January 7, 2022
Preface
On the surface, this post may not seem like a story about lung cancer. But the body changes with this disease. Perhaps I should say, the body changes with the treatments for the disease. I think this post, the one previous, and the one to follow, are about living with what happens after treatment, and for me, “after treatment” is just another part of my cancer story.
Part II Monday: Training to Glow In the Dark
As a cancer patient in the “active surveillance” phase, I have scans of body and brain every three months. In between, I might also have CT scans to see what kinds of mess might be causing trouble, e.g., impeding breathing.
Today I have body and brain scans, a PET scan for the body, and an MRI, for the brain. These will show if cancer is still active or migrated to another part of the body.
The PET involves a bunch of radiation. I tell my mother, in the event of a power failure, I’ll just enter a room and glow.
The PET
Preparing for the PET is straightforward. The day of, no food after 8:30 a.m. (4 hours before the test.) No caffeine. A low carb dinner the night before. (That was easy— after getting home from the ER past midnight, I gulped some plain yogurt and went to bed.) I get up at 8:00 and have a smoothie– I’m no dummy. My MRI isn’t over until 3:30 and there will be no time in between for lunch. Then I go back to bed. It seems like it’s only a few minutes before I have to get in the car and pick up Ruth. She’ll drive me home after the MRI.
What’s a PET?
A positron emission tomography or a PET scan is an imaging test that helps reveal how the tissues and organs are functioning. A PET scan test uses a radioactive drug called tracer to show this activity. The tracer is generally injected, swallowed or inhaled, depending on the site of organ or tissue being examined. The tracer collects in areas of the body that have higher levels of chemical activity, and that often corresponds to the area of diseases. On a PET scan, these areas show up as bright spots. ~https://www.medtravels.in/
These bright spots are said to be “hot”. You don’t want hot spots. They mean cancer. (Cancer cells have a higher metabolic rate than normal cells.)
Going into the test, the more relaxed the body and its internal pieces, the more accurate the results. So, part of the preparation is lying in a darkened room for 45-60 minutes. I jump when the technician touches my arm. I have had a big sleep.
I climb onto a table that will move me under the scanner. Each time the table moves, the PET scans the part beneath it, converting it to a 3D image. I care only that the blanket is warm.
After, the technician rushes me out– he’s got a time sensitive patient behind me. I’m not sure I want to see the pictures anyway. Ruth and I try to tell him we know the secret passages to the cancer center MRI, but he insists on escorting us to the right hallway. We begin the trek.
The MRI
Magnetic resonance imaging (MRI) is a medical imaging technique that uses a magnetic field and computer-generated radio waves to create detailed images of the organs and tissues in your body.
Most MRI machines are large, tube-shaped magnets. When you lie inside an MRI machine, the magnetic field temporarily realigns water molecules in your body. Radio waves cause these aligned atoms to produce faint signals, which are used to create cross-sectional MRI images — like slices in a loaf of bread. The MRI machine can also produce 3D images that can be viewed from different angles. ~The Mayo Clinic
There are two things about an MRI. First, that tube. It sounds easy, but after you’ve been moved into it, the tube is inches from your body. If you haven’t had claustrophobia before an MRI, there’s a good chance you will after.
The second is the noise. Nobody tells you it sounds like they’re building a subway tunnel around you. This is why, when I was first diagnosed, I decided I would always take any available drug before an MRI. Also, should you want to open your eyes– God, why would you– a cloth over your eyes helps you not freak out.
I have one pill– lorazepam–for the MRI. I am obsessing about when to take it. (After, I realize that if it has a 4-hour life span, I could have taken it before the PET and still have been happy in the MRI. Oh well.) In the MRI waiting room, I am told if I chew the pill, it will take effect faster. Yuck. The fact that they are scanning my brain to look for cancer does not enter my mind.
Meanwhile, there is paperwork. My favorite are the pages that ask if I’ve ever had______________ and I check Yes or No. (I wish they would ask something interesting. Have I ever had an injury from paragliding? Have I ever survived a grizzly bear attack? I have stepped on a nail and taken a few steps with a board attached to my foot, but they don’t want to know that either.)
Some questions come with opportunities to practice illustrating.
Where is your pain? There are two lines for my response: No pain, I write on the first line. Except existential, I write on the second.
Below this, rough side-by-side sketches of the human body, back and front, where I am to mark the places of said pain. My figures are as naked as newborns.
I am starting to not care. This is the glory of lorazepam.
I arrive at the mouth of the tube in fine fettle. I get the blanket, the eye covering, they slide me in and the banging begins. But this time, I realize the sounds come in certain patterns. I amuse myself by dancing my feet to the rhythms of the noise. The technician keeps interrupting with announcement of what comes next, how long it will take: I’ll do two scans now, back to back. Each will last a minute and a half. He is disrupting the rhythms, but it’s his job, after all.
After, my daughter steers me to the car, steers us home. There, I say, in complete confidence, I see no reason I couldn’t have driven myself. This prompts a variety of responses: eye-rolling, snickering, an outright guffaw. I sniff, turn away. They know nothing.
The Reports
By evening, the radiology reports have rolled into my digital chart.
From the PET:
Hypermetabolic lesion in right perihilar region in the region of posttreatment changes. It is less conspicuous compared to prior PET from 2/26/2021 but persists.
Multiple small right lower lobe pulmonary nodules are present but are distorted by motion. New area of groundglass is seen in superior segment of right lower lobe.
From the MRI :
A new subcentimeter enhancing lesion is identified in the subcortical paramedian right frontal lobe, moderately suspicious for metastasis. The possibility of an isolated subacute lacunar infarct is also considered, given diffusion restriction associated with the lesion.
PET translation: There’s an active badness in area of the lymph node that was previously treated. It’s not as big as it was, “but persists.” Those small nodules are still small, plus breathing made seeing them a problem. And more groundglass, too.
MRI translation: There’s a teeny weeny area of badness. It might be cancer, it might not. Or maybe it’s a teeny insignificant interruption of the blood flow to this area of the brain, which happens to people as they age.
Wednesday we see Dr. Oncology. Thursday, Dr. Radiology.
There’s lots to discuss.
To be continued….
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