Medical Updates by Number

                                                                           

         I believe God created heaven and earth; and when He created man, God provided man with emotions, allowing him to decide how to apply the emotions. When I was diagnosed with vocal cord cancer, I had to choose between crying or laughing. I chose the latter and all the difference that made. Below is a collection of medical updates 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 I would like to thank 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).

 

December 17, 1999

Dear friends and fellow hospital employees,

Thank you for your thoughts, prayers, and get-well cards. I 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 prolonged hoarseness. I assumed cancer was a strong possibility, but Dr. Stein assured me this was unlikely in a non-smoker.

With such assurances, I did not mention cancer to my wife, as she tends to worry. When Dr. Stein informed her of the diagnoses, it came as a shock. (She had read somewhere that people die from cancer.) Bummer!  Dr. Stein gently explained to her my cancer was in the early stages with a 90% chance of full recovery.

Twenty minutes later he informed me of the results, and the five-year survival rate had increased to 92%, a fact I found particularly reassuring. As I write this I expect my five-year survival rate should be approaching 112%!

The surgery was unremarkable, although I had to watch the nurses for any signs of a Foley catheter. (You can’t trust nurses!) Hopefully, the nurses did not violate me 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. That added a nice touch. The operating room was small but did have a crash cart with paddles etc. If they hadn't me strapped down, I could have checked the equipment more closely. I waited for the phone on the wall to ring with a reprieve from the Governor, but my parden never came. It must have gotten bored after that, as I fell asleep and didn’t wake up until the recovery room. Recovery was like waking up in bed. There was no nausea, slurred speech, or pain. And I could talk again! You can't appreciate speech until you lose it.

I will have radiation therapy five days a week for six weeks. I expect my vocal cords will become inflamed, making prolonged talking difficult. At least I won’t have to turn on the lights to read at night.

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

Larry

       

                      Medical Update #2                  

 

I am now down to eight 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 offer is a “well done” certificate after my tonsil are totally fried.

I have become 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 its descent. The Dilaudid comes in an aqueous base, making it smoother going down, but it leaves a nasty after-taste. The Dilaudid is more potent and tends to make one sleep all day. Both 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 daytime projects (sitting in the Jacuzzi and watching old movies, writing dumb medical updates, etc.) and can't afford to sleep all day.

My voice is now almost gone and my wife thinks she 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 without adult supervision, she will give me an extra dose of Dilaudid; I will still be sleeping when she returns. Occasionally she dresses me up and takes 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 surviving and life remains enjoyable. I appreciate the e-mails and get well cards. I’ll continue to keep everyone 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 my readers to quantify my pain on a scale of one to ten. 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 pain formula that better quantifies my pain level.

Larry

 

                      Medical Update #4                   

I completed my lasst radiation treatmeent tooday. It iss alsso the peeak of whaat I 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 iss hard getting any work done.

ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ

The mutations frrom the radiation treatmentz are progressing ratherr nicely. My wife hass begun to accept the warty skin growths but iss still leeery about the tentacles. I would send youz a picture, but I discovered I fog the filmm if I stand too closse to the camera.

ZZZZZZZZZ

I wass to have 30 treatments but they reducced it to 29. I assked why and the Radiation Oncologist showed mee computerized images of my throat with superimposed isobars outlining levels off radiation on which hee based his calculations. It may alsso have been shortened becausse the litttle red cylinder they implanted inn my neck poppped up.

ZZZZZZZZZZZZZZZZ

Afterr the end off the radiation treatment the dissscomfort and mutational growth wiill continue to increasse for five more dayss before subsiding. The disscomfort will decrease rather quickly, but it may take from two weeks to two months to get my voicce back. After careful and thoughtful deliberation, I have elected to go weeth the two-weeek option. Hopefully I can return to work in a couple of weeeks.

ZZZZZZZZZZZZ

Well that's the newz 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 on his assessment. It was only two days ago that I noticed any improvement. I am no longer using Dilaudid (hydromorphone) during the daytime, 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 considers sleeping until noon unethical, a concept I do not share. The Dilaudid does help in this regard. (Someone said it is already February.) Anyway, my wife heard 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 my throat as one large canker sore covering the vocal cords, epiglottis and esophageal opening. I am sure there is other collateral damage, which he did not have time to fully describe due to time constraints of his busy office schedule.

My big goal in life at this time is 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 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 sick-leave 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/Update.html.

Cyber space is indeed a wonderful medium. My medical updates began as a short e-mail messages sent to 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 excessive time on the Internet, but instead the Internet has evolved into a vast new media for human contact, sometimes the only contact for 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 vocal cord cancer. 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 numerous diplomas on their walls and exciting surgical procedures to try out. After considerable poking and probing as well as additional biopsies, they decided I had vocal cord cancer, which I already knew. They concluded more surgery would be needed.

After waiting several weeks, I was finally notified of the surgery date (June 5th). Apparently, they wanted to wait for a doctor who knew what he was doing. He is currently on vacation. The surgery will be 12 hours long. One doctor will slit my throat and yank out the offending 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 tag match.). He will do superficial brain surgery and remove 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 organs. If all goes well, he will use this to reconstruct the vocal cord. This procedure is supposed to be curative and also return my voice 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 exhausted 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.

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. It wasn't as exciting as I had expected, and I 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 head. This flap was lowered to my neck where they used it to reconstruct the vocal cord. To keep the new vocal cord moist, they covered the vocal cord with mucous-producing cells from inside my mouth. 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, allowing me to return to Marquette. Since this was a 400-mile trip, it required extensive preparations comparable to planning a National Lampoon “Vacation.” I still have two of my eight tubes remaining, (the tracheal and the nasal gastric tubes) which will remain for another 7-10 days. Several nursing staff members suggested the “barbarian look” was out, and I ought to shave before leaving. I had envisioned it as more of a Steve McQueen’s “Papillon look.” Shaving the upper lip was problematic due to the nasal gastric tube, so I suggested shaving everything except under the nostrils. The nurses also complained about that, 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 suctioning gunk out of my neck's blow spout and five daily 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 them tucked away in the car for in-flight snacks. On the day of departure, the hospital provided us with 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 suction my own trach. She packed this in the car and we were ready to go. One of the nurses asked if I needed oxygen on the way home. I told her 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 pawn shops will fence such items. The ultimate insult was they also stole a rechargeable pocket flashlight that I kept plugged into the cigarette lighter. Apparently, they used the flashlight to search though my belongings. You would have thought they could have brought their own flashlight.

Such obstacles would not have discouraged “Papillon,” and we did not allow this to 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. The Nutrin was too heavy to hang from the radio antenna. (The antenna bent over like a rabbit snare.)  Changing the Nutrin bag is also difficult at 70 MPH. I decided to dispense with the in-flight hospitalities.

Suctioning the tracheal tube was the next major problem. This procedure consists of inserting a rubber hose down the tracheotomy tube and into the lung. The hose is 20 inches long, but 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. The process is repeated until the patient turns blue. Since I no longer had the mirror my wife bought the previous night, I had to use the mirror on the car visor to guide the RotoRouter into the hole in my neck. The mirror was not adjustable and made the image appear twice as far away. Even with exotic yoga maneuvers, the procedure was nearly impossible. I, therefore, had to resort to spousal assistance. Since the two-person technique is a difficult manouver on the highway, we used highway rest stops along the way, making sure we parked in the far corner of the parking lot. Even so, 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 discovered five cases of Nutrin 1.5 (which we didn’t need) stacked against the door. They were probably purchased on the black market. What we did need were 5 cc plastic ampoules of normal saline that I use to flush the trachea tube. Nancy went to the Shopko pharmacy to purchase them.  The pharmacist informed her that normal saline was a prescription item. Since the pharmacist happened to be a personal friend of mine from the National Guard, he provided her with the sterile salt water anyway.  He figured 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, which feels good. I am still waiting to hear when the last two tubes will be removed, hopefully sometime next week.

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 significant. We did get a few weird looks from passing motorists on the freeway who appeared concerned 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 over 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, permitting 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 returned 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 eating ability. 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 that 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, but 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 pudding was "Go Blue." It was still better than blue water, so I ate the pudding and no blue pudding dripped from my tracheostomy tube. She told me most patients don't do that well at three weeks post-op. Teresa had forgotten 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 had informed 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 while using 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 is bored with 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 keeping it as a body piecing. You never know, the fad could 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 the 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 attend, 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 16th 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 I haven't had any recent medical updates. I informed him I don't 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

 

                         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 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 are 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 gives 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 my wife, Nancy. 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

 

    

 

   

 

 

 

 

                

                                        Author's Home Page