January 9, 2022
Preface
On the surface, this post, like the two before it, 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. I think, too, that I wanted to write the story of a sequence of events so that the ongoing nature of living with lung cancer comes through. Thanks, as always, for reading.
Part III The Doctors Weigh In
We saw Dr. Oncology on Tuesday and Dr. Radiology on Thursday. The differences in their perspectives were fascinating– and these differences make a good argument for researching the state of lung cancer today.
What Dr. Oncology said in the meeting was a little different than was came across in her notes. What she said was that she would need to wait for the tumor board to meet and make a recommendation. Her notes, however, available through MyChart, indicate that she sees the situation as a reason to re-stage, from IIIA to IV, and start a therapy targeted to my particular mutations.
The tumor board meets every Monday. All the -ologies attend: medical oncology, surgical oncology, pulmonology, radiology, some others I’m sure I’ve forgotten. I’m not allowed to go– Dr. Radiology says it’s because doctors are notoriously bad at confidentiality, e.g., “Remember that patient, Johanna Smith, from two months ago?” It sounds like discussions can become quite heated. Oh, to be a fly on the wall.
Dr. Radiology– have I mentioned how grateful I am to have her eyes on my situation?– sees things a bit differently. She doesn’t think the brain thing is worth any attention right now– nor does Dr. Oncology. The brain gets these blips as we get older, spots that have a momentary lapse in blood flow, and they show up as “lesions,” which is a creepy word, as far as I’m concerned. Dr. Radiology thinks the edges of the lesion are too diffuse to be a met (metastasis, for those of you watching at home.) She showed us the lesion and pointed out other spots in my brain that are of similar size and are pretty dead.
The little blips in the new spot in the lung? Too small to be conclusive right now, she thinks, but we talked about how an area that’s been traumatized does this thing as it heals: gathers up all the fluids and detritus into a more compact pile, then dissolves. Because I am a klutz, I am well aware of this phenomenon. A bruise or a cut often looks worse than it did originally, then, Poof! it’s fading. We agree– these are small spots and we can wait 4-6 weeks until the next scans to see what they do.
The lymph node that is smaller “but persists” is the trouble spot. The longer it stays, the more baby cancer cells it could be sending into my system. Its SUV* (I don’t think they mean a car) went down significantly from the initial PET, but on a scale from We Don’t Need to Worry to Holy Hot Spot, Batman, we’re at the latter. Dr. Radiology said we could potentially super-blast it 3-5 times with very targeted high-dose radiation, but the long-term issue with that is cell damage such that bleeding occurs 2 or so years down that road, and coughing up blood is gross. Then she brought up a really interesting idea. That pesky node sits very close to where the airway splits, and may be reachable for treatment through the airway wall via bronchoscopy. (Treatment such as, freezing it or something else– at this point, information was bouncing off me like little hail pellets. Mark wrote it all down– ask him.)
I suggested all of the treatment options should be considered within the context of the patient’s lifestyle and vision of what quality of life for them entails. She heartily agreed. (Has anyone asked me this yet? I bet you can guess the answer.) I said that I needed to be able to hike and ride my bike. She nodded OK.
She is going to the tumor board Monday. She usually doesn’t, but this time she is. Not only is she going, she’s going to call me afterwards.
She, Mark, and I agree that the bronchoscopy seems like the first best option. When I mentioned that Dr. Oncology saw the targeted therapy as the way to go, she said, “Has she read the scans or just the report?” Ooo, perceptive devil. My guess is that Dr. Oncology has read the report. Dr. Radiology, on the other hand, has studied the scans.
Dr. Radiology also was interested in the Emergency Room visit. Swollen legs are a cue something is going on. She looked at urine test results and had a few things to say about possibilities. I’m going to my primary care doc this week to follow up. Oh, and I have an echocardiograph tomorrow. Yay! Another test! Clearly, I have too much time on my hands….
A Final Thought
(I first wrote Epitaph, but then realized that was kinda wrong. <giggle>) I spent a fair amount of time in existential agony during the first weeks and months following my diagnosis. That’s enabled me to come to peace– or at least a stalemate– with some of the Big Questions: how to live a meaningful life, what really matters, etc. I think that deep, often debilitating thinking has left me more centered in the face of new developments.
Sure, I feel overwhelmed by the information, but most of the time, someone is with me taking notes and we have reviewed questions and possibilities the night before. And, sure, I feel so, so sad as I face new possibilities of being dead before I’m ready. And I feel exhausted.
All these feelings pass. I walk through a door to a new understanding. And some things stay true no matter what new landscape I find: I love and am loved. I can think and read and write. There’s the quiet of nature. And my bicycles!
And you, dear readers.
May you cherish any landscapes you discover.
*A little research reveals that SUV = Standardized Uptake Value, the amount of tracer a mass or other tissue absorbs and is consequently seen in PET scan.
Previous Parts of the Story:
[…] Background: Adventures with Lung Cancer Girl parts I, II, III […]