The Meet

Rob and I met with Dr. Litton today.

• He doesn't think that surgery will be of any benefit, but he would like us to meet with Dr. Collins to get his opinion. I plan on making the appointment tomorrow. (The 'spots' are in hard-to-reach places [one next to his heart], so he would have to perform a thoracotomy to get to them.)
  
• Rob will have an x-ray done and meet with Dr. Litton in six weeks.
• Rob will have another PET scan in three months.

That is all for now. I am really exhausted.

SUVs: No, We Are Not Getting a New Car

I am not going to wax poetical. I am copying and pasting the 'findings' and 'impression' from the PET scan results.

FINDINGS: There is hypermetabolic activity noted at the site of multiple surgical clips along the medial aspect of the right lower lobe [the doctor is referring to his lone lobe - since the other two were removed, in case you are getting confused] where soft-tissue prominence is evident. This has a maximum SUV of 8.4 and is quite concerning for recurrent tumor. Additionally, contiguous with this site of abnormal activity islobulation of the posterior pleural margin on the right with associated hypermetabolic activity identified on the PET/CT scan with a maximum SUV of 6.2. One additional site of hypermetabolic activity is noted anteriorly along the pleural margin (image 107) where additional pleural-based lobulation is noted.
This has amaximum SUV of 5.2.

IMPRESSION: Hypermetabolic activity associated along the right lung base at the site of surgical clips and with the lobulated pleural thickening, predominantly observed posteriorly although a focus is also noted anteriorly. The appearance is quite concerning for recurrent/metastatic lung cancer.

Looks like we are going to get a biopsy or two.

Rob's comment was, "Looks like we've got a bunch of SUVs and it is not cars."

(SUVs are the level of uptake from the radiation - the higher it is, the greater chance of cancer. Last time, he had two sites with SUVs of: 5.5 and 3.7 [which, incidentally, they said that the 3.7 score was too low to be cancer, HA! Rob proved them wrong, didn't he?] and this time: 8.4, 6.5, and 5.2).

Hurry Up and Wait

Can I tell you how difficult it is to 'hurry up and wait'?

With all of Rob's previous scans, the report was posted quickly and I was able to contact his doctor's office the next day to hear the findings.

His doctor's office called me today at and told me that the report has not posted because the nuclear medicine radiologist hasn't looked at the scan.

So. We wait. Hopefully, he will know that there are a bunch of people waiting on pins an needles for him to read, dictate, and post his findings.

Dog, Snake, and Rat

You are asking me, "What is with the title of this blog?"

Oh, oh, oh! Let me tell you. A dog, snake, and rat have something in common. They are all pets. Yes. Rob will be getting his PET scan on Thursday this week.

In my rush to get the information posted last night, I didn't really answer the burning questions that I posed to the doctor's office.

1. We don't know whether his cancer is back. "It is never a good thing when something that size shows up in a scan. It would be a good idea to get a PET scan to see what kind of uptake the nodule shows," said the PA to the worried wife.
2. Yes, the chances are pretty high that he has a broken rib. Remember the pneumonia he had in May? Well, with all of the coughing and hacking he did, I'm surprised that he didn't break more of them. Poor guy had to hold onto his side for dear life during every cough, for fear his remaining lobe would shoot out through his healed incision.
3. Liver? Don't know. Hopefully, there is no cancer in that organ. The PET scan will let us know how much metabolic activity is happening there.

I had asked the oncologist PA whether we should plan on a biopsy. She said that it really depends on what the PET scan shows, but it probably would be a good idea to just plan on it - if it doesn't happen, great!

So, thank goodness for pets. They tend to calm us when we are stressed. (Or is it the other way around?)

Deja vu?

"Ahhhhh!"

No, that is not me breathing a sigh of relief.

So. As you may remember from the last blog entry, Rob had his three-month CT this morning. Luckily, we were able to read the report online. Unluckily, we don't speak 'doctor.'

Let me relate to you some of the phrases that were in the report:

There is a nodular feature at the periphery of the right upper lobe best seen on image #34 and this measures 5 mm in diameter. There are a few associated linear densities. This was not definitely visualized on the prior exam from 01/07/09. There is some volume loss and a few coarse linear changes in the right base and there is a tiny effusion at the right base. The left lung is clear and no left effusion. So, he has more cancer?

On the prior exam there has been resection of a portion of the posterolateral aspect of the right 7th rib. The remaining ribs had appeared intact. On the current exam again noted is resection of the right 7th rib but there now is a fracture with some displacement in the 8th rib posterolaterally and then a nondisplaced fracture through the medial most aspect of the left 9th rib with some callus formation in that region. So, he has a broken rib?

A portion of the upper abdomen was included, and there appears to be an enhancing lesion in the lateral segment of the left lobe of the liver best seen on image #55. This was not appreciated on the exam from January 2007 which was a noncontrast exam. There is a questionable subtle low attenuating lesion in that region on the prior exam. On the contrast enhanced exam from 09/02/08 this was not seen. There is an old contrast enhanced CT of the abdomen from 12/30/05 and there is a subtle lesion in this region on that exam. Suspect this is a hemangioma though is not as well seen on that prior exam. (History: he did have a spot on his liver 3.5 years ago, but they thought it was just fine - so, is this getting bigger? Is it really cancer?)

Bottom line: what the, huh? Rob's oncologists office called me at 4:30 tonight to answer questions. (I called the office this morning upset, I guess six hours is a decent amount of time to call someone back when they are falling apart.)

Rob will be getting another PET scan (remember the drinking of nasty Kool-aid-type drink and then getting a super-duper powerful shot of radioactive isotope to see what kind of paranormal activity he has roaming around in his body?). We should find out soon when he will get his PET scan.

More information to follow.

Does this feel like deja vu to you?

Seriously.

The Weekend Countdown

Today, Rob is going to give blood. This is something that he has to do prior to his CT scans to make sure that his liver is still functioning. (Heaven forbid something else breaks down, right? We already know that he is a defective model and since we forgot to purchase the extended warranty on him, we are out of luck. hehehe)

Just in case you were wondering what we are going to do the next week, I thought I would lay it out for you...

• Thursday: 4 pm - give blood
• Friday: all day - think about the scan
• Saturday: all day - think about the scan
• Sunday: all day - take a break from thinking about the scan - since it is a day of rest
• Monday: 8:15 am - get the scan
• Monday: all day - think about the scan
• Tuesday: 9 am - Jessica to call oncology office to find out the results of the scan
• Tuesday: until 5 pm - wait until the doctor calls back

OR

• Tuesday: 12 noon-ish - go online to myhealth.com (Intermountain's super-cool website that allows their patients to go and look up their some of their medical information, including, but not limited to, x-rays, scans, blood work, did I mention scans?) -- This will only work, if the radiologist gets it in the system ASAP, otherwise, see the above step.
• Wednesday - July 31: all day/night - breath a sigh of relief, since everything will be just fine.

(He did go 3.5, well, 3.2 years without it coming back - so I am thinking that it would be abnormal if it came back this soon - RIGHT??? It has only been five months since his surgery.)

So, what I am trying to say is this: if you pray, please do so. If you don't, think about doing so.

What is even better than this? Doing it again in September! YAYAYAYAYAY! (I can hardly wait.)