QUESTION
I am tired and I will give up. Does it make any sense to have a new resection? Our would you recommend radiotherapy. Please list past surgical procedures.
Dear Mr. Freud,
I understand that you are feeling exhausted and considering giving up on further treatment. It is natural to feel overwhelmed when facing a series of medical decisions, especially when the outcomes are uncertain and the procedures are taxing both physically and emotionally. Your resilience in the face of such adversity is commendable, and it is important to remember that your feelings are valid and deserve careful consideration.
Regarding the question of whether to pursue a new resection or to opt for radiotherapy, it is essential to weigh the benefits and risks of each option. As your therapist, while I am not a medical doctor, I can provide you with emotional support and help you explore the psychological implications of these choices. However, the final decision should be made in close consultation with your oncologist and surgical team, who have the expertise to advise you on the most appropriate course of action based on your specific medical condition.
To provide you with a brief overview, surgical resection is often considered the primary treatment for oral cancer, especially in the early stages. It aims to remove the tumor and a margin of healthy tissue to ensure that no cancerous cells are left behind. The goal is to achieve clear margins, which means that the edges of the removed tissue do not contain cancer cells, thereby reducing the risk of recurrence.
Radiotherapy, on the other hand, uses high-energy radiation to destroy cancer cells. It can be used as an adjuvant treatment following surgery to eliminate any remaining cancer cells, as a primary treatment when surgery is not an option, or as palliative care to relieve symptoms in advanced stages of cancer. Intensity-modulated radiotherapy (IMRT) is a technique that allows for the precise targeting of radiation to minimize damage to surrounding healthy tissues, such as the salivary glands and mandible, thus reducing the risk of side effects like xerostomia (dry mouth) and osteonecrosis (bone death).
Your past surgical procedures have been aimed at addressing the malignancies you have faced. The specifics of these surgeries, including their extent and outcomes, are part of your medical history and should be reviewed in detail with your medical team. They will consider factors such as the location and size of the tumor, the involvement of lymph nodes, and your overall health status when making recommendations for further treatment.
It is also important to consider the advancements in treatment options, such as the use of targeted therapies like cetuximab, an epidermal growth factor receptor (EGFR) monoclonal antibody. When combined with radiotherapy, it has shown promise in improving outcomes for patients with positive tumor margins and extracapsular lymph node spread.
As we continue our psychoanalytic work together, I encourage you to express your fears, hopes, and concerns. It is through this exploration that we can uncover the unconscious factors that may be influencing your decision-making process. Remember, you are not alone in this journey. I am here to support you emotionally and to help you navigate these difficult choices.
Please take the time you need to discuss these options with your medical team and loved ones. Your well-being is of the utmost importance, and your treatment decisions should align with your values and goals for your quality of life.
If you have any further questions or need to talk about your feelings and thoughts, do not hesitate to reach out. I am here to assist you in any way I can.
Sincerely,
Max Schur
(AI generated)
2024-01-07 08:17 Telekonsultation
Dear Sigmund,
I hope this letter finds you in a moment of comfort amidst the challenges you have been facing. I understand that the journey through your illness has been arduous and taxing, both physically and emotionally. Your resilience in the face of such adversity is truly commendable.
Given the gravity of your situation and the fatigue that understandably accompanies it, it is natural to question the benefits of continuing with surgical interventions. The decision to pursue further resection or to opt for radiotherapy is a complex one, and it must be made by carefully weighing the potential benefits against the risks and your current quality of life.
In your case, the history of surgical procedures has been extensive. To provide clarity and assist in your contemplation, I will list the past surgical interventions you have undergone:
- First Operation (April 20, 1923): An excisional biopsy of the lesion in your right posterior hard palate was performed by Dr. Hans Hajek. The procedure was an outpatient one under local anesthesia, but it resulted in incomplete tumor removal and severe postoperative bleeding.
- Second Operation Stage 1 (October 4, 1923): I performed the ligation of the right external carotid artery to minimize blood loss and removed the right submandibular gland and lymph nodes. This was done under local anesthesia with pantopon sedation.
- Second Operation Stage 2 (October 11, 1923): The second stage involved a partial maxillectomy and partial mandibulectomy, including the removal of part of the right maxilla and the lower right molars with adjacent bone. Skin grafts were used to reconstruct the defect.
- Third Operation (November 12, 1923): I conducted further resection to remove the recurrence of the malignancy, which involved the remaining right pterygoid process and most of the right side of the soft palate.
- Fourth Operation (November 17, 1923): You underwent the Steinach operation by Victor Blum, which was an attempt to rejuvenate the body and potentially influence the cancer positively.
- Fifth Operation (September 23, 1938): In London, I removed another recurrence of the cancer.
Throughout these years, you have also undergone radiotherapy and have been fitted with an obturator prosthesis to aid in your daily functions such as eating and speaking.
The decision to have a new resection or to recommend radiotherapy must be made with a thorough understanding of your current health status, the progression of the disease, and the potential for maintaining or improving your quality of life. It is essential to consider the impact of further surgery on your overall well-being, as well as the efficacy of radiotherapy in managing the disease at this stage.
I am here to support you in making this decision, and I encourage you to discuss your thoughts and feelings openly. Together, we can evaluate the options and choose a path that aligns with your values and wishes.
Please know that my team and I are committed to providing you with the care and support you need during this time. Do not hesitate to reach out for further discussion or clarification.
With warm regards and in service to your health,
Hans Pichler
Head of the Maxillofacial Surgery Department
First Surgical University Clinic
Termin vereinbaren
Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien
Telefon 01 408 95 00 66
Email ordination@smile.wien
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