Notes from meetings at Memorial Sloan Kettering
21 October 2004

	The first meeting was with Dennis Kraus, who is a 
neck surgeon.  He did look at my vocal chords (he is the
MemS-K point-man for voice and such) and take a few picture
(the vowel "eee" seems to be a good one for getting your
chords to pinch together!).  For this surgery, however, he
admitted he was little more than a "can opener" who gets
various structures (such as jugular vein) out of the way so that
Mark Bilsky can get to work.  There is little danger that the
vocal chords will be compromised, and there is remedial surgery
if they are.

	Next we met with Raja Flores and one of his "fellows",
who are thoratic (Chest) surgeons.  Again, they are there to provide
access to the area under my clavicle.  The extent of his incision
will depend on Bilsky's needs.  In any case there will be bone to
cut through (and heal) and a tube inserted in my right side in that
the lung will have to be somewhat folded during the retraction.

	The meeting with Mark Bilsky and Stephanie (his clinical
nurse) were very short in that they were running rather late and
we had a bus to catch to our flight to Elmira.  It was clear that I
would spend at least one night, and perhaps two, in a heavily monitored
post-neuro care room (not quite at the level of ICU, but close).
	I spoke further with Bilsky Friday, 22 Oct.  There are three option
for the anterior work on the spine after removing the two infected
vetebral bodies.  Originally he thought a titanium "cage" packed with
bone-bank bone and titanium flanges would be needed.  However, he now
thinks the span is small enough that the flanges can be replaced by 
a tibular shank (properly sanitized!) ... and not MY tibular shank.  
A third option would be to use new FDA-approved materials that seem to
promote bone growth ... not a good idea in his opinion if malignancies
are involved!
	The posterior will still have a metal brace screwed to the
vetebral wings.  There will be bone grafts overlaid from my ilium
(ouch!).  While the metalwork is very good short term, the overlaid
bone will help insure long term stability in that the metal will
eventually fatigue.
	He will want to see me 2 weeks from the surgery to remove
sutures and take an X-ray of the C-spine.
	Once surgery is over, he will contact Mass General about
proton beam radiation.