Time reference:  
It has been 24 weeks since surgery (27 April being the 6 month point); 
radiation therapy (RT) ended one month ago on 9 March.

Overall health: 
I have reasonably good levels of physical and mental energy. I sleep 
reasonably well, although nerve pain in (see below) sometimes makes 
getting to sleep difficult.  My diet is ³normal², as is my weight.  
Overall, I am pleased with my general health.

Upcoming Appointments and Tests:
	I visit with Dr. Bilsky at MSKCC Thursday, 14 April.  A set of 
A/P and lateral X-rays of C- and T-spine will immediately precede this 
appointment.  If the films look OK, I may have the restriction of wearing 
the hard cervical collar in the car removed, enabling me to begin to 
drive again.
	I will also be bringing with me a copy of the CT and MR studies 
done in Boston that were used to determine the RT course of treatment.

Throat:
	My voice is close to normal, of good volume and projection both 
speaking and singing.  I have (temporarily?) lost a few notes at the top 
end of my vocal range, and lots of singing will leave me a bit "scratchy".
	I have no gagging or any other indication of any problem with my 
vocal chord operation.
	As noted in the close-out note from Mass General, there is some 
minor dysphagia, which I have had since even before surgery.  Thiere seems 
to be a small region at the back of my throat, roughly at tongue level, for 
which the swallowing mechanism is not working well.  Pieces of food get 
caught there infrequently and do not pose a problem for breathing.   
Careful chewing and a glass of water are the low-tech solutions.

Vision:
	My Hornerıs syndrome has highlighted my generally increased 
difficulty in reading.  A recent optometrist visit assured me that my 
vision overall is quite good and I am procuring a pair of reading glasses.

Use of Hard Cervical (Miami) Collar:
	I have not used the soft collar or the Philly collar in the last 
two months.
	I still have to wear the blue Miami collar while traveling by car, 
bus, plane or train.  However, other than that, I have totally discontinued 
its use as of 6 April and my rotational range of motion continues to slowly 
improve.  Once the automobile restriction is removed, I will start to drive 
again, starting with short trips over familiar terrain.  The need for 
wide-view mirrors will be investigated.

Weakness in Right Upper Extremity (RUE):
	I have met once with a physical therapist in Sayre (PA) as follow-up 
to my three PT visits at Mass General.  I have also resumed acupuncture 
with some specific attention being given this weakness.  
	Progress, while slow, is definitely measurable in both strength 
and range of motion.  On the occupational level, there are very few things 
that I wish I could do that are prohibited by this weakness.
	I have another PT meeting in Sayre Monday, 18 April.

Pain in Right Thumb and Forefinger:
	The nature and severity of this discomfort varies widely.  Sometimes 
it is in the very tips (last few mm, high severity, very low frequency), 
almost always in the pads (varies from numbness to hypersensitivity to 
painful pins-n-needles), sometimes in the joints (particularly of the thumb), 
sometimes along the shafts (usually hypersensitivity, and usually limited to 
the side facing the other digit involved) and occasionally extending to the 
base of the wrist below the thumb on the back of the hand.
	It is not clear that my 2x200 mg Neurontin (5:30 PM and bedtime), or 
acupuncture, or herbal patches on the C-spine have any definite effect. 
	During the day this is mostly just annoying, but occasionally is does 
interfere with sleep at night.
	This is the area in which my health has not improved since leaving 
Boston and it may have actually deteriorated.  Of course a lot is "going on" 
right now; increased activity at work and at home, six sets of PT 
exercises per day, no longer wearing the cervical collar, etc.

Other Numbness and Pain:
	This last week I have developed some nighttime numbness in my feet, 
with the right big toe occasionally being somewhat painful.  This is 
relatively new, although I had small doses of this as long ago as last 
summer, before surgery and again post surgery while I still had a lot of 
edema in my feet and hands.  It seems limited to night and to lying down.
	The right side of my jaw, which as yet supports no hair growth, 
also tends to get numb if slept on.