A week ago, I had a routine brain MRI that was the same as ever but also, in the end, very different. (Who ever thought the word routine could be used in the same sentence as brain MRI?) The only new things were the time and place: afternoon instead of morning, and in a satellite office instead of the cancer center’s central imaging location. Things that remained the same: lorazepam about an hour beforehand– it achieves maximum release 45-60 minutes after taking it– sleep during the banging and general hullabaloo breaking out around me, and dozing and sleep for the rest of the day.
But another difference displeased me enormously. A physician’s reading of the scan did not appear until almost 24 hours after the MRI. The cancer center’s report is usually in my chart within several hours. That evening and into the next morning, I began an internal process that I’d now characterize as a hissy fit.
Which led me to a little reflection. Was I being unreasonable? I swiftly determined I was not (heh, big surprise) and gave them until noon, whereupon I would call and ask for a result. I didn’t really know who I’d call since I’d gone to a different center, but details, details as the saying goes. You can’t just be giving people big-ass tests only to leave them hanging, not after they’ve learned through experience when to expect a result.
(Just ‘cuz doctors are smart and busy doesn’t mean they get to waltz though patients’ lives at their own paces. I’m not advocating for making obnoxious demands, but pleasantly requesting information is a way of reminding others you matter. Plus, asserting agency in a physical situation that’s out of one’s control is a critically important coping mechanism.)
Just as I was getting serious about figuring out who to call, the report appeared.
“1. Stable treated punctate metastatic focus in the high subcortical right frontal lobe. 2. No new metastatic lesion is identified.”
Hotcha!
Dr. Radiology’s notes from our followup visit on 7/20 give a little more detail.
“STUDIES: I personally reviewed her MRI brain from 7/17/2023 and this shows the treated high right subcortical metastatic focus to be without evidence of necrosis and without enhancement and is not growing. No other new or suspicious lesions. She also had a CT chest with contrast on June 21, 2023 which shows stable posttreatment [sic] changes in the right lung without evidence of recurrent disease.
During our visit, Dr. Radiology’s questions wandered into the bicycling arena. How it was going, she asked. I paused for a beat too long.
She asked, “Do you feel you’re plateauing?” I told her I wasn’t sure. I described the stiffness I felt in my treated lung on hard climbs. Her response: “You can feel your lung is not fully participating.” YES! (Is that not a brilliant way of describing it?)
She swiveled to face the computer again, pulling up scans of my lungs. She found the first scan, pointed to the big white blob in my lung. “That’s the tumor,” she said. She swiftly brought up the most recent scan. “And there there’s the lung now. You can see there’s no tumor but you can also see the scar tissue from the treated portion has collapsed on itself.” That’s the stiffness I feel.
“You can also see the diaphragm has moved up,” as has the liver. But check this out: the upper lobe of my left lung is bigger as it compensates.
She observed that as my heart gets stronger, that will also help compensate, as will strength training, particularly of my lower body.
“The exercise is excellent. You should keep it up,” she said briskly. She added that I needed to understand that the chemo, radiation, pneumonitis– the whole shebang– has permanently altered the way my body reacts. If I had been an elite athlete– I wish– I would also need to understand I’d never approach any records I’d already set. “Because of this, recovery between workouts may take longer,” she said. “It’s important to let the body rest and fully recover after an intense workout.”
As for brain health, sleep is critically important, she said, specifically the 3 hour REM cycle. Getting in a full 3 hour cycle allows the lymph system to flush crud from the brain (crud is not a medical term.) I’m not the best in the sleep department, I confessed. She nodded and went on to say the gentle up-down movement of cycling, squats, other such activities, creates the same conditions (maybe she said pressure?) to enable the flushing.
“Can I hurt myself by doing this intense exercise?” I asked. “Should I stop?”
Her response was immediate and firm. “No. You cannot hurt yourself. And no, you should definitely not stop.”
“OK, good, then all I have to do is deal with the fear I’ve been feeling,” I said wryly. I was only half joking.
We were moving out of the exam room, into the hall. She’d been double-booked and had another patient; she was poised to dash.
“I can certainly understand the fear, ” she said. “It’s normal after such trauma.”
She waved goodby as she hurried down the hall.
And I stood for a second, realizing I’d never thought of lung cancer in terms of trauma.
Keep riding, Karen. You rock.