Z80 - The Diagnosis Is Not Consistent With The Gender of the Patient

Details on my upcoming chemotherapy

Posted by David Poncelow Mon, 16 Oct 2006 20:20:00 GMT

OK, so here’s the full deal. Early Friday morning (early being 8ish) I had a CT scan done on my chest and liver. The CT machine looked like a big futuristic donut with a bed that fit inside - I laid down on the table and the technician made me comfortable and started an I.V. Once that was going she called Jim from nuclear medicine over to give me the radiation tracer for the bone scan I would get later.

I got one pass from the machine as a baseline- the donut began to move and a recorded voice said ‘Breathe’. A moment later it said ‘Hold your breath’ and the donut moved across the area they were scanning. The technician came back over (I wish I had caught her name, but well, it was early) and got ready for the real scan. During this portion there is a tracer that is injected during the scan under pressure. She got everything set up, hooked the hose up to my IV and started the scan. Almost immediately the cap on the hose gave way, spraying a clear sticky fluid all over me. She stopped the scan and frantically stopped the machine that was pumping the tracer that was now spraying all over. She apologized profusely and we laughed about it and then she cleaned me up and replaced the part that had burst. Everything started back up, I got a few more scans by the donut and was sent on my way.

I met with Dr. Garnett a little later about my port. The port is a little metal disc, probably an inch in diameter and half an inch thick that will be placed in my chest right below my clavicle on the right side of my chest. In the center of this disc is a pocket of a silicone-like substance that surrounds a small reservoir. A small hose leads off of the disc- this hose will be placed into my subclavian vein and fed down to just above my heart. A needle can then be inserted into the silicone center and injections given effectively directly into my heart.

When I’m receiving my chemo (and having blood drawn) everyone will use this port instead of IVs and needles in my arm. The main reason for this other than convenience is that the chemo drugs are very hard on veins. If they were injected normally they would have to find their way all the way up through the arm before getting distributed to the rest of the body, causing damage as it works it’s way through. With the port the medicine goes directly into the heart which mixes it all up and sends it packing through the body.

After I met with Dr. Garnett I went back to Jim in nuclear medicine for my bone scan. I had met Jim before my surgery when I was getting the radioactive tracer pumped in for the sentinel node biopsy. He’s a great guy, really willing to put up with my incessant questions. The injection he had given me before my CT scan was a radioactive material bonded to a phosphorous compound. The bones pick up this compound as they use it for building and maintaining themselves. During the course of the morning all of my bones had been picking up this phosphorous compound along with the bonded radioactive material. He led me into the scanning room, and as I walked by a shelf there was a loud buzzing noise. Jim looked over, turned off the gadget that was making the noise and said ‘sorry, forgot to turn the geiger counter off’.

He put me on a bed underneath a ‘gamma camera’. This looks like a big disc, around two and a half feet across and a foot thick set up to be moved around into whatever position is required. Jim positioned the camera into place, put me where he needed me and then asked me to stay still. The gamma camera picks up the gamma rays emitted from the radioactive material that was now in my bones. Basically, I was glowing and it was getting the picture of what glowed. Each picture took about three minutes, during which my job was to stay as still as possible.

The pictures that result are pretty amazing- they are very clear images of just the bones. There’s enough glow to the skin around that you get some context, but the bones themselves are very solid and easy to see. What they look for in these pictures are bright spots. When a bone is healing or changing, it’s picking up more of the resources it needs- in this test it ends up picking up more of the radioactive tracer. When we got to the scan of my legs Jim asked me how long I’ve been running- the front edge of my shins was noticeably brighter than the rest of the bones. On the right shin there was also a bright spot in the middle of the bone- probably a stress fracture that I didn’t know about. Just to be sure, Jim took a couple extra pictures from different angles. The whole test took about two hours, most of it spent just chatting with Jim. He was kind enough to give me a copy of all the pictures that he took- I’ll try to figure out how to get them scanned in so I can show them off.

Tuesday I will go back to see Jim for a MUGA test. This is somewhat similar to the bone test in that a chemical which will bond to red blood cells will be injected into me. After a while the same radioactive substance used into the bone scan will also be injected. The radioactive material then binds to the first substance. The result is that my blood will then be glowing. I’ll get back underneath the gamma camera and I’ll get pictures of how well my heart actually moves blood around. This is mostly a precaution- it may catch some heart problems I could have now, but mostly it gives a frame of reference in case something changes. A couple of the drugs I will be taking have a potential side effect of serious heart damage. This test allows us to check back to see if anything changes.

Wednesday morning at 11 I head back over to the outpatient surgery area at Swedish to have my port placed. Dr. Garnett will do it under local anaesthesia, though I’ll have an anesthesiologist there to make sure that I’m not paying attention too closely. I keep thinking of the ‘relaxant’ that I was given directly before my surgery last time- the anesthesiologist looked at me and said ‘I’m going to give you a little something to relax’, opened a little valve, and the world around me got really soft really quickly and I started slurring my words mid-sentence. ‘Relaxed’ is a pretty substantial understatement for the state I suddenly found myself in. So I’m not too worried that I’ll be anxious during the surgery. Anxious before then… well yes, I have to say that I am.

Thursday is when the chemotherapy actually starts. Dr. Garnett will leave my port ‘accessed’ on Wed- basically he’s going to leave a needle already in it (covered with a bandage) so that I won’t need to be stuck when the incisions are so fresh. I know that it should take me a couple hours, but other than that I’m not really sure what to expect. I’ll be getting chemo treatments every two weeks for sixteen weeks - the first 4 weeks will be a cocktail of Adriamycin and Cytoxan. Apparently these are the nastiest drugs I’ll get, so the first four weeks may be the worst. The next twelve weeks I’ll be taking Taxol.

After the chemo is done I’ll be doing radiation- I’m not sure for how long or how often. I’ll also start on the hormone treatment (Tamoxifen) and the Herceptin. The Herceptin is injected- I’ll go in for that every three weeks for a year. The Tamoxifen is an oral med- I’ll take that daily for five years or so.

I’ve got a busy week coming up, and then I get to settle into the chemo itself. I’m excited to be starting on this - it felt as though there was a lot of frantic action after the diagnosis and then a loooong couple weeks of waiting. The waiting is over and it’s time to get started again.