On Monday of this week I met with my GP to go through the results of the leg x-ray that he had ordered some time ago, and to discuss the results of Holter monitoring that was performed just before Christmas. I also decided that I was going to raise the question about my CT scan, ask about the Synthroid dose (thyroid medication), and get the doctor to take a look at a bit of an anomaly in the skin on my forehead.

Holter Test: Now obviously there was no problem with the Holter or the doctor would have been on the phone to me almost immediately.

You’ll remember that I am having some ‘balance’ issues. Dr. Williams has put it down to one of those chemotherapy side effects that they don’t tell you about. Dr. Naiker has been in agreement, but he is also a closet skeptic: he ordered the Holter monitoring to ensure that there isn’t a problem with blood flow to my head caused by the really invasive surgery I’ve been through to get rid of the oropharyngeal cancer. The end result of the Holter monitoring is that everything from that perspective is just fine. Over the 20 hours of monitoring, my heart beat something like 97,000 times. There were no issues diagnosed. Which then takes us back to the chemotherapy fallout as a potential reason for the balance problems.

Leg X-ray: This scan was done because of pain that I have been experiencing in my right thigh. I have been suspecting that I’m developing either a problem in my knee or my hip which is reflecting pain into my thigh. When the doctor pulled up the radiologist’s report, the first question he asked me was: ‘Were you a runner?’. Uh, yes… I ran distance from the time I was about 10 years old living in Guelph until the end of high school, making me 18. I stopped doing any serious running when I went off to University… and the only real running I have done recently has been a brief spurt at the local gym for the couple of years before I was diagnosed with cancer. Well, apparently it took its toll… and I should have continued running. We don’t have any arthritis, or damage to the knee or the hip… what we have is calcification on the muscles. No serious problems. Just basic wear and tear.

Synthroid; after a quick discussion about a rather unpleasant and somewhat embarrassing side effect, we agreed that we would try knocking back the dosage from 100mg to 75mg. Oh, and it turns out that the last set of blood tests show that my TSH levels were perfect.

Forehead anomaly; I forgot to bring it up. The discussion about the CT scan completely distracted me. It is something that bears watching, however…

Neck and Chest CT Scan; Realizing that Dr. Williams did say my neck and chest CT was okay, and that there was nothing there to be concerned about, I just thought that I would leverage Dr. Naiker’s skeptical nature and get him to review the results with me. Dr. Naiker printed out the actual report and gave it to me. We discussed it. I’m providing the text of the findings here. The red coloured text is my interpretation (and discussion with Dr. Naiker). The blue belongs to the radiologist.

Findings:An osteotomy is noted involving the body of the mandible anteriorly on the right side which has been transfixed with a plate and multiple screws. This is where they broke my jaw for the mandibular swing, then bolted it back together.
Multiple surgical clips are present in the region of the right palatine tonsil compatible with transmandibular/transoral resection of a squamous cell carcinoma. An associated free flap is noted. There is evidence for a bilateral neck dissection along with resection of the right submandibular gland and possibly resection of the right sternocleidomastoid muscle. Obviously the guy has either read the file and is merely corroborating it, or he’s really good! Additionally, there is evidence for a left submandibular gland transfer procedure into the submental region. This is evidence that they moved my saliva gland from its original location to low in the left portion of my jaw. A tiny/small soft tissue focus is present in the region of the right piriform sinus inferiorly. Absent contrast filling is noted within the transverse and sigmoid dural venous sinuses extending into the proximal internal jugular vein on the right side compatible with thrombosis. This made us both sit up and take notice. A ‘thrombosis’ is a clot. Is this a bit of scar tissue from the surgery? The location described indicates that it may be… and therefore may be responsible for my balance issues. The soft tissues of the neck are otherwise unremarkable. Scarring is noted at the lung apices. Note is made of congenital incomplete fusion of the posterior neural arch of C1. Okay, so that the beginning of the cervical spine, and, according to Dr. Naiker is not that unusual. To the extent visualized, the orbits, the paranasal sinuses, the mastoid air cells and the brain parenchyma are unremarkable. Other than the scar tissue, nothing sounds ominous. But the report goes on with a statement of findings.

IMPRESSION: The radiologist’s caps, not mine.
1. Findings compatible with transmandibular and transoral excision of a squamous cell carcinoma in the region of the right palatine tonsil with free flap reconstruction and bilateral neck dissection as well as left submandibular gland transfer procedure as stated above. A soft tissue focus is present with the right piriform sinus inferiorly which may simply reflect secretions, however, tumor recurrence remains a possibility. Further assessment under direct visualization may be helpful. This is the bit that Dr. Williams mentioned during our phone call on a week ago. He had performed the ‘visualization’ when we met, and we had talked about the increased mucous production, so he is not concerned.

2. Findings compatible with thrombosis involving the transverse and sigmoid dural venous sinuses as well as the proximal internal jugular vein on the right side. This is the possible scar tissue again.

As for what is the piriform sinus, I’ve lifted an explanation and a drawing from Wikipedia for you:

“On either side of the laryngeal orifice is a recess, termed the piriform sinus (also piriform recess, pyriform sinus, or piriform fossa), which is bounded medially by the aryepiglottic fold, laterally by the thyroid cartilage and hyothyroid membrane. The fossae are involved in speech.
The term “piriform,” which means “pear-shaped,” is also sometimes spelled “pyriform” (as in the diagram on this page.)
Deep to the mucous membrane of the piriform fossa lie the recurrent laryngeal nerve as well as the internal laryngeal nerve, a branch of the superior laryngeal nerve.[1] The internal laryngeal nerve supplies sensation to the area, and it may become damaged if the mucous membrane is inadvertently punctured.
While accurate, the diagram is misleading in that the piriform sinus is not a subsite of the larynx. Rather, it is a subsite of the hypopharynx. This distinction is important for head and neck cancer staging and treatment.

Dr. Naiker arranged to have a chat with Dr. Williams about these two ‘issues’. He then had his nurse call me and let me know that everything is as we thought, and that there are no worries.

All of this essentially means that I can continue to say that I am now two years cancer free!

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