From the category archives:

CAT Scans

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My new internist calls unexpectedly at 10.30 AM to give me feed back from my routine check up from three weeks ago. He is back from vacation and has just sorted through his pile of paperwork.

My blood count looks great. My cholesterol is 208, but only because I have 108 of good cholesterol, so nothing to give another thought. However, the routine x-ray showed a lesion – a granuloma he calls it – on the left lower lung lobe. It is only 8 mm.  Sounds insignificant to me because on the phone with the doctor I am unable to process that 8 mm is almost 1 cm which translates to almost half an inch. And I have no idea what a granuloma is although it sounds a bit more sinister than “lesion.”

“This is most likely,”  my doctor says — and his tone is authoritative and upbeat —  “a scar from old pneumonia.”  Since I had had pneumonia numerous times as a child, I eagerly grasp his straw.

Then my internist asks if I have had any other x-rays in the past year?

“No, I can not recall any chest x-rays.”

“Well,   then I will order a CAT scan, just because my radiologist is so obsessive compulsive.”

I do not blink. I am even cheerful because I know that, what ever is on my lung must come from my old pneumonia.  The word metastasis does not even enter my conscious,  I ask:

“What if it is not from pneumonia? What then?”

“Then you have to see a pulmonary specialist,” he says. “But it is too early for what ifs.”

He hangs up.

His abrupt tone and unwillingness to speculate makes me realize that the lesion could be breast cancer that has spread to the lung.

I look up granuloma on a pulmonary web site:   www.pulmonologychannel.com/spn/types

About 60% are of granulomas are benign,  most are the result of an inflammatory, immune system reaction. It could be pneumonia, tuberculosis, fungus. The other 40% of granulomas, or solitary pulmonary nodule as they are referred to (SPNs) are malignant, three-quarters of which are primary lung cancers, and one-quarter of which are metastases from other parts of the body.

First my blood trains. But  I feel fine, great in fact. I don’t cough. I am not tired.  I immediately push the unthinkable thought away. It has to be a scar from my childhood pneumonia.

Once more I have failed to pick up on this important clue: nurses, assistant, and post cards deliver good news. Doctors deal with the scary stuff.

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Finally, I am scheduled for radiation therapy or rather: Preparation for radiation. I meet with a technician to get my measurements set in a foam contour.  Actually, it turns out to be  nothing fancier than a plastic bag that she fills with warm liquid. I  then lie  down and my contours are set as the liquid firms up.  When I come for my therapy I will  lie down in exactly the same position every time.

The radiation oncology department has two waiting areas: one  for family or friends who accompany a patient. In this area there is an aquarium and a small reception desk, a few arm chairs.   It is almost empty.

A door with the sign: “Radiology Patients Only”  leads to another small, crowded waiting area. The ceiling is low and covered with acoustic tiles.  The chairs are the same type as in the outside waiting area.The magazines in the basket are out-dated and dog eared. Staff members, mostly women in blue scrubs, mill about, going in and out of side rooms, opening and closing doors, appearing or disappearing from behind curtains,  seemingly without purpose. Back against one wall is a blue drapery and behind it some cupboards above a low bench. That is where I am supposed to change into a cotton gown, property of the hospital, one size fits all — or nobody.

I also have a CAT scan which takes but a few minutes. I lie down on a narrow bed that slides in and out through a dough nut hole. I have no idea that I am receiving 6000 rads of radiation through out my whole my body. It is a  hundred times more radiation than a regular X-ray. Nobody explained the high level of radiation I would receive. Nobody told me why they need to have my cat scan although I recently had an MRI or why the MRI images would not be good enough.

Every day, Monday through Friday, for the next eight weeks, I will receive a prescribed dose of radiation to kill any cancer cells that may have been left. The therapy will cover my whole breast with some extra shock treatments concentrated on the breast area  where the tumor was (the tumor bed.)

A linear accelerator produces the treatment x-rays and this special  therapy to kill cancer cells is known as EBRT – external beam radiation therapy. (Without radiation, 40 percent of lumpectomy patients have a local recurrence of their breast cancer.)

The exact level of radiation will be set by Dr. Alpha and his medical dosimetrist. The actual radiation therapy treatments will be handled by his radiology technicians. I am told that I will be checked by Dr. Alpha, the radiation oncologist, every Monday.

I get to pick my time slot. I choose  2.15 PM Monday through Friday.  (Should I not be able to come one day, I can come twice the next day, as long as it is six hours between the treatments.) Finally, I get a parking pass, a yellow 8 x 11″ piece of paper with the words radiation oncology written in magic marker. It  is valid for the next eight weeks. When put on my dashboard, it allows me to park for free right outside the hospital entrance doors and to  avoid the crowded parking garage.

I am all set for my personal Chernobyl.

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