Category: Treatment Planning

The PET Scan

The PET Scan

Back at UTSW in Dallas for the PET scan. Got here early, and they called me right back, which was great. First technician tried twice to insert an IV, and both times it felt like he was trying to slay a dragon. He sent in another tech, who got it right away, thankfully. I had to drink what felt like a 55 gallon drum of “creamy vanilla” barium, then they wheeled in this device that was about the size of a food cart and filled me full of radioactivity. I’m just waiting for the Spiderman effect to kick in…

Anyway, I’m sitting her for an hour to let the barium and radioactive goo course through me, more later…

The Brain MRI Results

The Brain MRI Results

Just before the close of business today, Doctor Chiu’s nurse practitioner (the pulmonologist), calls and gives me the definitive word: The brain MRI is negative, no cancer in my brain. Thank you Tammy, thank you for calling and letting me know. Thank you.

Now we wait for the PET scan on December 10th. This will determine if, from the neck down, cancer is anywhere other than my right lung and the few surrounding lymph nodes. It is the final piece used to determine the stage of cancer I have. Right now, it is still considered Stage IIIa, which was supported by the negative brain MRI result. I see Doctor Chiu (pulmonologist) and Doctor Iyengar (radiation oncologist) to review the PET results the 11th, begin preparation for radiation, then Doctor Rashdan (medical oncologist) the 12th to begin preparation for chemo.

The Calming Doctor Rashdan

The Calming Doctor Rashdan

Right after the MRI, I had my appointment with the medical oncologist. I was quite anxious about the MRI results. I knew that the radiologist wouldn’t have time to review it and create a report since my next appointment was only an hour later, but would Doctor Rashdan give me any indication of what the scan showed?

When she came into the exam room, we talked about her role in my treatment; she is responsible for the chemotherapy and immunotherapy portion of my treatment plan, plus identifying genetic mutations that might exist and any treatment that this might help direct. She says that we will know more about the specific treatments we will use once the MRI and PET scan results are in.

I tell her that I just came from my MRI, and she said that while she was not a radiologist, she would take a look and see if anything obvious was there. Right in front of me, she pulled up the MRI and started scrolling back and forth through the scan, all the while I have my third moment of high anxiety; will she say “brain full of cancer” or “looks good to me?”

Finally she said that she didn’t see anything, but that the radiologist’s report would be definitive. That gave me relief, but it also made me realize just how much I’m living in these small pockets of time between every scan and doctor’s appointment, trying to compartmentalize each revelation in a way that allows me to remain calm.

We finish with discussion of what’s next, and how she and the radiation oncologist, Doctor Iyengar will work together to customize my treatment plan based on the last piece, the PET scan.

The Brain MRI

The Brain MRI

Off I went at holyshittooearly o’clock to Dallas to get my brain MRI. I was given a lovely set of pants and some blue socks, had an IV line inserted, and sat awaiting my time in the tube.

Captain Sexypants reporting for duty

After about an hour, I was led into the room, then placed in an iron maiden for my scan. Essentially, my head was locked in a cage with a small mirror that showed what was directly behind me, pieces of pliable plastic on either side of my arms so that they didn’t touch the MRI machine, a cord to squeeze in case of emergency, and some earplugs and headphones.

As they rolled me into the tight tube, I looked in the mirror which showed a poster of a bridge over the ocean leading to a hut. Nice, right?

Yeah, except for the miscellaneous equipment that was stacked right next to it, which kind of killed the tropical vibe. But I digress…

They asked me what music I would like to listen to. I said, “Wilco please.” They turned it on, and I couldn’t hear anything. After the first scan, I asked them to please turn it up. Massive improvement, now I could barely hear it when the MRI wasn’t running. When they came into the room to administer the contrast, I asked why I could barely hear it. They said, “Oh, it’s all the way up. This is why we have asked them to stop offering music.” Uh, cool.

After over an hour in the tube of fun, I was all done. Now off to the medical oncologist…

The Fantastic Doctor Iyengar

The Fantastic Doctor Iyengar

Before we went to the appointment, we looked at his credentials, and they were very impressive. He is a biologist, a researcher, and a physician. He runs research programs and clinical trials for lung cancer patients. And he’s fantastic when it comes to patient communication.

When he walked into the exam room, he instantly put me at ease with his attitude. It’s a rare combination of optimism and realism that doesn’t come across as an act. I believe this is just who he is, 100% of the time.

We start talking about where I am, what we still need to know, and where we likely go from here. He’s thorough, funny with a dry sense of humor, engaging and unfiltered in his assessments, which makes him a perfect fit for me.

He explains that his focus is on radiation, which is a part of my overall treatment plan. He thinks that I will tolerate an aggressive regimen of concurrent radiation and chemotherapy, but tells me he’ll be disappointed in me if I can’t handle it with a grin. Perfect.

I ask him what goal of his treatment plan is. Cure? Control? Relieve symptoms? Without missing a beat, he says “cure.” He goes on to say that this could also mean treating it as a chronic condition, which means frequent scans and potentially more treatment if they see even a dot of cancer. Of course, I hope that’s not necessary and it simply goes into remission, but knowing that this man is fighting for me makes me feel very calm about the whole process.

So, as long as the brain MRI and the PET scan come back negative – meaning that it hasn’t spread beyond my right lung and a few lymph nodes in that area – that it would be Stage IIIa, and he would recommend the following treatment plan:

  • Radiation – 5x a week for six weeks
  • Chemotherapy – 1x a week for six weeks
  • Immunotherapy – Once every three weeks for a year

I ask about this versus surgery, and he explains that his recommended treatment has the same level of efficacy as surgery without the inherent dangers of cutting you open and removing part of your lung.

Next is the brain MRI, which to me is a big deal. I don’t want brain mets (mets is shorthand for metastasis).