Paging Steph......and any other cognoscenti.... "more details"

Hi Steph... saw your reply thanks a lot... if you could PM me... I can send
you more details with the names/specifics of the two surgeons involved...I
talked again to the endoscopic guy this morning, and will be talking to the
pervious one this afternoon... please bear with me for the long post... I
have a real nutcracker of a dilemma, but need to make a quick decision and
need a pro's opinion: I have muscle disease in my limbs for which they have
suspended treatment until cancer surgery and this limb pain kills me...
cancer does nothing... plus, I am a voice pro, and so, I need to know which
one will not cause degradation of voice quality (not just the "hoarseness"
thing, I have to worry about tonal quality and range- there is no clear
literature for this- open or endoscopic).

Option 1: Endoscopic guy- 1" incision max; does 40% endoscopic surgeries on
a selective basis, does 100 thyroidectomies a year; no career stats on voice
loss; "minimally invasive" mantra; says his procedure will be tailored to
suit me and is not the simple "video assist"; is an ENT who specializes in
thyroid surgery. He says he doesnt remove lymph nodes during surgery, UNLESS
he can feel them and knows they are infected also, expects RAI to get them
later on; says if RAI doesn't get anything, I'll need a second procedure
anyway, be it endoscopic or open; based on my U/S scans he thinks I don't
have to worry about spreading to lymph nodes. Doesnt even want to look at my
second U/S scan which did a lymph study. Said he offered me endoscopic since
he thought I was a good candidate for it, given what I needed done. promises
to be extra careful with my cords. My tumor is 0.5" at max diameter.

Option 2: Open surgery- 2-3" incision with central neck dissection, did do a
lymph study and concluded that it hasnt spread; 0.04% chance of voice loss
over career; 1000+thyroid operations; 1-2% chance of loss of voice quality.
He said "endoscopy is a gimmick... went to Italy and learned it.. no medical
advantage offering it... so we stopped doing it.." but sure as hell
cosmetic advantage for some one else (not my concern of course..)

First guy is part of a top-ranked ENT department and says he is publishing
regularly about safety of his techniques and claims he has proved it is
safer or at least as safe as open surgery; Second person is also from a top
facility... and is supposed to be among the "top endocrine surgeons in the
country" according to the brochure

Neither has a clue about voice quality, since they haven't operated on pros
before.. I am their guinea pig Of course, there are no clear articles
about voice quality in general, and "pro" folks in particular...

Now, ignoring the voice aspect, I am really tempted by the endoscopic
option-- it is in town for me, smaller incision, lesser pain, I don't need
to travel to the east coast etc. but if it is a foolhardy option, I would
well avoid it... (not worried about size of scar... size of my biceps may be
)

Also, specificially, I came across about 6-7 journal articles that claim
endoscopic is just as safe- mainly from the Italian guy who pioneered this
for thyroid- from what you say about credible evidence, do you think these
articles hold no water? Specifically.. how about this paper?
http://www.springerlink.com/content/t7q313088217031v/

In the US, most endoscopic surgeons are in their 40s at best, and several of
them were trained in it, in Italy. I have spoken to a few about "voice"...

Obviously "voice" worries me more than the cancer itself! So, I hope Steph
and y'all don't mind my flood of info..

Thanks to steph and any others who have thoughts...

"el zorro" <zorrothefox@adelphia.net> wrote in message
news:jtadncY-HIS0--PanZ2dnUVZ_tKinZ2d@comcast.com...
> Hi Steph... saw your reply thanks a lot... if you could PM me... I can
> send you more details with the names/specifics of the two surgeons
> involved...I talked again to the endoscopic guy this morning, and will be
> talking to the pervious one this afternoon... please bear with me for the
> long post... I have a real nutcracker of a dilemma, but need to make a
> quick decision and need a pro's opinion: I have muscle disease in my limbs
> for which they have suspended treatment until cancer surgery and this limb
> pain kills me... cancer does nothing... plus, I am a voice pro, and so, I
> need to know which one will not cause degradation of voice quality (not
> just the "hoarseness" thing, I have to worry about tonal quality and
> range- there is no clear literature for this- open or endoscopic).
>

No PM's I'm afraid........too many loonies around.

I'm unable to pass opinions on either your surgeons or your singing.

It's not the number of thyroidectomies your endo guy has done, it's the
number he's done for cancer that matters. Most thyroidectomies are not for
cancer.

If it were me, I'd go the conventional route, but you're in the driving
seat. Sounds to me like your conventional surgeon has a better handle on the
stats, btw.

right. the endo guy is a thyroid cancer specialist and is both at the local
cancer institute and ENT department, but there is the clear chance not all
100 a year are cancer operations. I can press him for cancer-stats monday.
What worries me is what he says about "not operating more than necessary"
and not wanting to see Ultrasounds of lymph nodes, and expecting RAI to pick
it up, since there is no spread/tumor he can "feel". Is this a valid
approach or is it foolhardy?

Do you think all those guys frm Italy who have published that endo is safe
arent credible? As a researcher from an "other" field, I obviously cannot
tell. It only sounds to me, from the outside, like there are two schools of
thought... apparently they are trigger happy with endo in Asia, and not so
in the West etc.

Personally, I am leaning towards the endo approach because multiple people
have told me mine was a routine case, and the endo operation keeps it
simple, and my ENT whom I REALLY trust, recommended this guy and his
technique highly to me... my ENT is one of the best globally, and a terrific
person to boot... and I havent heard anything from the endo that would cause
my alarm bells to go off. barring this lymph theory, that I don't get.



"Steph" <steph@vancouvers.island> wrote in message
news:7cCfj.5609$EA5.2809@pd7urf2no...
>
> "el zorro" <zorrothefox@adelphia.net> wrote in message
> news:jtadncY-HIS0--PanZ2dnUVZ_tKinZ2d@comcast.com...
>> Hi Steph... saw your reply thanks a lot... if you could PM me... I can
>> send you more details with the names/specifics of the two surgeons
>> involved...I talked again to the endoscopic guy this morning, and will be
>> talking to the pervious one this afternoon... please bear with me for the
>> long post... I have a real nutcracker of a dilemma, but need to make a
>> quick decision and need a pro's opinion: I have muscle disease in my
>> limbs for which they have suspended treatment until cancer surgery and
>> this limb pain kills me... cancer does nothing... plus, I am a voice pro,
>> and so, I need to know which one will not cause degradation of voice
>> quality (not just the "hoarseness" thing, I have to worry about tonal
>> quality and range- there is no clear literature for this- open or
>> endoscopic).
>>
>
> No PM's I'm afraid........too many loonies around.
>
> I'm unable to pass opinions on either your surgeons or your singing.
>
> It's not the number of thyroidectomies your endo guy has done, it's the
> number he's done for cancer that matters. Most thyroidectomies are not for
> cancer.
>
> If it were me, I'd go the conventional route, but you're in the driving
> seat. Sounds to me like your conventional surgeon has a better handle on
> the stats, btw.
>

I think I should have said "head and neck" cancer specialist... he heads the
head/neck cancer department at the local oncological institute... his
procedure is similar to Inabnet's at Columbia, but is "general" anasthesia
in my case, and night at hospital, not same day...


"el zorro" <zorrothefox@adelphia.net> wrote in message
news:LoCdnRC-GvCRYOPanZ2dnUVZ_hynnZ2d@comcast.com...
> right. the endo guy is a thyroid cancer specialist and is both at the
> local cancer institute and ENT department, but there is the clear chance
> not all 100 a year are cancer operations. I can press him for cancer-stats
> monday. What worries me is what he says about "not operating more than
> necessary" and not wanting to see Ultrasounds of lymph nodes, and
> expecting RAI to pick it up, since there is no spread/tumor he can "feel".
> Is this a valid approach or is it foolhardy?
>
> Do you think all those guys frm Italy who have published that endo is safe
> arent credible? As a researcher from an "other" field, I obviously cannot
> tell. It only sounds to me, from the outside, like there are two schools
> of thought... apparently they are trigger happy with endo in Asia, and not
> so in the West etc.
>
> Personally, I am leaning towards the endo approach because multiple people
> have told me mine was a routine case, and the endo operation keeps it
> simple, and my ENT whom I REALLY trust, recommended this guy and his
> technique highly to me... my ENT is one of the best globally, and a
> terrific person to boot... and I havent heard anything from the endo that
> would cause my alarm bells to go off. barring this lymph theory, that I
> don't get.

"el zorro" <zorrothefox@adelphia.net> wrote in message
news:LoCdnRC-GvCRYOPanZ2dnUVZ_hynnZ2d@comcast.com...
> right. the endo guy is a thyroid cancer specialist and is both at the
> local cancer institute and ENT department, but there is the clear chance
> not all 100 a year are cancer operations. I can press him for cancer-stats
> monday. What worries me is what he says about "not operating more than
> necessary" and not wanting to see Ultrasounds of lymph nodes, and
> expecting RAI to pick it up, since there is no spread/tumor he can "feel".
> Is this a valid approach or is it foolhardy?
>

I wouldn't worry about nodes. It's the thyroid which has to come out -
completely.

> Do you think all those guys frm Italy who have published that endo is safe
> arent credible? As a researcher from an "other" field, I obviously cannot
> tell. It only sounds to me, from the outside, like there are two schools
> of thought... apparently they are trigger happy with endo in Asia, and not
> so in the West etc.
>

How many of those Italian ops are cancer? The paper didn't say.

> Personally, I am leaning towards the endo approach because multiple people
> have told me mine was a routine case, and the endo operation keeps it
> simple, and my ENT whom I REALLY trust, recommended this guy and his
> technique highly to me... my ENT is one of the best globally, and a
> terrific person to boot... and I havent heard anything from the endo that
> would cause my alarm bells to go off. barring this lymph theory, that I
> don't get.
>
>

Go with what you think is best. But thyroid surgery for small cancers is
standard stuff for a good head and neck surgeon, with excellent results. I'm
just telling you what I (as an oncologist specialising in thyroid cancer)
would do. It sounds like you've made your mind up, and "a man hears what he
wants to hear, and disregards the rest" as Paul Simon sang.

Actually, I was dead set against the endo and preferred the "focused"
endocrine surgeon ... but the negatives I heard from the ThyCa group and
elsewhere from the surgeons I talked to, were mainly from people who hadnt
had or hadnt done endoscopic. But, when I talked to the endo again and the
open person again yesterday, and found that the endo's particular technique
was common in New York, and he was no quack. I am skeptical about either
surgeon's complacence "Mine is the best" view, and am leaning towards a
"simpler for me" procedure, since my thyca is only a detour, and far less
painful and not life-stilling like my limb disease. The local medical
college have given up on treating my medical disease and told me to show up
at the Mayo even for a diagnosis...

My general physician was enthusiatic about either surgeon, but I took that
with a grain of salt, since I knew he didn't know either person personally,
nor followed their work.

Yes, I noticed too that that paper and several others didnt say "cancer"; I
think there was one that did.

To split hairs, the endo operates cancers regularly and publishes on
head/neck cancer mainly not thyroid and as his PhD is in immunology, most of
his papers are from that field. I wouldnt know if that disqualifies him to
any extent as a thyroid surgeon; in my field this would be a rather
coarse-grained and clear difference....

Not having to worry about lymph is reassuring; that was the oddity. Under
what circumstances- or how could the endo screw up- in removing the entire
thyroid? Is he disadvantaged severely as compared to an open surgeon?

Btw, he does have me stay overnight for Calcium monitoring due to the
potential parathyroid removal.


"Steph" <steph@vancouvers.island> wrote in message
news:H5Gfj.8227$EA5.2351@pd7urf2no...
>
> "el zorro" <zorrothefox@adelphia.net> wrote in message
> news:LoCdnRC-GvCRYOPanZ2dnUVZ_hynnZ2d@comcast.com...
>> right. the endo guy is a thyroid cancer specialist and is both at the
>> local cancer institute and ENT department, but there is the clear chance
>> not all 100 a year are cancer operations. I can press him for
>> cancer-stats monday. What worries me is what he says about "not operating
>> more than necessary" and not wanting to see Ultrasounds of lymph nodes,
>> and expecting RAI to pick it up, since there is no spread/tumor he can
>> "feel". Is this a valid approach or is it foolhardy?
>>
>
> I wouldn't worry about nodes. It's the thyroid which has to come out -
> completely.
>
>> Do you think all those guys frm Italy who have published that endo is
>> safe arent credible? As a researcher from an "other" field, I obviously
>> cannot tell. It only sounds to me, from the outside, like there are two
>> schools of thought... apparently they are trigger happy with endo in
>> Asia, and not so in the West etc.
>>
>
> How many of those Italian ops are cancer? The paper didn't say.
>
>> Personally, I am leaning towards the endo approach because multiple
>> people have told me mine was a routine case, and the endo operation keeps
>> it simple, and my ENT whom I REALLY trust, recommended this guy and his
>> technique highly to me... my ENT is one of the best globally, and a
>> terrific person to boot... and I havent heard anything from the endo that
>> would cause my alarm bells to go off. barring this lymph theory, that I
>> don't get.
>>
>>
>
> Go with what you think is best. But thyroid surgery for small cancers is
> standard stuff for a good head and neck surgeon, with excellent results.
> I'm just telling you what I (as an oncologist specialising in thyroid
> cancer) would do. It sounds like you've made your mind up, and "a man
> hears what he wants to hear, and disregards the rest" as Paul Simon sang.
>

Steph, btw... if you would indulge me... PubMed.gov did come up with a bunch
of papers on endoscopic for thyroid cancer, claiming it was fine... though
most were not from the US... I didnt even seen the ones my endoscopic
surgeon says he has written... though they could be in print.


"el zorro" <zorrothefox@adelphia.net> wrote in message
news:d82dneiXn-LqP-LanZ2dnUVZ_j6dnZ2d@comcast.com...
> Actually, I was dead set against the endo and preferred the "focused"
> endocrine surgeon ... but the negatives I heard from the ThyCa group
> and elsewhere from the surgeons I talked to, were mainly from people who
> hadnt had or hadnt done endoscopic. But, when I talked to the endo again
> and the open person again yesterday, and found that the endo's particular
> technique was common in New York, and he was no quack. I am skeptical
> about either surgeon's complacence "Mine is the best" view, and am leaning
> towards a "simpler for me" procedure, since my thyca is only a detour, and
> far less painful and not life-stilling like my limb disease. The local
> medical college have given up on treating my medical disease and told me
> to show up at the Mayo even for a diagnosis...
>
> My general physician was enthusiatic about either surgeon, but I took that
> with a grain of salt, since I knew he didn't know either person
> personally, nor followed their work.
>
> Yes, I noticed too that that paper and several others didnt say "cancer";
> I think there was one that did.
>
> To split hairs, the endo operates cancers regularly and publishes on
> head/neck cancer mainly not thyroid and as his PhD is in immunology, most
> of his papers are from that field. I wouldnt know if that disqualifies him
> to any extent as a thyroid surgeon; in my field this would be a rather
> coarse-grained and clear difference....
>
> Not having to worry about lymph is reassuring; that was the oddity. Under
> what circumstances- or how could the endo screw up- in removing the entire
> thyroid? Is he disadvantaged severely as compared to an open surgeon?
>
> Btw, he does have me stay overnight for Calcium monitoring due to the
> potential parathyroid removal.
>
>
> "Steph" <steph@vancouvers.island> wrote in message
> news:H5Gfj.8227$EA5.2351@pd7urf2no...
>>
>> "el zorro" <zorrothefox@adelphia.net> wrote in message
>> news:LoCdnRC-GvCRYOPanZ2dnUVZ_hynnZ2d@comcast.com...
>>> right. the endo guy is a thyroid cancer specialist and is both at the
>>> local cancer institute and ENT department, but there is the clear chance
>>> not all 100 a year are cancer operations. I can press him for
>>> cancer-stats monday. What worries me is what he says about "not
>>> operating more than necessary" and not wanting to see Ultrasounds of
>>> lymph nodes, and expecting RAI to pick it up, since there is no
>>> spread/tumor he can "feel". Is this a valid approach or is it foolhardy?
>>>
>>
>> I wouldn't worry about nodes. It's the thyroid which has to come out -
>> completely.
>>
>>> Do you think all those guys frm Italy who have published that endo is
>>> safe arent credible? As a researcher from an "other" field, I obviously
>>> cannot tell. It only sounds to me, from the outside, like there are two
>>> schools of thought... apparently they are trigger happy with endo in
>>> Asia, and not so in the West etc.
>>>
>>
>> How many of those Italian ops are cancer? The paper didn't say.
>>
>>> Personally, I am leaning towards the endo approach because multiple
>>> people have told me mine was a routine case, and the endo operation
>>> keeps it simple, and my ENT whom I REALLY trust, recommended this guy
>>> and his technique highly to me... my ENT is one of the best globally,
>>> and a terrific person to boot... and I havent heard anything from the
>>> endo that would cause my alarm bells to go off. barring this lymph
>>> theory, that I don't get.
>>>
>>>
>>
>> Go with what you think is best. But thyroid surgery for small cancers is
>> standard stuff for a good head and neck surgeon, with excellent results.
>> I'm just telling you what I (as an oncologist specialising in thyroid
>> cancer) would do. It sounds like you've made your mind up, and "a man
>> hears what he wants to hear, and disregards the rest" as Paul Simon sang.
>>
>
>

"el zorro" <zorrothefox@adelphia.net> wrote in message
news:d82dneiXn-LqP-LanZ2dnUVZ_j6dnZ2d@comcast.com...
>
> Not having to worry about lymph is reassuring; that was the oddity. Under
> what circumstances- or how could the endo screw up- in removing the entire
> thyroid? Is he disadvantaged severely as compared to an open surgeon?
>


The throid is like wallpaper plastered to the trachea. The recurrent
laryngeal nerves are buried in it. I would want my surgeon to have the
maximum exposure to do the job right.