Balls and Walnuts
more than you ever wanted to know
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.
This is easy. In my field, it’s ebooks/e-readers. Some say this means the death of publishing, others say it’s the salvation, but it’s by far the biggest development.
My son thinks most if not all books will go the way of the dinosaur. I think it may take a couple of generations — we’ll need to have ebooks that can function as children’s books (with illustrations, sound effects, perhaps even pseudo-popups?) before we’ll have a generation of individuals who don’t value an actual book.
I’m with you on the books, especially for children. I can’t see curling up with a sticky 2-year-old and a Kindle at bedtime. There’s a reason why toddlers’ books are made of cardboard.
On the cancer horror tales front, my mother used to regale us with stories of cancer treatment in the 60’s, when she started nursing (and, apparently, informed consent wasn’t such a big deal). Patients would go in for a biopsy and come out of anesthesia to discover their lower jaw had been removed.
In the field of education:
NCLB…which has raped the classroom teacher
The loss of tracking.
Open Enrollment
All are negatives…which is why fewer people go into education and fewer people stay for the long haul.
Chris, I can remember taking care of a guy who had had his oral cancer resected by two community ENTs. What’s the polite way to say this? The tumor got the better of them. He had a huge open wound which was chronically infected by his saliva. I’m not sure whether he survived it; we rotated off service monthly.
Sis, for the benefit of my readers, some of whom aren’t American:
NCLB = “No Child Left Behind”, George W Bush’s administration’s brainfart, which has replaced “teaching” with “teaching to the test.”
Open enrollment allows parents to place students in whatever classes they want their kids to be in, even if the kids are not intellectually suited for those classes.
Loss of tracking — that’s what I wanted to ask you about. What’s that?
Tracking is considered a dirty word in education, and it disappeared in the mid-90s. Students were placed in their core classes (math, Engish) according to their test scores/ability level. We have gone back to tracking at my school, but no one wants to admit it. They get around it by calling it Read Intensive I, a 9th grade class where all the kids have low reading levels, but the class curriculum is still geared to college prep. With tracking,all students are on the same page: A (regular college prep English where everyone is reading at grade level), AA (everyone in the class has a work ethic that helps them do above average reading/assignments; students’ reading levels can be anywhere from 2 to 4 years above grade level). A B level class would be composed of students who are reading 2-3 years below grade level.
So it’s the old XX, X, Y, Z, ZZ system . . . under another name? Opposite end of the alphabet (observant, aren’t I?)
Yes. The reason we went to the other end of the alphabet is because we actually thought it would be less “hurtful” to the students, but even C level students (the equivilent of ZZ)were able to figure out they were bottom of the barrel.
The people who set up the system were dummies. Make the smart kids “CCs” and the C or ZZ kids, call them As. Or hell, why do you even need to give the classes names that distinguish them by intellectual grade? As long as the teachers know what’s going on, isn’t that all that really matters?