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Weighing Surgical Treatment Option

Newly Diagnosed

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I really appreciate this forum, deeply. I've already encountered experienced & supportive response to my introduction.
As I mentioned there, I'm really very lucky: we're talking about a mixed nodule ( grey and solid ) of the following dimensions:
3.0 x 1 2.0 cm [ typo] (series 2 image 72), previously 2.8 x 2.4 cm and measured at a similar level, not significantly changed given differences in measurement technique.

The internal solid components measure up to 4 mm in a single focus (series 2 image 73) although there are multiple smaller solid foci.   

Having seen the radiological oncologist this week, I'm weighing the three options :

  1. continued observation
  2. surgery
  3. radiology

I'd like to set aside various "cognitive dissonances" ( some things that don't jibe ).

My biggest concern, right now, is that I practice daily Zen, which includes awareness of the ±21,000 breaths available each day.

I'm told the lung, like the brain, doesn't use its full capacity and so other areas could kick in, to compensate. 
I'm told that my nodule is in the upper lobe, which normally isn't used ( true ? ) 
I'm told that post-surgery, I'd still be able to climb a hill, but would get winded sooner.
What I wish to know isn't about climbing hills but the quality of my Zen breathing awareness — might I, following ample sufficient recovery, notice any
diminished capacity or quality of my moment-to-moment breathing ( which I've been noticing as I've been writing this post — and invite readers to do too, if they wish. )

No two bodies are alike, but I wonder if I may be able to ask a Zen meditator who's had a lung resection their experience  ( and how to go about researching that ).
Meanwhile, I know LexieCat and BridgetO have had resections and not noticed any insufficiency or change in quality of life and take that to heart. ( Amen )

I have a PET scan scheduled for a month from here, to see if anything's spread – and a 4th CT at that time to observe any growth. 

Then, both specialties want to roll up their sleeves and go to work. 

( I'm at UCSF.  I've asked Stanford if a 2nd opinion is possible there )

T G I F ( the 1st one of the year )  


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Alternatively, if anyone knows a yogi or mindfulness practitioner who's had lung surgery …  

Meanwhile, I'd love to hear more first-hand testimony / insights from anyone who's had lung surgery and experienced the lung compensating, finding homeostasis, and the how the adjustment finally feels...

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I'm not a yogi nor a mindfulness practitioner but have had lots of lung surgery experience and its affect on life after lung resection. In terms of scope, I lost my entire right lung and while that limited somewhat my physical activity (I can't run very far), it did not significantly alter my life.

I know almost nothing about Zen practice but I'll try and answer some of your questions.

Does the lung operate at full capacity during normal activities? No. There is air exchange at rest and air exchange at exercise and the latter requires more air.

Is the upper lung lobe normally used? I wouldn't know. I'm sure all lobes are used to support respiration but would think normal respiration cycles vary from person to person. The architecture of the lung with bronchus tubes branching from the main stem to each lobe suggests that the upper lobe is used during each respiration cycle, at least by design.

I can climb a hill post surgery? My climb may not be robust and depending on the slope, I may need a short rest but I can climb hills and stairs with about 30% total effective pulmonary capacity.

I don't know anything about Zen breathing awareness or other Zen practices and can't offer a response.

I'll offer my comments on your 3 stated options. My way of looking at a lung cancer and effective treatment is to select the treatment that is best able to stop the disease and prohibit recurrence. Of the three alternatives you mention, surgery is the most effective treatment. Lung cancer is so very dangerous because it recurs frequently after curative treatment. My understanding of your diagnostic stage is perhaps IA or IB, a single tumor without lymph node involvement. The most effective treatment for stage I disease is surgery and removing a lobe to remove a tumor within the lobe minimizes the concern about surgical margins and the like. Often lobe resection can be performed robotically and that dramatically reduces trauma and accelerates recovery time.

If your PET shows no other areas of metastatic disease, I'd choose surgery as my treatment method. The CT enlargement of the tumor suggests metastatic disease is present and this rules out doing nothing. If the PET SUV shows no metastatic disease for your tumor, then do nothing becomes a viable alternative. Here is an explanation of SUV that might interest you.

Precision radiation can be an effective substitute for surgery. But, is this method the best treatment for you now? Understand, I am a fan of precision radiation; it saved my life but it was a treatment method because surgery was not. After my pneumonectomy, tumors metastasized to my left lung, and surgery was off the table. The downside about precision radiation as your initial treatment is it rules out a surgeon putting actual eyes on your tumor and lung to confirm what scans are suggesting. Radiation might preserve some lung real estate but it is, my view, the second best method for dealing with your disease at this juncture.

If it were me, I'd press to move up the PET scan. Because irradiated glucose is the diagnostic agent, there is no need to wait to determine metastatic activity. I'd want to move quickly to get to treatment before cancer has a chance to spread.

Welcome here. 

Stay the course.



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Tom really hit on all the salient points.  I can only add my own experience which is that the pulmonary test I took 6 months after the resection I scored higher on than the one taken prior to surgery.  The reason was that prior to surgery I upped my 5-mile/day routine to 6 miles and increase incline and speed.  This helped me to better condition my lungs and muscles and after surgery I was able to pretty quickly regain that conditioning.  So, yes, if I'm carrying boxes upstairs with 40-60lbs of weight in them I can get breathless, but it's likely non-LC folks could as well.  I would say do all you can aerobically to improve your condition.  I've done yoga and regularly meditate and use controlled breathing, but taxing your system is the only way to truly get it to become more efficient.  I haven't heard that can be accomplished via breathing alone (although spirometers are a great tool).  Best of luck.


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