November 27 - I had quite an action packed doctor's appointment today!

The PA kicked things off by asking how the pain meds were going. I told her what had been going on, about feeling guilty, feeling like I failed, and wanting someone to outline some expectations for me. In short, she said the nurses shouldn't be making me feel bad for requesting refills but she explained their caution. I guess some of their patients in the past have become addicted, the pain meds were cut off too quickly, and bad things happened. She said they're trying to learn from their mistakes. Also, when controlled substances are prescribed for long periods of time, Dr. A is on the hook to give reasonable explanations for it to whatever authority governs this stuff. Lastly, she said that the words 'as needed for pain' were really important and sometimes patients lose sight of that. Patients who are known drinkers might take the meds to get a high equivalent to what they get when drinking (Yes, there was a pointed look here and I grinned.). The whole healing process goes on for such a long amount of time that it's natural for depression to set in and patient's take the meds to help them feel better. And in that same vein, there's a lot of anxiety involved with this whole cancer adventure so patient's take the meds to calm themselves down. In the end, she said that she can't outline expectations because 'everyone is different' (I'm getting really tired of that cop out.) but that it's important to have continuing conversations with  Dr. A about my pain levels, to be aware of the reason I'm taking the med (and the only reason should be pain) and that if I need pain medicine, then I need pain medicine and that's that.

Then Dr. A came in and of course, immediately commented on the weight loss. I jumped in and told her about the week of vomiting due to the diflucan. I then mentioned that the thrush was back already (maybe never left) and that I was on the second prescription she gave me but at half the dosage. This sidetracked her quite nicely from the weight loss rant. Turns out half a teaspoon a day doesn't do ANYthing and she doesn't know why the cute little Indian doc had prescribed it like that to me the first time around. I asked her if taking the 'miracle mouthwash' in conjunction with the half teaspoon might have a greater effect. She said not really. She then left the room to call a pharmacist. When she came back she verified that a potential side effect of diflucan to sensitive patients can be nausea and vomiting. (No. Really?) She also said she was gong to try me on something different. Thank god! I am now sucking on (5) clotrimazole lozenges a day. Thrush should be gone in 7 days at which point I can suck on (2) lozenges a day as a maintenance to keep it gone. I have a good feeling about this! I can't wait to see what my mouth feels like without thrush because I'm pretty sure I've had it non-stop for many weeks now!

She asked how the pain meds were holding up with the return of the thrush because the thrush causes its own pain as well as amplifies the pain already in my mouth. I told her I still had a dose or two left and that I'm working on weaning myself off of it per nurse Jane's instructions. I then showed her the little log I've been keeping for the past week and a half. Times range anywhere from 5 hours between doses all the way up to 11.5 hours between doses. She told me that trying to wean was fine but I might want to wait until we get rid of the thrush. She said there's absolutely no reason for me to be walking around in pain. (Why do I feel I keep getting mixed messages?!?) She then wrote out a prescription for 750 ml. This surprised me. I told her that nurse Jane had told me that legally they can't prescribe more than 500 ml. Dr. A said she could prescribe me a liter if she wanted to (although the pharmacist probably wouldn't fill the entire thing in one shot) and she doesn't know why Jane told me that.

She then mentioned that Jane had told her that I often take the pain med at night due to the gagging and she asked me how that was going. I told her that I could still feel my tongue touching the back of my throat 24/7 and that I was concerned that after 8 weeks it still wasn't diminishing. She had me hop up on the table to take a look. As soon as I opened my mouth she said "OH. The thrush really is back with a vengeance!". (Yep.) She then stuck a mirror to the back of my mouth and was shining a flashlight in. She said the passageway looked clear to her and that everything was looking really good from a healing standpoint. So I asked her if maybe I could be imagining it? I don't think I am but maybe there's some kind of phantom tongue phenomenon going on? She said no, she doesn't think I'm imagining it and went ahead and set me up to get a contrast CAT scan done tomorrow. She said the imaging will give her a better view of exactly what's going on in the back of my throat. She said if the scan shows that there IS still some excessive swelling going on, then she wants to put me on steroids. She said it's a bit of a bummer because the thrush will definitely come back if I'm on steroids. (Oh, yay.) I mentioned that the cute little Indian doc had put me on a low dose of those the very first time I complained about the gagging thing during radiation and they didn't seem to help. Dr. A said I would be on a much stronger dose this time and hopefully they WOULD help. If they don't, then she's going to call Dr. C who did the surgery and have him take a look at my throat to see what is going on.

So, lots going on! It was a very take-action type of appointment which felt really good. I feel like I've just been plodding along trying to survive my recovery. Now I have hopes of feeling quite a bit better in a very short time. It put me in a really good mood for the rest of the day! I actually found some energy to run some errands and do some cleaning around the house after work. It's amazing how much a good mindset can effect your life.

I had to reschedule my dentist appointment tomorrow due to the scan appointment. Dr. A said she'll call me by the end of the week to discuss the scan results. As soon as I hear something, I'll let you know!