Cancer Musings (PET Scan)

Today I had the appointment for the PET scan. This was my first PET scan (Positron Emission Tomography scan). This is a term for a test that I've heard thrown around my whole life when hearing others talk about cancer, but I never researched it or even asked anyone what it was. 

Here's the technical breakdown: It's a type of medical imaging that uses a radioactive tracer to visualize how organs and tissues are functioning. The process involves injecting a radioactive substance, waiting for it to be absorbed by the body and then using a scanner to create images. The tracer accumulates in areas where cells are most active such as cancerous tissues or areas with brain function. The tracer is a radioactive analog of glucose. Cancer cells often exhibit higher glucose metabolism than normal cells. This test is also used in testing for neurological disease (like Alzheimer's dementia) or cardiac issues. PET scans can reveal changes at the cellular and molecular level, sometimes even before the structural changes are visible on other imaging modalities like a CT scan or an MRI.

Here's the human breakdown: 

The things going through my head: 

• What? Wait. As a general practice, my entire life, I've avoided exposing myself intentionally to radioactive material, let alone injecting it into my body.  
• Glucose. Sugar. Got it. Looking for glucose in the body. Okay.

What I was told when I called to make the appointment: 

• The scan will take about 15 minutes. 
• There is some prep before the test and you will be sent the instructions in the mail. Follow the instructions very carefully. 

Instructions I received in the mail: 

• 24-hours before the exam, we recommend you eat a high-protein diet and avoid carbohydrates and sugars. Drink plenty of low-calorie fluids and/or water. 
• Examples of carbohydrates/sugars to avoid: potatoes, pasta, rice, bread, cereals, dessert, fruit, juice (hmm...this could be tricky).
• Examples of  high protein foods to eat: fish, seafood, chicken, turkey, pork, beef-all without breading; bacon, sausage, eggs, tofu (no, thank you), vinegar and oil dressing, butter/cooking oils, mayonnaise; non-starchy veggies: lettuce, spinach, tomatoes, broccoli, cauliflower, green beans, mushrooms. 
• Refrain from strenuous activity for 24 hours prior to your exam. 
• 4-hours prior to exam: Do no eat. Avoid liquid medications, gum, hard candy, and cough drops. Do not drink anything except water. Continue to drink water up to the time of your exam. 
• My reaction to these instructions: Hmm. That prep is a little intense and more than I thought it would be. 

The day of the exam: 

• I scheduled this appointment for 7:30 in the morning, thinking it would be quick (like a CT scan) and then I would head off to work. Greg always offers to go with me for the scans and I usually tell him, 'There's no need. It's just a scan. You'll just be waiting in the lobby". This time I took him up on his offer to go with me and wait because I wanted the emotional support. Then, we'd both head off to our separate workplaces after the appointment.
• We both arrived at the office, and I checked in for the appointment. Very shortly after checking in, the tech came to bring me back for the test. As he was leading me away, he casually said, "The whole process will take about an hour and a half because we have to wait for the tracer to get into your system, and then the scan takes about 20 minutes". This was a surprise. I looked at Greg with shock and apology on my face, and off I went. 
• I was taken to a lovely, quiet, private room with a comfy chair and given a warm blanket (the good things of life). An IV was placed in my arm, and the tracer was injected into my body. The tech then told me he would come back in about an hour and bring me back to the scanner. He also said I could use my phone to read or listen to something but they ask that I not do any "heavy texting" or "game playing" on my phone. That movement (which oddly enough could be viewed as strenuous activity) will cause glucose to activate in that area and could give a false impression on the results of the exam. So, I sat and listened to an audiobook I've been working on (The Next Conversation by Jefferson Fisher--very good book. Highly recommend). I refrained from multitasking. It was quite relaxing. 
• After an hour, the tech came back to get me and led me to the scanner. The scan involves lying on a table, completely still, with your arms above your head while a machine, much like a CT scanner, scans your body. That process took about 15 minutes. Quick and painless for the most part, perhaps just a little uncomfortable. Before you knew it, I was on my feet again, being led to the waiting room, hugging Greg goodbye, and heading off to work for the day. 
• And there you have it. The underworld of the PET scan process through a patient's experience. And now, we wait for the results and I will follow up with the oncologist next week. 

Cancer Musings (Oncology Appt/Follow Up CT)

 Last week, I had the follow CT scan of my chest performed. Today I saw the oncologist to review the results. 

First, let me explain to you how I handle test results. I typically do not look at test results before my follow-up appointments with the oncologist (even though they are automatically sent to me electronically usually within hours to a day of having the test performed). I don't need my own interpretation of the information in my head before I hear the medical explanation (and the plan for addressing it) from someone with clinical experience and expertise. My imagination is not my friend in these particular scenarios. I've been pretty disciplined in this approach all the way through this journey, and I'm comfortable with it. However, I have noticed with the past few appointments that the medical professionals assume I have already looked at the results and they walk in talking about plans before I actually know what the test showed. 

This time around, I decided to look at the results of the CT scan, with Greg, the morning of the appointment. We read it together. And I cried. The scan showed new spots on my lungs and consolidation of the spots that had already been there, and the word "infectious" appeared a few times throughout the report. It felt pretty grim to us. It sounded like cancer, but the radiologist's recommendation was to follow up with another scan in three months. We felt discouraged, disappointmented, and a bit frightened. So, we prayed together. We thanked God that nothing is a surprise to Him and He is in control. 

When we saw the oncologist, as I suspected, she came into the room expecting us to be upset and assuming we had already looked at the results. She showed us the images and explained that some of the spots looked "suspicious" to her eye but she wasn't sure either. The recommendation was to do another scan in three months, but she was leaning toward ordering a PET scan. The spots were too small to biopsy at this point. She wanted to run it by a pulmonologist friend of hers and get his expert opinion on how he would interpret it. 

She called me after the appointment. She ordered a PET scan to be done and wants me to follow up with her after the results are in. 

So, the waiting game continues, and we are trusting God.