Guess what, Ma? It's another PA ...

It was off to visit with my ENT's partner today. My ENT was out of town and I couldn't stand to wait for the biopsy results next week, so talked them into letting me come in and see the partner instead.

After I waited a half hour a young doctor strolled into the room. When did doctors start looking young enough to be my kids? I immediately decided he was the Chinese Doogie Howser (TV show back in the 90s featuring Neil Patrick Harris as a 17 year old doctor -- guess you had to be there). Anyway, Dr. Doogie was very polite and nice and told me I could probably guess the diagnosis. Yep, it's another pleomorphic adenoma. The good news was that the FNA was benign. Whoop-tee-do. Most of the old hands here know that it's great to have a benign FNA, but you can never say never till the cuttin's done.

Dr. Doogie had enough sense not to talk down to the plump gray-haired lady with the irritated countenance. "Guess you know what that means", he ventured. "Another surgery," I replied. "Yep, I guess it would be what, your third or fourth?" "Try sixth," I said. His face fell a little. "Well," he said brightly, "the usual recommendation would be the surgery and then you should probably consider ..." "RT," I hastened to reply. "Yes, I just finished it in November."

The kid looked crestfallen, so I decided to go easy on him and let him talk. He told me that patients like me are never easy (heck, I knew that, just ask my college boyfriends), and the options for someone who's had RT are limited and doctors hate situations like mine. Sorry to hear I'm upsetting you guys. Anyway, to boil it down to its essentials, we have an escalating menu of varying surgical interventions.

The first option is to just go in there and scoop out the offending nodule, trying as much as possible not to damage the nerves. When last I went through this cafeteria line the doctor's options were pretty straightforward. He went in there, popped out the nasty nodule, then sent me off to RT in the hope that baking the tumor bed would finally cure me. Now we've got an already fried (oops, baked) tumor bed, which means that the surgeon may have to spend a lot more time fishing around for tumor cells and little teeny tumors in their tumor pre-schools, and try to get rid as many as possible. It's possible that we're looking at some nerve impairment because he may feel compelled to dissect the nerve. Think along the lines of someone who uses a knife and fork to peel meat away from a chicken bone. Hard to do it without nicking the bone.

The second option is not so much an option as a main course at the banquet for the mandatory seminar your boss made you attend. Everybody has to pick one of two or three choices. The first problem concerns the skin lost through multiple surgeries. I've already had two re-workings of my scar, so we're beginning to run out of space on my face. Eventually, if we continue with frequent surgeries, we'll have to find a source of skin to slap over the spot. I immediately thought that a loss of skin from my hips, rear, or thighs wouldn't do me any harm, but apparently they usually take the skin, along with some veins to provide a blood source, from the forearm. Not fun. I'd rather send the dish back to the chef.

The third option is a radical parotidectomy. I pointed out that I've already had a total parotidectomy, which he acknowledged, but he pointed out that the only way to destroy whatever it is which brings out my tumor tendencies is to clear the deck and set a new smorgasbord of blood vessels, nerves, skin, and some muscle on that side of my face. He added that a portion of the nerve running to my tongue could be redirected toward my mouth to alleviate the droop, and said I could always get the gold weight in my eyelid to force closure of the paralyzed eyelid. You folks who've been through the radical stuff know what he's talking about. This option would require major reconstructive surgery, something my ENT is not able to do, and would probably require a referral to another hospital - most likely Johns Hopkins.

He told me several times that he felt I should talk to my ENT, and reminded me that I could always ask for a second or third opinion. I was thinking it wouldn't hurt to show up at an ENT convention with my films and highlighted copies of my medical records.

At least we agreed on an imaging study, so I'm off to the MRI on Wednesday evening, and will meet with my regular ENT on Friday. Dr. Doogie told me he wanted me talk to my regular doctor before jumping to any conclusions about my prospects. Still and though, this isn't looking too great.