Page Launched: January 2022
Thomas C. Sielatycki
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sielatycki-ct-jan-4-2022.pdf |
sielatycki_ct_-_jan_18-2022.pdf |
sielatycki-ct-feb-3-2022-borgess-ascension-kalamazoo.pdf |
sielatycki-ct-march-4-2022.pdf |
blood-lab-02-03-2022.pdf |
biopsy-sielatycki-tom-from-01-07-2022.pdf |
History
Healthy 54 year old male with history of acid reflux initially controlled by Nexium and then resolved by diet. Family and personal history of high cholesterol that is controlled by daily 80mg tablet of Pravastatin. Youngest of 7 children with both parents deceased. Father, John, died of heart attack at 54 (Tom was 9) and Mother, Dolly, died in 2017 at 89 years old. Older brothers and sisters are still living except nearest sibling, Lora, who died in 2018 of breast cancer at age 54. Current weight of 215 lbs, Tom lost 40 pounds from March 2020-December 2020 via a modified KETO diet and has continued to maintain the previous typical weight. Married to Danielle who is a non profit CEO, son Jack (19) is college baseball player, and daughter Lucy (17) is a senior in high school at Portage Northern. Tom is active with golf and lake activities but does NOT currently exercise on a regular basis.
November 28, 2021 - Problems Begin
Symptoms of sore throat, sinus, and hoarse voice started on or about November 28, 2021 after screaming at the Michigan vs Ohio State Football game. Symptoms persisted and Family doctor prescribed 5 day Zpack (Azithromycin) on December 2, 2021. Tom attended the Michigan vs Iowa Big Ten Championship game on December 4, 2021 and subsequently lost his voice completely. Borgess urgent care prescribed a 10 day course of Augmentin 875mg on December 10, 2021. Tom also received an oral steroid during the visit. Tom started that prescription for 4 days and was feeling better so he stopped the pills (I understand it's not the right thing to do). On December 23, 2021 the sore throat symptoms returned so Tom returned to the urgent care and received another oral steroid and then restarted and completed the remaining Augmentin.
December 27, 2021 thru January 2, 2022 - Relief!
Tom traveled with his family to Florida and his symptoms nearly disappeared from December 29, 2021-January 2, 2022.
January 4, 2022 - University of Michigan Emergency Room
The symptoms of sore throat returned on January 3, 2022. Tom visited his dentist, Dr. Michael Leonard, on January 4, 2022 and he recommended a CT scan with an ENT. The referral was being pushed off weeks in Kalamazoo and the symptoms of soreness and swallowing seemed to be worsening, so Tom drove to the University of Michigan Emergency Room on the evening of January 4, 2022 and was diagnosed with two masses about 2 cm in the base of the tongue and smaller mass in a nearby facial muscle.
The ER doctor identified the mass by CT with contrast as "99% squamous cell carcinoma". It is described in the report (attached) as two lesions in the tongue, one in the base of tongue/vallecula and one deep in the geniohyoid muscle.
The ER doctor identified the mass by CT with contrast as "99% squamous cell carcinoma". It is described in the report (attached) as two lesions in the tongue, one in the base of tongue/vallecula and one deep in the geniohyoid muscle.
sielatycki-ct-jan-4-2022.pdf |
January 7, 2022 - Dr. Lindsey Moses, Biopsy
Dr. Lindsey Moses, MD (Fellow) at University of Michigan was assigned to follow up with Tom. She performed a Direct laryngoscopy with biopsies on January 7, 2022. Dr notes... A toothguard was placed and a dedo laryngoscope was used to examine the oral cavity, oropharynx, larynx, and hypopharynx. No mucosal lesions or abnormal findings were noted. The patient was placed in suspension and multiple biopsies were taken from the expected location of the lesion on CT in the right base of tongue. Frozen section analysis showed benign tissue on all specimens. A core biopsy to reach to the pre-epiglottic space was attempted but was not possible given the length and position of the laryngoscope. Immediate results of the biopsy's were negative and the official pathology was also negative, reported on January 13, 2022.
Attached Reports
Mucosal surface: Irregular lesion in the base of tongue area measuring 1.6 x 1.1 x 1.9 cm (AP by TR by CC) (series 3, #82 and series 900, #76). Peripheral enhancement with central hypoattenuation. The lesion causes effacement of the right vallecular fossa and associated thickening of the epiglottis. Additional enhancing lesion just anterior to the hyoid in the region of the geniohyoid muscle, likely satellite lesion, measuring 1.4 cm in anteroposterior dimension (series 900, #78). VIEW REPORT (PDF)
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January 11, 2022 - Dr. Keith Casper, Michigan Medicine
Dr. Casper reviewed the medical records and performed an exam on January 11, 2022. The lesion is "unidentifiable" and could be either an infection, and/or cancer. It is medically coded as a "neoplasm of uncertain behavior of base of tongue". Dr. Casper noted that the vocal cords and tongue looked clean. Dr. Casper also said that the location of the mass is not typically where he would expect to see cancer. Dr. Casper has scheduled a follow up CT scan with contrast with an office visit on Tuesday January 18, 2022. Dr. Casper also scheduled another surgical biopsy "with curved tool" on Wednesday January 19, 2022 to attempt to locate the difficult to reach mass in the base of the tongue. The interventional radiologist was NOT confident that he could access the tumor with the CT guided method. Tom gave a blood sample via a NavDx kit to test for HPV with results negative.
Plan of Attack #1
CT with contrast scheduled for Tuesday January 18, 2022 at 11:10am
Follow up visit with Dr. Casper on Tuesday January 18, 2022 at 2:45pm
Surgical Biopsy with "curved tool" to be done on Wednesday January 19, 2022 (if needed)
NOTE: IR Biopsy is not possible per discussion with the interventional radiologist
Follow up visit with Dr. Casper on Tuesday January 18, 2022 at 2:45pm
Surgical Biopsy with "curved tool" to be done on Wednesday January 19, 2022 (if needed)
NOTE: IR Biopsy is not possible per discussion with the interventional radiologist
January 18, 2022 - RESULTS
The CT ordered by Dr. Casper unveiled that the two lesions are resolving. One lesion in the geniohyoid muscle is essentially gone. The lesion in the base of the tongue has significantly reduced. So biopsy was cancelled. A follow up CT is scheduled for March 1, 2022. This is the best possible news.
sielatycki_ct_-_jan_18-2022.pdf |
January 18, 2022 thru January 31, 2022 - Relief for Two Weeks!
I had very few symptoms except some food trap when swallowing and felt like I was on the road to recovery with all of this behind me!
February 1, 2022 - Symptoms Return
My throat began to become sore again and I hoped it was a coincidental virus. When I awoke on February 2, 2022 my throat was as sore as it's ever been and the swelling was back in my neck and was painful to the touch. Dr. Casper ordered a CT Scan. Due to the snowstorm, I had the CT done in Kalamazoo at Ascension Borgess with Dr. Mark Shaman. A neuro radiologist read the report and identified the mass at the base of the tongue as as large as it's ever been recorded. However, he also said it was most likely infection and/or possible Vallecular Cyst. (SEE REPORT BELOW)
sielatycki-ct-feb-3-2022-borgess-ascension-kalamazoo.pdf |
Plan of Attack #2
I've already tried two courses of Augmentin (I understand that I cut one course short) and the lesion has come back stronger each time. I've asked the doctor if it would make sense to change the family of antibiotics. I'm even willing to do inpatient IV antibiotics if necessary. It's difficult to swallow and I'm in constant pain. If in fact, a vallecular cyst, will it keep coming back? Do we need to remove? Waiting on recommendations from the doctor.
POSSIBLE DIAGNOSIS: Vallecular Cyst?
POSSIBLE DIAGNOSIS: Vallecular Cyst?
February 4, 2022 - Status Update
Difficulty swallowing and swollen neck is painful to the touch. Most recent CT (02-03-22) indicates possible Vallecular Cyst and/or infection. Other possibilities are still being considered. Concerning questions are how to treat this moving forward? If antibiotics then which ones? In-patient IV? If it's a Vallecular Cyst, does it need to be surgically removed to avoid continuous recurrence?
February 8, 2022 - Phone Consultation with Dr. Casper
Dr. Casper's evaluation (Tom's Notes) ...
Most recent scan shows that this is more superficial or towards the surface.
Could be cystic with a bacterial element causing it to flare up
Not likely but close to "thyroid remnant"
He said that we should "remove the area" or "unroof it" by removing the mucosa (lining of the tongue)
Then send to pathology
It's right above and near the voicebox
He is planning a robotical surgery with Air tube thru the nose
Use angled camera with clamps to expose about 30% of tongue base
Risk is bleeding but they will not be going too deep so not a big concern
It'll be like getting tonsils removed and two weeks post soreness
Thinks it should be scheduled week of February 21st or week of March 1st
Most recent scan shows that this is more superficial or towards the surface.
Could be cystic with a bacterial element causing it to flare up
Not likely but close to "thyroid remnant"
He said that we should "remove the area" or "unroof it" by removing the mucosa (lining of the tongue)
Then send to pathology
It's right above and near the voicebox
He is planning a robotical surgery with Air tube thru the nose
Use angled camera with clamps to expose about 30% of tongue base
Risk is bleeding but they will not be going too deep so not a big concern
It'll be like getting tonsils removed and two weeks post soreness
Thinks it should be scheduled week of February 21st or week of March 1st
February 20, 2022 - Symptoms Return AGAIN!
Symptoms of sore and raspy throat are minor but have returned over the past 3 days. I completed my third course of Augmentin on February 16, 2022. After my CT on February 3, 2022, the doctor and neuroradiologist identified the mass in the base of my tongue as a "possible infected cyst". However, there has not been a true biopsy of the actual mass since it was diagnosed on January 4, 2022 as squamous cell carcinoma. I am awaiting surgery with Dr. Casper to remove the infected area with a "robotic surgery" sometime before March 11, 2022. Dr. Casper said to hold off on antibiotics.
February 22, 2022 - Cleveland Clinic
Secondary opinion from Dr. Eric Lamarre at the Cleveland Clinic. Dr. Lamarre did a physical examination, scope thru the nose, and evaluation of the previous 3 CT scans. He agrees with Dr. Casper that this is likely a cyst or thyroid remnant that should be removed and biopsied.
February 26, 2022 - Symptoms Return with a VENGENCE
While traveling in Florida my neck became very swollen and throat very sore. I started my next course of Amox-Clav 875 per Dr. Casper. The symptoms began to resolve 3 days later.
March 3, 2022 - Transoral Robotic Surgery at U of M
Dr. Casper performed a transoral robotic surgery to attempt to remove the mass at the right base of my tongue. After several attempts and consultation with several other surgeons, it was determined NOT to attempt the removal due to poor exposure of it's exact location. After consultation with my wife, it was determined to proceed with caution and discuss the next steps after another CT scan.
March 4, 2022 - CT Scan #4
The CT scan at University of Michigan indicates that the lesion in the right base of tongue has reduced to 5mm. (SEE ATTACHED REPORT ABOVE)
March 7, 2022 - Sistrunk (or variation of it) with Dr. Casper
It is determined by Dr. Casper that the best way to remove the cyst, lesion, or thyroid remnant is the cut thru the neck. This involves either removing a portion of the hyoid bone or circumventing it to remove the infected area. A determination of the extent and exact surgery will be made during the surgery and based on information known at that time.