A Humorous Look at Throat Cancer

Medical Updates by Number

I believe God created heaven and earth; and when He created man, God provided man with emotions, leaving it up to him to how to use them. When I was diagnosed with vocal cord cancer, I had the choice of crying or laughing. I chose the latter and all the difference that made. Below is a collection of medical updates that I sent to friends over Internet. I hope you enjoy them. Despite the humor, I feel I received excellent care by a host of medical professionals and would like to thank all those wonderful people who made my recovery possible from the physicians down to the janitor. If you have any questions or comments, I would be happy to hear from you. Larry Buege, PA-C. (LSBuege@aol.com)

Medical Update # 1

December 17, 1999

Dear friends and fellow employees,

I would like to thank you for your thoughts, prayers, get well cards, E-mail messages, and flowers. I have received so many E-mail messages my wife is getting suspicious. (I had told her the hospital only hired male nurses and staff!). I considered writing one of those cute little Emily-Post-type thank you cards but decided on an informative letter instead.

As most of you know I have been having hoarseness without any other upper respiratory symptoms. I assumed cancer was a strong possibility, but Dr. Stein assured me this was unlikely in a non-smoker. During his career, he has only seen one case (I make number two!), which led me to my wart on the vocal chord theory.

With such assurances, I did not mention that possibility to my wife, as she tends to worry. When Dr. Stein informed her of the diagnoses, it was a shock. Apparently she had read someplace that people die from cancer. Bummer!

Dr. Stein was kind and gentle and told her the cancer was in the early stages and chance of full recovery was 90%. He spent a lot of time with her and answered all of her questions.

About twenty minutes later in the recovery room, he informed me of the results. By this time the five-year survival rate was up to 92%, a fact I found particularly reassuring. By this time I assume my five-year life expectancy should be close to 112%!

The surgery went well. The nurses and staff were pleasant and professional. I did have to watch the nurses closely for any signs of a Foley catheter, as you can’t always trust nurses! Hopefully, I was not violated while I was under. As I was wheeled into the operating room I received a salute from one of the medics I knew from the National Guard who was working there. I thought that was a nice touch. The operating room was small but did have a crash cart with paddles etc. I would have checked the equipment more closely but they had me strapped down. There was a phone on the wall, and I waited for it to ring with a reprieve from the Governor, but it never came. It must have gotten bored after that, as I fell asleep and didn’t wake up until I was in the recovery room. Recovery was like waking up in bed. There was no nausea or slurred speech. No pain. My thought processing was no worse than usual. And I could talk again! You don’t appreciate the ability to talk until you lose it. They surgically removed the bulk of the tumor from my left vocal cord, but I am sure some of the cancer still remains.

I will have radiation therapy five days a week for six weeks. Dr. Stein feels I will be able to work weekends during the six weeks. I am not sure if this is overly optimistic or not. The amount of radiation will be small since the area being radiated is minimal, but I expect to have some inflammation of the vocal cords. Prolonged talking may be difficult. At least I won’t have to turn on the lights to read at night! Treatment won’t start until after Christmas, as I scheduled for more evaluations. It is possible I will return to work before then.

Thanks again for your thoughts and acts of kindness. I will keep you posted.

Larry

Medical Update # 2

I am now down to 8 more cooking lessons at Marquette General after which I shall receive my diploma. I asked if I would graduate summa cum laude if I did well. They say the best they can do is give me a “well done” certificate.

I am getting to be an expert on narcotics, having progressed from Tylenol #3 (with Codeine) to Dilaudid (hydromorphone). The Tylenol #3 has an alcohol base, which marinates the tonsils on the way down. The Dilaudid is in an aqueous base. It is a little smoother going down but has a nasty after taste. It is also more potent and has a tendency to make one sleep all day. Both of the medications cause nausea for which I take compazine. I treat the cancer with radiation, the radiation with Dilaudid and the Dilaudid with compazine. It is similar to the nursery rhyme in which the lady who swallowed a spider swallowed a bird to eat the spider and swallowed a cat to eat the bird etc.

For the most part I use the narcotics only at night as I have too many things to do in the daytime (sit in the Jacuzzi and watch old movies, write dumb medical updates, etc.) and cannot afford to sleep all day.

My voice is now almost gone and my wife thinks she now has the perfect husband. I never complain. When she asks a question I give her an inaudible grunt, which she interprets any way she pleases. When she leaves the house and I am left alone without adult supervision, she will give me an extra dose of Dilaudid, and I will still be sleeping when she returns home. Occasionally she will still dress me up and take me out in public. Saturday we went to Michigan Tech to see the ice sculptures. Copies of some of the pictures can be seen at Ice Scuptures2000.

I am still doing OK and life is still enjoyable. I appreciate all of your e-mail letters and get well cards. I’ll continue to keep you updated with my weekly reports from the medical front lines. Feel free to pass this message on to those poor souls without e-mail.

Larry

Medical Update # 3

I have been asked by one of the medical update readers to quantify my pain on a scale of one to ten with ten being the worst pain. Naturally this was an OB nurse.

Pain is difficult to quantify due to the many influencing factors and mitigating circumstances. I therefore refer the reader to a web page with a pain formula, which will better quantify the level of pain. It can be found at Pain Scale.

Larry

Medical Update # 4

I completed my lasst radiation treatmeent tooday. It iss alsso the peeak of whaat I will call “dissscomfort”. ZZZZ I am ussing more of the Dilaudid which iss a type of oral morphine. The medicine doess cause soome side effects suuch as sluurring of speeech although thiss has not beeen noticeable. It can alsso affect the memory. I have not seeen any of thaat eitherr. ZZZ I have not seeen any of thaat eitherr. ZZZ The biggesst problem I have with the medicine iss that it makes me veery ssleepy and it is hard to get any work done.

ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ

The mutations from the radiation treatments are progressing rather nicely. My wife has begun to accept the warty skin growths but is still a little bit leery about the tentacles. I would send you a picture, but I have found that I tend to fog the film if I stand too close to the camera.

ZZZZZZZZZ

I was to have 30 treatments but they cut it back to 29. I asked why it was reduced and the Radiation Oncologist showed me computerized images of my throat with superimposed isobars outlining levels of radiation on which he based his calculations. I think it may also have been cut short because the little red cylinder popped up in the gadget they implanted in my neck.

ZZZZZZZZZZZZZZZZ

After the end of the radiation treatment the discomfort and mutational growth will continue to increase for about five more days before starting to subside. The discomfort will decrease rather quickly, but I am told that it may take from two weeks to two months to get my voice back. After careful and thoughtful deliberation, I have elected to go with the two-week option. Hopefully I can then return to work in a couple of weeks.

ZZZZZZZZZZZZ

Well that's the news from Marquette, where all the PA’s are radiant, patients are wearing thin and the snowfall is above average.

ZZZZ Larry ZZZZZZZZZ

Medical Update # 5

It is now one week since the nuclear ceasefire. Dr. Thieme, commander of the nuclear bombardment, predicted the discomfort would increase for about five days before there would be any improvement. He was not far off in his assessment. It has only been after the last two days that I have noticed any improvement. I am no longer using Dilaudid (hydromorphone), so my updates may not be as imaginative as in the past. I have decided that, like Edgar Allen Poe, I do my best work “under the influence.” I am, however, still using Tylenol #3 (with codeine).

My voice had been down to a mild inaudible whimper but is returning. I test it every morning by yelling at my wife who by then has been up for several hours. She thinks it is unethical to sleep till noon, a concept I do not share. I did have some help with the sleep from the Dilaudid. Someone said that it is already February. Anyway, my wife was able to hear my stage whisper from the other room this morning (about noon).

This evening I notice actual “noise” emanating from my vocal cords. This is not always reproducible but still impressive and comparable to potty training and crawling in the progression of human dignity. I now walk around the house whispering, “testing, one, two three, one, two, three.” Through experimentation I have discovered I am limited to low tones. This is because the vocal chords do not have to vibrate as fast for the low tones. My vocabulary is, therefore, confined to low-pitched growls, which I use sparingly and only when a low-pitched growl provides appropriate punctuation to one of my whispered orations.

This afternoon I saw Dr. Stein (ear, nose, and throat specialist) who grabbed my tongue with 4X4 gauze and pulled it out and across my lapel. Using a dental mirror, he looked down my throat at ground zero and with his best bedside manor exclaimed, “Boy, that looks ugly!” He described it as one large canker sore covering the vocal cords, epiglottis and esophageal opening. I am sure there was other collateral damage, which he did not have time to describe due to time constraints of his busy office schedule.

My big goal in life at this time is to be able to say “Her mother and I” on March 11th for Laura’s wedding. I am afraid if the wedding has to be postponed, her boyfriend might get away.

And that is the news from Marquette where the PA’s are growling, and the snow is melting, and all of the medical updates are above average.

Medical Update # 6

This is most likely my final medical update. Unfortunately, all good things must come to an end including vacations. I find it amazing how much time off one can get with selective tanning of the neck and talking in a low husky voice. With a few supportive medical update letters people will believe anything. It reminds me of my favorite Bible verse, Hezekiah 2:24 “Blessed are the gullible for they shall be taken.” For my next vacation I plan to have a scar tattooed over my appendix.

I have just completed two days at work. My voice continues to be low and deep prompting my co-workers to anoint me with the moniker of “Froggy.” They say I have a sexy voice, leading me to believe women want to turn me into a prince by kissing me. So far I have been able to fend them off with a switch, but I don’t know how much longer I can hold out. I hate the way women treat me as a sex object. I suppose that it is one of life’s many burdens, and I must learn to grin and bare it.

My medical updates have been a major success. The circulation has increased considerably since the first issue. They have been posted on bulletin boards, reprinted in newsletters, and translated into at least one language (English). Two people have wished upon me a mild form of infirmity, which would do no harm but keep the updates coming. Maybe someday there will be a sequel, the marauding hemorrhoids or such. Monday when I returned to work I was severely chastised for leaving several co-workers out of the cyber loop for which I am truly sorry. I have been asked about reprints of back issues. These can be found at the following web site: Http://LarryBuege.com/Updates/MedicalUpdates.htm.

Cyber space is indeed a wonderful medium. My medical updates began as a short e-mail messages sent to a few close friends and relatives, something I would not have done if it required addresses and stamps. I soon began hearing from people from past employments and friendship circles. I have heard from people I have not heard or seen for over 15 years. People in the media are criticizing the Internet for making social hermits out of people who spend too much time on the Internet, but instead it is a vast new media for human contact and the only contact for some individuals who are otherwise homebound.

Many people have asked how I can remain upbeat with a good sense of humor during such difficult and trying times. It has indeed been painful and mentally taxing, but I have been provided with medicine for pain and a light at the end of the tunnel. Those of you from HNJ hospital may have read the quote of the month that I placed on last month’s schedule calendar. It was a quote from Shakespeare and states, “The miserable have no other medicine but only hope.” This proved to be my best medicine. The light at the end of my tunnel was bright and shiny carrying a 90% survival rate. It is the second most curable cancer after non-melanoma skin cancer. During my treatment I met many people with no light at the end of their tunnels. Many had chemotherapy and radiation and were in the terminal stages of painful cancer. It is hard to feel bad about not having shoes in the presence of those without feet.

Lastly I would like to thank all of those in cyber space and any other space for the prayers and support. You were the light at the end of my tunnel.

Larry

Medical Update # 7

As most of you know, a little over a year ago, I was diagnosed with cancer of the left vocal cord. This is extremely rare in non-smokers, but that just proves what an exceptional guy I am. They decided the best treatment would be radiation, which would cure it in 90% of the cases. But, being an exceptional person, I was in the other 10%, and on April 18 (my birthday) they confirmed by biopsy that the cancer was made out of stout material and had survived the radiation.

I was sent to University of Michigan where the doctors have lots of diplomas on their walls and new surgical procedures to try out. After considerable poking and probing as well as additional biopsies, they decided I had cancer on the left vocal cord, which I already knew. They concluded that more surgery would be needed.

After waiting several weeks, I finally got the surgery date, which will be June 5th. Apparently, they wanted to wait for a doctor who knew what he was doing. He was on vacation. The surgery as described to me will be 12 hours long. One doctor will be in charge of slitting my throat and yanking out the left vocal cord as well as any lymph nodes that might get in the way. He will also put in a temporary tracheostomy so I can drink water and breathe all at the same time. When that doctor gets done playing with me, another physician will take over (it's a relay team.). He will do superficial brain surgery and take fascia from the left side of my head. For you non-medical types, fascia is a thin fibrous sheet-like material that covers muscles and most of the organs. If all goes well, he will use this to reconstruct the vocal cord. This procedure is supposed to be curative and also get my voice back to about where it is now, which is deep and sexy.

I am currently pain free, but my voice wears out quickly, and I frequently get spasms of coughing. I will try to keep everyone updated although I will probably be totally exhaustive when I wake up after 12 hours of surgery. I lost my previous e-mail list, so if someone wants to be included in the medical updates and is not listed above, have them e-mail me. If someone is on the list and does not want to be -- Tough!

Larry

Medical Update # 8

Greetings from Michigan!

Today Dad had his 8-12 hour surgery to remove the portion of his vocal cord that had cancer growth on it. The surgery went smoothly, the doctors got off to a late start yet finished before they were scheduled to be done. We met with the doctors after the surgery and they spoke very positively about his recovery. Dad will be in Ann Arbor in the hospital for about a week while the doctors monitor the healing of the new-fashioned vocal cord.

Thanks to all of you for remembering Dad in your prayers! We will keep you posted on his progress.

Holly

Medical Update # 9

I am not sure if this should be #8 or #9 as I had my ghostwriter (Holly Buege Miller) send out an update. As you are aware, I did not receive a reprieve from the governor, and the surgery took place on Tuesday as scheduled. The length of the surgery varied depending on whom you talked to. The doctor said ten hours, but I thought it was closer to twelve hours. It wasn't as exciting as I had expected. I soon got bored and slept through the whole thing. The surgery went well; the margins of the left vocal cord (portion extracted during surgery) were free of cancer, a very good sign. The reconstruction was different than I had described previously. I had thought they would take a graft from my temple area, but instead they took a flap from behind my ear with the blood vessels still attached to my body. This flap was lowered to my neck where it was used to reconstruct the vocal cord. To keep the new vocal cord moist, mucous-producing cells from inside my mouth were used to cover the cord. The vocal cords are currently held apart by a stint, which plugs up the airway, requiring a temporary tracheostomy. I will also need nasal gastric tube feedings for the next three weeks (you can start feeling sorry for me anytime).

When I got up to my room, I had a total of eight tubes protruding from my body. Some were coming from strange parts of my anatomy, leading me to believe some nurse violated my body while I was under.

On the first post-op day two nurses said we were going for a walk. I carefully explained that I was a P.A. and therefore exempt from the ritual of walking the first day. They said that was interesting, but I was still going for a walk. I guess nurses are the same everywhere. Since one of the nurses was holding my urine catheter bag, I decided to follow her wherever she wanted to go.

Dr. Stein, my Marquette ENT doctor came to visit. I don't know what he charges for a 500-mile house call. While he was in the area, I think he was planning to attend his son's medical school graduation.

If all goes well, we should be heading north with suction devices and tube feeding equipment for the three weeks before the removal of the Trachea. I don't think I will be very socially active during those three weeks, but your e-mails and letters are welcome. I will keep you posted as changes occur.

Larry

Post script from the "ghostwriter": (ghostwriter is a liberal title!) The above letter was originally penned (literally) by Dad. I have typed it up, as he doesn't have a computer available to him. As we receive messages (via email or snail mail) we are printing them out and bringing them to the hospital - Dad appreciates hearing from you.

Dad is down to approximately 4 tubes. He is no longer using morphine, and his mobility is increasing rapidly each day. He is determined to get home on schedule! His rapid progress seems amazing, especially since we were told the previous radiation treatment would possibly slow the healing process. Must be a result of all of your prayers!

Thanks again!

Holly

Medical Update # 10

Today is June 9 the fourth day of my captivity, and the institution is taking on a routine. It starts at 6 am when a cadre of overly pleasant women arrives to poke and probe their constituents. They do allow 24 hr eating, but it comes in a can and the only hint of flavor is when the cold fluid flows through the tube in my nose and esophagus. As far as the tubes go, I'm at the half way mark of four. I started with eight.

Early in the morning Jane Fonda arrives impersonating a physical therapist and conducts calisthenics. I think she does better on TV, as she expects far too much class participation. Physical Therapy should be a spectator sport. Today we plan to walk up and down stairs. I suggested an elevator and possibly a tour of the cafeteria. My suggestions were not met with enthusiasm.

My only access to the outside world is a white board with an erasable marker. Some people say I talk too much and the marker will soon run out of ink. They do tend to exaggerate and I'm sure that my pen will continue to...

Medical Update #11

(The Great Escape)

On Wed., June 13th, I finally got my parole papers and was released to return home to Marquette. Since this was a 400-mile trip, fairly extensive preparations were needed comparable to planning a National Lampoon “Vacation.” I still have two of the eight tubes remaining, the tracheal and the nasal gastric tubes, which will remain for another 7-10 days. Several members of the nursing staff suggested that the “barbarian look” was out, and I ought to shave before leaving. I had thought of it as more of a Steve McQueen’s “Papillon look.” Shaving the upper lip was somewhat of a problem due to the nasal gastric tube, so I suggested shaving everything except under the nostrils. The nurses complained about that also stating it would give me the “Hitler look.” Nurses can be difficult at times; anyway I now have a start on a mustache.

The two main en route medical activities were to be periodically suctioning gunk out of my blow spout in my neck as well as five feedings of that wonderful Nutrin 1.5. No problem! The hospital provided us with a half case of the Nutrin the night before, and Nancy had tucked it away in the car for in-flight snacks. On the day of departure, we were provided a portable handy-dandy suction machine with all of the appropriate accessories. Since I have a hard time seeing my shoes, let alone my neck, Nancy purchased a hand-held mirror, so I could do my own suctioning. This was also packed in the car and ready to go. One of the nurses asked if I was to have oxygen on the way home. I told her yes the doctor wanted me on 20% oxygen en route. She wandered off looking for additional equipment and mumbling that no one ever told her anything.

Unfortunately, the night before we departed, some of the local inhabitants broke into our car stealing the half case of Nutrin, the new hand-held mirror, CD's, and a portable CD player. I have no idea what the black market price is for Nutrin, but I expect not too many pawnshops will fence such items. The ultimate insult was they also stole a rechargeable, pocket flashlight, which I kept plugged into the cigarette lighter. Apparently, they used the flashlight to search though my belongings. You would have thought they could have at least brought their own flashlight.

Such obstacles would not have discouraged “Papillon,” and we were not to let it dampen our spirits. At high noon we headed north. Our first problem came with my in-flight snack (Nutrin, of course). Normally, the Nutrin hangs from an I.V. pole and flows through the tube in my nose by gravity. We had no place to hang it above the level of my nose. A skylight would have been nice. It was too heavy to hang from the radio antenna, and the antenna bent over like a rabbit snare. It was also very difficult to change at 70 MPH on the highway. I decided to dispense with the in-flight hospitalities.

The next major problem was the frequent suctioning of the tracheal tube. This procedure consists of inserting a rubber hose down the tracheotomy tube and into the lung. The hose is about 20 inches long, but most of the time I try not to insert all of it. Once it is inserted to the proper depth, the suction is turned on producing all sorts of weird gurgling noises as it as is withdrawn. When this is done, the process is repeated until the patient turns blue. Since I did not have the mirror Nancy bought the night before, I had to resort to using the mirror built into the car visor to guide the tube into the hole in my neck. This was not adjustable and also made the image appear twice the distance as reality. Definitely a challenge, and even with some yoga maneuvers, it was almost impossible. I, therefore, had to resort to spousal assistance. This two-person technique is difficult on the highway, and we used the frequent highway rest stops along the way, making sure we parked in the far corners of the parking lot. Even so, the other visitors could still see the silhouettes of a man gasping for breath as a woman straddled him while trying to jamb something into his neck. No one ever came to my rescue, but you have to remember these were downstate rest stops, and it was most likely considered normal activity.

Eventually, we made it home where we were provided with five cases of Nutrin 1.5 (which we didn’t need). It was probably purchased on the black market. What we did need were small 5 cc plastic ampoules of normal saline that I use to flush the trachea tube. Nancy went to the Shopko pharmacy to purchase some but was informed by the pharmacist it was a prescription item. The pharmacist happened to be a personal friend from the National Guard who provided her with the sterile salt water anyway figuring as a physician assistant I could write my own prescription if push came to shove. I will try not to overdose on the salt water!

We are now home and doing fine except at a snail’s pace. I am still waiting to find out when the last two tubes will be pulled, hopefully, next week sometime.

Will keep you informed.

Larry

Medical Update # 12

I just received notice of my next appointment in Ann Arbor, which will be Wed. at 4:15. If all goes well, I expect to have the pressure cuff on my tracheotomy tube released and the tube capped. If there are no problems after 24 hours, they will probably remove it entirely. It will be nice to be able to breath normally again. Maybe they will remove the feeding tube. Anyone want to buy five cases of Nutrin 1.5? I plan to save some of the Nutrin to use as bait and see if I can catch that low down, sleazy, scum bag who stole my CD's!

Larry

Medical Update # 13

(Return To The Scene Of The Crime)

Wednesday, June 20, I headed back to Ann Arbor for a check up. It is a good seven to eight hour drive during which time I am supposed to have two feedings of that wonderful Nutrin 1.5. As I mentioned in one of my prior orations, this normally takes an hour since the Nutrin flows into my nasal tube by gravity as it hangs from a tall pole. This was not possible in a car without a skylight, but I found it works just as well using several injections from a 60 cc syringe. I can do it in five minutes. It amounts to gulping your food, but if you can't taste it, who cares? I also discovered I could produce an impressive belch if I pumped an extra 120 cc of air into the tube. It at least makes me feel like I had eaten something. We did get a few weird looks from passing motorists on the freeway who wondered about the cocaine-colored substance I was injecting into my nose, but we just smiled and waved back.

My appointment was for 4:15 PM, and the doctor arrived on time with a group of eager residents and med students. He placed a fiber optic periscope down my right nostril (the left nostril still has a tube in it.) and got real excited. Everything was functional. He passed the scope to his senior resident who also got ecstatic. They continued to pass the scope around until everyone had a chance to look down my nose including the janitor, and they all got excited. It would have been more reassuring if they had acted like they had seen the procedure work once before.

One resident thought the vocal cords looked entirely normal, or maybe that was the janitor. Anyway, the vocal cord is now entirely colonized with mucosal cells. If you remember, they took small plugs of mucosa from the inside of my right cheek to plant onto the cord. These have now spread to cover the entire area, so I now have a slimy, rebuilt vocal cord.

They replaced the plastic tracheostomy tube with a smaller, metal tube. The plastic tracheostomy had a balloon cuff, which prevented air from flowing past the tube and into the mouth. The inflated cuff was a constant irritation and caused frequent spasms of coughing. The new tube without the cuff was a welcome relief. I can now breath through my mouth. I had found the previous tube too small, and it felt like breathing through a straw. Anytime I walked a hundred feet, I would become short of breath. Now I can get plenty of air and can be more active.

With the new tube, I was also able to take the reconstructed vocal cord for a test spin and found it works quite well, but I need to work on the volume. This should get better with time as the swelling goes down. They don't want me to talk too much yet, so I will have to keep this letter short.

I still have the feeding tube, but they did give me some water to check out my swallowing. He told me to expect some of it to leak down the windpipe, as that is normal at this stage. He seemed a little disappointed when I drank the water without any difficulty. He is, therefore, allowing me to have some fluids and easy-to-swallow foods. He said since I was a PA, he would leave it up to my judgment. I have therefore started on soft, thicken foods and will gradually work up to more difficult foods. Tomorrow, popcorn and peanut brittle!

I think next week they will pull the feeding tube entirely.

Will keep you posted.

Larry

Medical Update # 14

(Blue Breakfast)

Wednesday I went back to Ann Arbor for one of my weekly visits. This time it was to see Teresa Lyden, a speech pathologist, who was to evaluate my ability to eat. I have been using a feeding tube in my nose for the last three weeks, and Teresa must have thought that I had forgotten how to eat. I assumed it was like riding a bicycle. Some things you never forget.

The evaluation started with blue water, which I was to drink. If blue water came out of the tracheostomy tube, I would receive a failing grade. I passed the test without problems. Next, we moved up to blue water with a thickening agent. The water was tasteless, and the thickening agent did nothing for the palatability. I again passed. When I was beginning to tire of the water, Teresa finally brought out something with calories: blue vanilla pudding. I asked if she had any colors other than blue, perhaps some Michigan State green. She replied at the U of M Hospital all they had was "Go Blue." It was still better than blue water, so I ate the pudding and no blue pudding came out of my tracheostomy tube. She told me most patients do not do that well at three weeks post-op. Teresa was unaware I have had years of eating experience. We moved up to blue fruit and finally dry cookies. I told her I might have trouble with lobster, and we should try that, but she appeared satisfied with the previous tests and would recommend removal of my nasal-gastric feeding tube.

Before she could remove the tube, Teresa had to confer with one of the residents. She left to make a phone call and returned saying the resident told her I had an awesome vocal cord. The resident must have been talking to the janitor (see Med Update #13). The resident invited Teresa to the next viewing of the vocal cord, which will be 3:30 on July 11th. It is hardly the place I would take a girl on a date, but people at U of M can be kind of weird. Teresa was all excited and placed it on her appointment schedule. Apparently, people are already lining up to see my artificial vocal cord. Actually, it is more like a rebuilt carburetor as they used all old parts.

It is nice having the tube removed, which allows me to eat real food again. I started with eight tubes and am now down to one: the tracheostomy tube. I really don't need that, as I have been taping across the opening so I can talk and still use both hands. My voice is weak, but I have been told it will improve with use. They don't want me to over-use it at this time. Hopefully, when everyone gets done looking down my nose at my vocal cords, they will remove the tracheostomy tube and let me start really using my voice. Then I can practice yodeling from the mountain tops to strengthen my voice. Will have to see how it goes.

Larry

Medical Update # 15

(True Confessions)

On Wed., July 11, I made another pilgrimage to the great Mecca in Ann Arbor. I was to be seen by both Dr. Teknos and Dr. Chepeha. Unfortunately, Dr. Teknos had a family emergency and was not able to attend the viewing. There were still plenty of people lined up to look down my nose, including the speech pathologist who came by special invitation. All in all, it was a good turn out. Everyone took their turns and asked me to say "E" so they could see the arytenoids move. All except for the speech pathologist who had me count to ten in addition to the "E." Everyone was again ecstatic.

As you remember from Update #13, I said it would be nice if they acted like they had seen the procedure work before. Dr. Chepeha finally "fessed up" and admitted they have never done the procedure at U of M. He had studied under a physician in Canada who was doing this kind of reconstructive surgery, and Dr. Chepeha was hoping to introduce the procedure to U of M. During the last six years he has never had a patient who had highly localized vocal cord cancer and met all the criteria for the procedure. He said I was a perfect candidate. Apparently, us perfect people are hard to come by. Anyway, I am happy with the procedure and the janitor is also pleased with the results. Dr. Chepeha thinks the Canadian physician and he are the only physicians doing this procedure. Most surgeons are performing partial laryngectomies without reconstruction of the cord. Speech is then obtained only when the opposite vocal cord compensates by extending past the midline. In my case, the reconstructed cord is able to move on its own. It remains to be seen how much better my voice will be.

After the formal viewing, a decision had to be made concerning my tracheostomy tube. Normally, the tube has to be capped for 48 hours to prove the patient can survive without it before it is removed. I, however, had capped it with a piece of tape a week earlier without problems. I have become used to the tube and considered leaving it as a body piecing. You never know, the fad might catch on. Dr. Chepeha informed me body piercing was not an option, as that would void the warranty on the original procedure. Sentiment was evenly split on whether or not tracheostomy tube should be removed immediately or after 48 hours, with the janitor holding the swing vote. Dr. Chepeha eventually swayed toward immediate removal and the others fell in line. (He is the boss!) The last tube was, therefore, removed. I am now as tubeless as a Firestone Radial and just as reliable.

With the removal of the tracheostomy tube, I am left with a hole in my neck. It will eventually close on its own; but in the meantime, I have what amounts to a second naval. I have been trying to decide what to do with it while I do have it. A jewel would be nice, but I would prefer a glass eye if I can find one.

I don't have to go back to Ann Arbor until Sept. 5th when I will again see both Dr. Chepeha and Dr. Teknos. The Janitor will not be able to make it, as he will be consulting on another case.

As you remember from Update #11 (the great escape), our vehicle was vandalized just before I was discharged from the hospital and our car phone, CD player, multiple CD's and a case of that delicious Nutrin 1.5 were stolen. Since there were no real clues to the crime, and I was more concerned about staying alive, we did not report it to the police and left for home. Last Monday, we got the phone bill with seven phone calls made by the thief. I had expected multiple 1-900 phone sex calls as well as a personal Tara reading. Instead the, not so smart, thief made multiple calls to his friends, and we now have a list of the numbers called.

With the new evidence, we decided reporting the robbery would be worthwhile. The State Police in Negaunee were not interested and told us to report it to the Ann Arbor Police. I was worried they might catch the culprit too soon before he had a chance to fence the case of Nutrin 1.5. I had visions of the case being returned and added to the five cases I still have.

I discovered there was nothing to worry about. We stopped at the Ann Arbor Police Dept. where a gentleman in a police uniform, but no badge, took our report. His shoulder patch said "Public Service Assistant." I had typed out a brief summary with dates, addresses, list of stolen property, and other needed facts. The person taking the report studied the summary from a distance of eight inches and handed it back to me. He then proceeded to ask for the information on the summary. He neatly wrote it down on a yellow legal pad and told us the report will make its way downstairs to the detective office in about a week and a half. We felt much more secure when we left the police station. I was glad to note he had been issued neither gun nor bullet.

I am now almost totally cured except for a very weak voice. I have been told I may now work on strengthening the voice. I plan to recite the Gettysburg Address daily into my computer where I will be able to monitor my progress. If nothing else, I could grow up to be the 16^th president of the United States.

Some of you may be getting the Medical Updates for the first time. This is at the request of one of your alleged friends. If you don't like it - Tuff!

May your ulcers rest in peace,

Larry

Medical Update # 16

Last Saturday I ran into Mike Johnson (HNJ Hosp. PA) who asked why there have not been any recent medical updates. I informed him I do not have any appointments until Sept. 5 and my medical status has remained unchanged. I still have a weak voice and post-surgical edema around the vocal cords. Otherwise I have been doing well. Mike said it would still be nice if I could provide another medical update.

I considered calling U of M for an earlier appointment, but that would require another trip to Ann Arbor. Besides, the Janitor was on sabbatical. I finally decided to see Dr. Stein, my ENT physician in Marquette. I was scheduled to see him anyway. I explained to Dr. Stein that I needed a medical problem about which I could exaggerate and incorporate into a medical update. He was not optimistic but would see what he could do. He grabbed my tongue with 4 X 4 gauze, pulled it down beside my navel and inspected my vocal cords with a dental mirror, which he extended halfway to my gizzard. After an in-depth exam he apologized stating he could find nothing medical-update worthy, but he would use the fiber-optic scope (AKA hose in the nose), which might show something.

After numbing my nose down to the tonsils, he extended the hose into my nose for a closer look. He informed me the best he could do was declare the possibility of an early polyp (non-cancerous) and perhaps some angioedema. He said if it got worse and impaired my breathing, he could put me on steroids and reinsert the trach tube. I immediately began breathing better.

I thanked him and said I love my friends, but not enough to reinsert the trach just to create a decent medical update. I guess they will have to settle for an indecent medical update

On the non-medical side of life, I have moved into my rejection phase of my book and have send four queries to book publishers. I expect to send out others, as I am a glutton for punishment. I don’t expect the first rejection for two to three weeks and already have a notebook in which to store them.

For those of you at HNJ Hosp., I hope to stop by next Tuesday afternoon to say hello and maybe attend the medical staff meeting. I am getting so bored even staff meetings sound exciting.

Stay tuned for any late breaking medical news.

Larry

The End Of The Journey

In December of 1999 I embarked on an ineluctable journey over uncharted waters. I had just been diagnosed with squamous cell carcinoma of the left vocal cord, an unlikely diagnoses for a non-smoker. As a physician assistant with over twenty years of experience, those should have been familiar waters. I should have been able to predict the journey’s dénouement. But cancer is unpredictable. It chooses its own course and its own schedule.

My first reaction was to scour the textbooks and itemize the possible outcomes. A painful, drawn-out death was an obvious possibility and the first one that came to mind. When I was a child growing up, my grandmother admonished me that I would catch my “death-of-pneumonia” if I went outdoors in the wintertime without my hat. She was born in 1885 and assumed death-of-pneumonia was one word. Born before penicillin, she had the expectation that all people with pneumonia died. In my twenty-eight years of medical experience, I have yet to have one of my patients die from pneumonia (knock on wood.)

When I was growing up (born in 1946), I assumed cancer, like my grandmother’s pneumonia, was a death sentence. Times change and medical knowledge expands, but the lingering childhood thought of death remains. I still considered a painful death a high probability.

I was faced with two options: cry or laugh. Since crying did not seem very satisfying, I began looking for humor in the treatment I was receiving. It was easy to find. I began sending humorous medical updates by e-mail to a few close friends. The electronic missives were immediate hits. More people asked to be added to the e-mail list. At the end of my treatment, I had over sixty individuals on my list. Today it would be called a Blog. After the worst was over, I was still receiving requests for reprints. For the sake of convenience, I added the messages to a web site and shoved it to the back of my mind. I assumed only people I personally referred to the site were reading it. In January of 2006, I added a counter to the web site as well as a logbook for comments. The web counter did not identify who was visiting, but did provide the city and state of the visitor as well as the search words that brought them to my site. To my surprise people from all over the world were reading my letters. In the first eight months of monitoring, I had visitors from twenty-one different countries. I was averaging more than one visit per day. Cancer is a universal concern that transcends all geographic boundaries.

The sheer number of visitors viewing my web site necessitates a concluding medical update to sum up the outcome of my journey. On June 7, 2006 I returned to the University of Michigan Hospital in Ann Arbor, Michigan for my final check up: no signs of cancer were found. My voice is deep and husky, but I can communicate with all except the hard of hearing. The tracheostomy and feeding tube are history. I have returned to work as a physician assistant at Helen Newberry Joy Hospital in Michigan’s Upper Peninsula (now part time in retirement mode.) My only handicap is the inability to sing in the shower, which some view as a blessing. At the end of my final check up I was given an “Alive After Five” survival button from the hospital physicians and staff.

One would think receiving this survival button would be a great honor. The truth is I am not the one who earned this honor. I was just the patient who went along for the ride. The true heroes were the countless friends and healthcare personnel who made my survival possible. It would be impossible to list all of those individuals, but I will try. Please forgive me for any overlooked individuals.

Dr. Craig Stein, retired Marquette otolaryngologist and personal friend. He diagnosed my cancer and provided the hometown follow up.

Dr. Randy Folker, Marquette otolaryngologist who replaced Dr Stein on his retirement and now provides my medical care.

Dr. Paul Thieme, Radiation Oncologist at Marquette General Hospital, who supervised my radiation treatment.

The Radiation Oncology staff at Marquette General who provided the actual radiation treatment. They were cheerful and upbeat in a very challenging and stressful medical environment.

Drs. Douglas Chepeha and Theodoros Teknos, University of Michigan otolaryngologists, who tag teamed my ten-hour surgery. They have that unique combination of preternatural knowledge in their medical field and the pleasant personalities that give the impression you are their only patient.

The nurses and staff of the University of Michigan’s fourth floor. They were the unsung heroes who provided the twenty-four hour hospital care for nine post-op tubes and appendages protruding from various parts of my anatomy.

Tammi Miller, RN, B.S.N., Clinical Care Coordinator: the office factotum who made things happen when they were scheduled to happen.

Teresa Lyden, M.A., CCC-SLP, Speech & Language Pathologist: Teresa was the only Michigan State graduate I met. She was an enchanted island in a sea of “Go Blue.” Not only did she evaluate my speech and ability to swallow, she removed that #%##@ feeding tube. Thank you Teresa.

I would be remiss if I didn’t mention the ubiquitous janitor who represented the clerks, typists, custodians, and all the non-medial personnel who make the big people look big.

My friends and co-workers at Helen Newberry Joy Hospital who provided encouragement by e-mail when I was unable to talk.

My son, (Scott Buege), my daughters (Holly Buege, Laura Buege, Carrie Buege) and their spouses who not only provided moral support, but also provided low-cost housing (free) for our many visits to Ann Arbor.

Lastly, I would like to thank Nancy Buege, my wife. She is normally squeamish about blood and medical procedures, but learned to suction my trachea, fill my feeding tube, and nag me when I needed nagging.

These are only a few of the people responsible for my five-year survival pin. I thank you all. To you I dedicate this pin.

Larry