I would not be one to argue for blind adherence to medical dogma, there have been far too many instances in medicine where those ill informed, or comfortable in their ways, have continued to treat patients with techniques and ideas that have been out of date clinically for years.

You were likely a formidable litigator when that was your venue, and you argue your points well. Before replying, I wish to be the first to say that disagreement is healthy for the most part, and I will be the first to also clearly state here that I am only speaking from what I have seen from 7 years of doing OCF now, and listening (I do listen, for those that might believe otherwise) at cancer conferences where I am on the program or attending to further my knowledge. Even with these assets, there are untold gazillions of topics and issues that I am significantly under qualified to even have an informed opinion on. I am not here to prove to anyone that I know tons, or seem like I am opposed to any views other than my own. I just am not vested in things that change as frequently as they do, as I continue to learn more. You will see me frequently defer on these boards to others like Gary who has likely forgotten more about radiation that I will know, and others more versed in other topics. This is not my fiefdom, nor do I care it to be.

You became a very active part of your treatment process, and in that respect you are unlike the vast majority of patients. I am always appalled at those on the extreme other side of things, that really do not want to know anything about their disease, or the treatments that they are going to be subjected to. This blind trust defies all logic, but some find the cancer diagnosis so emotionally overwhelming, that dealing with any of the treatment choices is just more load on an already overloaded mind. They just defer to have things done to them, deferring to what they believe (or hope) is a great doctor.

I still respect your decision to choose your own path through this, but I find the logic of it all elusive. You clearly state that in doing without a PEG, it was painful to eat and drink, and that only through pain meds was doing this possible. That eating was time consuming in the extreme, and certainly far from pleasant, even painful. So given these points, why, if an easier path that required less pain, fortitude, potentially less medications, and discipline was available, would one not take it? None of what you have stated yields a tangible benefit to the decision to go without. That you didn't have to undergo a minor surgical procedure would be one, or that you might have been one of the few who develop some complication, could be added to a list of potential benefits, but I think you paid dearly and unnecessarily for them.

You may be the exception in many ways because of your high muscle mass ratios even at your age, your tolerance for pain, or more. Those qualities perhaps do not define the average person on this path. They do not even define the average American, who is too often like your doctors, out of shape to the extreme, and if like me, a whiner of extraordinary intensity. Given this, while I applaud your fortitude, and especially your seeking of information that would allow you to make good decisions, I do not think your example is ideal for the bulk of individuals.

I also do not think that this thread has taken a negative tone. I do not sense it in your post, and I did not intend it in mine. If we are going to explore something, it will require people to dissect opposing perspectives until we distill an appropriate end. We could choose to not do this, but then anything could be said on the boards whether or not it was valid, applicable to the common experience, or even harmful. That would be unacceptable.

I would like to say, as in most things, there are no absolutes. To PEG or not to PEG certainly falls into that realm. But I think we should leave the discussion (and this hijacked message thread) with some thoughts, such as; excessive weight loss (as indicated by the original poster in this thread) is indicative of things which are not good happening to a person's health, at a time when it is compromised in other ways as well. That for those who wish to chance it, that they can certainly try to go without a PEG, until it become measurably obvious this is not the correct path for them. I myself fall into this group because I was dead set against getting one. By week 3.5, I had lost massive weight, and my doctors were not going to allow me down that path any longer. So I understand the motivation and the reality. I do not think that for those who wish to, particularly in elderly patients or those with other medical issues, that having a PEG installed prophylactically is unreasonable. If they do not use it, which in this group I think unlikely, they can always have it removed without incident or undue harm when the potential need for it passes. Using my gastro doc at MDACC, whom I spoke with today prior to this reply, as a reference point, more than 85% of all the head and neck patients that are receiving radiation at their institution end up with PEGs, sooner or later. That means that 15% manage without it, but in his opinion not without some loss of nutritional benefit and whatever unmeasured slowing in healing, loss of energy, reduced immune response, etc. that may entail. Those individuals also make up a disproportionate number of people that end up needing emergency hydration. I defer to his comments as someone who sees hundreds of patients a year, and is significantly more qualified to comment.

I think it is reasonable that people that ask about PEGs here on these boards get a full picture. That we clearly make the benefits of them known, mention the possible complications, and discuss the nutrition issues in detail. If someone wishes to mention that they were part of a minority that got through without one, so be it, but I do not think we should be advocating for what is a minority position here, and at treatment facilities. I do not believe that PEGs are common because doctors are failing to change with the times or technologies, but because the are still not only useful, but there are no significant other options for people at this time, a situation that may or may not change as treatments and technologies evolve. I have no problem with you or anyone saying they didn't have one, as long as that is said in context of an overall picture.

The only personal observation that I will make RESPECTFULLY, is that you are new to much of this, and when you have watched hundreds of individuals post or talked to them for several years, your perspective on this perhaps may change. You may develop the sense that your path was unique when compared to the many.