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.