Jeremy Slater, M.D.: Physician Chooses His Own Hospital for Cancer Treatment
It’s been said that doctors make the worst patients. Nothing could be further from the truth in the case of neurologist Jeremy Slater, M.D., according to the two physicians who treated him for tonsil cancer. Dr. Slater is director of the Texas Comprehensive Epilepsy Program at Memorial Hermann-Texas Medical Center, the leading program in the southwestern United States for the diagnosis and treatment of epilepsy in patients of all ages.
During a December skiing vacation in Colorado, he noticed a swollen lymph node high on the right side of his neck.
“I thought I’d caught a cold, or that it might be related to my chronic sinusitis,” says Dr. Slater, who holds the Kraft W. Eidman Development Board Professorship in the Medical Sciences in the department of Neurology at McGovern Medical School at UTHealth.
When it didn’t subside in January, he saw his internist, who prescribed a course of antibiotics. “The antibiotics shrank it, but the lump didn’t disappear so we did a second course of antibiotics,” he says.
“In retrospect I should have gone to an ENT right away, but you want to believe that there’s nothing really wrong. You don’t want to think you might have cancer. As doctors we tend to think of our patients as the people who get diseases, and we get used to thinking of ourselves as bulletproof.”
By spring, Dr. Slater became more concerned and went back to his internist, who referred him to Amber Luong, M.D., Ph.D., an associate professor and research director in the department of Otorhinolaryngology-Head and Neck Surgery, who also directs a laboratory at the Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases. Dr. Luong’s primary research and clinical interests lie in the understanding and treatment of chronic rhinosinusitis.
By the time he saw her it was early May. “I was still in complete denial,” he says. “With her characteristic sense of humor, Dr. Luong said, ‘Well, it’s clearly not rhinosinusitis,’” he recalls with a laugh. “After examining me, she was concerned that it might be malignant and referred me to her colleague Dr. Karni.”
Later the same month he saw Ron Karni, M.D., chief of the division of Head and Neck Surgical Oncology and an associate professor in the department of Otorhinolaryngology at the medical school. “I’d been trying to cope with the idea that I might have cancer from the time I’d seen Dr. Luong, and there I was, sitting in Dr. Karni’s office with my wife, and he told me he wanted to do a fine-needle aspiration.”
About 80 percent of the patients seen by Dr. Karni and his partner Kunal Jain, M.D., present with an asymptomatic lump in the neck. “Like Jeremy, they’re not smokers or heavy drinkers but they find a lump,” Dr. Karni says. “When we did the needle biopsy in the office, we detected squamous cell carcinoma in his neck lymph. A more thorough exam showed Stage 3 tonsil cancer.”
Dr. Slater remembers it as the single most frightening experience of his life.
“We were waiting in the office. When Dr. Karni walked in and told us it was cancer, it was devastating,” he says. “I was very scared, but I have to say, he made it okay. It reminded me of something my wife told me when we first started dating years ago. She teaches medical students and always tells them that the primary job of a physician is to give hope. When she first told me this, I disagreed with her, but in dealing with my diagnosis of cancer I realized how true it is. While I was devastated and terrified, there was a part of me that listened to Dr. Karni and thought it would be okay. He didn’t sugarcoat it. It was clear to me that he knew exactly what he was doing. At that moment I knew I wouldn’t be going to MD Anderson for a second opinion because I had absolute confidence in him.”
After meeting with the members of Dr. Karni’s multidisciplinary team, Dr. Slater elected to undergo minimally invasive transoral robotic surgery (TORS) using the da Vinci® Surgical System, which offers advantages beyond traditional surgical approaches to the throat, especially in the region of the tonsils and tongue. “Rather than having to divide the lower lip or divide the jaw in the midline, we can approach these tumors directly through the mouth using the robot,” says Dr. Karni, who focuses his practice on head and neck cancers.
“The robot’s camera provides a highly magnified 3-D view around structures like the tongue and allows us to carefully remove cancers, along with a narrow rim of tissue around them. We assess the margins to make sure we’ve removed it all. TORS also allows for decreased radiation following surgery.”
In a quick and precise surgery, Dr. Karni performed a radical tonsillectomy and selective neck dissection, removing all the lymph nodes with cancer and preparing his patient for radiation therapy.
Before the procedure, he referred Dr. Slater to Kris Conley, CCC-SLP, who works with patients under the direction of Carolina Gutiérrez, M.D., director of TIRR Memorial Hermann’s Cancer Prehabilitation and Rehabilitation Program.
“Throughout radiation therapy and a month afterwards, I did the swallow exercises Kris taught me,” Dr. Slater says. “To her credit, by working on that I didn’t need to use a feeding tube and also didn’t need postsurgical rehabilitation for swallow.”
I hope reading about my experience will help other people be comfortable with treatment, and I also hope that it will encourage them to seek diagnosis and treatment early.”- Jeremy Slater, M.D.
Dr. Slater underwent six weeks of radiation therapy with Angel Blanco, M.D., a radiation oncologist with Mischer Neuroscience Associates in the Texas Medical Center and an associate professor in the Vivian L. Smith Department of Neurosurgery at McGovern Medical School. “If there’s anyone as genuinely nice, compassionate and professional as Dr. Karni, it’s Dr. Blanco,” Dr. Slater says. “I couldn’t have done better with the doctors I had in terms of their skill and ability to relate to patients. Dr. Blanco did IV hydration a couple times a week, which made a big difference.”
“We have incorporated much more aggressive hydration into our program here, which in our experience can improve the acute side effects that can result from radiation, including fatigue, skin reaction and energy levels,” says Dr. Blanco, who specializes in adult radiation oncology with an emphasis on breast, central nervous system and body stereo-tactic cases, and has expertise in Gamma Knife® radiosurgery, intensity-modulated radiation therapy (IMRT) and high-dose rate brachytherapy for cancer patients.
“The fact that Dr. Slater underwent a margin-negative dissection with TORS allowed for a lower dose of radiation.
We believe a modest reduction in dose, combined with hydration, speech and swallowing therapy, pain management, dietary support and other multidisciplinary components of cancer care, can reduce long-term toxicity and benefit the patient. He was also able to be treated unilaterally rather than bilaterally, which decreases both acute and late radiation side effects in the neck.”
Dr. Blanco describes Dr. Slater as the ideal patient. “He was a delight and joy to take care of,” the radiation oncologist says. “We don’t always expect that of physicians. He was full of insightful comments, questions and suggestions, which we appreciate in a patient.”
In the end, Dr. Slater regained 90 percent of his ability to swallow. “I feel like I was Dr. Blanco’s poster child,” he says. “I can eat anything, and 90 percent of my ability to taste has come back, which is wonderful because at the end of radiation therapy I couldn’t taste anything. I have to be honest. I was totally miserable the last month of radiation. Still, they made me laugh. The radiation oncology team was fabulous.”
Dr. Slater finished radiation therapy at the end of July and returned to practice on Sept. 1, 2016. “My associates in the epilepsy division did a heroic job of covering for me during my three-month absence,” he says. “As soon as I returned I was doing full clinics and went back on call. I keep the same schedule I had before and it’s been fine. I hope reading about my experience will help other people be comfortable with treatment, and I also hope that it will encourage them to seek diagnosis and treatment early, no matter how busy their schedules are.”
Dr. Karni attributes Dr. Slater’s fast recovery to the quality of care he received and his strength of character. “The old adage that doctors don’t make good patients didn’t apply to Jeremy,” he says.
“He’s tough and smart, and he asked the right questions. We’re always humbled to treat one of our peers.”
“In retrospect, the whole experience seemed really quick: diagnosis, PET scan, surgery scheduled and bam, let’s get it over with,” Dr. Slater says. “The entire team was professional and caring throughout my entire experience. Given the choice, I would rather not have had cancer. I’m fine now, back to work with a pretty scar on my neck, and I feel fabulous.”
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