Monday, September 16, 2013

How a CAT Scan Works

Chemo #7
Sept 9 2013
Wow, the day is beautiful!  It is perfect for a road trip.  Too bad this road trip is to Chapel Hill.  Of course I want to go, but at the same time I do not because I hate feeling sick.  I go, though, because I want to live as long as possible. 

Greg and I arrive right at 10:00 am which is the time of my first appointment.  I really am not worried about being late today because I spend quite a bit of time waiting for my appointments anyway even if I arrive early.  It was true about my having to wait.  I was called to have my port accessed and blood taken at 10:37.  Then I went to the next area to alert all involved that I was ready for my next appointment.  Today I was seeing the nurse practitioner, Ms. O., instead of my oncologist.   I had met her previously and liked her right away. 

The best description of how a CAT scan works
Today, there was still no radiology report from UNC-Chapel Hill.  The nurse practitioner said she would look into why this had not been done.  “You requested it, she said, it should be here.”  In the two previous appointments, I had requested that someone at UNC-CH look at my CAT scan to determine if the lung tumors had possibly shrunk. On an earlier scan, the largest was 7 mm with 5 tumors being seen.  On the newest scan the largest was 3 mm and there were only 2 tumors noted.  In an effort to try to explain to me how this might have occurred, Ms. O. gave me the best analogy I have heard on how a CAT scan can miss tumors and how a large tumor may appear smaller than it is.  She explained it this way.  “Think of the area to be scanned as a piece of bread with raisins scattered throughout.  The scan slices that piece of bread every 5 mm.  The spaces in between are where tumors 
cannot be seen.  For a larger tumor, the CAT scan may only slice the tumor at the end of it therefore it may show a 3 mm sized tumor instead of the 7 mm that it may actually be.”  That created a wonderful visual for me.  So for now, I will have to let go of my hope that the tumors have shrunk and be thankful that everything appears stable at this time.

Note:  My oncologist has said the CAT scan can show tumors as small as 2 mm. 


We also discussed my diarrhea problem.  Ms. O. let me know that I could take more than the recommended dosage of Imodium until it was under control.  She said, “If you become constipated then you know you have taken enough.  One thing you can do is keep a journal of what you eat and drink to see if what you are eating is causing the diarrhea.  Then you would know what to avoid.” 

Flu Shot

During my conversation with Ms. O., I inquired about getting a flu shot.  In the past, I have not had the flu shot because I believed the shot was developed for the new flu season based on what developers believed the strain would become in the following flu season.  The vaccine was an educated guess, so there is no guarantee.  With all that being true, Ms. O. still believes I should get the shot.  I really don’t want to get sick especially with my compromised white blood cell count.  I expressed concern about getting sick from the inoculation.  Ms. O. said that the shot is fine.  You should stay away from the nasal spray because that contains the live virus.  You could contract the flu from that.  So with that, I suppose a shot is in order.

Shingles Shot

I also inquired about the shingles vaccine.  Ms. O said not to get that vaccine because it was only given nasally and, like the flu vaccine, it contains the live virus.  There is no shot for that one.  With a compromised immune system, I won’t be getting that vaccine.

Since I am having a difficult time figuring out what the cause of my coughing is, I asked Ms. O. if it were possibile that my cough was caused by the nerves surrounding the tumor between my lungs. She said, “It could, but really there is no way to be sure.  You should consider continuing to use your daily inhaler as this may help keep your airways open”.  The inhaler tends to make my hoarseness worse, but the coughing episodes are completely unpleasant.  I will go back to using my daily inhaler.  Perhaps I will notice a difference this time.

I had one mild complaint for Ms. O..  My lympheodema in my right hand had worsened.  She said, ”Taxotere is to blame.  It causes inflammation and causes edema (swelling of tissues), so there is nothing I can do but to wear my compression glove.  It is just another aspect of the new me.  Yuck!

My weight is now 102.7 pounds.  I have gained over ten pounds since my treatment began.  My weight had gotten so low before I knew the trouble my body was really facing.  Irritable Bowel Syndrome was to blame.  It left me eating very plain food and lots of water.  For months, I had sought help from two gastroenterologists.  The last one sent me to Chapel Hill since he couldn’t figure out why I was not responding to the drugs that had been prescribed.  The doctor at UNC-CH explained that I was being over-medicated for acid reflux.  This was not my problem.  He prescribed the right drug and soon I was eating and drinking whatever I wanted. 

The steroids, too, have probably helped me gain weight.  I am glad I have gained weight, but, the negative aspect from steroid use is it tends to swell my belly area.  It makes me feel really uncomfortable.  Stomach pooches have always been my nemesis, but this feels much worse.

After the doctor, it was on to the infusion room.  The appointment was at 12:00, but of course there was the waiting time.  By the time the pills were taken, the Pepcid had been given through my port, and the saline solution was dripping into my body, I estimated all would be completed by 5:10 pm with still two hours to drive home.  That is a better time than many of my previous appointments have been, so a good day overall.    

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