The last 20 years

I was wondering today about this question: what’s the biggest thing that’s happened in my field in the last 20 years?

I think it’s the advent of combined modality chemotherapy and radiation as an alternative to surgery for advanced head and neck cancers (here, for example). This may not sound like much to you, so let me explain.

In the old days, if you had a small laryngeal cancer, docs could cure you with radiation. If the cancer came back and you were lucky enough to have the cancer limited to one vocal cord, you could have a hemilaryngectomy, leaving you with a crappy but mostly normal voice. But most folks had to have a total laryngectomy, which is not a nice thing to have. Not only do you lose your normal voice, but you also lose your sense of smell (since air no longer circulates within your nasal cavity) and, because of that, most of your sense of taste.

The VA study changed all of that. Soon it was being applied to other head and neck cancers — most significantly, in my opinion, tongue cancers. So consider tongue cancer for a moment. Once again, if the lesion were small enough, you could have removal of a part of your tongue followed by radiation therapy. With any luck, your voice and your ability to swallow would be unscathed. But if you were unlucky enough to have a larger tongue cancer, especially one of the base of tongue, then you would need a total glossectomy (removal of the tongue).

And it’s worse than you can imagine, because if the tongue goes, the larynx has to go, too. You can’t protect your airway without a tongue — you end up aspirating your own saliva. I suspect some folks managed to avoid the laryngectomy, but I know that a lot of our patients ended up with everything going. Thus in exchange for surviving cancer (which was by no means a given — the five-year survival from such tumors could be as low as 20-40%) you lost your ability to speak, eat, smell, and taste. Without a tongue, speech rehabilitation is impossible. Nowadays, you’d be stuck with one of those Stephen Hawking-style speech pads.

Now, 20 years later, I can’t remember the last time I saw one of those glossectomy/laryngectomy patients. Chemo/radiation protocols are that good nowadays. I have a few laryngectomy patients, but even they are a rarity nowadays — the radiation oncologists do an awfully good job keeping them out of our hands.

Which in my opinion is a really, really good thing.

So: what’s the biggest development of the last 20 years in your field?

D.

Another nose cleared

I had intended to write a post tonight explaining that 2 Girls, 1 Cup is merely the natural heir to goatse.cx, and that with multimedia’s evolution, some day soon we will doubtless be treated to 1 Cup, 2 Girls, 3D, or its equivalent, but instead I was called into Urgent Care to pull a bead out of a two-year-old’s nose.

I tried to save my employers some money (they pay me overtime for “call-backs”) by telling the Urgent Care pediatrician to spray the child’s nose with a decongestant. With any luck, she’d blow it out, a smooth, shiny, pink projectile. Alas, my trick didn’t work this time, and the pediatrician asked me to come in.

I’m not sure I understand the affinity of toddler noses for smooth, shiny, brightly colored things, but it’s something akin to black holes and matter. The child sees this bead, this corn kernel, this Tic Tac, and thinks Must! Shove! Or perhaps it’s the pediatric version of Will It Blend? Call it: Will It Fit? (Hint: it always fits. It rarely comes out without my help.) In any case, children and beads make me happy because it’s easy overtime money: fast, low stress, inevitably successful.

Which leads me to wonder whether we have it all wrong, giving the kids in our office stickers of Tinkerbell, Dora the Explorer, or Batman. Perhaps they’d rather have something smooth, and shiny, and brightly colored.

D.