I'm A Vegatarian (Almost) and Didn't Even Know It

Since the last dilation procedure I have been trying to find some additional food items that I could eat. Lets face it, there are only so many variations of omelettes until they start to get boring. One of my favorite ways to try out new things is to check out the Chinese buffet bars they have at grocery stores. Its a great way to try a small amount of something without having to commit to a full sized serving. (Yep... its that whole fear of commitment thing. Who knew that it applied to food as well.)

Last week I was checking out the buffet at the grocery store and they had Panang Tofu. For those of you that don't know Panang Ped from a local Thai restaurant is probably one of my favorite dishes. I figured that I would give it a try even though I am not a big fan of tofu. Sure enough I could eat it without too much of a problem. The only real issue was the carrots were cooked to be crunchy and that causes problems. The tofu on the other hand was no problem at all along with the steamed summer squash. (Some steamed vegetables are not a problem as long as they are soft).

Once again putting all those late nights watching the Food Porn, I mean Network, channel to good use I decided to give it a try at home. I tossed together a simple dish with Panang curry, coconut milk, steamed carrots and summer squash along with tofu and baby portabella mushrooms. At a bit of seasoning and poof, a almost normal dish that I could eat. Big time Yippee! on that one. Another thing I discovered is that the "heat" from this dish, it is a bit spicy, doesn't bother me as much as it would have a few months ago. I take that as a sign that my throat is starting to recover a bit more from the treatments.

One of the problems I have had with normal food is eating meat. In small amounts with lots of gravy I can eat dark chicken or turkey. I also tried some duck from the take out buffet as well. Some things like certain fish sticks or salmon if it is swimming is sauce are OK. Not having a protein has the main part of the dish has been a limiting factor. Now with the tofu option on the table so to speak some other possibilities are opening up. This will allow me to add a few more items to the list of things that I can eat at home while working on improving my swallowing technique and undergoing the dilation procedures.

Time to get back to the Food Network....

Dilation Procedure VII

Today was dilation procedure number VII. This procedure was able to maintain my esophagus opening at 15mm but wasn't able to increase it beyond 15mm. I had hoped that it would increase to at least 16.5 mm but this isn't the first time that I have gone in and just was able to maintain the existing size.

When I went in today the doctor did ask if I thought it had decreased in size. At the time I didn't think it had but when I got home and tried some food it appeared to be easier to eat some things than it was before today so my guess is that the esophagus did shrink back some. One thing I don't know if this is related to my throat still healing from the radiation treatments. A few weeks ago (I know... I am remiss in keeping the blog up to date.) I met with the radiation oncologist and he said that the throat and nasalpharengeal region was still red and swollen.

Unfortunately the next procedure won't be until after January 1st. I have established a moratorium around the holidays and they would like to have more time than two weeks between procedures.

On the eating front I am able to eat things like omelets, mashed potatoes and other mushy foods. The key is that the food needs to be able to be chewed up into separate pieces and not come together to form a plug when I swallow. One thing I plan to try is to make some braised dishes. I think these should be able to work. At this point I am not using the PEG tube for feedings daily. By making food myself and taking some time I am able to eat enough to get off of the tube feedings. The radiation oncologist wants me to keep the PEG tube in until at least 1-2 months after I am done with the dilation procedures. Big time bummer on that one. I understand the reasoning and agree with it but it still would have been nice to have it removed.

Right now my short term goals are to try to broaden the food choices that I can eat somewhat normally and cut down the prep / eating time. I probably spend 4-5 hours or more at times a day on overage with food prep and eating to get enough calories to maintain my weight at its current level. The goal is to add some weight but for now I am happy if I can maintain. Fortunately with the holidays upon us I do have one great option available to me... eggnog! At around 400 calories for only 8 ounces it is an effective means to up the calorie count. An added plus is that I really like eggnog. (Have I mentioned that when all is said and done I will be ready for the cardiologist?) Seriously another recent food item that I have found I can eat is risotto. I made it for the first time this weekend and it worked out well. As part of my never ending food experiments I plan to try different variations to see what I can add to risotto and still eat it.

Operation Garbage Plate Update

The front lines in operation Garbage Plate have made significant progress in the last week. Typically after a dilation procedure it takes about a week or so for things to settle down and then I can start to get a feel for where I am at regarding swallowing. It's amazing the difference that only an additional 1.5 MM in the size of my esophagus can make.

I have created three classifications for how I can eat foods. Those that I can eat somewhat normally, those that I can eat but with some problems and those that are still beyond reach. The list of foods that I can eat normally is still fairly short but growing. Most soups are now OK to eat. Some mushy foods like deviled eggs are also in that group though just eating the white part is still a problem. A surprise but welcome entry into the group are some cookies. The recipe for cookies on the back of the Heath Bar bits package, available in all fine and not so fine grocery stores, isn't much of a problem either. That is probably because over half of the cookies is sugar and the toffee candy bits. This is a great portable snack though really not a long term solution due to the potential dental problems. :-) Some other things in the somewhat normal category include deserts like cheesecake, apple pie if the skin is peeled off of the apples, some soft cheeses like brie, pate and some breakfast cereals like lucky charms.


In the I can eat it but with some problems category there are bean burritos, McDonald's grilled chicken snack wraps, rotisserie chicken with lots of gravy, meat loaf with lots of gravy, steamed chinese dumplings, some items from your typical chinese buffet and omelettes wit some fillings. (Thanks to Alton Brown my omelette technique has improved quite a bit!) These are items that if given enough time I can eat but not something I would want to do in public. If things get stuck going down there is only one other way for them to go. :-)

One thing I am learning is that there are multiple variables involved in what I can and can not eat. The esophagus opening is one item and that is slowly moving forward. The other issue is related to the change of geometry in my throat due to the treatments. It seems like anything with raisins in it is definitely out of the question. The problem is that the raisins, when chewed, seem to cling to the back of my throat. What is odd is that breakfast cereal with dried cranberries don't pose the same problem. The change in geometry and the dry mouth issues are something that at this point in time really can't be corrected. What I am doing instead is experimenting and essentially retraining myself to eat some foods differently. For example with burritos I know that they tend to form a plug in my mouth and can get stuck when swallowing. To accommodate that I am taking smaller bites but also swallowing it small amounts with sips of water. It took a few days worth of testing with some "interesting" results to get the technique right and I feel I will get to the point where I don't think about it anymore but do it instinctively. I liken this to the way a child learns to eat. They take a few years to move from liquids to mushy food to small solids. I am trying to compress this learning cycle into a few months if not less.

The next dilation procedure hasn't been scheduled yet. I think they want me to slow down a bit and see where I settle out at after each procedure. Most likely the next procedure will be after Thanksgiving. Around both Thanksgiving and Christmas I have decided to not have procedures just on the off chance something went wrong and I had to spend some time in the hospital.

Happy Anniversary!

No... its not my wedding anniversary, that was a few days ago. It's the anniversary of the start of my treatments to eradicate cancer. It was a year ago today that I started chemo and radiation treatments. I always felt it was appropriate to start radiation treatment on Halloween. If it was a grade B horror film there would have been lightning in the background and some sort of mutation would have occurred. Just think about what cool super powers I could have gotten.

Fortunately it was just another day, one of many during the treatment phase. The net result is that 6 months after treatment ended there is no detectable sign of cancer. A big time yippee! for that. While I will be tested every few months the next major milestone is at 2 years. recurrence for this type of cancer is fairly low though they can't give me specific numbers. The population pool especially in my demographic is just too small. However I have been told it is less than 10%. Good news!

Now all that is left is the recovery phase a.k.a. Operation Garbage Plate. Things are proceeding according to plan and next week I will update where I am at and what the current state of swallowing is. My approach to recovery was mentioned in an column about cancer in the local paper. Here is a link to the article.

Dilation Procedure Number VI

Today was dilation procedure number VI. The results were once again a success. This time we moved from 13.5 MM to 15 MM, a 23% increase in volume. This should start to open up some solid food opportunities. It takes a few days for the soreness to go down so I may wait until then to really try to push it. I was able to eat a can of clam chowder soup once I got home without a problem.

On other news I can just about eat macaroni salad without too much of a problem. That means one component of the garbage plate is almost in reach. Yippee!

Garbage Plates For Cancer

What does this have to do with my recovery? Not much, actually nothing but a friend sent me a link to an article about how one fraternity in Rochester runs (literally) a fund raiser for cancer research that also involves a garbage plate. Definitely worth reading and watching. Here is the link.

Deconstructing a Garbage Plate

No, this isn't some nouveau approach to cooking or an attempt to turn such a great culinary treat as the garbage plate into high cuisine. It's just my plan to take tackling the garbage plate in stages. The most recent dilation procedure has started to move me into the beginning of solid territory so along with the other food tests I thought I would start to tackle parts of the garbage plate. For those that have forgotten what a wonderful thing a garbage plate is here is a link to the video the food network ran. BTW I have been to Nick Tahoe's to have an authentic garbage plate.

So why deconstruct a garbage plate? One of the things that I have learned during my swallowing rehabilitation is that there is more involved than just opening my esophagus. In some respects I need to relearn how to eat again and my stomach needs to get used to eating again. It will take at least two more dilation procedures until I even get close but that doesn't mean I can't start training now so I am ready when my esophagus is. After all if you plan to climb to the peak of Mount Everest you don't just go and do it. You need to train, start at base camp and slowly progress up the mountain. Fortunately I won't need any Sherpas to scale the Garbage Plate. (Antacids yes, Sherpas no.)

The plan is to train to eat each component of a garbage plate separately. When I say eat I mean eat in a somewhat normal fashion. The target is the best garbage plate there is, the cheeseburger plate with macaroni salad and home fries. As things progress I will post updates. Who knows, maybe in just a few months I will be planting my flag on the top of the Cheeseburger Garbage Plate.

Dilation Update

Today was dilation procedure number 5 and once again there was some success though not quite as far as I would have liked. This time around we got to 13.5 MM. It is a half millimeter less that what I was hoping for but still provides a 26.6% increase in the volume of the opening. They tried 15 MM but that was a no go. One interesting thing I learned about the dilators they are using is that they have a build in safety system where if they feel a certain amount of pressure they stop inflating. That is a good thing as it helps prevent any serious injuries. The next procedure should be in 4 weeks.

One thing I am learning about swallowing is that if you haven't done it in awhile it takes some time to get back into the swing of things. Even just chewing food felt strange the first week or so I tried it because it had been over 10 months since I chewed anything. After this latest procedure I was able to go home and have an entire can of Progresso Clam Chowder soup (2 servings) along with some bread with butter. Probably 500 calories total. Then I was able to eat some home made banana bread also with butter for around another 100 calories. While I am still not mainstream when it comes to food it is nice to be able to get a decent amount of calories through eating.

Over the next few weeks I will start trying to eat some more small solid items. Even if they don't go down well right away I have found that by practicing now when my esophogus is opened up wide enough they go down easier.

CT Scan Update

It always seems odd to be rooting for negative results. The latest CT Scan came back negative and once again that is a good thing! I did wait until a bit after 12:00 today to call for the results and the radiation oncologist returned the call in about an hour. Everything looks good and this scan was probably the most comprehensive that I have had since my initial diagnosis. There is a certain amount of symmetry in getting the results this week. It was a year ago this week that I first was diagnosed with cancer.

Operation Garbage Plate Update

There has been some progress in the war on swallowing. A milestone has been reached this week. Last night I had to go to a meeting and afterwards one of the people suggested going out to a local place. Normally this is the tradition after these meetings. I figured I would give it a try and if I couldn't get anything on the menu then I would just get water. The place we went to served Guinness and since I was off of the Fentanyl patch... I figured what the heck. Of course being Guinness I had no problem drinking it. :-) Another plus was on the menu they had one item, an appetizer that I could almost eat normally. It was a baked brie and avocado on bread with sun dried tomatoes. I knew that the tomatoes was a definite problem so I asked if they could make it without them. It wasn't a problem and I was able, albeit slowly, able to eat most of it. So for the first time in about 11 and a half months I was able to go out to a place and get something to eat and drink. Admittedly it was only one item on the menu but it is a start.

What's On Tap For This Week

Last week was a busy week with the PEG tube replacement, the CT Scan (no results yet) and coming off of the pain meds. This week is a bit lighter with just another dilation procedure scheduled for Thursday. This will be the 5th procedure and hopefully will get me up to 14MM. That would start to put me in the solids territory. 18-20 MM is the final goal. Supposedly once I get to 18 the size of my esophagus will no longer be the limiting factor in eating. Ideally I would like to get to 20 just to have some extra space to spare. I will post another update later this week when I get my CT Scan results back and / or after the procedure.

CT Scan Today

It's hard to believe it but just about 6 months has passed since they pulled the PIC line out on my last chemo treatment. To celebrate its time for my 6 month CT Scan today. Yippee! Yes, I do know how to live it up don't I? Seriously 6 months is one of those milestones after treatment to see how you are, or more appropriately put, how the cancer is doing. Today's CT Scan will be the whole thing, head and neck, so it will take a bit of time. The only pain about this, aside from the IV, is that because I am allergic to the contrast dye they use for the scan I have to take some prep medicines 13, 7 and 1 hour before the procedure so it doesn't make for much sleep the night before. I probably won't know the results until sometime mid next week or so. My next appointment regarding the cancer is with the medical oncologist in 2 weeks though if I don't hear anything I will call before then for the results.

Speaking of medicines I dropped the last remaining one from treatments. I am now off of the last medicine from my treatments. I dropped the Fentanyl Patch this week. It takes a day or two to work its way out of my system and then up to a week of withdrawal side effects. This is one of those heavily controlled pain medications. I decided to drop it because I think most of the pain left in my throat is as a result of dry mouth. (Also the side effects from the patch were not all that fun.) Without the patch I can get a better feeling for how I am doing in managing my dry mouth condition. Now instead of doing the mouth rinses and such on a pre set schedule that doesn't take into account how my mouth and throat are doing I can more appropriately use them on a as needed basis. Fentanyl also helps contribute to dry mouth so hopefully this will allow me to produce more saliva.

Time To Replace Some Plumbing

My PEG tube has been getting loser and this weekend it seemed like it wanted to just pop out. While I can't wait for the day when I can get rid of the thing today is not that day. So on Monday I called the GI docs office to let them know what was happening. They said as long as it hasn't popped out of the hole yet then I should be OK and they scheduled me in to have it replaced today. One thing I like is these guys use terms even I can understand. Technically the hole is called the stoma but it took me a few months to figure that out. Fortunately they had my size of the button style PEG tube in stock at the hospital. When I first had it put in to replace the old one they had to order in a kit for my size.

Today I got to go in get it replaced. It turns out that the balloon on the inside that holds it in place ruptured. The way the PEG tube works is that there is a balloon on the inside that gets inflated with saline after it has been inserted and deflated when it needs to come out. This is how the PEG tube is held in place and tight to the stomach. Fortunately this time around the replacement was easy. I was in and out in an hour and a half and the first hour was spent in the waiting room. With the public WiFi and my iPod Touch I had no problem passing the time. The new PEG tube has a smaller stem and that is good. This makes it hold tighter to the stomach and keeps it more secure.

BTW the GI doctor probably described my approach to recovery the best. His said that I was aggressive in my pursuit to swallow again. That suits me fine.

Hot Diggity Dog

Once again living life on the edge I decided to try some more food experiments this weekend. We were at a tailgate party and I decided to try a half of a hot dog. Surprisingly I was able to eat it in very small bites. It took lots of sips of water but it did go down. Eating it wasn't exactly normal but I have approached eating and swallowing from a new angle. My view is that aside from the operational mechanics such as the size of the esophagus and saliva production there is also getting used to actually eating again. When I first started drinking liquids again it took quite a bit just to get a few ounces down. Even when my esophagus opened up it took some time to get used to drinking. Eating I feel is going to be the same way. So while eating a hot dog isn't an enjoyable experience now I am hopeful that in a few weeks after my next dilation procedure it will be better.

Music Therapy

Most of my blog entries the last few months have focused on Operation Garbage Plate. One thing that I have not mentioned is some of the other side effects. One that is related to the chemo is neuropathy. In my case this manifests itself in a loss of dexterity in my fingers. To help combat this I was trying to figure out what exercises I could do for my fingers when it hit me. Start playing the piano again. So starting this week I am adding in some time playing the piano each day to help increase the agility in my fingers. I am optimistic this will help.

My Schedule

As it stands now I am making definite forward progress in Operation Garbage Plate. My next dilation procedure is tentatively scheduled for October 9th and hopefully we will hit the 14MM mark this time around. To keep things moving forward I am trying to at least eat small amounts throughout the day that maximize the use of my esophagus to keep it from closing back up. This week I have a CT Scan on Friday that is my 6 month followup. It hasn't quite been six months since the end of treatment but its close enough. I was told it could take 7-8 months for most of the recovery process to happen and at the 1 year mark I would have a good idea of the ball park I would be in.

Forward Movement On The Front Lines

Yesterday was the fourth dilation procedure and the results were positive. In this case positive is a good thing. This time around they were able to go from 10MM to 12MM. That results in a 44% increase in volume that the esophagus can open. It is definitely a move in the right direction. One difference this time around is that I did make an effort to try to swallow larger amounts of liquids or solids (mushy stuff) to the point of being uncomfortable or some slight pain. The thought here was use it or lose it. My throat is still healing from the treatments and will be for a few more months. That means strictures are still going to form and that is what is narrowing the esophagus. Prior to the procedure yesterday I told the GI doctor this and he said there was some validity to that. Going forward my intent is to continue this practice until my throat is healed. One technique that I have developed is to take a large sip of water and then do a "hard swallow" where I try to force it down as fast as possible. I do feel some momentary pain doing this but I feel that demonstrates that it is pushing the esophagus to its current limit and breaking any strictures that may have recently formed.

I did find a study that looked at the sizes of the esophagus in relationship to swallowing disorders. Anything below 18 MM was considered a problem for swallowing solids with 13 MM considered the minimum for any solids. Below 13 MM liquids start to be a problem. I can attest to those numbers at this point. Being at 12 MM makes a huge difference swallowing liquids compared to 10 MM. When I got home yesterday I was very hungry. Because the procedure is done under general anesthesia I can't "eat" for over 8 hours before the procedure. That generally puts it in the middle of the night so for me its over 12 hours without any feedings. The first thing I had when I got home was some Progresso tomato soup and I had no problem eating it this time around. It was easy enough to eat that I had two servings and was able to get 360 calories from it. This soup is pureed and has no solids in it but I did have a slice of bread with butter. If I ate the bread in very small bites with the soup and it was almost a normal meal and close to 500 calories.

At this point Operation Garbage Plate has almost fully liberated, I mean reclaimed, eating liquids. My next procedure will be in a few weeks and hopefully this will start to reclaim some ground in solid territory.

I Need To Move To France

No.. its not to pursue some experimental procedure or get freedom fries from the source. My desire to move to France is a bit more decadent. It's for pate and brie. I made an interesting discovery in the war on swallowing this week. On the weekend Sue picked up some port wine cheese. Always looking for things to test out in the mushy diet category I decided to try some. Also wanting to continue my quest to live life on the edge I decided to try it with a bit of a cracker that was also out on the counter. I discovered two things. First that that particular brand of port wine cheese wasn't all that good. Second that cracker brand was made with swallowing disorders in mind. (OK, maybe they had other things on their mind but I can dream can't I?) This particular cracker brand tended to crumble into nothingness and unlike other bread type products didn't reassemble into a mushy plug in your mouth but stayed separate. That is a key feature when your esophagus is narrowed like mine. By staying in particle form I was able to actually eat the cracker with something on it.

So what does this have to do with France? Two days later I was at a local grocery store checking out the various food buffet bars. I was near the cheese counter and took a look over there and saw that they had pate but in larger portions than I was comfortable buying for an experiment. The person at the counter asked if they could help and I said sure. I explained my situation and she offered a taste of the pate to see if I could eat it. Sure enough the pate went down without a problem. I could actually eat it like I normally would have and I didn't even have my water bottle with me. Of course this makes sense seeing as pate is essentially pureed chicken or duck livers with added flavoring. (Yes I know, surprising that someone who has named their swallowing recovery "Operation Garbage Plate" would also like Pate.) The person at the store cut the portion they had in the case in half and off I went. At home the pate with the cracker was the perfect in between tube feedings snack. It has the added bonus of having lots of fat and calories as well. (Did I mention I need to eat between 2,500-3,000 calories just to maintain my weight?) It took less than 24 hours for the Pate to disappear.

Still, what does this have to do with France? Well in the interest of science, and my being able to taste something other than Ensure, I decided yesterday to give brie a chance. Now that I had a snack transportation vehicle that worked, the cracker, I decided to try a mushy cheese and what better one than brie. (Really, I do have diverse taste. Or put another way I will eat almost anything.) The brie also went down OK with the pate. Not quite as easy but still not a problem.

Once again... what does this have to do with France? The French Connection part comes back from my college days when I spent some time back packing around Europe. One of the things we would often do for an inexpensive lunch was get a loaf of bread (of the french variety of course) some pate and brie, find a park bench and that would be lunch. You could get that stuff at almost any market and they would have a wide variety of types at different prices. Here these items are treated more as high end gourmet foods and are priced appropriately. Also the selection, at least locally, for pate is very limited. While these foods are great for me to have at home they don't do much to increase my food mobility in this country. However if I lived in France....

Of course now I can find a use for the time spent watching the Food Porn, I mean Food Network, Channel. Today I am going to try to make my own Pate with a recipe from Emeril. At around $14 a pound for store bought vs. around 2$ in ingredients to make at home I figured it was worth a try. The brie on the other hand I am going to leave to the professionals, for now at least. :-)

So score another small victory for Operation Garbage Plate. (Hmmm... maybe a pate garbage plate would work.) Today brie and pate tomorrow Stilton Blue Cheese. Viva la France! :-)

Operation Garbage Plate: New Mission This Week

Another dilation mission, I mean procedure, is on for this week. This one will be two weeks and two days after the last one and hopefully my esophagus won't have closed up again. To help avoid giving back any ground that was gained I have developed a new strategy regarding eating. My first strategy was to try to get back to eating some of the foods that I normally would have eaten before starting treatments for cancer. I tried, without much success, things like bits of a cheeseburger, clam chowder soup and such. Foods that I though would be obvious success's but didn't work out so well.

The axiom that a battle plan is only good up until the time a battle is joined rings true in this case. As I have mentioned before there are several physical aspects to swallowing one of which is the ability of the esophagus to open up enough to swallow solids. This time around I decided that the primary goal in eating was just that, eating. Anything that I could get down even if it wasn't pleasant or something I would usually eat is what I planned on trying. That along with drinking large sips of water. While I have a nifty thermos bottle with a straw that I carry around with me at home the goal was large gulps of water from a glass. That is a much more efficient means of drinking large amounts of water. The goal with all of this was to keep using the esophagus, hopefully up to its current maximum size, so that it couldn't start to seal back up. On Thursday we will know if this works or not.

The idea for this approach came to me when I started the exercises to increase the opening of my mouth. The morning is the time when my mouth opens the least. I think this is because it has had all night to start to go back to where it was and give up some ground. To counteract this I have to do exercises multiple times a day. Then it came to me (Que revelation music now) that this may be what is happening to my throat. It is still healing from the treatments and if it isn't being used then it will close back up.

The primary foods that I am eating are deviled eggs with the egg whites, Jello Instant Pudding Cheesecake, waffles cut into minuscule pieces with lots of maple syrup, home made candied peanuts (I would have never bet that would work but it does, sort of.) and pureed soups. I picked up a small food processor with a big motor to puree soups like split pea. So far it is working out well. A larger food processor would not do as good of a job. Thanks to the Mega Industrial Food Appliance Complex (M.I.F.A.C. for short. :)) for providing an endless set of kitchen gadgets.

I plan to keep up the eating attempts to keep the esophagus open and hopefully this week we will find out that has worked. Hopefully we can keep to the same schedule and have the next two procedures also scheduled only 2 weeks apart. Then I could get in 2-3 more procedures before Thanksgiving.

All's Quite On The Western Front

Bonus points to anyone that understands that reference! It does describe how the last few weeks have been.

Everything is going well at this point. I am continuing to get my strength back and have continued but slowed down my food testing. I met with the medical Oncologist the week before labor day and one thing they were concerned about is that I lost some more weight. So as a result I am focusing more on doing PEG tube feedings now to help gain some weight. I am not overly thrilled by it because it is disruptive to have to keep using the PEG tube for feedings during the day. Still weight gain is important so I am focusing more energy on that for the moment.

On the food front I have made some interesting discoveries at two picnics we attended on Labor day. The first is that the filling for deviled eggs goes down pretty good. I made a basic filling at home and put it through the strainer. I worked without a problem. The egg white portion on the other hand was an issue. The other interesting discovery was that the instant Jello Cheese Cake is good to eat in small quantities. It also dissolves into nothing in your mouth. The down side to all of this is that so far getting protein and fiber has been elusive. There may be a solution on the way though. I have tried things like split pea soup but the problem was with the bits of skin in it. That would cause problems that really were not much fun. However a neighbor just made some lentil soup that I am trying out. She ran it through a food processor and then a strainer. It is pretty thick so there is some substance to it but more importantly it does seem to go down OK and has both protein and fiber in it. Big time plus there and it also tastes pretty good. Right now my throat is pretty sore from the dilation procedure I had done today but I plan on eating it in the next few days when my throat recovers. I could eat it now but it is hurts to swallow and I would rather wait and eat it when I can enjoy it.

That brings me to the next item. Today, or actually yesterday, I had dilation procedure number 3. Unfortunately we didn't make any forward progress. My esophogus had started to close up a bit and they were able to open it up back to 10 MM again. The plan is to go in in 4 weeks for another procedure. I am committed to keep doing this until I stabalize in the 16-18 MM range. With another 40-50 years left to go I figure it is worth the effort. After all there are so many foods still waiting out there for me to eat. It would be shame to disapoint them.

So that is where things are at. Lots of activity in terms of appointments and such but in the end my swallowing function is still where it was about a month ago. I am more aware of what works and doesn't work now but from a functinal point of view things haven't changed. All's Quite On The Western Front as the saying goes. :-)

Operation Garbage Plate: The Avocado Mission

Things have been moving slowly in the last week or so. I had a regular checkup with the medical oncologist and I dropped 5 pounds or so since the last visit. It was suggested, in a nice way, that I shouldn't measure success by getting off of the PEG tube as fast as possible. In other words focus on the weight. :-)

I had tried to get to the point where I would use the PEG tube for about half of my nutrition and would try other things. The problem there is that it is hard to get in the calories when it takes a half hour to eat a poached egg. So I am back to using the PEG tube as my primary source for calories and nutrition. I can drink things like Ensure and Carnation Instant Breakfast but they are not meant as a long term by themselves diet where the feeding supplies they give me are. Right now I use Ensure primarily as a portable nutrition when I may not be able to get back to do PEG tube feedings.

There has been some moderate success on identifying foods that I can eat. I may do a post at some time about what I have learned from my food experiments. One thing that was suggested to me was to try a mashed up avocado. In essence guacamole without the solids like tomatoes or onion. It turns out that the avocado actually went down pretty well. It wasn't fast and still took almost an hour but it is a pretty good source of calories and does have some nutritional value unlike the milkshakes I make on occasion. It isn't going to replace the PEG tube feedings but it is something else to eat on occasion.

I am in good company

I was recent sent a link to this article. It appears that Babe Ruth and I have something in common, the same type of cancer. Now if only we shared hand eye coordination. :-) The article is a good read and definitely shows how things we think are true in fact may not be.

Waking Up Miss Silvia

Another major milestone was reached today. I fired up my trusty espresso machine. For the past week or so I have tested the waters with some cappuccino's from my favorite coffee shop. Those have gone down without a problem so I purchased some fresh roasted espresso beans from the same coffee shop and today I brought Miss Silvia out of retirement.

For those of you that don't know I am a bit of a coffee addict. In particular espresso. I have a Rancillo Silvia, aka Miss Silvia, home espresso machine that can make with the proper grinder and fresh roasted beans shots of espresso just like you get at a coffee shop and in some cases (say... Starbucks) much better. (Yep... you can just feel the espresso snobbery. :-))

The picture above isn't my specific machine but the grinder shown and bean storage container are the same as I have and this is pretty much what my set up is like. Now I can combat fatigue the traditional way, with caffeine.

Another Milestone

I did also reach another milestone today. Today I started the drug to help with saliva production. Its a pill I have to take 3 times a day. The pills are pretty small, 0.3 inches in diameter, so I thought I would give swallowing them a try. The test was wildly successful and swallowing these pills with water was not a problem. This is great news because crushing up pills and putting them through the PEG tube gets real old fast. One of my hesitations on going on this medicine was having to take 3 additional pills through the PEG tube. Being able to just pop one in my mouth and take it with a glass of water is a huge step forward.

A Few Steps Forward and One Step Back

So far the results from the last dilation procedure have been good but not what I expected. As I mentioned the procedure went well and was better than last time. Drinking liquids is definitely easier. What it has done is highlighted other problems that are related to dry mouth.

The New Battle Begins

Up until now I had set aside the dry mouth problem. This was for a few reasons. First I didn't want to add in another set of drugs into the mix at the time I was still recovering from the cancer treatments. The second reason is that I am still only 4 and a half months away from the end of the last chemo treatment. I have been told that it is during the first 6 months most of the recovery occurs and after about a year I should have a good idea of where I will end up at. Finally I am on some drugs that cause dry mouth. So my view was that taking on dry mouth at this point may cause some additional problems and at the same time it would be chasing a moving target.

My first priority was the swallowing problem. (After all, there is only so much time left in the BBQ season!). That was a problem that wasn't due to the drugs I was on and seemed to show no improvement at all so that was the one I decided to go after first. Now with my esophagus opened up to 10 MM some other problems have become apparent and it appears that while pursuing the swallowing problem I will simultaneously pursue some other issues as well.

This approach actually appeals to me. One thing I don't like doing is just sitting around waiting and hoping things get better. I would rather have a plan and things to do.

Operation Garbage Plate

Next up is operation Garbage Plate. One of my food goals is to be able to eat a garbage plate. Other than the crusty bread served with a garbage plate everything else on it looks like something I should be able to eat. Two cheeseburgers (no buns), macaroni salad, home fries (real ones made on a grill not fried) covered with a chili type sauce and onions. I may have missed something but all of that is solid and can be cut into small pieces if required.

There are 3 fronts in Operation Garbage Plate. The first front I haven't really talked about in the past is how much my mouth can open. Right now it is very limited and I couldn't get a hot dog in there if I tried at this point. Well, maybe without the bun but that is it. There is a device that has been recommended to me called Therabyte that helps stretch your mouth a bit at a time. Basically you use it 7 times a day and after several weeks you start to stretch the muscles of your mouth to increase the opening. It can be a bit painful and requires doing multiple times a day but at least there aren't any drugs involved. This isn't required to eat food but will make it easier once I get to that point.

The second front is the one that I have been focusing on and that is my esophagus opening. So far that has been going well and most likely will take another 3-4 procedures to complete. My final goal is to get to somewhere over 15 MM and keep it there. Fortunately the doctor that is doing the procedures is taking a cautious approach to avoid any damage and has done quite a bit of research on the procedure. One of the nurses at the last procedure told me that they ordered in dilators just for this. Way to go GI doc!

The third front is dry mouth. I was aware this was going to be a problem but I wasn't aware of how much of a problem it would be. This is going to be the hardest one to solve. There are basically 2 parts of this problem that need to be addressed. First is the production of saliva. The second is the results of dry mouth on my mouth and the swallowing process. This is what I didn't realize, that dry mouth affects swallowing more than just a lack of liquid to chew food with. Dry mouth injures the oral cavity and that causes problems with swallowing. In my case the back of the tongue is sore when I try to swallow as a result of dry mouth and based on my meeting with the radiation doctor on Friday there is a large section of the back of my tongue that is coated with a thick cover of mucus. This appears to be where the current swallowing problem is coming from. Food particles are getting stuck at the back of the throat on what I have found out it the tongue. (BTW one thing I have found is that the tongue is a lot bigger than you realize. Its definitely several times larger than the part you use to eat an ice cream cone with or stick out at someone. :-)). This area is also near the part of the throat that covers your airway when swallowing. As you can imagine getting something stuck there has some interesting consequences. :-)

So the plan here is two fold. First tackle the cause of dry mouth and that is saliva production and second tackle the side effects in damage to the oral cavity from dry mouth. I had started somewhat on tackling the impact on my mouth. There are a series of products from a company called Biotene that are used to help treat dry mouth. These are essentially a special tooth paste, mouthwash and spray to help when your mouth is dry. I can say that they do have some positive impact. In addition the radiation doctor added a new drug into the mix that increases the production of saliva from the glands that are still intact. He also gave me a sample of a prescription mouthwash to use. This is supposed to help treat the effects of dry mouth. Last he took me off of the sea sickness patch. This patch was used to help control the mucus flow but it also increases dry mouth. He felt my body may have become dependant upon it to regulate the mucus flow. The downside is that the mucus flow is back but he feels that after a week or two it should subside. Fortunately at this time I am not dealing with all of the other issues that I was back when I was undergoing radiation and chemo therapy.

Hopefully the multi front approach of operation Garbage Plate will meet with success. The hardest part of all of this will be dealing with the mucus build up on my tongue that is causing food to get hung up on it. I had better get to work, there are Garbage Plates waiting to be eaten!

Quick Dilation Update

The dilation procedure went well today. They did not have to go in through the the stomach so no worries there. This time they were able to open my esophagus to 10 MM. That is approximately 0.40 inches. 10 MM is short of the final goal of 15 MM or more it is a definite improvement and going in the right direction. While 10 MM is only a 25% improvement in diameter is a 56% improvement in area. 8 MM was a circle with an area of approximately 50 MM. 10 MM is circle with an area of approximately 78 MM. On the other hand 15 MM is a circle with an area of approximately 176 MM.

For the first day they want me to consume liquids only. My throat is sore from the procedure but drinking is easier and feels more normal than it did before this dilation. That gives me hope that I may be able to start to some small solids in the next few days.

Whats On Tap This Week

Dilation #2 is scheduled for Tuesday this week. So far the first one seems to be keeping open. It may have shrunk a bit but I am still able to drink liquids better than I was before. We were on vacation last week and I was actually able to order a kids size soft serve ice cream in a cup and eat it. (A ice cream cone at this point would have been a definite problem.)

For this go around I am hoping that they are able to open it up enough so that I can start to try small solids. Things like soft fruits and such. One thing the first procedure did highlight is my dry mouth condition. Now that I am able to swallow liquids better what little saliva I have doesn't just hang around. I plan to start looking into some of the treatment options available in the next few weeks. I am generating some saliva but not enough to eat any type of dry food with. I tried a junior mint candy the other day and while I was able to swallow it in small amounts OK it was a challenge because there wasn't any saliva to help it go down. How important saliva is to eating and oral hygiene is one thing that this whole process has made me aware of.

One plus to being able to swallow liquids better is that I have given Ensure another try. The new improved flavors are definitely better than before. Still not what I would reach for as a preferred drink but they are now drinkable. What this means is that I can start to substitute those in for some of my regular feedings. This lets me have some portable nutrition and be away from my feeding supplies for longer periods. Last week we were on vacation up in the Thousand Islands area and it was a big help being able to drink Ensure while out and about.

I am hoping that after the next dilation procedure I will be able to start to get more of my nutrition from regular foods. I will probably post my next update at the end of this week after my throat has recovered from the procedure.

There Is Always Room For Jello

A quick update on the swallowing and eating saga. At this point I can drink liquids in a more normal manner than I was in the past. Also drinks like the yogurt smoothies you can by in the store with bits of fruit in them are also OK. I can feel the fruit going down but it isn't a problem.

Eating solids on the other hand is still not there at this time. After the dilation procedure I esophagus was widened to 8 mm. That is about the size of a cherry bit. However I think it has shrunk a bit based on how drinking liquids feel and 8 mm is the max opening. As I learned trying a very watery pork and beans eating anything that is near that size just doesn't work. Jello on the other hand seems to go down OK. Its slippery enough and when you chew it it breaks into small pieces and doesn't stick together. That helps it go down. Outside of that non liquids are not possible at this point.

The next dilation procedure is scheduled for the second week in August. Hopefully after that procedure I will be able to try to eat some solids. From what I understand 3-5 dilation procedures may be required to get my esophagus to be wide enough to eat "normal" foods and not have the opening close back down.

Swallowing Update

So far the results from the dilation procedure have been positive. I am not eating solid food yet but drinking is definitely easier and and I am able to eat things like soup with some small solids in them. Right now I am testing out different foods being careful that none of them have anything larger than 8 mm in them. I also did try a silver of a chocolate chip cookie yesterday. One thing I noticed is that it feels strange to chew anything. It makes sense seeing as the last time my mouth had to chew anything was around 8 and a half months ago. (Ahh... how the time flies when you are having fun. :-))

One thing that has become more apparent is dry mouth. Now that the esophagus is opened up a bit more the saliva I do generate goes down the esophagus when I swallow. Also my saliva production has been damaged by the radiation. At this point it is impossible to tell where I will end up. I am still in recovery mode and will be for several more months. I also am still wearing the scopolomine ear patch and the pain patch. Both of these contribute to dry mouth. For the moment it is only a problem when I talk for more than a few minutes, eating of course and sleeping at night. I have started to carry a water bottle with me during the day to help with dry mouth when talking. That seems to work. Also at night there are some products I can use that will help with dry mouth at night. As for eating I am going to have to learn how to eat using sips of water between bites.

I did meet with the GI doctor yesterday and the next procedure is scheduled for the second week in August. Unfortunately between his schedule, my schedule and being on blood thinners there wasn't any other earlier time that would work. I could have had it done this Thursday but I need to be off of the blood thinners for at least 5 days prior to the procedure. Unfortunately that means Thursday was out. Big time bummer.

All in things are moving forward. I think after the next procedure I will start to get a bit more adventuresome in the food that I try and see if I can eat some "normal" food.

Plumbing Update

I had the esophageal dilation procedure done on Tuesday and for the most part it went well. There were some minor problems but as I have said in the past I am working on making sure I experience all the possibilities. :-)

The first issue that came up was how much I could open my mouth. Because radiation makes the tissues in the area affected more fragile they were going to put in a airway tube to protect my breathing. Unfortunately due to lack of use and strictures from the radiation my mouth doesn't open up as much as they would have liked. This meant that they had to use a different type of sedation in order to put in the tube. No big deal but one more thing that would take some extra time.

The larger problem was with finding an opening to thread the balloon through. In order to do the dilation they need to fin some opening that they can thread the deflated balloon through and then inflate it. If they couldn't find one going in from the mouth then they would have to go in from the stomach. Of course I already have a ready made opening in my stomach where the PEG tube is.

So around 8:00 AM they put we under for what is normally a 30 minute procedure and I woke up in the recovery room around 11:00 AM. Why the extra time? Part was from putting in the airway tube but unfortunately they couldn't find an opening going in from the mouth so they had to go through the stomach. To do that they had to remove the PEG tube and then dilate the hole that went in so the scope and dilator could fit. Basically they had to widen the stoma (aka the hole in my stomach) to fit the tools through. Then they were able to find a opening from below and successfully dilated the esophagus to 8 millimeters. Not as much as I hoped for but enough to make some difference in swallowing liquids.

The major side effects from the procedure were being out of it for the rest of the day due to the anesthesia, soreness in the stoma (aka the hole in my stomach. :-)), (they did put the PEG tube back in) , and a very sore throat from the procedure. Fortunately the soreness in the stoma area and the throat have subsided by today.

The first day due to the sore throat and being out of it I didn't do much testing of swallowing. I did drink some water right when I got home and it was easier to swallow. When the meds they gave me during the procedure wore off and the sore throat really kicked in I stopped testing.

The next day we went to the Roswell Park Cancer Institute for a follow up appointment now that I have completed the treatment plan. One of the goals was to get more information on esophageal dilation in cancer cases like mine. Based on what the doctor said the goal for normal swallowing function is to get the esophagus to open up to at least 15 millimeters. It will take a few procedures to get there and it may take a few o keep it there. Sometimes the esophagus will start to close back up. Aside from opening up the esophagus to swallow there is a certain amount of coordination between muscles in the throat in order to swallow. Fortunately it appears as if that part is working OK. I meet next week with the GI doc for a check up on this procedure and the plan is to schedule the next one in 3 weeks.

The initial results have been positive. I can swallow liquids in a "normal" manner. I am also starting to test liquids with some solids in them. Egg drop soup seems to be going down fine. prior to the procedure the egg strands would give me problems. The only major issue so far is I need to water down any liquids that are acidic. They tend to burn the throat. I did try some tomato bisque that I couldn't swallow at all prior to the procedure. I can swallow it now but it is too acidic to eat at this point. Later this weekend I plan to try cream soups like shrimp or crab bisque. As much as I would like to hurry the process along I need to be careful and take it slow at first. Hopefully when I have the next procedure in August I will be able to move on towards solid foods. Then I start to attack the recovery food list.

Other News From Our Visit To Roswell

A few other questions I had for the doctors up at Roswell were regarding other side effects, follow up testing, recurrence and milestones. Starting with milestones the major ones are 6 months, 2 years and 5 years. They took a look at the latest test results and also used the scope to look in the nasal area (Really, I think all doctors in this area of medicine just look for reasons to use that thing. :-)) Based on the results and what they saw they also felt I responded well to the treatment plan. Regarding dry mouth there are some drugs that are available but they are only about 30% effective. For now the dry mouth is a problem but not so much that I want to start taking drugs for it. First I want to solve the swallowing and other throat problems. Even just being able to drink more water is helping with the dry mouth. The other question I had was about fatigue. He did order up some additional blood tests to check my thyroid function. One of the comments that he did make was that basically I won't know where I will end up at until about a year after the end of treatment. That basically means I should continue to improve for awhile yet.

A Twisted View Of Food Labels

One thing I don't think I have mentioned is I have been searching for higher calorie foods in liquid form. I have found some like Carnations Instant Breakfast that you add to milk and smoothies in a bottle. The other day I found in the dairy section a Chocolate Milk Shake in a bottle. It was over 400 calories! Yep, now I get excited by things with high calorie counts. At the current point in time I need to consume somewhere around 3,000 calories to maintain my weight.

Time for the Roto Router Man

Last week I met with the medical oncologist and the GI doctor on Monday and Tuesday. The meeting with the oncologist was fine. We discussed the side effects I am still feeling and I told him about the esophageal dilation procedure. He agreed that it was a good idea and said that they have referred people to the GI doc for that procedure. One potential hang up is the blood thinners that I am on. He said I can go off of those for the week before the procedure. (Yippee!!! Warfarin is definitely not a fun drug.) For now the only drugs I am on regularly is the ear patch and pain patch.

The next day I met with the GI doc to talk to him about the dilation procedure. He reviewed the written report from the swallowing eval and also agreed that this was the direction to go in. Normally they dilate the lower esophagus but he has worked in the upper esophagus area as well. Because it is near my wind pipe and I had radiation treatment to the area they are going to proceed slowly and just try to open the esophagus up a little bit at a time. This means I will most likely have to undergo several procedures. I am OK with that if it works. There is also the potential for the throat to close back up after a period of time and the procedure would need to be repeated. I view it as cleaning out the plumbing. From what I have read in some cases the procedure takes and there isn't much if any follow up treatments required. In other cases it appears that the procedure needs to be repeated every few months to keep things open.

Basically the procedure involves the doctor, with the aid of scope, threading a wire down my throat to find a passageway that is open. Then they slowly inflate a balloon to open up the area that does not open when swallowing. In my case this is most likely due to strictures that formed as a result of the radiation treatment. The radiation treatments will make the esophagus more "fragile" so they will proceed carefully to avoid tearing or puncturing the esophagus. They may also put in an air tube to protect my breathing. Fortunately I will be under sedation during the treatment. For those that are interested here is a link to a video on YouTube that shows the procedure.

All in the procedure takes less than a half hour. I go in early in the morning on Tuesday and should be back home by mid morning. From what I have read they will be able to tell almost immediately if it worked or not. It it does work then I should be able to start to swallow normally and eat some foods like soups that have bits of food in them. Right now I can only consume things that are liquid or readily melt into liquid form.

Also later in the week I head up to the Roswell Park Cancer Institute to have them review my current status and also talk to them about the side effects that are persisting. I did discuss the dilation procedure with the lead doctor on my case and while he couldn't comment on my specific situation he did say that dilation is often done in cases like mine. He also mentioned that he has worked with my ENT Doctor on cases and would trust his opinion.

I will try to post an update on Tuesday about how the procedure went.

Mortimer not Mic-Key

The PEG tube replacement went off without a hitch except that they didn't order the Mic-Key replacement but what I would call a Mic-Key knock off. While the nurse was setting me up for the replacement procedure she gave me the manual to the PEG tube replacement. I then became aware that it wasn't a Mic-Key tube but one that looked like it. Normally I wouldn't be concerned about something like that, most of the drugs I take are generics but in this case the Mic-Key tube made specific statements about being able to swim with it while this other one mentioned nothing about swimming.


We had time before the doctor arrived so the nurse researched the replacement tube and called the company that makes it to ask about swimming with it in. She also called the manufacture of the Mic-Key tube. Interesting enough neither company would give the green light for swimming. My guess is that they don't want to commit even though the Mic-Key tube uses swimming as part of its marketing on the web site. They have a story of a girl with a Mic-Key tube that swims and goes to water parks.


From looking at the tube they wanted to use on me and the Mic-Key I couldn't really tell any difference. I spoke to the doctor when he arrived and he couldn't see any reason I couldn't go swimming with the tube they were going to put in so we went ahead with the new tube. So far everything with the new tube is working out fine.

Swallowing Update

The day before the PEG tube replacement I met with the ENT doctor to review my status. At the meeting I asked him to take a look at the swallowing evaluation and get his take on the dilation procedure. He looked at the swallowing evaluation and called the next morning to let me know that he felt esophageal dilation would be appropriate for the procedure.

This week the Roswell Park cancer center called to reschedule my follow up appointment. Initially they wanted to move it to August. I was not overly amused by the delay and was able to get them to reschedule it for the middle of July. At the same time I was able to get a moment to talk to the doctor on the phone about the dilation procedure. He said that it is done in head neck and throat cancer patients and that he has worked with my ENT doctor on several cancer cases a year and would defer to his opinion on the procedure.

Then just a day later I was at the ball park with my youngest son and ran into a person that I I knew from my sons team in prior years. He didn't know that I was being treated for cancer and I mentioned the dilation procedure he knew what I was talking about. Apparently he had it done on him self for a narrowing of the esophagus from a different cause. He used the same GI practice that I do and said they do hundreds of these a year. Good news! (See, all of the good info can be found just hanging out at the ball fields or in the Winter at the skating rinks. :-)). This is good news as I am scheduled to meet with the GI docs next week to discuss the procedure and have them follow up on the PEG tube replacement.

Speaking of next week I have a follow up appointment with the medical oncologist to check on my status and I also have the appointment with the GI doctor to discuss the dilation procedure. Hopefully they will be able to do the procedure locally and I can have it done in July. Initially I had wanted to have it done at Roswell Park but given the delay in scheduling and that the local doctors have done several of the balloon dilations I am starting to feel more comfortable about having the procedure done locally. Also I will most likely require several procedures to fully widen the esophagus and some patients require follow up procedures as maintenance. With radiation patients they tend to be more careful and only try to enlarge the opening a bit at at time.

Sing it with me... M I C...K E Y...

No, I haven't joined the new Mickey Mouse Club, yet that is. The Mic-Key is a type of PEG tube that is waterproof. Tomorrow I get my PEG tube replaced with a Mic-Key tube and this one will let me do things like go swimming and kayaking, if I am up to it, on the lake. The current tube can not be submerged at all. I am looking forward to this. Last week when it hit 90 we opened up the pool and while everyone else was able to go in all I could do was sit on the ladder and put my feet in. Now I should be able to go swimming with the family. Yippee!

Swallowing Update

On the swallowing front I met today with the ENT doctor that did the initial diagnosis. He scoped me to check on how things were and also to take a look at the swallowing issue. He is also going to take a look at the tests the physical therapist did. So far he seemed to think that dilatation would be the direction to go. Tomorrow when I have the Mic-Key tube installed I am going to ask the GI doctor about his findings on dilatation as well.

I most likely won't have anything done until after I meet with the doctors up at the Roswell Park Cancer Institute in July. They see more of this type of cancer and I am curious as to what their thoughts are on the dilatation procedure.

One thing the ENT doctor did tell me is that many times the procedure needs to be repeated. In some cases the patients are able to do it themselves. Basically you have to stick something down your throat like a sword swallower. Either way anything that can improve the swallowing function would work for me.

A Little Bit Of A Normal Life

One of the biggest downsides to cancer treatment is that it has prevented me from doing things with the family outside of the house. I essentially missed all of the boys hockey season this year and baseball season so far. (The baseball games are in the evening for the most part and right around 6 o'clock is when I start to head south.)

Well last weekend I was able to take the boys out fishing on Sunday morning for about 1 and a half hours. We went to a place that is only 10 minutes from the house and had a great time. My 11 year old son caught two fish including his first bullhead. He handed both by himself and was suitable proud. My younger son didn't catch anything but did learn how to cast is his first spinning rod. All in it was a short but good time and almost felt like a normal existence again. Admittedly I went home and crashed afterwards but it was still a good time. Everything was catch and release.

My Role In a Sci Fi Show

So last week was a bit interesting. First I had my regularly scheduled check up with the medical oncologist office and the usual blood test. Nothing really noteworthy came out of that appointment. I met with the nurse practitioner and basically they just reviewed my vitals, what drugs I am on and how I am doing. It lasted all of 20 minutes and ended up with a scheduling another appointment for next month.

Last weeks big fun was the speech therapist meeting for a swallowing evaluation. This was pretty high tech, at least for me. They sit you in a chair that has a specialized x-ray machine. Essentially what it does is show a live x-ray video. It was setup to show my head and throat. It looked like one of those sci fi movies or TV Show where you see a live animated x-ray of a person as they look for some sort of embedded chip. (Hmmm.. I wonder what that thing was that said Big Brother Inc. on it?) The big plus is that the monitor was situated so that I could see it and watch it live as it happened. Definitely a way cool experience.

So with this nifty hi tech tool they had me swallow different puddings of various thickness along with a small, and I mean small, nibble of a turkey sandwich all of which were laced with barium so they would show up on the x-ray. In essence what the test showed was that there is a part of my esophagus that isn't opening when it should. The test wasn't designed to see why it wouldn't open but just what the was stopping things from going down. From the test it appeared that liquids could make it through the part of the esophagus that wasn't opening but not solids. They did give me two exercise to do a few times a day. One was an exercise down with a dry swallow that is designed raise a part of the larynx that helps keep liquids from your airway. The other exercise was more of a swallowing technique designed to keep liquids away from the airway. That has been a problem where sometimes a bit of what I swallow goes down the wrong way and causes a coughing fit. So far it appears that this swallowing technique has reduced the number of times that happens.

Another thing that came out of the eval was my question about how they open up the esophagus when it won't happen. This is typically handled by the GI doctors and it is caused Esophageal Dilation. There are several forms that this occurs in but in essence they thread a tube down your throat and then inflate a balloon to open up that area. The idea is that there are strictures that are preventing that part of the esophagus from opening. I did some research and this can be a side effect from getting radiation treatment of your throat. On my way out I stopped by the radiation suite and asked the nurse there about it. They have had one patient that had this procedure done. The first time it lasted 6-7 months. They had to do it a second time and there was some bleeding so they stopped. She did say that the person who had the procedure done was much older than I am and I may not experience the same thing.

This bit of research comes at a good time. The ENT doctors office called at the end of the week to schedule a follow up appointment for the 19th of June. I am also going to meet with the GI doctor in the next week or two and plan to ask them about the procedure as well. Lastly I head up to Roswell for an eval in the week after the 4th of July. That will let me get a few different opinions on the procedure and then discuss it at Roswell. I have done some research and what I have found out so far is that the procedure is generally considered safe. The success rate depends upon the skill of the person performing the procedure. This is a case where I will ask each group I talk to how many of these procedures they have done and what the success / failure rate has been.

Outside of that nothing is on tap for this week. This weekend I have been having some stomach issues. I don't know if its from another bug I picked up or from trying to many different types of drinks to swallow. So far I have determined that ice water is not a good idea at this time no matter how good it feels going down. My stomach just isn't used to something that cold. Also the sports drink and grape juice seem to be a bit too acidic. For now I have throttled back my attempts to mix it up and have been just keeping to water at room temperature. (OK, I did have about 4-6 ounces of a chocolate milkshake left over from one I made for one of the kids. That did go down OK.) :-)

CT Scan is Negative... and That Is Good!

I met with the radiation oncologist today to go over the CT Scan from last week and it came back negative. In this case negative is good. The lymph node the were tracking shrunk some more and there doesn't appear to be any signs of the cancer remaining. Of course the definitive test is a PET scan and I will probably have one of those some time this summer but at this point everything is looking good.

Of course it wouldn't be a visit to the radiation oncologist office without pulling out the scope and checking things out through my nose. This time it went easier than the last time. The CT Scan was for the neck area. With the scope the doctor checked out the nasalpharynex area where the main tumor was. As with the CT Scan there is no sign of the tumor. Yippee!!

Next he checked out the throat area. It is still red and swollen. The esophagus has narrowed. Some of that could be due to the lack of use and some from the treatment. We discussed my attempts at swallowing and what steps to take next.

Right now the swallowing has gotten a bit easier but is still far from easy. Basically it is still liquids or things that turn into liquids only. Any solids won't go down no matter how small and cause problems. I found that out today when I tried some shrimp bisque that had microscopic pieces of shrimp in it. It was a problem until I ran it through a strainer. Then there wasn't any problems. Another oddity is that food with fat in it goes down much easier than water. I had read this was the case and the doctor confirmed it. Another strange thing is that I decided to live life on the edge and try a bit of root beer today (what can I say, it was calling to me at the grocery store.) and that wasn't a problem. It may be the carbonation. Keep in mind all of this is done via small sips and a total of 2 ounces at a time.

After a week of my home brew swallowing therapy I can say that things have improved in areas that I hadn't thought about. For the past 6-7 months there hasn't been any liquid going down my throat and now I realize that helped contribute the the thick mucus that was plaguing my throat and nasal passages. (I have also learned through all of this how much your nose, mouth, throat are all connected.) Just by consuming the liquids that I have in the last few weeks everything has loosened up quite a bit. This has reduced the congestion and discomfort in my throat and made things like sleeping easier. It took a few days to have a noticeable impact but it has helped.

Next week I meet with the speech therapist and I hope to get some guidance on how to improve swallowing. I realize that I am not going to just jump in and start eating fried chicken (though some Seneca Farms fried chicken sounds really good right about now) but I do think there should be some sort of progression to slowly introduce semi solid foods. One thing the radiation oncologist suggested is to try egg custard. I may modify that and make some flan tomorrow. Home made flan tends to be a bit loose and could go down well but also have some characteristics of a solid. It also tastes pretty good and who knows, after that I could try creme brulee. Hey if this works out I could get used to this type of swallowing therapy. It wouldn't be too bad if I had to eat flan and creme brulee on a regular basis as part of my recovery. :-)

What's Up Next With The Recovery Plan

I am being patient with the recovery but do want to get started on a defined plan with goals to work towards. Just hanging out waiting for things to recover isn't really my style and I don't think its the best course of action. The doctor today did give me several exercises to start on that are designed to stretch the neck muscles and help me open my jaw wider. He even game me a stack of tongue depressors to use as a tool to help. I am hoping that the speech therapist will be able to provide an action plan to help move forward with the swallowing.

The doctor also gave me some samples to try to help with dry mouth. At this point I have some dry mouth. It manifests itself when I am talking and trying to eat. I seem to generate enough saliva to avoid dry mouth during normal activities and at night it isn't that bad. I do carry a spray bottle with me to spritz my mouth when talking for any length of time. Over time this should improve a bit but I have accepted that I will most likely have some permanent dry mouth. All that means is that I most likely won't be munching on saltines by themselves but that's OK because I was never much of a totally dry snack person. (I will miss some things like popcorn but I can live with that.)

One last thing the doctor today did was give me a prescription for the thrush infection. I am currently using miracle mouthwash but he feels based on what he saw with the scope that the miracle mouthwash may not be reaching far enough back in my throat to deal with the infection. This is a drug I have had before and it seems to work well. Getting rid of the thrush infection should also help as well.

On the physical therapy side I am continuing to use the Wii Fit and that is working out very well. My goal at this point is to focus primarily on the legs and balance exercises with a mix of the balance games and some basic yoga. In another week or so I will start to add in some of the strength exercises for the legs and the arm exercises. After a week of using the Wii Fit I have noticed a significant improvement in my legs. The Wii Fit isn't a silver bullet for solving everyone's exercise problems but in my case it provides a great way to slowly start to ease into exercising again at a pace I am comfortable with. I also think that even after I get by my cancer recovery phase it will still be an integral part of my exercise training. In another post later on I will provide a more detailed review of how it worked out for my recovery. At this point I would recommend it to any cancer patient that is looking for a way to get back into exercising.

Whats Up This Week

On Wednesday I get the results of the last MRI Scan. As always I am a bit apprehensive but don't think there should be any bad news. I think they are going to use the scope again to check things out and I want to ask them about what is blocking my throat.

On the swallowing front I can swallow ice cream and soups a teaspoon at at time. I have also tried this ice cream called Dibbs that is essentially small bite sized chunks of ice cream covered in chocolate. These I eat in very small quantities. Its better than ice cream because it forces me to chew it a bit but still melts completely. This is getting my jaw muscles working. The first time it was hard to even open my mouth. Keep in mind that it has been 6 months since I had to chew anything. One interesting thing I have noticed is that swallowing thicker soups like cream of mushroom is easier than thinner liquids like water. I still can't consume anything solid but just being able to get down a few spoonfuls of soup at a time is progress. The way I am approaching this is the same way I am approaching my physical rehabilitation. Take it slow one step at a time. With swallowing the goal is to just use those muscles in some manner a few times a day. It isn't a lot of fun at this point but I think it is a necessary step to go through.

On the physical side I don't think I have talked about this much but part of the result of 6 months of inactivity and the weight loss is that my muscles, in particular my leg muscles, have really diminished. With my legs it was at the point where just standing up from a kneeling position was difficult as was climbing stairs. This week I started doing some training with a Wii Fit. I have only been using it for a few days but I can say this is just what I needed to get started. The balance exercises actually do work your leg muscles and in my case it allows me to do a little or as much as I can handle at the time.

One of the things that kept me from starting other exercises for my legs is that most of them involve some sort of motions like knee bends and such that I just couldn't do. With the Wii Fit and the balance exercises and games there are activities that I can do that benefit the leg muscles without worrying about starting something like knee bends that I can't finish. I have already noticed some positive results just after a few days of using it. Right now I am doing 20 - 25 minutes a day. At first I just did the games to get my legs used to do any type of activity. The games may seem simple but after 20 minutes you do start to break a sweat. In the last two days I added in some of the most basic yoga poses. One, the warrior I could do OK. Another, the tree I think its called, would have been a good candidate for America's Funniest Home Videos. You have to stand on one leg and needless to say I wasn't able to hold that pose in any type of balance position at all. One of the nice things about the way Wii Fit works is that you can choose the activities you do. So for most of the workout I can keep focused on the simple exercises that I can do but I am able to add in one or two that require more effort every now and then to see how I do.

After this week I have a few more appointments. I meet with the medical oncologist office for a status check and then with the speech therapist for an evaluation later in the week. The radiation oncologist office was able to get that appointment moved up a week. I will post more information on how those appointments went next week.

Update To The Recovery Food List

As part of my taking charge of my recovery I decided to start with some basic clear broth soup to see how that would work. In the last week I determined I can swallow about 2 teaspoons at a time. I figured that out because that is the amount I need to take of the Miracle Mouthwash for the Thrush infection.

I had been trying to sip some flavored water but the combination of sucking on the straw and swallowing seemed to be a bit difficult. So I thought what if I used a spoon. And of course what do you eat with a spoon, soup. That led me to today. I ordered up a clear broth soup with mushrooms from a local sushi place that I like and decided to try to see if I could eat a spoonful or two. In the end I put 4 ounces in a separate bowl and eating it one teaspoon full at a time I was able to consume all 4 ounces. Yippee! 4 ounces isn't a lot but it is a start. Also I am taking this slowly. My stomach has known nothing but the feeding formula for the last 6 months or so and even if everything else was working properly, and it is not, my stomach would still need to adjust. However having said that I didn't have much of a problem consuming the soup a spoon full at a time. The plan for the short term is going to be to try to eat 4 ounces of clear or broth based soup a day for the next few days and see how that goes.

As I try new soups out I will add them to the recovery food list. Any items highlighted in yellow are items that I have tried. Hopefully the list will start to grow over the next few weeks.

Update on what is coming up next...

The CT Scan went well today. In the past when I had these at the hospital they were done by the people in the radiation department so I stopped in there first. It was great to talk to the people there again. I hadn't seen them in awhile after seeing them for 7 weeks straight. So we chatted for a bit and I mentioned that we should be the CT scan started. That's when I found out that because it was a diagnostic scan and not one for treatment I was supposed to be over in the main hospital. Oops. Oh well, fortunately that was only a two minute walk away and the nurse escorted me over.

One result of talking to the radiation folk is that I asked when they called to confirm the CT scan about physical therapy. They setup of an appointment to be evaluated in June by the speech therapist. Unfortunately its not until June 10th though they are going to see if they can get it moved up a bit. I am looking forward to getting the opinion from the physical therapist. My view is that there are three types of things I can do to affect my swallowing. I could do things that help the situation, have not impact or make it worse. Obviously I don't want to do the latter so working with the speech therapist should help let me know what I should or should not be doing. Also I should be able to get some reasonable expectations. At this point I am just looking to be able to consume liquids. I could get by quite well on soups and smoothies/ milk shakes. No problem there. I am also convinced that there are probably things I could be doing to help the situation along. Its been over 5 months since I last really used my throat for eating and that length of inactivity is bound to require some work to help restore swallowing. Just waiting and seeing doesn't seem like an option to me at this point.

So next week on Wednesday I get the results of the CT Scan. I am a bit apprehensive as I am before all of these tests. I have no reason to think that anything will show up on there but it still causes some apprehension. The week after that I go into to meet with the medical oncologist for a regular checkup. Then the week after that is the eval for physical therapy. (Hopefully that can be moved up a bit.)

On the swallowing front I did make some progress in the last week before the 24 hour hurricanes hit. I seem to be able to swallow, with difficulty, 2 teaspoons at a time. That is good because that is what the miracle mouthwash amount is. I stopped taking that during the whole 24 hour episode and the few days recovering from that. Now I need to start that up again. I also tried out some sugar free candy. That was interesting because it did demonstrate that I could take something that was a solid and chew it up enough in a small enough quantity and swallow it with water. It was a sugar free Stoffers coconut candy covered with chocolate. I literally nibbled at it. I also tried a small, and I mean small, strip of ham and was able to get that down in nibble size bites with water. The plus side of all this is that I could taste the ham fine and the candy fine. It wasn't satisfying at all because I had to work at chewing the food up and drink water to barely choke it down but still it was progress. That along with the vanilla ice cream I tried last week leads me to believe that my taste buds seem to have come through OK. That is good news. I have notice that my jaw range of motion is reduced. This is a potential side effect though I have read that though physical therapy the range can be improved somewhat. That will make chewing a bit easier.

That just leaves the swallowing problem as the main limitation. Hopefully there will be some physical therapy options that will help improve the situation at least to the point where liquids will go down fine.

Weekend Update - A 2 Hurricane Affair

Something new developed this weekend. Apparently I picked up a 24 hour stomach bug that decided to test my ability to vomit on the hour every hour. :-) Starting Friday night until Saturday was an interesting experience to say the least. Fortunately my oncologist was the on call doctor for the weekend. At first I thought maybe it was something to do with my swallowing attempts that was causing the problem. So I kept trying to keep the feedings going, big mistake there! I talked to the doctor on Saturday and he had me stop the feedings for several hours and then only start back with a limited amount. Sure enough by Saturday night the stomach pains had subsided and on Sunday morning I was able to keep the feedings down.

While not a fun time at all I was glad to know that my swallowing exercises did not cause the problem. Today I am still recovering from the 24 hours of fun but I have introduced something else into the swallowing exercises. I took a little bit of some strawberry kiwi sports drink that we had and used that to help with the swallowing. I only take in 1-2 teaspoons at a time but having a bit of flavor does help make the effort worth while. I am also going to start to try to use ice chips as well. Just to keep something cold and wet in my mouth to help with the swallowing.

I also tried out one of the sugar free candies today. This did point out that I most likely will end up with some permanent dry mouth as a result of the treatments. I was able to suck on the candy as recommended but it didn't help out much with saliva production. I had to add in some water now and then to make it work.

Whats Up Next Week...

Next week I have another MRI to check on how things are going. This one is just of the neck area. I won't get the results until the following week. (Bummers on that one. They really need to work on developing instant MRI results.)

Changing Tactics

This last week I took a change in tactics that I think is helping make some forward progress. Things seemed to have stagnated and I wasn't scheduled for another appointment with the doctors until June. I called Roswell to schedule a follow up appointment with them. The only options I had when I called was for an appointment in July. :-( I went ahead and made that appointment but I also talked to the doctors nurse about the swallowing problem. One thing she mentioned was to keep trying to swallow something and that in some cases they end up prescribing physical therapy. After I got off the phone a light bulb went off in my head. Physical therapy seemed to make quite a bit of sense. If you break a leg and are in a cast for 8 weeks or so you need physical therapy for the muscles that haven't been used for 8 weeks. When the cast comes off you don't just start running around. I remember how it was with our youngest son when he broke his femur and was in two casts for a total of around 12 weeks. It took several weeks of physical therapy for him to start walking without a walker. At first it was painful and slow but he wasn't going to get any better without going through those phases.

So this week I decided to apply the same concept to swallowing keeping mind that my throat is still healing so I couldn't expect too much or for this to go too quickly. At the same time I think I developed a Thrush infection again. This is an infection in the back of the throat and mouth. The standard treatment is something called Miracle Mouthwash that is a blend of drugs unique to each practice. (Yep, old time medicine at its best.) The last time I had this was near the beginning in November and at the time I wasn't able to use the Miracle Mouthwash because I couldn't swallow it.

I called the medical oncologist office and told them that I thought I had a Thrush infection again and asked if they would call in a prescription for Miracle Mouthwash and they did. So this week I tried three different strategies. First was to use the small spray bottle they gave me at Roswell to spray a small amount of water in my mouth and try to swallow it. At first it was hard. Rather than just try two or three times and then quit when it felt like I was going to throw up I kept at it for a few more attempts. Sometimes it worked, sometimes it didn't. I figured that was just the price I would have to pay. I started the spray bottle prior to getting the Miracle Mouthwash.

The second strategy was to not keep spitting out the mucus / saliva that would accumulate in my mouth but instead try to swallow it. I did this on an intermittent basis along with the spray bottle and had about the same results. Still at least two or three times a day I worked on this strategy. I actually got a little carried away on the first day and took a teaspoon and got a partial spoonful of vanilla ice cream. I was able to slowly lick off the equivalent of about 1 teaspoon of vanilla ice cream. Yippee!!!! Of course I then paid for that later and I learned to keep my intake to fluids.

The first day I just did this a few times during the day. The more I used the spray bottle the easier it got though indigestion started to become a problem. There was another beneficial side effect to this. By running more water down my throat it seemed to loosen up the mucus. The mucus I cough up after working with the spray bottle is much looser and not composed as much of solid chunks. This has me wondering if trying to drink more water will help with the mucus issue at the back of the throat.

The third tactic was using the Miracle Mouthwash. I could have asked for a drug that also works on Thrush infections. This is what I had to do back in November. Instead I thought I would try to see if I could swallow the Miracle Mouthwash (MM). With MM I need to consume 2 teaspoons by swishing it in my mouth and then swallowing it. Up to now I have not been able to swallow any type of meaningful volume so I was a bit apprehensive on trying this. Fortunately it appears that by starting out with the spray bottle a few days prior to trying MM I had paved the way for swallowing the 2 teaspoons. Keep in mind it doesn't go down easy at all but it does go down and stay down. This is definite progress.

What Next?

So where to go next. First I have started to use the spray bottle more during the day. I also try to swallow the mucus / saliva combination in my mouth rather that spit it out. The goal is to keep working those muscles that swallow food. I also want to try to swallow something other than the Miracle Mouthwash in 2 teaspoon increments. I picked up one of those fortified water drinks that are out there in a melon flavor to try. The flavor was important not for the taste but for the acidity. Drinks like Gatorade or Grape Juice are too acidic for my throat at this point. If I am able to swallow this in two teaspoon increments then next week I will up it to three with the goal of working my way up to 6 teaspoons (1 ounce). At that point I would consider liquids a success.

The other tactic is to start sucking on sugar free hard candy to help promote the production of saliva.

I have done some research on physical therapy for swallowing and wasn't able to find much our there for my level. It all seemed to be aimed at patients that have it far worse than I do. Those recovering from surgery where physical parts of the throat or tongue have been affected. One thing I did gather from what I have read is that repetition is key so I need to do this each and every day to achieve results.

I also need to keep my expectations in check. This is a program that I have come up with and may not produce much in results at all or it may really help move things along. Hopefully by the end of next week we will see some additional progress. Still I feel it is better than just sitting around waiting for things to improve.

On Again Off Again

Just a quick update. My blood work on Friday came back and the levels for Warfarin were high again so they took me off it for a day and reduced the dose a bit. Apparently it is a trial and error process in getting the right amount dialed in. The downside is that this drug does cause other problems when the level gets too high. Hopefully this time the dose will be at the right level. I get tested on it again at the end of this week.

Not much to update at this point

I hadn't planned on taking this long to post an update but I was hoping that my next update would be that I was swallowing again. At this point that hasn't happened but I do feel that my throat is making progress. The mucus problem is still there but it is different now than it was two weeks ago. Two weeks ago I was coughing up a larger volume of mucus and it was denser. Now the volume is less and it isn't as thick. Still all I can do at this point is choke down a very small sip of water. Somewhere along the lines of a teaspoon sized sip. If I try to take anywhere near a normal sip of water it comes back up faster than it went down. Fortunately I am aware of this potential and have things setup to handle it. :-)

The other two major side effects that I am experiencing are tiredness and a lack of some strength particularly in my legs. The tiredness is from a lack of energy. I have found out that while I can spend a day doing somewhat normal activities the next day I am going to end up sleeping most of the day wiped out from the previous days activities. I am not talking about doing anything strenuous just not spending the entire day lying around. From what I have read and what the doctors have told me the energy level is going to take some time to come back. Part of it is due to being inactive for the last 7 months and part of it, perhaps the majority, is from damage due to the treatments. This also applies to the reduction of strength. In the last 7 months I have lost around 50 pounds. A lot of that was muscle mass from lack of use. To help combat this I have started doing some light exercises each day. This is one area where I am trying to be careful about not over doing it. I have to admit that I have a tendency to want to rush my recovery but there is only so far that this can be pushed.

One of the first things that go through your mind when you complete treatments is that once the chemicals are out of your system your body will go back to normal quickly. Unfortunately that is not the way cancer treatments work. The damage they do to your body can take a long time to heal. There are things that you can do to help the process along but at the same time I need to be realistic about what my capabilities are.

There are two barometers that I use to gauge my progress. The first is the status of my throat. At this point it is still very sore and I can tell when it approaches the time to change the pain medicine patch. Along those lines are the mucus issue. I am told that part of the mucus issue is related to the throat. The mucus is designed to help protect the parts of the throat that are still healing. Once again I can tell when the ear patch that I wear is getting close to needing to be changed as the mucus flow increases greatly. The second indication that I use is my facial hair. At this point it is growing a bit faster than it was before but I can still go weeks without having to shave. This is also an area where there has been some change so I do know that progress is being made just slowly.

Other than that there isn't much more to report. I did have one interesting thing happen regarding the blood clot medicine. Apparently they were supposed to be monitoring with blood test weekly but somewhere that didn't get scheduled or communicated. When I went in for a checkup two weeks ago at the end of the appointment the doctor noticed that a particular test for monitoring the blood clot medicine hadn't been run in awhile so he had me give another sample after the appointment. I have to admit that I wasn't overly thrilled as I had already given a sample right before the appointment. It was at the end of the day and I had been kept waiting for an hour for the appointment and just wanted to get home at that point. They initially asked me to drop the new sample off at the hospital for testing. Apparently the courier had already left of the day. I said I wasn't comfortable with that and they ended up handling it. I also was starting to tire out from the day. So I got poked again (did I mention that one thing out of all this is that I have been cured of my needle phobia?) and gave another sample and then went home. Based on the results I am glad I did agree to the test even though at the time I wasn't too thrilled about it.

I ended up crashing early that evening but the doctor called around 8:00 and told Sue that I should stop taking the blood clot medicine and wanted to know if I had already taken it for that day. I was asleep and Sue didn't want to wake me so she put a large note on my computer monitor telling me to stop taking the medicine. That is where I normally stage my drugs to get ready to take them so I did see the note when I woke up and fortunately I hadn't already taken the medicine. Apparently there was some test that showed the level of the drug was too high in my blood or something along those lines. They wanted me to stop taking the medicine until that level came down. We figured it was serious when the oncologist calls you at home at 8:00 at night and kept asking Sue if I had already taken that days dose.

One thing to note about this drug is that the instructions are very specific in how you take it. You need to take it the same time each day and if you miss a dose you are not to double up on the dose. If you do accidentally take a double dose then they have you call your doctor immediately. That gave us some indication that they were serious about my not taking anymore of the medicine until they could test my blood again. I also looked at the side effects from taking too much of the drug, Wayfarin, and some of those side effects were the same ones that I was experiencing at that time during week three of the chemo treatment. Once I stopped taking the drug I did start to feel better.

The next week they tested me again and the levels were down so they started me on the drug again only this time they are monitoring me weekly. I went into the doctors office for another test that same week and things came back normal. At this point they have set up a standing order for tests at the convenient care facility 5 minutes from home. All I have to do is just show up and say I am there to be tested and the lab will draw the blood and perform the test. I don't have to schedule an appointment in advance I just show up. This makes it very convenient for myself. Generally the convenient care facility is pretty quick with running blood tests and I am in and out of there in about 10 minutes. They also have public WiFi access so I can bring my iPod Touch with me and surf the Internet or check out YouTube while waiting.

That's all there is to report at this point in time. The plan is to update once a week as things progress unless there is a break through in eating then that will get reported right away.