Day 46 – Dr. Mammar

Another long and very difficult night. The pain and the coughing fits started even before going to bed this time and it was difficult to get the evening medicine down.

I got up a little later than usual and feeling a little weaker than usual. It took me all morning to get ready as has become habit.

I went and got my treatment and waited to see a doctor. I was very pleased to be ushered in to see Dr. Mammar. He remembered me well and was amazed at how long it’s been since we had a consultation together. He was very pleased with how I look (throat and neck) and feels I am tolerating the treatment very well. I told him I would hate to see the neck and throat of someone who’s tolerating it worse. He said I was definitely doing better than most. We spoke of my difficulties and looked for possible solutions together. There’s not much to be done about my biggest problem: the coughing fits. He checked me out with a stethoscope and looked up my nose with a special light. I don’t have a cold. The coughs come from the balls of saliva. There’s nothing they can do to break those up or stop them from forming. All I can do is keep trying the “magic mouthwash” he gives me to protect the throat. He gave me a prescription for some syrup to coat the throat to help protect it from the acid formed when the saliva goes up and down and when I wretch. They don’t have a solution for the spots (pimples) on my tongue either. He says those are a reaction from the chemotherapy and not the x-ray therapy. They are caused by a chemical reaction in my saliva which mixes with my tongue and is quite acidic. This is caused by the antibodies in my body fighting off the chemo chemicals while still eliminating them from my body. The spots will go away naturally and eventually as the chemo chemicals are fully eliminated. I told them that they make it difficult for me to eat as they make most food sting and burn in my mouth. He recommended I try the liquid protein drinks I had been prescribed earlier. As it turns out I had drunk one for the first time today, as I was having difficulty getting anything else down, and it actually was not that bad. He told me to try and have at least one if not two per day. I then asked him if there was anything that could be done about the pain in general. He said they couldn’t do anything in addition. I asked him in addition to what? He was absolutely flabbergasted by the fact that I was not taking morphine. He prescribes a morphine patch, systematically, at the beginning of treatment to all patients who have the levels of radiation therapy I have and especially all those who have radiation therapy and chemotherapy together. The patch is worn on the shoulder and it slowly distributes small doses of morphine in to the body over a 3-day period. The patch is replaced every 3 days by the patient. He had assumed I had the patch the first time we met and hadn’t even asked or proposed anything since. He was quite impressed I had gone this far without regular pain killers. He explained, however, how it is too late to start the morphine now as there is only one more week of treatment left. At this stage they would already be starting to work on the “weaning period” where the dosage is slowly reduced to get the patient off of the morphine without getting addicted. I told him that I had been taking Efferalgan (paracetamol) with Codeine in the evening. He prescribed me twice the dose and told me to take it three times a day. I’m looking forward to that!

We talked about the treatment in general. He is very easy to talk to. He too was very pleased that I had gone through two full cycles of chemotherapy and felt that was more than enough. Both the chemo and radiation therapies they are putting me through are at the maximal levels. He said this is because I am so young and healthy. I told him I didn’t feel either these days. I asked him about when the PAC (catheter in my chest) would be removed. He explained that normally with cancer at my level (stage 4 --- without actually mentioning that) they would normally keep the PAC in for 6 to 12 months in case they had to go back to chemotherapy if the cancer came back. However looking over my surgery records and the fact that all of the tumours had been completely removed, and the large levels of radiation and chemotherapies, he felt that the PAC could be removed without risk. The decision must come from Dr. Kanoui. However it can not be moved until all of the “toxicity” has left my body which will take another two months. I will therefore ask Dr. Kanoui about it when I seem him on December 20th but the earliest would be mid-February. We spoke a bit about post-treatment and what happens after the end of next week. We spoke about the tests (scanners and blood) and the exams (Dr. Hagege and his cameras up my nose and down my throat) that I’ll have to go through repeatedly over the next year or two. It ain’t over yet! Overall, as always, it was great to talk with him. I left there, as usual, feeling like I had covered everything I wanted to and had a full an honest answer.

I got home feeling relatively good. I spent a portion of the afternoon installing my new Palm TX and transferring all of my data from the old to the new. I then started preparing the, now old, Palm Tungsten T3 to be sold on eBay. I was asleep by the time the women of the house got home.