Tag: Side Effects

Body changes over time

This page will identify changes over time to physical attributes like my weight.

Weight Changes

  • Jul 29, 2019: As stated in other posts, I’ve been trying to bulk up prior to commencing treatments. That’s been fairly successful. It’s weird, though, to see how much my weight varies. I’m sure the variability reflects the time of day at which I took my weight, how much I’ve eaten prior to weighing, and how much water I’ve sweated off through outdoor activities.
  • Aug 23, 2019: Bulking up is over. Now I’m just trying to keep my weight up.
  • Aug 31, 2019: As you can see, my weight’s bouncing around like crazy. Part of the reason is that some days I weigh when I’m wearing my jeans, and some days I’m wearing lighter-weight shorts.
  • Sep 9, 2019:Weight continues to fall. Food tastes bad, cancer suppresses appetite, while tissue is being re-generated. But, I’m still above my normal weight, and I’ve only 4 doses left, so I’m hopeful this weight loss trend won’t last long.
May 22, 2019: Diagnosis Day
August 1, 2019: First Radiation Treatment
September 13, 2019: Last Radiation Treatment

Other Changes

Considerations regarding chemoradiation therapy (CRT)

Introduction

In an effort to determine whether I want to receive chemotherapy concurrent with radiation therapy, I am finding sources of information relevant to this question. The following are links to relevant studies/articles, or quotes from cited papers.

How can chemo be applied?

Update July 17, 2019
Chemo may be used in several different situations: (American Cancer Society)

  • Chemo (typically combined with radiation therapy) may be used instead of surgery as the main treatment for some cancers. (This is called chemoradiation.)
  • Chemo (combined with radiation therapy) may be given after surgery to try to kill any small deposits of cancer cells that may have been left behind. This is known as adjuvant chemotherapy.
  • Chemo (sometimes with radiation therapy) may be used to try to shrink some larger cancers before surgery. This is called neoadjuvant or induction chemotherapy. In some cases this makes it possible to use less radical surgery and remove less tissue. This can lead to fewer serious side effects from surgery.
  • Chemo (with or without radiation therapy) can be used to treat cancers that are too large or have spread too far to be removed by surgery. The goal is to slow the growth of the cancer for as long as possible and to help relieve any symptoms the cancer is causing.

History of treatment options

The following is an excellent editorial article from Annals of Translational Medicine. It provides a very clear description of chemo treatments for OPSCC.

Current Standard Treatment

The standard treatment for HPV-positive OPSCC, as of April 2019.

The standard of care for the definitive nonoperative management of cisplatin-eligible patients with advanced disease is concurrent chemoradiation with high-dose cisplatin given every 3 weeks. For patients undergoing initial surgical resection, adjuvant chemoradiation with concurrent high-dose cisplatin given every 3 weeks is recommended for patients with positive margins and/or extranodal tumor extension.

Deintensification of treatment of patients with p16+ oropharynx cancer should only be undertaken in a clinical trial.

Role of Treatment Deintensification in the Management of p16+ Oropharyngeal Cancer: ASCO Provisional Clinical Opinion April 2019

Problems with Cisplatin

Cisplatin CRT leads to higher toxicity and morbidity in short and long term, and possibly has higher non-cancer mortality.

Disturbingly, 10-year results of RTOG 91-11 demonstrated increased non-cancer mortality in the concomitant chemo-radiation arm (30.8%) when compared to the induction chemotherapy arm (20.8%) and the radiation-alone arm (16.9%), suggesting the current system of monitoring and grading late effects of treatment may be inadequate [49]. Worth noting, however, is that larynx cancer patients have higher baseline comorbidity and thus late cisplatin-related toxicity may not be mirrored in the more medically fit HPV-positive OPSCC patient population.

Treatment de-intensification strategies for head and neck cancer November 2016

Regarding long-term side effects…

Oropharyngeal cancer caused by Human Papillomavirus (HPV) infection … has a better prognosis than most other head and neck cancers. Patients cured of their disease often have to live for several decades with the side-effects of their treatment which can be permanent and have a major impact on quality of life.

Cardiff University Centre for Trials Research

The mainstay of treatment is combined chemoradiotherapy, and the prognosis for survival is good, but many patients will have long-term experience with the debilitating side effects of treatment.

Human papillomavirus–associated oropharyngeal cancer: review of current evidence and management 2019

Regarding high vs low Cisplatin dosage schedules. Note that this study did not differentiate HPV-positive from HPV-negative.

Given concurrently with conventional radiotherapy in locally advanced head and neck cancer, high-dose three-weekly cisplatin has often been replaced with weekly low-dose infusions to increase compliance and decrease toxicity. The present meta-analysis suggests that both approaches might be equal in efficacy, both in the definitive and postoperative settings, but differ in toxicity. However, some toxicity data can be influenced by unbalanced representation, and the conclusions are not based on adequately sized prospective randomized studies. Therefore, low-dose weekly cisplatin should not be used outside clinical trials but first prospectively studied in adequately sized phase III trials versus the high-dose three-weekly approach

The Oncologist May 2017

Chemo-brain really does exist

Top

Problems with Cetuximab

At least three trials are investigating the pros and cons of using Cetuximab rather than Cisplatin in combination with IMRT.

  • 5 years results: RTOG 1016: Cetuximab versus high-dose cisplatin concurrent with accelerated IMRT (70 Gy in 6 weeks)
  • 2 years results: De-ESCALaTE HPV: Cetuximab versus high-dose cisplatin concurrent with RT (70 Gy)
  • No results yet: TROG 12.01: Cetuximab versus weekly cisplatin concurrent with RT (70 Gy) once per week

However, Cetuximab appears not to have suitable overall survival outcomes.

For patients with HPV-positive oropharyngeal carcinoma, radiotherapy plus cetuximab showed inferior overall survival and progression-free survival compared with radiotherapy plus cisplatin. 

Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial November 2018

Results of our study show that, in the setting of low-risk oropharyngeal squamous cell carcinoma, the use of cetuximab bioradiotherapy instead of cisplatin-based chemoradiotherapy resulted in no overall benefit in terms of toxicity but showed significant detriment in tumour control. Our trial also highlights that the good survival outcomes of HPV-positive low-risk oropharyngeal squamous cell carcinoma are in part a function of the type of treatment received, and not merely a reflection of favourable intrinsic tumour biology. Therefore, cisplatin-based chemoradiotherapy should continue to be considered the standard of care in this setting.

Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial November 2018

Cisplatin vs Cisplatin & 5-FU

In the following, Regimen A was Cisplatin CRT (IMRT) with 6 weekly cycles, and Regimen B was Cisplatin and 5-FU CRT in 2 weekly cycles.

Patients on regimen A were more likely than patients on regimen B to experience thrombocytopenia (odds ratio 2.41, 95% confidence interval 1.14–5.14, P = 0.02); 46% (22 of 48) of patients on regimen A experienced acute thrombocytopenia compared to 26% (21 of 81) of patients on regimen B (Table 2). However, the majority of thrombocytopenia experienced (90.0%) was less than grade 2 in severity and therefore not limiting (Table 3)

Comparison of Acute Toxicities in Two Primary Chemoradiation Regimens in the Treatment of Advanced Head and Neck Squamous Cell Carcinoma June 2012

De-escalated treatments have good results

The following study reports that de-escalation of both RT and CRT is very possible.

As of July 11, 2019, it appears that the survival rates for HPV-positive OPSCC patients receiving radiation only (i.e. no chemo) are very high, in fact much higher than for many other cancers.

Several studies have demonstrated that amongst HPV-positive patients some have an extremely low oncologic failure risk (especially non-smokers with less than T4 or N2c-N3 disease) [32], [36]. For these patients the addition of chemotherapy to radiotherapy does not seem to significantly increase overall survival benefit, suggesting that chemotherapy may be omitted completely. Chen et al. [37] have reported very good outcomes in a series of 19 HPV-positive OPSCCs treated exclusively by radiation, including 17 (74%) patients with stage III/IV and 18 (79%) non-smokers (<100 cigarettes in a lifetime). The 3-years overall survival and locoregional control rates for patients with stage III/IV disease were 81% and 88%, respectively. Among the 18 HPV-positive patients who were never-smokers, the 3-years rates of overall survival and locoregional control were 100% for both.

Treatment de-escalation for HPV-driven oropharyngeal cancer: Where do we stand? January 2018

Can chemotherapy be completely removed, leaving only IMRT treatment?

An alternative de-intensification approach is the omission of chemotherapy. The ongoing HN-002 trial (NCT02254278) is a large randomised phase II study of nearly 300 patients assessing two different de-escalation strategies. Eligible patients are those with HPV-associated T1–T3 tumours with N0–N2b nodal status and ≤ 10 pack-years smoking history, falling under the low-risk classification put forth by Ang et al. [15]. Patients are randomised to receive accelerated radiotherapy alone to 60 Gy given six fractions a week over 5 weeks versus 60 Gy using standard fractionation over 6 weeks with dose-reduced weekly cisplatin (40 mg/m2 weekly, total 240 mg/m [2]). Retrospective data suggest that the weekly chemotherapy schedule results in significantly reduced severity of mucositis compared to the traditional schedule of delivery every 3 weeks [54]. Notably, both arms represent a 10 Gy reduction in total radiotherapy dose. The primary end-point of the study is 2-year progression-free survival of at least 85% as well acceptable swallowing function based on the MD Anderson Dysphagia Inventory. This combination efficacy and toxicity end-point is novel, and demonstrates the emphasis of selecting therapies in which patients are likely to be cured, but also have minimal long-term morbidity.

Treatment de-intensification strategies for head and neck cancer November 2016

Studies of radiation therapy (RT) vs chemoradiation (CRT) therapy showed RT alone to have very good results.

RESULTS: In all, 23 patients with HPV-positive cancers were identified. With a median follow-up of 28 months (range, 6-85 months), the 3-year actuarial rates of overall survival, locoregional control, and distant metastasis-free survival were 83%, 90%, and 88%, respectively.

CONCLUSION: These findings attest to the exquisite radiosensitivity of HPV-positive head and neck cancer. The clinical outcomes observed from this selected series compare favorably with historical controls treated by more intensive chemoradiotherapy strategies.

Definitive radiation therapy without chemotherapy for human papillomavirus-positive head and neck cancer November 2013

Apparent improvements from CRT may be false.

In this study of real-world patients what appeared to be improvement in OS with the addition of concurrent chemotherapy to conventional radiotherapy was confounded by HPV status.

Did the addition of chemotherapy to conventional radiotherapy improve outcomes in treatment of oropharynx cancer in Ontario, Canada? A marker-treatment interaction study 2016

Current thoughts

As of July 11, 2019, I am leaning towards not having any chemotherapy, but I’m still in my information-gathering phase.

I will be meeting with my radiation oncologist tomorrow to get answers to some questions, and I’ll try to get his opinion about this. I’ll also set up another meeting with my medical oncologist, and I’ll be attending an information session all about chemotherapy at the Victoria Cancer Clinic next Tuesday July 16 where nurses and pharmacists will be able to answer questions.

Updates, July 15, 2019

I found another article that indicates CRT is not recommended for Stage II (that’s me) HPV-positive oropharyngeal cancer.

Stage I-II: Concurrent systemic therapy is not recommended for patients with stage I-II OPSCC receiving definitive RT, due to a lack of evidence supporting its use for early-stage disease.

New ASTRO guideline establishes standard of care for curative treatment of oropharyngeal cancer with radiation therapy April 16, 2017

The American Cancer Society makes it clear that CRT is really tough.

Side effects tend to be worse if chemotherapy is given at the same time as radiation (chemoradiation). Both the radiation and the chemotherapy side effects are worse, which can make this treatment hard to tolerate. For this reason, it’s important that anyone getting chemoradiation be in relatively good health before starting treatment, that they understand the possibility of serious side effects, and that they’re treated at a medical center with a lot of experience with this approach.

Radiation Therapy for Oral Cavity and Oropharyngeal Cancer March 2018

Update, July 17, 2019

In the context of HPV-positive head & neck SCC, high-dose Cisplatin treatments significantly increase short-term side effects.

… higher incidences in severe (grade 3 or higher) adverse effects in functional mucosal, muscular fibrosis, as well as cytopenia and nausea/vomiting in the combined group … the addition of chemotherapy to radiotherapy increased the incidence of severe adverse effects (grade 3 and higher) from 34% to 77% …

Optimal regimen of cisplatin in squamous cell carcinoma of head and neck yet to be determined June 2018

Update, July 22, 2019

The following article lists the pros and cons of de-escalation, including the option of removing systemic therapy entirely in favour of using RT only.

Point/Counterpoint: Do We De-escalate Treatment of HPV-Associated Oropharynx Cancer Now? And How? May 2018 ASCO Educational Book

The following article indicates that smoking status is a very high determinate of recurrence, leading me to think that, because neither RTOG 1016 or De-ESCALaTE had results based on smoking status, that the chance of recurrence, under Cisplatin CRT, for me is lower than those studies indicate. These were, however, mostly Stage IV patients.

One hundred and two patients (82.3%) had HPV-positive tumors. Over two thirds (68%) of patients with HPV-positive tumors were tobacco users. Among HPV-positive patients, current tobacco users were at significantly higher risk of disease recurrence than never-tobacco users (hazard ratio, 5.2). Thirty-five percent of HPV-positive ever tobacco users recurred compared with only 6% of HPV-positive never users and 50% of HPV-negative patients. All HPV-negative patients were tobacco users and had significantly shorter times to recurrence, and had reduced disease-specific survival and overall survival compared with HPV-positive patients. Compared with HPV-positive never-tobacco users, those with a tobacco history showed a trend for reduced disease-specific survival but not overall survival.

Tobacco use in human papillomavirus-positive advanced oropharynx cancer patients related to increased risk of distant metastases and tumor recurrence February 2010 PubMed

The following article indicates that for patients with low risk of metastasis, there was no significant difference in controlling distant metastasis between RT and CRT.

The [distant control] rates for HPV-positive, low-risk [of distant metastasis] N0-2a or less than 10 pack-year N2b patients were similar for RT alone and CRT…

Deintensification Candidate Subgroups in Human Papillomavirus–Related Oropharyngeal Cancer According to Minimal Risk of Distant Metastasis
February 2013 Journal of Clinical Oncology

The following article implies that some recurrences are due to inadequate volume delineation.

A significant proportion of local–regional recurrences from HPV-positive oropharyngeal cancer represented geographical misses which possibly could have been prevented with more meticulous attention to IMRT planning.

Inadequate target volume delineation and local–regional recurrence after intensity-modulated radiotherapy for human papillomavirus-positive oropharynx cancer June 2017 Radiotherapy and Oncology

First meeting with Medical Oncologist

I met with my medical oncologist (MO) Thursday July 4, 2019 to talk about chemotherapy (aka systemic therapy).

Almost right off, my MO said that chemotherapy, for me, was entirely optional, which surprised me. I’ve always thought that the primary purpose of chemo was to implement a mechanism for killing off any cancer cells that might have migrated beyond the regions that surgery and radiation target.

But my MO corrected me; the primary purpose of chemotherapy, at least when applied to HPV related oropharyngeal cancer treatment, is to improve the efficacy of the radiation treatment. The platinum in Cisplatin (the drug that would be prescribed in my case) binds to the cancer cells and the platinum makes the cells more sensitive to the concurrent radiation therapy. Without the chemo, the radiation simply has a harder time killing the cells.

What I thought was the primary purpose of chemotherapy is instead the secondary purpose. And, what I also learned about HPV related base-of-tongue cancer, is that cancer cells very rarely migrate beyond the lymph nodes. Therefore, if the cancer is treated soon enough, as mine will be, that secondary “seek and destroy” purpose is almost unnecessary.

My MO also made me aware that, for HPV related oropharyngeal cancer, no randomized clinical tests have been conducted that show conclusively that the standard chemotherapy treatment actually has a significant impact on 5 year survivability. It’s possible that chemo would not actually help me.

A little background is required here. Please note that the following is what I remember my MO telling me; it may not be entirely accurate. I’ll provide updated information, and supporting citations, in future posts.

  • Older survivability studies of patients with oropharyngeal cancer showed 5 year survivability rates of roughly 60%. In those studies, patients who received chemotherapy in addition to radiation therapy had a survivability rate about 8% higher than those patients who had radiation therapy only.
  • But those studies did not differentiate patients who had smoking related cancer from those with HPV related.
  • Studies show that people who live 5 years after treatment for the HPV related version of oropharyngeal cancer do not die of the same cancer; they are cured.
  • Studies also show that the survivability rate for HPV related oropharyngeal cancer patients who receive both radiation and chemo therapies is around 80%
  • But no studies have returned results yet that show that the chemotherapy that HPV related patients receive has the same 8% impact on survivability. Given that the HPV related cancer is a very different beast from the smoking related version, it’s very possible that the impact of chemotherapy is much lower than 8%. In fact, it’s possible that the chemotherapy could have a negative impact on survivability rates, because chemotherapy comes with side effects that can be very devastating.
  • Nonetheless, the standard cancer treatment for oropharyngeal cancers, as recommended by ASCO (American Society Of Clinical Oncology) and ASTRO (American Society For Radiation Oncology), is radiation supplemented by Cisplatin chemotherapy. This will remain in effect until studies show that the chemotherapy is unnecessary. Studies have been started, but they have been running less than 5 years, so results aren’t in yet.

So I’ve got about 2 weeks to decide whether I want to have chemo. My MO is going to book a bed for me for the first day of treatment (see treatment plan below), and I can cancel it at the last minute (although giving a day’s notice would be better so they can give the bed to someone else).

Posts in the next couple of weeks will include my investigation into the pros and cons of chemo for HPV related oropharyngeal cancer. Those posts will include links to source materials.

Current Treatment Plan

  • Chemo-radiation therapy will start Monday July 29, 2019
  • I will be given radiation over a 7 week period. In that period I will have 35 daily treatments, Monday through Fridays.
  • I will have 3 cycles of chemotherapy. Each cycle will comprise 1 daily treatment. Treatments will occur on Day 1 and Day 22. If my MO thinks it’s appropriate, I will have a treatment on Day 43.
  • Cisplatin chemotherapy treatments take a long time, because it’s critical that the platinum be washed completely out of my vascular and renal system by the end of the treatment, and that my kidneys be checked before I leave the hospital. Therefore, just to make things a whole lot simpler, I will be checked in as an overnight patient for chemotherapy treatments.
  • I have the right to go through the first cycle, determine that the side effects are too uncomfortable to continue, and discontinue treatment. Similarly, my MO could also decide to terminate chemotherapy if he decides that costs of continuing do not warrant the hoped-for benefits.
  • My MO frequently suspends chemo treatments after the 2nd cycle

Alternative Treatment Plan

If I decline chemotherapy, my radiation oncologist would put me on an accelerated treatment plan. I would still receive my total dosages (70 Gy to the primary site and 56 Gy to elective sites), but over just 6 weeks. On one day of the week I would receive 2 doses instead of 1.

This alternative radiation plan is given to accommodate the lack of chemo. As I noted above, the primary purpose of chemo is to accelerate the death of cancer cells by making them more sensitive to concurrent radiation therapy. The doubling up of doses is intended to make up for the fact that the cancer will be less sensitive.

Other Systemic Therapies

The chemotherapy that my MO has in mind for me is known in BC as “HNLAPRT” (Head and Neck Locally Advanced Platinum Radiation Therapy). The BC Cancer Agency’s patient handout for this therapy talks about the following.

  • what Cisplatin is
  • its intended benefits
  • the HNLAPTR treatment summary
  • treatment protocol (i.e. cycle details)
  • chemotherapy side effects and management
  • radiation side effects and management

Other systemic therapies available for use with radiation therapy include the following. Patient handouts and protocol summaries for each of these can be found at the BC Cancer Agency’s Head & Neck Chemotherapy Protocols page.

  • HNLAALTPRT (Head and Neck Locally Advanced ALTernate Platinum Radiation Therapy)
    • The treatment cycle changes so that the patient receives smaller but more frequent doses
  • HNLACETRT (Head and Neck Locally Advanced CETuximab Radiation Therapy )
    • Cetuximab is used when Cisplatin cannot be used, for example when the patient’s renal function is already impaired, or already has tinnitus or some hearing loss
  • HNLACNFRT (Head and Neck Locally Advanced CArboplatin and Fluorouracil Radiation Therapy )
    • This treatment is very hard on the body and is very rarely used anymore

Cisplatin Side Effects

  • nausea, often with vomiting
    • The MO would attempt to reduce nausea by having me take anti-nausea medication prior to taking the Cisplatin. The anti-nausea drugs themselves have side effects.
  • diarrhea
  • mucositis is the painful inflammation and ulceration of the mucous membranes lining the digestive tract
  • damage to bone marrow leading to
    • reduction in number of red blood cells resulting in fatigue
    • reduction in number of white blood cells resulting in reduced ability to fight infection
    • reduction in number of platelets resulting in increased bruising
  • kidney damage resulting from platinum damage to cells
  • hearing loss
  • hair loss from the Cisplatin is rare
  • tinnitus is the perception of noise or ringing in the ears
  • neuropathy is the loss of feeling in fingers, hands, and feet, and can sometimes become permanent
  • weight loss that compromises health
  • increased susceptibility to auto-immune diseases

Why I am a good candidate for Cisplatin treatment

My ECOG performance status is 0. That means that I am “Fully active, able to carry on all pre-disease performance without restriction”. Therefore, I should be able to handle the additional burdens placed on my body by the chemo supplement better than someone at higher ECOG ratings.

The Eastern Cooperative Oncology Group (ECOG) is one of the largest clinical cancer research organizations in the United States and conducts clinical trials in all types of adult cancers.

The ECOG performance status is a scale used to assess how a patient’s disease is progressing, assess how the disease affects the daily living abilities of the patient, and determine appropriate treatment and prognosis

Radiopaedia

Weight loss issues

My MO tells me that the dietitian that I’ve been assigned to is a person who is very determined to maintain my weight at acceptable levels, and will be on the MO’s case if my weight drops more than 10% of my baseline weight. From reading the HNLAPRT protocol document, I see that, when the 10% is hit, either the patient gets a feeding tube and the chemo dose drops by 25%, or chemo must be discontinued.

I asked which of my many weights is deemed the “baseline”, because, knowing that weight loss is an issue, I’ve been bulking up. I was 169 lbs when had my open biopsy on May 22, and my desire is to have that treated as my baseline; on my 6’1″ frame I’ll definitely be skinny if I drop to 152 lbs, but I won’t be on death’s door. According to my MO though, the standard baseline is defined as the weight I have when treatment commences, which I’m hoping will be around 185 lbs.

Thinking about this more, I’m starting to think I may be really wrong in thinking that allowing myself to drop 18% from 185 to 152 would be OK. That 10% figure indicates that the treatment is having a very significant effect on my body, and that the treatment needs to be amended some way to ameliorate the side effects.

My thoughts

I’m seriously considering not going with the chemo. I really want to minimize the side effects of my treatment, and some of the chemo side effects sound pretty severe.

I might also say, “Let’s try one cycle, and see how it goes.” But I don’t know how the radiation oncologist would like that; would he want, or not want, to accelerate his treatment?

I think I’ll chat this over with other members of “my” team (dietitian, radiation oncologist, speech language pathologist, and general practitioner in oncology) to get their thoughts.

Diagnosis Side Effects

Fine Needle Aspiration (FNA) Biopsy (level II lymph node)

I had two FNA biopsies.

  • The first (March 1, 2019) was done by a relatively young doctor in a hospital setting. She applied a topical freeze to my lump before inserting the aspiration needle. Nonetheless, the feeling of having material removed from the lump is uncomfortable. Not, for me, painful, but uncomfortable. There were no lingering side effects.
  • The second (March 22, 2019) was done by my ENT in his office. He eschewed the topical freeze and said, just before he inserted the biopsy needle, “This is going to hurt.” He wasn’t far off. His method was more probing than that done in the hospital. It still wasn’t “painful”, but it was very uncomfortable. Well, maybe it was painful. The lymph node was still sore the next day. But no other side effects.

Open Biopsy (Primary Site: Base of tongue)

My Experience

My open biopsy (May 22, 2019) occurred under complete sedation monitored by an anesthesiologist in a hospital operating room. Recovery took place in the Recovery and Post-op Day Surgery areas, under the watchful eyes of apparently very experienced post-op nurses. I had no difficulties walking out of the hospital into my wife’s waiting car about 1 hour after waking up from surgery. Most of the post-op time was in a semi-reclining position. No further side effects other than the predicted soreness. My surgeon had prescribed Tramaset, a combination of two pain relievers – tramadol (an opioid analgesic) and acetaminophen, as a painkiller, but all I took was three T3’s. (My approach with painkillers is to apply as necessary and when necessary.) Your mileage may differ, but I hope not.

Andy Krauska’s Experience

For some, like Andy Krauska, biopsies do have side effects. He and I appear to be of similar age, and appear to have similar symptoms and timing. A notable difference between one of his biopsies (Andy’s Cancer Journey: Biopsy – Back of Throat) and mine is in the use of painkillers; he took the prescribed acetaminophen and hydrocodone. The following comes from an email that Andy sent me.

The biopsy surgeon did not prepare me at all for the gag flex and vomiting.  I almost called 911  as I couldn’t breath for several moments and was thinking, “you gotta be kidding me, I’m going to die choking on my own vomit!”  The gagging and vomiting repeated even while the doctor was on the phone and saying only “keep drinking water.”  What she should have said before the surgery and in writing was: You need to sit up in your bed with your head tilted slightly back to get the uvula back in your throat so it doesn’t touch the tongue, that’s what’s triggering the gag reflex and vomiting.  It may take 4-6 days for the uvula elongation and the tongue swelling to go down.  To help that process, you can suck on crushed ice, rinse hourly with salt (1/4 tsp), water (8 ounces) and baking soda (1/4 tsp) solution. Also, be aware that you will have ulcerations in your mouth on the inside of the lips and under the tongue and on the uvula, they will appear white.  They are normal and will go away over the next week; they are caused the surgery and are normal side-effects.  Besides the rinsing every hour, you can get an over the counter rinse called Gly-oxide and use it 2-3 times a day topically or as a rinse. Sleeping in a sitting position will also help reduce the swelling of the tongue.

Andy Krauska, June 29, 2019