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We will soon know what’s inside my chest. My friend Shelley met us at the hospital at 7 a.m. on a bitter below-zero Wednesday, Feb. 22. The sun had not yet met the horizon, and the city was beginning to wake up. The hospital light looked dim in the surrounding dark, one of the only fully lit buildings downtown. Today’s patients and staff were trickling in by ones and by twos. There were three of us. It was biopsy day. After checking in, I stared at the woman behind the counter for a minute, confused. I needed directions to the lab and then IR Radiology. Not knowing where anything was located caused a few strange looks from the staff. How was I to know? It had been five years since I was in the hospital for a SVT ablation, and that took place across the street at the other hospital. And, what was "IRrational Radiology?" The whole day was efficient, to say the least. Wait time for lab was less than 15 minutes. The person drawing my blood was roly-poly and talkative. I tried not to engage. It was a somber, scary day for me. As the days passed ever so slowly, I found talking had became more and more difficult. The cough was deep and painful. Sometimes it felt like I would never catch my breath. Fatigue set in. I was grateful for a good night’s sleep before this procedure. The unidentified mass was in my right lung. I usually fell asleep on my right side, curled up, knees to my chest, until my husband came to bed. At that time, I switched sides to avoid an accidental elbow to the face. Eventually, I had to learn to sleep on my back. Although Dr. Curl told me later that there was no way I could have been squeezing my lung by laying on that side, I believe it did. However, sleeping on my right side became increasingly uncomfortable. My lung cried out in protest. The sound was more a protest than a wheeze. During an afternoon nap, which soon became a daily routine, I began batting at my pillow, thinking there was an insect buzzing near my right ear. Winter’s cold in the high plains usually meant the end to flying pests — it was my lung — crying. After the blood work, the three of us made our way to the inner sanctum of the lower level of the hospital. Somehow I avoided eye contact with the one person we knew in the entire hospital who happened to be waiting for the same elevator. Darn. I wasn’t really ready to share. I’m still not sure about sharing, especially before knowing what was going to happen to me. I didn’t want sympathy or questions for which were still no answers. We barely had time to settle into the waiting room before being called back to prep for the biopsy. First, the hospital gown; more like a half of a hospital gown. After all these years, you would think they could come up with something more comfortable and covering then the thin, washed up tie-in-the-back gowns that you can never really tie properly. One staff shared their thoughts on the gowns worn and faded condition. It was so people wouldn’t steal them. I guess that makes sense. I laughed for the first time that morning. I took my position as the center of attention on chair behind the curtain and looked forward to the heated blanket; but not looking forward to what came next, the IV. It creeps me out to have that needle thing on the back of the hand, although my veins are perfect for needles — close to the surface of brown spotted old hands bulging with blood. For years, nurses and phlebotomists openly admired my veins. Because the biopsy required me to put my hands over my head on the CT scanner, we opted for the IV to be placed further up on my wrist. Even creepier. My support group of two stopped by for a few minutes before I was escorted into the dimly lit scanner room. My spouse and friend listened carefully to the procedure instructions, followed by the wait time. Wow, the biopsy was over in a New York minute, but I had to stay until the puncture wounds sealed and the staff made sure my lung didn’t collapse — two or more hours. In the event something would go wrong it would mean an overnight in the hospital with a tube to inflate my lungs. I think they went to breakfast. Never having thought much about how lungs, filled with God’s breath (I might remember to talk about that later), are the ultimate source of life. After that first x-ray, before I knew about the biopsy, I Googled lungs. Lungs are funny organs. One has two lobes to accommodate the heart, and the other has three lobes. I heard they look like North Dakota’s winter trees, bare branches of all sizes shaped like an oval. I was surprised to learn after the biopsy, lungs are much higher on the back than I expected. I didn’t know what to expect. I never gave it thought until now. Under the influence of the IV sedative, before they carted me off to the “room,” I asked the doctor to remove his mask. I wanted to see the face of the man about to stick a needle in one of my precious lungs. He was quite handsome, and very young. In the scanner, a barely lit room, face down with my hands over my head, I realized what day it was and said to the young lady, the only person in my field of view, “It’s Ash Wednesday.” “What?” “Ash Wednesday. You know, the beginning of Lent. The 40 days of Lent (not counting weekends) before Holy Week and Easter,” I explained. “Oh.” I don't think it was on her radar. The biopsy was painless and over in a very short time. I waited back in my curtained cubical. My lung was fine, everyone was fine. No hospital stay or complications. “This isn’t so bad,” I thought. We heard nothing about the biopsy. The next day, Thursday, Feb. 23, was PET scan day. It occurred to me at this moment, Ash Wednesday, this day was the beginning of my Lenten journey. I did not emerge from my “nest” until Easter dinner at Ernie’s, 46 days later.
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- lung cancer
- tumors
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Almost every lung cancer survivor has a positron emission tomography (PET) scan these days. Now, a PET is often given with a computerized axial tomography (CT) scan. The diagnostician is a radiologist; a discipline that does not write in lingua franca. What do the report words mean? Here is a summary of my August PET-CT to interpret radiology speak. INDICATION: (Why am I getting this scan) “The patient…with non-small cell lung cancer of the right main bronchus diagnosed in 2003 status post pneumonectomy….He has undergone previous surgery for bronchopleural fistula repair…Chemotherapy last administered May 2006…Cyberknife therapy for recurrent disease in March 2007…He more recently has cough and chest discomfort.” That’s me, no doubt, but this summary is important. Radiologists see many scans and sometimes results are misreported. TECHNIQUE: (Test scope and method) Note details about the accuracy of the CT. “These images do not constitute a diagnostic-quality CT….” The CT results help to precisely map or locate the PET results but cannot generate a diagnostic grade image. COMPARISON: (Other scans reviewed while looking at this one). “Report only (no image reviewed) from PET-CT 3/8/2013. CT of chest and abdomen 8/22/17 (looked at image).” A CT scan is normally performed first. PETs follow and accuracy is enhanced if the radiologist has access to prior images. To improve access, have all your scans done at the same medical facility. FINDINGS: (The result) “…showed no convincing PET evidence of FDG-avid (fluorodeoxyglucose — radioactive tagged glucose seeking) recurrent or metastatic disease.” This is what we want to see in the first sentence. Then, the radiologist peels back the onion with detail. “There is mild heterogeneous hypermetabolism (diverse increased rate of metabolic activity)…with a few small superimposed foci (above the hypermetabolic area that is of particular interest)…more intense activity showing a maximum SUV of 3.5 (SUV — standardized uptake value)….When compared to [past reports] uptake…showed SUVs ranging from 2.6 to 2.9. This is strongly favored to be inflammatory.” Relief —this is my chronic pain site caused by 3 thoracic surgeries in the same location! “A somewhat retractile appearing mass (drawn back into lung tissue)…in the left upper lobe is stable in size…This shows minimal uptake…and is most compatible with the site of treated tumor.” My CyeberKnife-fried tumor scar. I do love precision radiation! What are concern ranges for SUV uptake? First, consider what is measured — cellular metabolic rate; more simply is demand for glucose, the fuel of metabolism. Cells with high metabolism ingest more tagged glucose. The PET shows differences in consumption (uptake). SUVs below 2.0 are normal. SUVs above 2.0 are suspect but between 2.0 and 4.0, uptake could be from injury or inflammation. Readings above 4.0 tend to be cancer but there can be other explanations. Higher than 4.0 is likely cancer, especially when paired with a CT find. Cancer demands glucose to fuel mitosis or growth by cellular division. Get and keep copies of all your diagnostic imaging. Keep track of the findings. I use a spreadsheet to record date, location and indications. Dr. Google is a great source for medical definitions. The best possible outcome for any scan is NED (no evidence of disease). May NED be with you. Stay the course.
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- diagnosing lung cancer
- pet scan
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"Count-off...One, Two...Count-off...Three, Four...Bring it on down now...One, Two, Three, Four, One-Two...Three-Four!" My life is filled with counting. As a young soldier on the march, we counted cadence to stay in step. The rhythm of the cadence was an elixir to the mile-upon-mile-upon-mile of forced march in full combat load. They always scheduled the forced march on the hottest day, or the wettest day, or the coldest day of the year. One memorable march was the day after a hurricane! Weather or not, we marched and counted. After diagnosis with lung cancer, my life embraced a different sort of cadence. There was the countdown to scan day, then time stopped waiting for results. One...what time is it...just ten in the morning...the clock battery is out...is it back...how bad...how many nodules...how big...ten-oh-two...mets in the bones...liver also...scan tech didn't smile...he saw something...ohGod.... Life just stopped waiting for results. Time stopped! Waiting for scan results is absolute misery coupled with measured doses of agony and anguish, torment, despondency and gloom thrown in for good measure! Each day was a twenty-five-mile forced march that started but never ended. Cancer sucks but waiting for scan results sucks squared! Stay the course.
- 3 comments
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- scanziety
- waiting for scan results
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I was diagnosed with stage 4 lung cancer in January 2016. Started Opdivo in June after 6 sessions of platinum chemo. Each ct scan has shown no new growth and no new cancer, which is good. My last ct scan showed no growth in the original spot on my lung but did show several new minuscule spots. My oncologist and myself decided to continue the current Opdivo therapy and revaluate with the next ct scan in 7 weeks. Has anyone had this experience with Opdivo and if so, was there improvement when the original treatment was continued or more growth and a switch to a new therapy?
