Saturday, July 24, 2010

Merkel Work-up

June 8,2010 I have a post-op visit to remove the drain from my neck. The facial nerve was not overly damaged as I can smile with both sides of my mouth and raise my eyebrows. I do have some numbness in my left ear.

He sets up an appointment with a dermatologist to check me for the primary.

We have used Dr David Tashjian in the past. He is unavailable and his patients are being seen by Dr Edgar Macias. He checks me out but finds only a small lesion on my leg which he biopsies and sends to UCSF dermatopathologist.

During this visit, I have my first emotional response becoming very tearful. Dr Macias is very comforting. I surprise myself with the tearful comment that I feel like I have let everybody down by becoming ill.

June 9, 2010 I have noticed a red spot in front of my left clavicle. I return to have it biopsied.

I go to Valley metabolic Imaging for a PET CT

It shows one questionable lymph node in the left neck, level 2, possibly the same node as on the original CT. I have the CD of the images but it does not work well on my computer.

June 10, 2010. I play poker every month with a group that includes Tom Hackett, who is an oncologist. I call him and ask him to care for me. He refuses saying that he doesn't take friends as patients but strongly recommends his associate, Dr Marshall Flam. I have known Marshall for many years and have great respect for him. He ia a very knowledgable oncologist and I trust his judgement.I see him Thursday morning. He spends almost two hours with me going over the reports, calling my Docs including the pathologist, and doing my physical. He searches for a primary and suspects a lesion on my left cheek.

He recommends a radical neck dissection followed by radiation treatment. If the primary is not found, chemo before the radiation although he says he has no evidence that it will help. He says it may because Merkel is histologically similar to small cell carcinoma of the lung. He says he would not have a problem if I declined the chemo.

I return to see the dermatologist for a biopsy of my cheek, and he also biopsies a small lesion on my back.

June 11,2010. I go to work in the morning to try to get my mind off everything. I work 8-12 AM. It doesn’t work very well because all the other Radiologists come to visit and offer their words of encouragement.

I go to the bridge club and have a fine game, coming first of 9 tables. Bridge is more distracting than work.

My oldest son does some research on the internet and finds the MCC group.

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