Hello Dr Joshi,I posted about our consultation with Dr Nutting and wanted to ask you about the choices that have been made available and will know more next week regarding surgery with brachytherapy.Will know more about this once he has had meeting with surgeon .Got the impression that Dr Nutting feels surgery may be the best option as Paul had terrible experience with RT first time round and reacted badly at end of 1st week and then by week 3 was admitted for Nutrapoenia Sepsis so he is obviously radiosensitive if that would be the right expression.

Have been reading Mimi and Petes updates on their experience with the IMRT .It definately seems so much better than they type Paul and most of the other mebers here have experienced although still traumatic .

My concen is that Paul will have to have the full set of this IMRT treatment minus one week although no Chemo but unsure as to how this will work out for him physiacally as he already has significant damage from fist time round,with the other original RT . Paul's mouth is totally bone dry and his nose is very congested with mucous etc although previous operation to remove a lot of the scar tissue has helped, also stiff neck on one side .

The second possible option is the brachytherapy and it may be the surgeon will only be able to gain access through the inside of Paul's mouth at the upper gum level I think .I wish we had asked more questions about this at time .Do you have any knowledge about the recovery in the mouth with this type of operation as regards to any nerve damage on top lip or maybe fistula formation where he may have speech damage, also his teeth etc .Think we understood about the RT being passed along the wire type structures attached to small pea shaped growth which be inside plastic tubing which would come down his nasal passages I think !!

His mouth is so dry already and wondering how healing would take place here.It all sounds a little scarey with the proceedure.

Was hoping you may have a little more information for us about this .I may be asking you too much here ,but feel he has an awful big decision to make here and want to have as much information as possible .He said the success rate was 30% and this has made Paul wonder even more about weighing treatment against quality of life .It has been a lot to take in and yeaterday and this morning he is starting to be more positive again and thinking things through more clearly .

Best wishes ,

Paul & Bell.

PS.Did mention your name to him and he smiled and said he knew you. Was a very charmig gentleman .