I have a question that perhaps someone could shed some light on who is more in the know than me.

I just completed my scheduled quarterly scan followed by appointments with my MO, RO and ENT. It never works out to where I can see all 3 Docs on the same day which, including the scan, means 4 separate 82 mile round trips usually within a week or so. I was blessed by having another clean quarter but now, here is my question.

Why is it that now, one year post TX, is it necessary to have follow-up appointments with the RO and MO? This is assuming that my scans keep coming up clean. My ENT has always seemed to be the one at the top of the "pecking order" throughout this whole battle, beginning with her original Dx in April of '06. I certainly feel that it is important to maintain follow-up appts. with her above all else. The now routine seems to be that I first have the scheduled scan followed by the appts. with all 3 Docs. If scans stay clean I just don't see the purpose of having to meet with the RO and MO. They seem to spend maybe 5 minutes with me, look down my throat, probe and squeeze my neck, ask a few questions and then they are out the door. Am I really getting anything out of them at this point?

Bill D.

Great question Bill. I spent 4 hours at Emory Monday. The 4 hours consisted of 3 hours and 50 minutes of waiting and 5 minutes with both my RO and MO. What's the point?

Good question. I have been lucky so far in that my docs will schedule together. There is still the issue of the copays. I have the same roundtrip. Right now I'm going through trying to get a clear scan so I will keep them all involved but I agree that at your point it may be redundant. Some people may just feel better have all the involvement. Still this is a very good question.

I only had a H&N surgeon and a RO and a periodontistand they weren't in the same town much less hospital. What I did was schedule it so I saw one a month. That way I had someone exmaining my mouth and throat every month. I figured that way they probably wouldn't miss a reoccurence. At the end of 2 years, my RO no longer felt it necessary to see me. I still try to keep my ENT appt and dental appts so they don't occur in the same month for the same reason.

Take care,
Eileen

Lee 33, I don't know how your insurance works but, mine has a deductible that must be met and then has a coinsurance maximum for the year. I have paid my deductible and met my coinsurance maximum so, essentially, I owe nothing more this year. They always try to get me to pay the copay but, I refuse and ask them to call Blue Cross. Every time they give in. I guess they would rather lose the 40 bucks than have to deal with Blue Cross. I would assume you have met your maximums as well.

I only saw my RO for a couple of months after rad ended. And he didn't do much except look in my mouth and tell me I still had mucositis but appeared to be healing. I actually mentioend swallowing issues to hom before anyone else and he just told me it would get better with time--didn't even suggest a swallowing test. In short, I think my visits with him were useless.

At two years out, I have regular appointments with my ENT and my MO. But the MO has treated me for both breast cancer and oral cancer so my followup with him is about both. He is a very good, very careful, and very knowedgable doctor, so I don't mind at all I still have appts. with him. But my ENT is really the main guy keeping an eye on me as regards oral cancer.

Nelie

I especially do not see the purpose for continued follow-ups with the RO at this point. I had no unusual radiation issues following Tx last July. When I saw him last week he gave me the tongue depressor and took a look, felt the skin on the right side of neck and warned me of direct sunlight exposure to that area again. He explained back in March the fact that my skin would always be thinner in that area and to use sun screen on that area of my neck when outside. He spent all of 5 minutes with me followed by a pronouncement that "all looks good". Was that really worth a round trip of 82 miles, $4.00 for parking, 3 hours of my time and a $25 co-pay? I just can't see it unless I'm missing something.

Bill D.

I saw the RO and the ENT for the first year, followed by the ENT alone after that, now down to an annual visit. For the first year, I was very glad to have two docs examining my neck and my mouth, as they had a slightly different technique, so I felt I was getting a good checkup. As far as the MO, I just e-mail him annually with a humorous update, which he appreciates enough to forward to everyone in the department, whether they knew me or not.

I'm now three years past the end of treatment and my radiation oncologist wants to continue seeing me every six months, as she's done over the past two years. First year after treatment, she saw me every 3 months.

When I asked her about these visits, she said that one of the things that she was keeping an eye out for was osteoradionecrosis, that is death of the jaw bone, which can be an after effect of radiation. While this is more common with those patients who receive 66 Gy doses or more, she said, it is not uncommon at lower doses and she wants to catch this, should it occur, as quickly as possible.

Like Eileen, I feel like the more trained people looking in my mouth improves the chances of catching a recurrence or post-treatment complication quickly.

I have to drive about 200 miles to my appointments and it seems like there must be some bylaw that my ENT and RO can't have office hours on the same days of the week, which doubles the travel time. Nonetheless, these regular follow ups provide a sense of doing all I can to avoid a recurrence. - Sheldon

William, after I finished radiation treatments I saw my RO one time. I've never seen him again since. All of my follow ups have been with my ENT. I saw him once a month for the first year, then it went to I think every two months, then every three. Now I'm at 6 month checkups four years out.