Medical Journal: 11/15/18

Never a dull moment. Saw Dr. Sulica, and learned many things:

-Yes, the dubious region in that X-ray is new. Likely a pneumonia, caused either by a gram-negative bacterium or an anaerobe. Fortunately, zithromycin is broad-spectrum and excreted in bile, so it puts no burden on the kidney. Will start on that tomorrow.

-No, the cough probably wasn’t anything to do with the carcinoma, even though the carcinoma was discovered looking for a cause of the cough. Maybe it’s continued irritation of the throat by the radiation, though that seems to have died down. Maybe it’s the pneumonia, but probably not. Maybe it’s self-reinforcing; no reason not to try dextromethorphan (that was my suggestion) to see if that breaks the cycle. Failing that, yes, we might even try Advair. But it’s quite possible that I’m simply “a guy with a cough,” with nothing to be done about it. (Still doesn’t answer why I’ve gone from a normal-sounding cough to a sick-sounding one.)

-Yes, the voice might continue to recover. Or it might not. As a result of the radiation, there’s now a little bit of webbing between the working vocal fold and the paralyzed one. (The tumor was right in the crotch between them.) That means they can’t close up all the way. Surgery would have had the same side-effect. No, there’s basically nothing to do about it; I’m going to have whatever voice I have. Since Dr. Sulica is famous for fixing voices, I have to regard that as a definitive judgment. (Someone told me she found my current voice sexy; we’ll see how that works out, but my past performance isn’t encouraging.)

-Yes, he’ll write a letter clearing me for a kidney transplant. He wants to see me once a month for six months; he estimates the recurrence risk at well under 10%, but it’s not zero. For now, as predicted, the tumor mass is gone.

Dr. Sulica is fairly convinced that both the carcinoma and the heart disease are delayed-onset side-effects of the radiation treatment I had for Hodgkins Disease eighteen years ago. That treatment was described to me at the time as “a little bit of consolidation radiation treatment” to put the last nail in the coffin of the HD after six rounds of enhanced BEACOPP had killed it. That makes me wonder how much my risk of having the HD come back (estimated at the time at around 10-12%) would have gone up if I’d skipped the radiation. What I’m sure of is that my oncologist at the time –who was very good about consulting me on treatment decisions, including whether to use standard or enhanced-dose BEACOPP, treated the radiation as a fixed point, and that no one said “This could do nasty things to you two decades from now.” As Dr. Sulica pointed out to me when I was choosing between radiation and surgery this time, radiation oncologists never see the delayed side-effects of their treatments; no one at UCLA is going to find out about my carcinoma or my heart disease. Is radiation over-used as a consequence?

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: