Hi Marie-Lyne --

It is quite a shock to get a diagnosis like your husband's, similar to my husband's -- out of the blue and essentially symptomless. You and he will have to be strong -- the radiation treatment is long and stressful.

My husband had his primary (tonsil) tumor removed but no other surgery, and received 7 weeks of radiation and 7 low-dose chemotherapy infusions, which is a standard protocol where he was treated (Hopkins). They radiated both sides of his neck, the right -- where he had two positive nodes -- and a lower ("prophylactic") dose to the left side. The advice, given strongly by medical and radiation oncologists and the nutritionist alike-- "if there is bilateral radiation you *will* need a PEG and if it is one-sided, you *may* need one." They recommend getting it put in before radiation starts, to allow time to recover and also, while you are still in good shape. Some people refuse, and some of them make it through OK (but struggle near the end) and others end up getting a PEG put in later -- often after becoming somewhat debilitated. I know a lot of people on this forum have said the PEG was literally a lifesaver for them!

My husband got a PEG, with a great deal of reluctance, and ended up never using it! For some reason, he did not get as severe mucositis as most patients and was able to swallow throughout, although he did lose some weight. To add even more irony, the PEG failed in his last week and fell out - they opted not to replace it as he was doing so well.

I should add that our ENT and both oncologists stressed, nay -- threatened -- that he needed to *keep swallowing* something -- even if only sips of water -- throughout or he could lose the ability to swallow as the muscles, tendons etc. can atrophy through disuse -- just as if you had your arm in a cast for 6 weeks.

So I guess the moral is: maybe he can make it through radiation without a PEG, but it would ensure he can maintain addequate hydration and nutrition, which will in turn prevent interruptions in treatment (which can reduce treatment efficacy) and improve his chances for a quick recovery. It is not that big a deal, just a bit of a pain to flush each day. He should try to eat as long as he can and continue to swallow. Get Difflam -- available over-the-counter in NZ -- benzydamine HCl mouth rinse -- which helps reduce severity and duration of mucositis. Our dental oncologist was in a clinical trial of that product and thinks it worked great for HNC radiation, but it's not available here yet. Ask your RO or nurse about it.

My husband Barry was eating regular but soft foods eight weeks' out of treatment and now, 4 months' out, is eating everything but very spicy stuff and very dry things like crackers and crisps. So hopefully for David this will also only be a "bump in the road" and that he will soon return to baseball (in New Zealand?) with his full strength.

Gail