Dear Sheryl, Four surgeries in 18 months is a lot. It's good that Charles is able to get the peanut butter smoothies down. The extra nutrition will help him cope with the treatment better.

Is he finding it hard to talk about his situation? Has he got access to a psychotherapist at the hospital? John saw a psychiatrist after he found out about the metastases. I think it gave him a chance to talk about things that he wasn't sure he wanted to talk to me about. I, too, saw a psychiatrist who was and still is a great help to me.

John never really felt anything from the mets to the lungs. For him it was the chemo, the swallowing problems and the silent aspiration that caused him all kinds of problems. My understanding was, if the airways became affected, then the patient would have difficulty breathing. That was the reason John's MO suggested the two later treatments of radiation -- to zap the swollen lymph nodes that had appeared in his airways.

Keeping you both in my thoughts.