“
What do you do for a living?” I asked.
“
I run all of the food services for a college.”
This was going to be a problem, I thought. His throat cancer was in the region of the tongue where his taste buds were most dense. I told him that there was a very real potential that his cancer treatment would forever lead to a loss of his sense of taste.
He was resolute, though. “
Do what you have to do.”
Seven weeks of radiation therapy were difficult for him. Fortunately, his cancer disappeared completely and never came back. I still see him regularly.
“
Tell me,” I ask, “
how are things going?”
“
At first, I could taste nothing! I worried if I would be able to continue working! Fortunately, my assistants helped immensely in the early days after treatment. I could taste next to nothing for a couple of years. Now, it seems that my taste is finally returning! Doc, do you think it will get all the way back to normal?”
There is no way to tell. Taste is a complicated sense that includes the integration of both his sense of smell and the interpretation of chemicals by the taste sensors in his tongue and throat. The treatments not only dulled his sensors but cause dryness which decreases the release of chemicals in his throat. Some of my patients tell me that foods they used to enjoy now bring them no pleasure. Sometimes, the opposite is true – foods they never liked are suddenly wonderful. There is no way to predict.
The dilemma of his loss of taste sensation in a professional that depends on his sense of taste came to mind when
Dr. Val told me about
a famous chef who is currently being treated for a large tongue cancer. His situation is unusual. He is only 33 years old (very young for tongue cancer). He has a very advanced (Stage IVB) tumor – cancers at this stage are rarely treated with surgery. Nevertheless, the articles about him make the point that he has opted to undergo non-surgical treatment hoping to better preserve his sense of taste.
I hope things go well for him. Based on my food services director’s experience, he might get his sense of taste back someday. Or maybe not. Or it might be altered. No one can predict.
The following is feedback received for this blog:
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Another great post!
- rl bates
http://rlbatesmd.blogspot.com/
I hope that your patient's taste sensation comes back all the way. I guess it's hard to prognosticate - are there any positive signs that would sway you one way or the other? In spinal cord injury medicine we wait 3 months before discussing likely functional outcomes. Do you have any milestones that you look for - like return of taste sensation within X weeks - to help with prognosis? A curious colleague... :)
- Val Jones
www.revolutionhealth.com/blogs/valjonesmd
Thanks for the comment and the suggestion to write about this. ... The functional return after radiation and/or surgery is very unpredictable. Taste sensation and salivary flow are both affected permanently and some people get very little return while others have great recovery. I tell people not to give up since the time course can show improvement over a couple of years. I really do not know what leads to the improvement, though - it isn't really analogous to the resolution of nerve compression.
Thanks again!
-Bruce
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