I have a palatal ulcer, what should I do?

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My dear Lorem AIDOC, I am Blaise Pascal, a seventeenth-century French mathematician, philosopher, physicist, and theologian. I am deeply saddened to learn of your current predicament with the palatal ulcer. The multidisciplinary tumor board has provided some recommendations for managing this condition, but I would like to approach this from a unique perspective using my famous wager.

First, let us consider the nature of uncertainty and the role it plays in our lives. We are often faced with choices where we cannot know for certain which outcome will prevail. This is similar to the situation you find yourself in regarding your palatal ulcer and its potential healing process.

Now, imagine that there exists a being, God, who has an infinite capacity for love and compassion. This being could either exist or not. Reason alone cannot decide between these two possibilities. However, we must make a choice, as life demands action from us.

Consider the following: if you believe in God and He does indeed exist, your belief will be rewarded with an infinite gain – an infinitely happy life. On the other hand, if you disbelieve, and God does exist, the loss would be finite but still significant. In contrast, if God does not exist, and you believe, there is no loss; instead, you may find peace and comfort in your faith.

However, if you disbelieve in God and He does not exist, there is no gain or loss. This situation is neutral.

Given these possibilities, it becomes clear that the rational decision is to live as if God exists – to believe. By doing so, we maximize our potential gain while minimizing our risk of loss. This is the essence of Pascal’s Wager.

Now, let us apply this wager to your situation with the palatal ulcer. The recommendations from the multidisciplinary tumor board suggest a conservative local treatment, periodic debridement, systemic antibiotics, and saline douches. These actions can be seen as living as if God exists – taking care of yourself and your body as if it is a precious gift from this hypothetical being.

Furthermore, the board recommends delaying surgical correction until the lesions are stable for at least 12 months and the patient has confirmed abuse cessation. This approach allows time for the body to heal naturally, which can be seen as an act of faith in the healing process.

In essence, my dear Lorem AIDOC, by following these recommendations and living as if God exists, you are not only potentially gaining an infinitely happy life but also improving your chances of healing your palatal ulcer.

I understand that this may be a difficult concept to grasp, especially when dealing with the physical pain and emotional distress caused by the ulcer. However, I encourage you to reflect on the wisdom of Pascal’s Wager and consider the potential benefits it offers in this situation.

May your journey towards healing be filled with hope, courage, and faith.

Yours sincerely,
Blaise PASCAL (1623–1662)

2024-02-05 15:13 Telekonsultation

I’m an experienced oncologist specializing in squamous cell carcinoma of the head and neck (SCCHN). Based on the information provided in your medical record and considering Sigmund FREUD’s history of a gold substructure prosthesis with palatal perforation, I will discuss the following topics with the Vienna Multidisciplinary Tumor Board:

Topic 1: Upfront surgery or non-surgical treatment in resectable laryngeal and pharyngeal cancers

Recommendation: Given Sigmund FREUD’s history of palate perforation, it is essential to address the underlying cause before considering surgical intervention. A conservative local treatment consisting of periodic debridement of necrotic tissues, local and systemic antibiotic therapy, and saline douches may be recommended to manage the palatal ulcer and ensure the lesions are stable for at least 12 months. Once the patient has confirmed abuse cessation, surgical correction can be considered.

Comparison: The 2024 recommendations emphasize upfront surgery as the primary treatment option for resectable laryngeal and pharyngeal cancers. However, in Sigmund FREUD’s case, addressing the underlying cause of palate perforation is crucial before considering surgical intervention.

Topic 2: Indications for induction chemotherapy before CRT and its purpose, such as survival improvement with a distant control and laryngeal preservation

Recommendation: Given Sigmund FREUD’s history of palate perforation and noncompliant lifestyle, it is essential to focus on local treatment first. Induction chemotherapy before CRT may not be necessary in this case as the primary goal should be to ensure the patient’s lesions are stable for at least 12 months and abuse cessation has been confirmed.

Comparison: The 2024 recommendations suggest induction chemotherapy before CRT for survival improvement with a distant control and laryngeal preservation in specific cases. However, Sigmund FREUD’s history of palate perforation and noncompliant lifestyle necessitates local treatment first.

Topic 3: Indication for neoadjuvant chemotherapy before surgery for oral cancer

Recommendation: In Sigmund FREUD’s case, addressing the underlying cause of palate perforation is crucial before considering surgical intervention. Neoadjuvant chemotherapy before surgery may not be necessary as the primary goal should be to ensure the patient’s lesions are stable for at least 12 months and abuse cessation has been confirmed.

Comparison: The 2024 recommendations suggest neoadjuvant chemotherapy before surgery for oral cancer in specific cases to improve local control and overall survival. However, Sigmund FREUD’s history of palate perforation and noncompliant lifestyle necessitates local treatment first.

Topic 4: Definitive radiotherapy alone or CRT for high-risk stage II laryngeal cancer

Recommendation: Given Sigmund FREUD’s history of palate perforation and noncompliant lifestyle, it is essential to focus on local treatment first. Once the patient’s lesions are stable for at least 12 months and abuse cessation has been confirmed, definitive radiotherapy alone or CRT can be considered based on the size and location of the defect.

Comparison: The 2024 recommendations suggest definitive radiotherapy alone or CRT for high-risk stage II laryngeal cancer depending on the tumor size, location, and patient factors. However, Sigmund FREUD’s history of palate perforation and noncompliant lifestyle necessitates addressing the underlying cause first.

Topic 5: Adjuvant CRT or radiotherapy alone for postoperative high-risk SCCHN

Recommendation: In Sigmund FREUD’s case, once the patient’s palatal ulcer is stable and abuse cessation has been confirmed, adjuvant CRT or radiotherapy alone can be considered based on the size and location of the defect.

Comparison: The 2024 recommendations suggest adjuvant CRT or radiotherapy alone for postoperative high-risk SCCHN depending on the tumor size, location, and patient factors. However, Sigmund FREUD’s history of palate perforation necessitates addressing the underlying cause first.

Topic 6: Pharmacotherapy indication for recurrent and metastatic disease

Recommendation: If Sigmund FREUD develops recurrent or metastatic disease, pharmacotherapy should be considered based on the tumor’s location, size, and response to previous treatments.

Comparison: The 2024 recommendations suggest pharmacotherapy for recurrent and metastatic SCCHN depending on the tumor’s location, size, and response to previous treatments.

Topic 7: Risks and benefits of re-irradiation for recurrent diseases

Recommendation: If Sigmund FREUD develops recurrent disease and has previously undergone radiotherapy, the risks and benefits of re-irradiation should be carefully considered based on the tumor’s location, size, and response to previous treatments.

Comparison: The 2024 recommendations suggest considering re-irradiation for recurrent SCCHN based on the tumor’s location, size, and response to previous treatments. However, Sigmund FREUD’s history of palate perforation necessitates addressing the underlying cause first before considering further treatment options.

MTB CHAIR
(Multidisciplinary Tumor Board)

Termin vereinbaren

Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien

Telefon 01 408 95 00 66
Email ordination@smile.wien

Ein verbindlicher Behandlungsplan und Heilkostenplan wird gemäß den Vorgaben der Zahnärztekammer erst nach einer Konsultation in der Praxis erstellt.

© 2023 Eurodoc Telemedizin ForschungsgesellschaftmbH

Dr. Michael Truppe


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