So far I have not been scheduled for surgery but it should happen very shortly. Even though I am not looking forward to surgery I am concerned as to how much worse things may be getting as a result of the delay. In the meantime as I look down the forked pathways of option I wonder what others have considered, chosen and done as they hope for the best outcome. My thoughts become so muddled as I try to look closely at each alternative I can think of (there may be others) but perhaps the thoughts of others will help me to make the most beneficial decision.

Self Termination: Considering al else the thought has flashed by but seems worthless for it instantly terminates all hope and positives.

Palliative Chemo: It is my understanding that some folks choose this route. As with all things related to cancer there is no certainty as to how things will progress toward the end. Some can live reasonably normal lives for a few months and others can do the same for a few years.

Accept current Doctors proposal: Emory Hospital (anyone here gone there?) in no uncertain terms has now told me for the second time what they will do if I want them to provide their services and a second opinion is out of the question. To make a decision for treatment they have explained (as typical) that they have all cases reviewed by a large board of staff specialist in order to determine the treatment they will perform. Their decision is to remove my tongue and I should accept that during surgery they will most likely remove my voice box also. I am having one heck of a time accepting that approach for it is so permanent; the struggle to recover and exist will be enormous (do I have the willpower to deal with all the things/parts/pieces involved to survive). I understand and respect their approach and realize their final decision might be the best that be currently made by earthlings. However, in my situation I keep wanting to seek out other alternative and hopefully uncover something that will make it all go away. I have found that John Hopkins is one place where I can send all my records and get a second opinion. In order to get a second opinion I must have a �Consultation Request Form� signed by my physician but my physician will not sign such a form. I understand that decision if it is true that no one else can offer any better prospects but how do I know that better prospects do not exist.

Find the best on earth: If I had the money I would try to find (who can tell you who and where they are) the best doctors and cancer centers on earth and consult with each and everyone of them before accepting and making a final decision. However, I am not in a position to do that. To leave my immediate area for treatment would be a hardship but to get the OLD better quality of life back I would certainly consider it. So far I have looked at Sloan Kettering, MD Anderson and John Hopkins plus of late been introduced to the Univ. of Pittsburg as being a place to consider. Of the first 3 (which I understand to be amongst the tops) John Hopkins is the only one that will offer a second opinion, without going there, if you send them all of your records inc. PETS, MRI etc. I can and will do that if I can get a physician to sign the necessary papers. From the info provided I would certainly hope they could provide a reasonably accurate diagnosis and hopefully positive and to my liking. If such were the case then I would certainly want to go there for direct observation. I know nothing but I wonder why immediate personal direct personal observation is so important. It seems to me (a know nothing person) that good records from a reliable institution is good enough for a start. From my experience, the only thing that happens during direct observation is someone sticks their finger deep into my tongue base area and looks down my nose with a lighted scope of some sort. I am sure all institutions have policies in place for their own good reasons but I would hope it is not monetarily driven. At Sloan Kettering I was told �at this time we do not offer second opinions without seeing the patient�. Maybe they will in the future. On a couple of occasions I have heard, from professionals, that a reason for some of the institutions ranking higher than others is because of PR and marketing. I understand that because we are certainly a marketing society. However, in the field of cancer it seems there is more than enough work for everyone and I would prefer to think everything is cure driven and not driven by comprtitive monetary benefits.

Well, I could go on (may later) but I have been up most of the night and it is past 6:00AM and I must sleep. Once again, thanks for reading through all my stuff and I look forward to any thoughts anyone can share.