Quarterly scans all clear, but . . .

Thursday morning I had both an MRI of my leg and the full set of Chest, Abdomen, and Pelvis (CAP) CT-Scans. These scans, of course, were preceded by a Wednesday evening “nightcap” of “Creamy Vanilla Smoothie” (a.k.a., Barium Sulfate Suspension), with the same for breakfast Thursday morning. I have to admit, the Vanilla was the best of all the flavors I have tried. That’s not to say that I liked it either, but rather that it was the most tolerable of the ones I’ve had thus far. Next time though, I think I’ll press my luck and go for the (even newer) Mocha flavor! Mmm . . . Mocha . . . I just hope I can stand the anticipation between now and then! [No, not really; I can wait. :)]

Now for the good news: my quarterly scans where all clear! Yeah!!! This leaves me sitting easy for the next 3 months. Honestly, I never really worry too much about what may or may not be going on in-between scans. Yes, I typically do get a little nervous the evening before my scans, but the truth is there’s really nothing I can do that will make my results either better or worse than what they are going to be. And that’s not fatalism or defeatism by any stretch; that, my friends, is acceptance.

So what’s the but about in the title? Well, way back in July, 2008 (when I was getting my first full set of scans), it was noted that I have a rather sizable lipoma under my right armpit (see dark area within the red outline in the scan picture on left). Though my latest radiology report describes this as “a right axillary lipoma, stable from the prior exam”, Dr. Monson (my orthopedic oncologist) recommended that I get it removed.  (Note that I also have several other smaller, more typical-sized lipomas in various locations, but the doctor has no interest or intention of removing those.)  Though his advice was couched with “no rush”, the concern is that a large lipoma could change into something cancerous. I suppose he’s probably right (he certainly has an amazing reputation and impeccable credentials). Even so, I’ll want to get another opinion as well as find out more details about the surgery itself, particularly the risks and recovery time. I think my main hesitation here is I'm not looking forward to any surgery, especially if it will take days to weeks to fully recover.  Furthermore, it's not currently bothering me or giving me any type of discomfort.  If anybody has any information or advice for me here, I’m all ears.

And there’s one more but worth mentioning here: all my scans this time were done without IV contrast. Why? Well, recent blood tests showed slightly elevated creatinine levels (mine is 1.5) and there was some concern that the powerful intravenous contrast agents (those used with the CT-scans especially) might send my kidneys “over the edge”. What’s surprising to me is that I’ve always been good about drinking plenty of water and I’ve made a point of drinking 2 – 3 bottles of water immediately after each CT-Scan in an effort to quickly flush these from my system (as suggested by the radiologist).  Even so, it's possible that the sum of all these dyes to-date has led to my elevated creatinine levels. But it's even more likely (as one comment below suggests) that in my case what I'm seeing here is a late effect of my chemotherapy drugs. Either way, I will need to avoid contrast agents going forward.

To be clear, I’m not blaming anyone for this. Dr. Monson never ordered any contrast with my scans and has long since preached against this practice, arguing that the risk outweighs any perceived benefit. Furthermore, in my case, I am told that about 80% of any Myxoid Liposarcoma recurrence would show up as “chest nodules”, which is something you don’t need contrast to see.

So why was IV contrast used in the first place? Well, it’s the radiologists who seem to prefer it. But even there, they were fine with skipping it knowing that my creatinine levels were elevated. In fact, they were very appreciative that I had my levels tested and that I brought this to their attention.

So why even mention this? The point here is that one needs to be aware that cancer treatment and/or prevention can lead to yet a new set of problems. Also, if you’re having MRIs and/or CT-Scans with IV contrast, be sure to drink plenty of water immediately after the exam to help flush these dyes from your system. Finally, make sure that your doctor monitors your creatinine levels (especially if you've had chemotherapy drugs) so that any issues are caught early . . . before they have a chance to become big problems.

OK – I’m done. I’ve rambled on long enough. Expect to hear from me in another 3 months.

Scans all look good

Just a quick update – the preliminary results on both my CT Scan and the MRI are positive. No spread of the cancer was readily evident in the CT Scan and the MRI showed some further shrinkage of the tumor. The official report from the Radiologist should be out later this week and they'll let me know if the news is any different.

I also have a surgical date/time set up: Wednesday, March 11, at noon. According to the doc, I should be out of the hospital within 2 days and then on crutches “only as necessary for balance”. Dr. Monson also stated that they would be putting staples and drains in my leg, all of which would come out 3 weeks post op. Beyond that, he said that I was looking great and that he didn’t expect any problems with either the surgery or my recovery.

What more could I ask for?!?

UPDATE 2/18/2009 --
I got a call this morning from my doctor's office to let me know that the "official" radiology report for my CT Scan has confirmed that there was no apparent spread of the cancer. Yeah!

MRI Results

I was able to see a doctor at Resurgens Orthopaedics on Friday, June 20, 2008. They looked at it, took an X-Ray, and said they needed to do an MRI with contrast.

The MRI got set up for Monday, June 30 at a private imaging center (as they could get me in sooner than Resurgens). Though I didn't see the advantage at the time, it turns out that since this was a private facility, I got to take home my MRI Images the day of my MRI. (They then fax the Radiology report to my doctor "within 24 hours".) But my followup appointment with the doctor was scheduled for 3 weeks later (July 21). And that was all fine with me since I was OK (or so I thought).

After getting home, I couldn't help but look at the films and was shocked with what I saw. Though I'm not a doctor, it seemed quite clear that there was a serious problem. Here are some of those films:

For the first time, I was actually nervous that I had something bad. I was convinced it was some sort of tumor; I just had no idea if it was benign or malignant. But this thing is huge: about 7.5 x 4 x 2 inches in length, width, and depth – elliptically shaped. Googling the subject revealed a few possible diagnoses, all of which were bad. I was getting more nervous.

I called my doctor's office who promised to share with me the Radiology report over the phone the next day. Now we wait . . . .