A week has passed since visiting the VA Hospital for a second opinion about my prostate cancer. Now the day has arrived when I’m supposed to get a bone scan and a CAT scan, looking for evidence that the cancer in my prostate has spread beyond the gland to other places like lymph nodes and bones. I frankly felt scared this morning. I feel like my life is changing suddenly, permanently, and unpleasantly. I had a definite feeling of butterflies in my stomach, as though I were a kid facing uncertain punishment. As I drove to the medical center I felt strangely alone. Everyone around me is being positive and supportive. But good wishes are not going to have much effect on the studies planned for today.
First up, the bone scan in the nuclear medicine department. Very pleasant reception people took me to visit a technician who put a needle into a vein on the inside of my left elbow and left it there. This was a place for injecting the radioactive material that is supposed to be attracted to active growth in bones, and will show up on the scan when it’s done a little later today. She was very pleasant and we talked a lot about this radioactive stuff. Most important thing is that it has a half life of only 6 hours, which means that, although I’ll be slightly radioactive for a few hours, at six hours I’ll be only half as radio active as I was at the start; at twelve hours I’ll be down to a quarter, and at 24 hours, down to a sixteenth of my original level. Even the half way down level is supposed to be low enough to sleep with a person (like my wife) and the under a sixteenth level is supposed to be low enough that I can be within typical social distance of a pregnant woman (like a colleague who is a couple desks away from me at work). I keep having this fantasy that I’m going to glow in the dark. Evidently not!
After the technician squirted in the radio active stuff, painless, she told me to come back in three hours at which time they’d use a special camera to see where the radioactivity had concentrated. My hope: it concentrates nowhere and there is no cancer in my bones. We’ll see.
After she was done making me into “radioactive man” she sent me over to the CAT scan folks who set me up for about 45 minutes of high resolution x-rays taken in one of those big doughnut machines that has a little table you slide in and out on. The point is to see if there are swollen lymph nodes anywhere between my neck and thighs that would suggest that cancer might be growing in them. I hope they are unable to find anything.
I didn’t even have to get very undressed. Under cover of a cotton blanket I was asked only to pull my trousers down to my knees as I lay down. Shirt and underwear no problem. The test was ordered “with contrast” meaning that they would squirt some clear looking stuff into the needle that the nuclear medicine lady had kindly left in my arm, and this stuff would make my blood vessels obvious in the CAT scans. This contrast material includes iodine, and the big issue is that some people are allergic to iodine and have severe reactions to a bunch of it being injected into them all at once. I have not had such an experience, so I hoped it would not happen to me.
The technician explained the there would be five runs in and out of the machine. The first two were “scout” runs, and pretty fast. Like 10 seconds each. Then the first real run, which took a couple minutes. Then they injected the contrast stuff. It had the same sort of warming effect that you’d feel after downing a generous shot of whisky. I swear I could feel it in my prostate. Another slow run through the machine. Then a wait of 10 or 15 minutes, and a final slow run. Painless. By this time the flushing sensation was gone, and none of the relaxing effects you’d expect from whiskey ever appeared. I think they could improve this test by adding a little alcohol to the contrast.
The staff was very professional. I felt very much at ease. When the scanning was over I got up, adjusted my trousers, and was sent off with a recommendation to get lunch before the picture taking part of the bone scan.
While I was eating, I noticed that the butterflies in my stomach had gone. I think it was the “business as usual” professionalism of the staff that made me feel at ease and safe. As I thought about it I realized that I was very grateful for the very considerate way they were handling me. And I enjoyed lunch.
About an hour later, a little after noon, I went off for my total body picture bone scan session. The pictures are based on the radiation coming from my body. The camera is a huge thing that can be positioned around a narrow bed of sorts. When the doctors look at the images the camera produces, they see something like a Halloween skeleton. Hot spots show up where the bone is active, like a healing fracture, or a place where prostate cancer is growing. I hope, of course, that there is no sign that the cancer has already spread outside the prostate. But this test is going to show what’s going on. I think it is learning this that is causing the butterflies I felt in my stomach.
As the technician set me up for the bone scan he engaged in some small talk, confirmed that the test was to look for possible spread of prostate cancer, explained that I was supposed to remain as still as possible for the study, and ended saying that, “You do want a clean scan, don’t you.” Indeed I did. He then wanted me to take stuff out of my pockets, and take my belt off, but shoes, trousers, shirt and underclothes were all fine for the event. I wish that TSA could do as well at an airport.
This test involved a couple of runs. First table carrying me passed slowly through the camera. It took about 40 minutes. Painless. No injections of anything. I went to sleep. Then the technician came back and adjusted the camera for some side shots. This time my arms were to be over my head. He asked if I had arthritis anywhere. I assumed he was worried about asking me to put my arms over my head for another 5 minutes or so. Then it dawned on me that he could probably see the picture that the camera was generating. Arthritis might show as a hot spot, I figured, and I guessed that he was wondering if something like arthritis was causing hot spots he was seeing. I asked if there was some something going on in my right hip, a place where I’ve had some pain that I think is related to bicycle riding, and his response surprised me. He said that there was something in both shoulders and my left knee. He was taking extra pictures to be sure the radiologist who read the study would have the information he needed.
Not so good. The last thing I wanted to hear was that I had unexplained hot spots on my bone scan. I decided to try to ignore this bit of unnecessary information. After all, this technician is not a radiologist and is not trained to interpret these studies. He just sees a bunch of them and is only doing his job. I keep trying to tell myself this when the tech comes back into the room and tells me that I’m done and invites me to pick up the stuff I’d taken from my pockets.
The radiology folks tell me that the results of the tests will be sent to my urologist in a few days, early next week at the latest. And they very kindly provide me with a CD that contains the test images. It only took about 15 minutes to burn, and I will be sending it to the NIH people who will make an independent reading of the images as part of their evaluation my case. I also have a routine primary care visit for some other minor problems scheduled for the afternoon, and getting there on time will be difficult. I’m a little hurried. Traffic is congested. Parking is difficult. So I pretty much block out this question of hot spots.
Aside from feeling scared and helpless in the face of an illness that medical science cannot fix in the same way that it can handle a broken bone or a case of pneumonia, I’m beginning to feel that my daily life is being appropriated by the medical machine. I have to arrange time off from work to get this stuff done. It’s important to me, and I’m willing to do it. But it is difficult. In addition the schedule my wife and I have been planning for months is suddenly in flux. And we’re hoping for some international travel (Australia? Europe?). All of this is taking back seat to this illness that I now know I have. Once I’m on some sort of treatment program I expect all this to get much worse. I’m very fortunate to have good care around me, and a supportive family and friends. So I apologize for whining. But it is annoying. And frightening.
After the primary care appointment I head home and share the day’s experience with my wife. I tell her about my worries about the hot spots on the bone scan, and emphasize that the study has not been seen by a radiologist yet, and until we hear the interpretation we don’t know anything at all. I kind of wish the guy had not asked me the questions. She’s a little worried as well, but agrees we simply have to wait. Again.
So, results next week. The butterflies in my stomach have been replaced by vultures overhead. My thought for the circling birds: “You are WAY early. Don’t count on anything down here any time soon!”
First up, the bone scan in the nuclear medicine department. Very pleasant reception people took me to visit a technician who put a needle into a vein on the inside of my left elbow and left it there. This was a place for injecting the radioactive material that is supposed to be attracted to active growth in bones, and will show up on the scan when it’s done a little later today. She was very pleasant and we talked a lot about this radioactive stuff. Most important thing is that it has a half life of only 6 hours, which means that, although I’ll be slightly radioactive for a few hours, at six hours I’ll be only half as radio active as I was at the start; at twelve hours I’ll be down to a quarter, and at 24 hours, down to a sixteenth of my original level. Even the half way down level is supposed to be low enough to sleep with a person (like my wife) and the under a sixteenth level is supposed to be low enough that I can be within typical social distance of a pregnant woman (like a colleague who is a couple desks away from me at work). I keep having this fantasy that I’m going to glow in the dark. Evidently not!
After the technician squirted in the radio active stuff, painless, she told me to come back in three hours at which time they’d use a special camera to see where the radioactivity had concentrated. My hope: it concentrates nowhere and there is no cancer in my bones. We’ll see.
After she was done making me into “radioactive man” she sent me over to the CAT scan folks who set me up for about 45 minutes of high resolution x-rays taken in one of those big doughnut machines that has a little table you slide in and out on. The point is to see if there are swollen lymph nodes anywhere between my neck and thighs that would suggest that cancer might be growing in them. I hope they are unable to find anything.
I didn’t even have to get very undressed. Under cover of a cotton blanket I was asked only to pull my trousers down to my knees as I lay down. Shirt and underwear no problem. The test was ordered “with contrast” meaning that they would squirt some clear looking stuff into the needle that the nuclear medicine lady had kindly left in my arm, and this stuff would make my blood vessels obvious in the CAT scans. This contrast material includes iodine, and the big issue is that some people are allergic to iodine and have severe reactions to a bunch of it being injected into them all at once. I have not had such an experience, so I hoped it would not happen to me.
The technician explained the there would be five runs in and out of the machine. The first two were “scout” runs, and pretty fast. Like 10 seconds each. Then the first real run, which took a couple minutes. Then they injected the contrast stuff. It had the same sort of warming effect that you’d feel after downing a generous shot of whisky. I swear I could feel it in my prostate. Another slow run through the machine. Then a wait of 10 or 15 minutes, and a final slow run. Painless. By this time the flushing sensation was gone, and none of the relaxing effects you’d expect from whiskey ever appeared. I think they could improve this test by adding a little alcohol to the contrast.
The staff was very professional. I felt very much at ease. When the scanning was over I got up, adjusted my trousers, and was sent off with a recommendation to get lunch before the picture taking part of the bone scan.
While I was eating, I noticed that the butterflies in my stomach had gone. I think it was the “business as usual” professionalism of the staff that made me feel at ease and safe. As I thought about it I realized that I was very grateful for the very considerate way they were handling me. And I enjoyed lunch.
About an hour later, a little after noon, I went off for my total body picture bone scan session. The pictures are based on the radiation coming from my body. The camera is a huge thing that can be positioned around a narrow bed of sorts. When the doctors look at the images the camera produces, they see something like a Halloween skeleton. Hot spots show up where the bone is active, like a healing fracture, or a place where prostate cancer is growing. I hope, of course, that there is no sign that the cancer has already spread outside the prostate. But this test is going to show what’s going on. I think it is learning this that is causing the butterflies I felt in my stomach.
As the technician set me up for the bone scan he engaged in some small talk, confirmed that the test was to look for possible spread of prostate cancer, explained that I was supposed to remain as still as possible for the study, and ended saying that, “You do want a clean scan, don’t you.” Indeed I did. He then wanted me to take stuff out of my pockets, and take my belt off, but shoes, trousers, shirt and underclothes were all fine for the event. I wish that TSA could do as well at an airport.
This test involved a couple of runs. First table carrying me passed slowly through the camera. It took about 40 minutes. Painless. No injections of anything. I went to sleep. Then the technician came back and adjusted the camera for some side shots. This time my arms were to be over my head. He asked if I had arthritis anywhere. I assumed he was worried about asking me to put my arms over my head for another 5 minutes or so. Then it dawned on me that he could probably see the picture that the camera was generating. Arthritis might show as a hot spot, I figured, and I guessed that he was wondering if something like arthritis was causing hot spots he was seeing. I asked if there was some something going on in my right hip, a place where I’ve had some pain that I think is related to bicycle riding, and his response surprised me. He said that there was something in both shoulders and my left knee. He was taking extra pictures to be sure the radiologist who read the study would have the information he needed.
Not so good. The last thing I wanted to hear was that I had unexplained hot spots on my bone scan. I decided to try to ignore this bit of unnecessary information. After all, this technician is not a radiologist and is not trained to interpret these studies. He just sees a bunch of them and is only doing his job. I keep trying to tell myself this when the tech comes back into the room and tells me that I’m done and invites me to pick up the stuff I’d taken from my pockets.
The radiology folks tell me that the results of the tests will be sent to my urologist in a few days, early next week at the latest. And they very kindly provide me with a CD that contains the test images. It only took about 15 minutes to burn, and I will be sending it to the NIH people who will make an independent reading of the images as part of their evaluation my case. I also have a routine primary care visit for some other minor problems scheduled for the afternoon, and getting there on time will be difficult. I’m a little hurried. Traffic is congested. Parking is difficult. So I pretty much block out this question of hot spots.
Aside from feeling scared and helpless in the face of an illness that medical science cannot fix in the same way that it can handle a broken bone or a case of pneumonia, I’m beginning to feel that my daily life is being appropriated by the medical machine. I have to arrange time off from work to get this stuff done. It’s important to me, and I’m willing to do it. But it is difficult. In addition the schedule my wife and I have been planning for months is suddenly in flux. And we’re hoping for some international travel (Australia? Europe?). All of this is taking back seat to this illness that I now know I have. Once I’m on some sort of treatment program I expect all this to get much worse. I’m very fortunate to have good care around me, and a supportive family and friends. So I apologize for whining. But it is annoying. And frightening.
After the primary care appointment I head home and share the day’s experience with my wife. I tell her about my worries about the hot spots on the bone scan, and emphasize that the study has not been seen by a radiologist yet, and until we hear the interpretation we don’t know anything at all. I kind of wish the guy had not asked me the questions. She’s a little worried as well, but agrees we simply have to wait. Again.
So, results next week. The butterflies in my stomach have been replaced by vultures overhead. My thought for the circling birds: “You are WAY early. Don’t count on anything down here any time soon!”
