which they can counteract with the medication Procrit.
Another medication they will use is 5-FU (Fluorouracil) – this can cause diarrhea and mouth sores which will be temporary in nature, but still annoying. Several other drugs were mentioned – Aloxi, Emend, I believe these were all anti-nausea drugs.

It will be important to keep Dave’s nutrition at a high level, but eating may become difficult because of mouth sores, decreased saliva output, swelling of the throat, etc. For that reason they may want to insert a feeding tube, to be used when and if eating becomes difficult. The effects of the radiation on throat tissues, both internal and external, are similar to a heavy sunburn, but as radiation continues, internal throat swelling may occur. There are meds to counteract this, too.

Dr. Atienza anticipates a 6-week course of radiation and chemo – both together the first and last weeks, and radiation only in between. He also discussed the drug Ethyol (helps to reduce the occurrence of moderate to severe dry mouth) which will be used to prevent esophagitis and neuropathy in the throat (I’m really having to dig deep for my biology vocabulary!! – we’ll all be a lot more educated by the time we are through with this!) A possible deleterious side effect of Ethyol is a rash, and if he gets the rash, the drug is immediately discontinued.

I felt very comfortable about this doctor – he was thorough, understanding, easy to talk to. Dave asked him for a “guesstimate” of his chances of going through all this treatment and beating the cancer – the doctor said, at least 50-50, which was of course NOT what Dave wanted to hear. Would have to give the Dr. a D- on that particular bit.

He also explained that the surgery for this problem is HUGE – massive loss of tissue in the jaw and neck – and that is why they much prefer to treat the problem with chemo and radiation. He also said that, should the surgery become necessary at some later date, having had the chemo and radiation previously would not have a negative influence on the surgery. Obviously, this is an option we all would hope would never become necessary.

This IS tonsillar cancer, metastasized to the lymph gland. This is ONLY on the left side, which certainly is a plus.

He referred us also to the NIH and NCI websites, also PDQ, and a site called PLWC (People Living With Cancer).