Once again, I’m too tired to write much. Just the facts. No humor content. Sorry.

The first appointment today was with Dr. Ang, radiation oncologist, who examined Paul’s mouth, reviewed his previous radiation history, and then told us he thinks that, in Paul’s case, surgery is most likely to be curative. The radiation/chemotherapy combo that Dr. Weber mentioned yesterday could be used in the area of the tumor itself, as Paul hasn’t been zapped there, but they couldn’t give what they would consider to be a curative dose of radiation to the lymph nodes in the neck. Why, we ask, is this important if there’s no lymph node involvement visible on the CT scan? Because, we learn, tumor cells are found in the lymph nodes of about 30% of patients whose nodes look normal on scans. (Ulp!) Therefore, when the treatment approach is non-surgical, they have to assume that there is in fact microscopic lymph node involvement, and zap the neck nodes. Oh, and chemotherapy on its own isn’t curative for this tumor, so any tumor cells that they might miss if by holding back on the radation would be free to go forth and multiply… not good. If Paul has surgery, and there is some lymph node involvement, the radiation dosage that they would give as “clean-up” would be less than the “main course” dosage, and he would be better able to tolerate that.

The second appointment was with Dr. Martin, oncology dentist, whose job it is to assess the teeth of potential radiation patients, and to extract them if they’re not healthy. That’s because, following radiation to the jaw and the subsequent reduction in blood flow to the area, it’s common that the wound caused by any tooth extraction will not heal. (Yikes!) So, if you have that radiation, you become a “frequent flyer” at your dentist’s office, have to apply flouride to your teeth daily, and pray that you never break a tooth. Fortunately, Paul’s teeth are all in good shape. The dentist cleared him for whatever the radiologists might want to do to him.

It appears that, after a brief lag, surgery has pulled ahead again in the race for the cure. We know more about the race today than we did yesterday; that is good. I expect that we’ll know even more tomorrow…

… oh, and today the train to Bangalore was on time.