March - April 2012 (this is a long post and covers a period of almost 4 weeks)
I went in for a follow-up appointment in early March 2012, Dr. Brennan was very happy with my current state of health and said we can probably start moving my follow-up appointments farther apart. He did a physical exam of my neck and scoped my throat and said everything looks very good. We talked about the fact that I was now 2 years out from my last treatment and that I’m getting through the point where recurrence happens, but seeing as things are looking good I probably don’t have to worry too much any more. We decided to do a PET/CT scan and then to follow it up with another in a year. So in the future I would be getting scans in my anniversary month. I said that even though I had gotten a scan back in August (just 7 months ago), I was ok with getting another one if he thought it was a good idea. So he scheduled me for the scan and we agreed to meet again in 3 months.
I got the PET/CT scan on 15 March and the following day went off to Germany for a meeting. It had been 6 months since I had seen some of the meeting attendees and many of them asked about my health and how I was feeling. I told them about my last meeting with Dr. Brennan and how he was very happy with my progress and that we were moving my scheduled appointments out to a longer period between visits.
When I returned from my trip the following Saturday, Terry informed me that Dr. Brennan had called and informed us that during the PET/CT scan they had found a hot spot on my left lung. Bam!! Punch to the solar plexus. He left a message that he had put in a consultation with the pulmonary clinic and that I should be hearing from them in a few days. The report also mentioned I should maybe get a liver scan. On Monday I stopped at Wilford Hall Medical Center and got a copy of my PET/CT scan report so we could go over it and try and decipher what was reported. Not much luck there, just as in the past, it’s all medical speak and we spend more time Googling medical terms to figure out what is being reported than actually reading the report. It’s very frustrating and we of course spend some time on the internet searching for info on lung cancer and spots on the lung, what it could mean and what all the options are. It’s hard not to think the worst, but we are optimistic it’s just going to be a false positive finding.
On Tuesday I called Dr. Brennan’s office to schedule a follow-up appointment to discuss my possible liver scan and get a 16 Apr appointment. The pulmonary clinic called and offered me an appointment for the 10th of April. I was scheduled to travel to Europe for 3 weeks starting on the 9th and asked if they had anything in early May. Terry was standing there listening to this exchange and was getting hot about me not taking the first available appointment. In the background she was saying, “No, you take that first appointment, you don’t need to be traveling, it’s not that important.” I accepted the early May appointment and proceeded to go to the gym for a workout.
I knew Terry was pissed, and I also knew I had probably made a mistake not taking the earliest appointment. It was silly to think I had to go to meetings when I could be having a recurrence of cancer. During my workout I decided I’d call and change to the earlier appointment first thing the next morning.
3 Apr 12
Terry and I went in to see Dr. Matthews at the Pulmonary Clinic at Wilford Hall Medical Center on Lackland Air Force Base. Dr. Matthews pulled up the PET/CT scan and showed us the spot on my upper left lung. The scan report said the spot was 9x8x8 mm. That’s pretty small, but it showed up real bright on the computer screen. He said it could be and infection, or just a jumble of veins, or it could be cancer, there is no way to tell from the scan. Prior to the actual PET/CT scan they inject a radio active isotope called Fluorodeoxyglucose (18F) or FDG about 90 minutes before the scan. The FDG is known to be taken up by cancer cells, which then makes them very noticeable during the scan. Knowing that, I wasn’t too receptive to the diagnosis that the spot being an infection or anything else. He recommended that a biopsy be performed to make sure. We agreed and he put in the consultation to Interventional Radiology (IR). Two days later I received a call from IR and we setup an appointment for the next Tuesday.
10 Apr 12
Tuesday afternoon I met with Dr. Goie and we again went over my PET/CT scan. He also recommended that we get a biopsy of the spot. We went out to talk to his scheduler and they offered up 20 April, I asked if I could fly 2 days after the procedure knowing that there was a good chance that during the biopsy they might collapse my lung. They recommended that I not fly that soon after the procedure. So, we looked at the next available date and it looked like it was going to be early May. The scheduler decided to talk to the doctor about my possibly flying 2 days after a procedure. Dr. Goie came into the room and recommended I not fly, so I said I would cancel my trip and opt for the procedure on the 20th. The doctor thought about it for a minute and then said he could admit me to the hospital and then they could do the procedure when ever he wanted. I said that was ok with me, the sooner the better. They checked his schedule again and decided to admit me to the hospital the following morning.
11 Apr 12
Interesting 2 days. Due to the lack of available appointments the Doctor opt'd to admit me to the hospital, but that didn't work out too well. I showed up at my appointed time (Wednesday, 10:00am) was admitted and set-up comfortably in a room to myself. The doctor came in and talked with us for a short period and said I should be called at approx. 1:00pm. About 1:00pm he came back and informed us it'll be a while yet, maybe around 2:00pm. About 3:00pm they came and got me. I hung out in the prep area about another hour and then was finally wheeled in and placed on the table of a CT scanner. They hooked me up to an EKG, and the port in my chest so they could administer drugs and a sedative. I was put on my right side, strapped in and the doctor came in and tried to find the lesion using Ultrasound. He could not find it, and said they will use the CT scan to find it, and then try using the ultrasound again.
At that point everyone left the room and I took a nap. Sometime later everyone came back in and I was informed they were giving up for the day. One of the primary technicians was unavailable (CT or Pathology not sure which), so they couldn't perform the procedure. So, I was told I'd have to spend the night and have the procedure on Thursday morning. I was sent back to the staging area to wait, because I had been sedated. After about 45 minutes the doctor came back in and said I was being given a 12 hour pass, so I could go home for the night. Back to the ward, changed clothes and was walking out when the primary ward nurse stopped us and said they couldn't give me a pass. Big conference takes place with the ward nurse, his lackies and the doctor. Next thing I knew I was being discharged from the hospital and told to come back at 7:30am on Thursday morning and we'd try it again. Meanwhile my stomach was rumbling because I hadn't eaten in 24 hours.
Fast forward to Thursday morning 12 Apr 12.
We arrived on time and I was taken back to the prep area and went through all the paperwork and preparation one more time. Everyone was in a cheery mood and things seemed to be going like clockwork. Approx 8:30 I was once again wheeled into the procedure room (not an operating room), placed on the CT scanner table, hooked up appropriately to everything, given some happy juice and slid into the CT scanner where I immediately fell into la la land. Next thing I know, I'm in the recovery room being questioned by the nurse and Terry. They got satisfactory answers and I dosed off for about an hour more. Doctor came in and said they got some good samples and they should have the pathology results Monday or Tuesday. I did suffer a partial lung collapse (3% or so) they kept me around for observation and took a chest x-ray. They finally decided I was recovered enough to go home. Doc said I should go home plop myself on the couch, put my feet up, turn on the TV and drink a couple of beers, Mrs. Miller protested. I told her it was doctor's orders, but she over ruled again. So, I spent the afternoon dozing off and on, on the couch.
I've got a small puncture wound on my left side under my arm pit and it kinda feels like I've been punched in the same location. Other than that, I'm good to go. Just waiting for the results.
18 Apr 12 Good news.
It was a very long weekend and it wasn’t made any better when I went for my appointment with Dr. Brennan. My pathology report wasn’t back yet, so we pretty much just discussed the PET/CT scan results and the recommendation for a liver scan. Dr. Brennan seemed very confident that the biopsy would be negative, but it was prudent to have done the biopsy. He did his usual exam and decided he needed to see me again in 6 – 8 weeks. A shorter period between our usual appointments.
Yesterday I spoke with Dr Goei, who performed the biopsy, my pathology report has finally come in and it reported negative for cancer. However it did say, “orgainizing pneumonia with focal poorly-formed granuloma.” What the heck does that mean? From what the doctor tells me, and what I could find on the internet it means, the body is encapsulating something (bacteria, fungus, infection, inhaled foreign matter, etc.) causing inflammation and creating the granuloma (nodule, spot, etc). What are they going to do about it? For now, wait. Today I talked to Dr. Matthews from the pulmonary clinic and he pretty much told me the same thing as Dr. Goei (they were both working from the same pathology report). They both recommend that we wait 3 months and then do another CT scan, if it shows enlargement or anything else; Goei will do another biopsy to ensure there is no change. There is a possibility it will spontaneously go away.
So everyone is cautiously optimistic this isn’t anything to get too worked up about. It should be monitored, and if anything changes then appropriate action will be taken. What that action is, they’re not saying. Doctors, they’re always so vague. I guess that’s why they call it practicing medicine.
Life seemed to be back to normal, doctors seemed happy with my progress, follow-up appointments were being scheduled farther apart, and then bam! Reality slaps me up side the head. I guess this is the way it’s going to be from now on, periods of normality and periods of anxiety and frustration. I spent a lot of time thinking about if it was cancer again, what the outcome would be. I can’t be radiated again, more chemo? If it’s a different type of cancer would the treatment be harder than the first time. Will it keep coming back until it beats me?
There was no doubt in my mind that I would standup and fight it with all I had one more time. I’m not ready as Dylan Thomas said, to “go gentle into that good night.” But for the moment, I’ve dodged the bullet. I know I must not let my guard down. I’ve must pay less attention to the small stuff and pay more attention to Terry, my family, my friends, the important things in life.
So that was my last four weeks. Not the best of times, but a wake up call. A reminder I must be vigilant and work at being a bit healthier. It’s been a while since my last update. Things were going good and it didn’t seem like there was anything that needed reporting. I’ll try and not wait as long between reports and hopefully, they’ll all be good reports in the future.
