More biopsies

            Yesterday was another fun filled day of needles and cameras.  I’m running out of analogies to use to explain things to Rebecca.  Last week when I was scheduled for the MRI and PET scan, Beck had some questions about what the tests involved.  I knew instantly that she wasn’t scared of the information but she was terrified by the things she was wondering about.  I used her recent trip to Idaho over the 4^th of July as a springboard event to help her understand.  Over the week she was here we used several different types of cameras.  We used a digital camera for taking pictures on dry land, we used an underwater camera at the water park and while in the river, and then I reminded her of the old klunker of a Polaroid that Dad uses.  Each camera has a different way of taking pictures, each camera can produce different types of pictures and each camera has a specific purpose (the jury is still out on the Polaroid there).  I told her the PET scan would take one type of picture and the MRI would take another type of picture, etc. etc.  (I told her if I ever saw a doctor carrying a Polaroid that we needed to call the police).  This seemed to make some sense to her and ease her fears. 

            I got to the hospital yesterday morning ready to get through this round of imaging.  The schedule for the day included a CT scan of my liver and a biopsy of my chest wall.  If the CT scan indicated that the spot on my liver was still suspicious they would biopsy that spot, as well. 

            I got checked in through the outpatient clinic and sat down for a minute or two.  Then a lady holding a chart waved to me said, “Ok”.

 I looked at her and said, “Who? Me?”

“Yep.  Let’s go over here”.  She sat down at a desk and started typing away.  “So you’re back again?”

I had no idea who this woman was.  Seriously?  How many hundreds of people she must have seen all week, and she remembers me?  “Ok, you’re all checked in.  Just go to the elevator, head down one floor, turn to your right, step to your left, put your right foot in, and you’ll be in the imaging department.  Got it?”

 

Um, yeah, sure.   

            I found my way to the right place, grabbed a crossword puzzle and waited to be called.  When the nurse called me back into my room for the day, she tried to be somewhat comforting, letting me know that I was getting the designer version of a hospital gown.  I looked for the DKNY label, but no luck.  She explained the process and I told her that I needed to be cognizant of any fun photo ops.  She looked at me like I was crazy until I explained the journal and the missed opportunity with the pseudo flux capacitor last week.  Just then the radiologist, Dr. C. (not to be confused with Mr. C of Happy Days fame) walked in and informed us that he had an operational flux capacitor in car and was quite careful to stay within the precautionary speed limit.  I instantly knew he was a good guy.

            A few moments later my hero walked in.  No….not Huey Lewis.  It was the radiology tech and he became my momentary hero because he handed me a fantastic bottle of water.  Keep in mind it’s about 1230pm now and I haven’t put anything in my system since about 10pm last night.  I needed to have a full bladder for the CT scan.  RIGHT ON!!! Gulp, gulp, gulp….aaaahhhhh. 

            All prepped and ready we headed to the imaging room.  Huey explained the process of injecting the contrast for the scan and the sensations I would experience.  I have to say his descriptions were dead-on.  Holy cow.  That’s all I have to say about that.  Before I knew it Dr. C was standing over me describing how they were going to do both biopsies here and now.  He had read the scan and felt it was necessary to take a piece of the spot on the liver in addition to the spot on the chest wall.  I felt my heart jump into my throat.  I was sure they wouldn’t have to.  In a matter of seconds, Huey was standing beside me marking me up with a pen and here came the drapes and nasal cannula and LOTS of people.  I couldn’t see the nurse who had promised me the “you won’t feel a thing” drugs so I asked for her.  I never did actually see her there but I think I heard her voice, and really didn’t feel too much (with one exception) so I’m going to give her credit for being there.

            After it was all said and done and I was back in my room, I talked with the nurse about the one time I felt some strange pinching.  She said she learned that I was a “sedation lightweight” (I still haven’t decided if this is an insult or a compliment) and at one point my lung relaxed onto the tube being used for the biopsy.  I started feeling a little sick to my stomach and then immediately found out why I wasn’t encouraged to drink the water earlier. 

            As I was getting ready to leave, I did get to have a little fun.  The nurse started to tell my friend about my care instructions for the next 24 hours.  She explained that one of the drugs I was given would probably make me forget things so don’t be surprised if things need to be repeated to me.  “Yeah”, I said, “I just hope they can get this biopsy done and over with soon”.  The look on her face was priceless. 

Angels 6, Orioles 5

The good news is the Angels beat the Orioles yesterday 6-5.  With few exceptions, yesterday was somewhat lacking in the “good news” department.  I’m just going to lay it all out there…

The scans from last week indicated some additional areas of concern.  First, a spot inside my chest wall that appears to be another melanoma site.  Secondly, the scan also revealed a suspicious spot on my liver.

The spot in my chest appears to be just external to the intercostal muscles and the subcutaneous fat.  While I would, of course, prefer this wasn’t there at all, this isn’t the worst location in my chest cavity.  Being external to the intercostal muscles means that it’s not inside my lungs which would present numerous additional challenges.  They are not 100% sure if this is another melanoma site.  Whether or not it is determined to be another melanoma will play a huge part in treatment plans.  A biopsy of the area will be done on Tuesday.  The liver lesion most likely is not an area of concern.  The doc has ordered an additional CT scan scheduled for Tuesday to be sure.  The results from both tests should be available next Friday which is when I meet with Dr. Z again.

How this plays out: PLAN A vs. PLAN B.

PLAN A

This is the best case scenario.  If the chest biopsy comes back negative the next move will be to schedule removal of the rest of the tumor in my scalp and to remove the spot on my face.  This will most likely be done in two different surgeries within the next couple of weeks.  Following that will be 12 months of daily chemotherapy injections.  Right now my understanding of the way this would works would be an initial 30 day regimen of I.V. treatments followed by intramuscular shots for the remainder.  He didn’t paint a fabulous picture of how people respond to this treatment, but EVERYONE responds differently.  This is definitely do-able from St. Lukes. 

PLAN B

If the biopsy results come back positive, because of the physical distance between the lesions the diagnosis will then be considered metastatic and the treatment plan is altered dramatically.  At that point a referral would be made to a “major medical facility” in a larger city.  Part of the treatment would require inpatient care and definitely isn’t my choice for how I’d like to spend the next year. 

CURRENTLY

I flew back to California with Mom yesterday afternoon.  I’ll be here for the weekend, returning home and bringing my youngest sister with me on Monday. 

Dad, Mom, and I sat down for a couple of hours last night making sure we all have similar understandings.  This has probably been the toughest part for me.  I’m having a hard time looking either of them in the eyes because they both seem so full of fear.  I’m really not fearful.  I’ve been saying for the last few weeks that I’ve had a huge sense of “God’s got this”.  I can’t change much of the situation so I’ve really got the easy part, I just have to keep moving through it.  The feelings I’m fighting right now are mostly feelings of anger.  Anger at the possibility that I may not be able to follow through with what I’ve started this year.  I’ve spent 10 years hoping to move back to the area and I’m starting to get really frustrated with the idea of not being able to finish school.  Obviously, I don’t know what next week will bring, but this is the first time I’ve had feelings I couldn’t immediately work through. 

I’ll spend the rest of this weekend hanging out in Orange County.  Lots of time with both of my grandmothers (it was awesome to walk into Nana’s room yesterday and say “Hi Nana” and have her respond with, “Heather?”. Having her recognize my voice without hesitating was pretty cool).  I’ll head over to see Grandma later today.  I’ll probably spend some time at the batting cages and mostly likely will head to the beach for a little while. 

Oh yeah, and Angel games are televised here.  I’m DEFINITELY taking advantage of that!

 

The makings of a plan

Dr. B (dermatologist) just called this evening.  Lots of information.  The biopsy on the spot on my face reported as a melanoma-in-situ.  He did receive a copy of the biopsy results from 2 years ago confirming that it was previously non-cancerous.  His hope was that he could prove the spot on my face was the primary source of the cancer, but it’s very rare for an in-situ to cause the type of melanoma found in my head.  They will be removing the spot on my face entirely (I forgot to ask when this will be done but my assumption is they will do it at the same time they do the tumor removal).  They’ll do some further testing on it after it’s removed. 

 

He also somewhat laid out the timeline for the next couple of weeks.  The next new doctor I will see will be the oncologist (Dr. Z) on the 25th.  The head and neck surgeon/ ENT (Dr. R) is out of town next week and I will meet with him when he returns.  Until then I will be sent to get the other tests: liver, lungs, brain, and bone. If ALL of these come back negative then they will send me for the sentinel lymph node biopsy (Yes, Mom, he was thoroughly impressed you knew what this was).  The goal right now is to determine the source. 

 

I have to try to make contact with the first doctor who performed the first biopsy years ago in San Diego.  For some reason, the records that were sent didn’t include the 1st biopsy. 

 

I did ask about travelling next month and he said not to cancel anything just yet.  I’ll pop in to get the stitches out on Wednesday.

I’m definitely concerned…

These were the words from a doctor I met yesterday.  This doctor would begin to tell me that the lump on my head that I have come to know and love as a friendly neighborhood cyst, in fact, probably wasn’t. 

I’ve told people over and over again that I have a firm policy against worrying unless I have a specific reason to worry.  It drives me nuts when people freak out as their doctor gives them a list of all the possibilities.  My perspective has always been that unless the doctor tells me that something is absolutely wrong then the possibility exists that it’s really nothing bad.  Assuming either way isn’t helpful.

So the doctor spent what seemed like 30 minutes pulling and cutting and tugging inside my head yesterday.  Luckily, I didnt’ feel a thing.  They did an excellent job of numbing me up.  They (by ‘they’ I mean the doctor and the nurse) seemed to be having some difficulty stopping the bleeding.  After about 6 or 7 minutes of searching for where the blood was coming from and several zaps of the cauterizing instrument, the bleeding was controlled with some extra stitches and he was ready to close.  Eight more stitches on top of the scalp and I was able to sit up for the first time in about 90 minutes. 

I glanced over to the tray the doc had been working from and saw what looked like part of one of my old Lincoln Log toys.  “Is that it?”, I thought.  It was twice the size of the lump I felt on my head.  I would soon come to find out that he hadn’t even removed half of what he saw.  I asked about this and he explained that he didn’t feel comfortable removing any more of it in an office setting.  Anything more would require surgery.  Like in an operating room. 

The doc went on to explain it would take 7-10 days to get the results from the lab and added that he liked the lab here in town as they were very quick and thorough.  In the meantime keep the wound dry and come back next week to get the stitches out. 

The nurse dressed the incision and I set up the follow-up appointment. 

My phone rang a few minutes ago.  It was the nurse.  The doctor has my results and wants me back in his office at 4pm today.  When I hesistated she said they could possibly wait until first thing tomorrow morning but the doc needs to see me as soon as possible ”to discuss the options”.  This is never good news.  So much for having 7 – 10 days.