Sharing the Journey

I can’t imagine traveling this cancer road alone.  No one should ever, ever have to.  I’m so very grateful that I’ll never have to.  In fact, my family has grown through this journey.  This struck me again today when the caregiver wife of a ROS1der posted a heartfelt and loving message to us all. While I’ve never met any of the ROS1ders, I feel incredibly close to them in the 22 months since I found the facebook group established for cancer patients who are ROS1+.  This family has nearly tripled since I found it, and is worldwide.

The ROS1der FaceBook group is a closed group (public site: ros1cancer.com), and I cannot share the details of that lovely post or anyone’s specific information, but  I can share what makes them my “family”.   Most, but not all, have lung cancer. Most, not all, have metastasized cancer.  Most, not all, have been on the drug  Xalkori crizotinib, my treatment hero, the reason I survived long enough to even call this a journey.  Many, maybe most, are younger than me, many with children at home.  Many have had treatments that I’ve not had.  Many are in clinical trials, some on the same drug as me (lorlatinb – hero drug #2), some on other targeted therapy drugs that are giving hope to ROS1ders.  All are either ROS1+ or the caregiver of someone who has ROS1+ cancer as required to be a group member.   Because of all we do have in common, there is always someone who understands, or can relate to, what another is experiencing.  Beyond that even, there’s just such a feeling of empathy and sincere caring about one another’s well being in the group.  In this group we share information, learn how different oncologists approach different topics, hear about procedures and tests as described by the patient, get the latest news on clinical trials and research, share tips about dealing with side effects and symptoms, options for and how to access healthcare/treatment, and so much more.

I’ve tried to think what it is that makes this family so very special compared to other organizations I’ve been part of and even considered family. I believe it is the never-ending optimism, the incredibly high level of HOPE, STRENGTH, COURAGE, and FAITH.  The people in this group have so many (not every!) reasons to feel and speak only doom and gloom, but not in this family.  Our fears, worries, and sadness can be freely expressed and we know they will be responded to with caring and genuine concern.  It is a safe place.  This is a difficult road to travel.  Love, compassion and support, research and answers, virtual shoulders to cry on and hands to hold are all offered.   Always, always with an eye on a future where, if not a cure, then treatment for managing cancer as a chronic disease, always HOPE.

My ROS1der family, a FaceBook group. Who knew I’d find such camaraderie in such a place.  Huh.  Another of the countless blessings that have come my way on this journey.  May every human needing such a place, find theirs.

Finding joy in the everyday, every day.IMG_3189.jpg

 

 

HAPPY cancer-VERSARY to ME!

Two years of LIVING life to the fullest, enveloped and supported by those who love me.  Cause for celebration for anyone, anytime! For sure for me when you flip the pages of my story back two years.

What date to choose for the start of this journey?  Hmmm… When I first felt ill, or maybe when I developed that cough, cough?  Nope, not then…I didn’t know then.  Okay, so maybe the Sunday I had the life-saving X-ray, or  the Tuesday I got the call (while at lunch with my granddaughter) that I needed a CT scan because of “something” the radiologist saw on that X-ray.  Could be then, but nope.  Must be pneumonia or something. Ah ha!  Got it!  Not just the date, but the exact moment.

The day this journey began was Thursday, January 7, 2016.  Dan and I were sitting in an exam room, and my PCP knocked and entered slowly, too slowly.  It was a surreal moment.  The expression on her face showed everything I didn’t want to know.  It was kind of like in the movies whenever the doctor says there’s no hope, only sadder, and real; too sad, too real.  Her sad voice broke as she explained that I had a mass in my left lung hilum.  I asked if it could be anything other than cancer, even before she said it was.  She slowly shook her head,  and not wanting to give me false hope said, “No, not really.  There really isn’t anything else it could be.”  And then, after processing the news for just a few seconds, we went on to lay out a plan to first get a diagnosis.  That’s it.  Yup.  That’s the day.  Thursday, January 7, 2016, approximately 9:50 AM.

And thanks to medical researchers, research doctors, the incredible staff at Dana-Farber Cancer Institute (go there the second there is a cancer diagnosis), the prayers, well wishes, and positive thinking of many, and the support of those who love me, HERE I am!! Not just alive, but living!!

Loving LIFE with Dan, our family, the three little dachshunds, and Dottie and Matilda, the Nigerian Dwarf Goats.  Finding (and spreading I hope) JOY in the everyday, every day.  Content. Happy.  Satisfied.  A meaningful life, filled with HOPE.

Climb Every Mountain

Warning: long post, somewhat rambling!

Time flies! There’s never enough time… Where did the time go?  Or, maybe, just maybe, there really is no such thing as time.  That’s what physicist Julian Barbour thinks.  Instead of time as a measure of change, Barbour sees each individual moment as a whole, complete and existing in its own right. He calls these moments “Nows.” And our lives are a succession of Nows.  There is only now.  Huh.  Go figure.  Now I begin to understand a conversation I had over ice cream a few months ago.  This post is about a succession of Nows over the past what I thought was time period called a decade.

When I turned 50 I announced that maybe, just maybe I had reached middle-age.  My plan was to surpass 100 and I felt that was a reasonable goal.  My true goal, which has not changed, is to stay young forever, however long that may be for me.  The decade since that announcement has been filled with highs and lows, as I suspect everyone’s life probably is between 50 and 60.  Both of our mothers died, a year apart, expected someday maybe, but still ever so painful when it comes, and so sad, still.  Something countless others can relate to.  We had two beautiful grand-babies born between those deaths, totaling five. Our heart hero grandson had surgeries and grew stronger, and “time” went on.  Suddenly, it seemed, all the grandchildren were in school, and our oldest grand-daughter entered high school. She’s now a nursing student, 3rd year – wow!

During most of those years, I worked, learned, and played with the most wonderful people.  My relationships with some are still strong and wonderful today.  Somewhere in those years, I was privileged to be invited to work with some extraordinary teachers to develop and implement learning adventures for students that were like no others; traveling to Alaska to volunteer at a remote Iditarod checkpoint, and a ranger-led backpacking expedition to the bottom of the Grand Canyon.  Both times students worked to raise funds, and studied and trained for the adventure.  Amazing can’t begin to describe this opportunity.

Dan and I went on some very exciting hunting trips in Saskatchewan.  There is nothing like 10 hours of sitting in a tree stand surrounded by Saskatchewan nature.  From the tiniest snowflake to the majestic whitetail bucks, I captured it all with my Canon and in my mind – the wildlife, the snow, the sunlight through the trees, the quiet like nothing at home.  And yes, one buck per hunt, most years, with my Browning lever action 7 mm-08 to take home to the freezer.  The best times were when Dan and I sat together in a stand, sometimes during a snowstorm, spending hours waiting for just the right snowflake to fall on our hat to “shoot”!  And, reviewing those pics over tea in the cabin that night.

We renovated our Salt Pond camp near the start of this decade. Camp Gramma evolved, I’m not sure how long we’ve done it. I’ve mentioned it before, and it deserves a post of its own, with pics.  Every Gramma should have the opportunity to spend her summers playing in the outdoors with her grandchildren.  Talk about joy!

I left the job I loved rather than compromise my integrity and go along with things I believed were wrong in 2013.  But every cloud does have a silver lining if you look or pursue it, and my job transition to my “beginnings” as an educator in early childhood allowed me to pursue a passion – nature and nature-based education.  A course taught by The Maine Master Naturalists opened my eyes and minds to the world around me in ways I never imagined.  This passion feeds me now, bringing me joy and comfort, and always an interest to pursue.

Dan and I found hiking during these years.  Our goal became to climb every mountain we found, or maybe that was Dan’s goal!  I like hiking.  Hike we did! At 55 I was the most fit I’d been in my life.  We climbed Katahdin, Mt. Washington, Cadillac, Big Spencer, and Blue Hill Mountain (over and over and …)  Climb every mountain you can while you can!  The view is always unique.  We went on crazy adventures to Tanzania to climb Kilimanjaro and go on a photo safari, and back country backpacking down and up the Grand Canyon with my sister and her husband.  At almost 58, I was the baby on that trip!

Then came what was to be a very strange year – 2015.  It certainly had its highs, beginning with that trip to the Grand Canyon in April, four big kids on a once in a lifetime adventure.  Another high was the naturalist course that I use the learning from every day as I find joy in the everyday.  And Camp Gramma that summer was sensational!  But a strange “series of unfortunate events” took place that year, big events for us, life-changers really.  First our oldest dachshund died.  He had truly been Dan’s faithful companion.  Shortly after losing Rocky, Dan nearly lost his boat and his life when his lobster boat filled with water and he raced “time” to run it aground before it sank.  Scary, something that stays with you, life-changing REALLY.  And then, 3 months later, August 17, 2015, we had a house fire.  No one was home.  From the outside our home looked as if nothing had been harmed.  In reality, the house would be gutted and rebuilt inside, and we would lose all of the contents, forty years of our life’s “stuff”.  Life-changing REALLY.  And then, while working to inventory all of our things, oversee the work at the house, and teach, I got sick – cancer crept in while I was otherwise occupied…  Weird year, that 2015.  Life-changing REALLY.  Some silver linings?  Always.  We winterized camp and lived in the most beautiful natural setting.  We adopted Ruby Jean the dachshund.  We deepened relationships with those close to us who understood that support is needed even if not asked for when life-changing is your NOW.

2016 was the year we learned about lung cancer.  And brought Dottie and Matilda, the Nigerian dwarf goats, into our lives.  It was the year I think that our 44 year relationship deepened and we reconnected with renewed and strengthened love as we stopped reeling from our life-changing events, all the while beginning to deal with cancer.  We’d gotten mighty comfortable in our roles over the years, if not taking each other for granted, then maybe taking life for granted, and then, we couldn’t anymore.  Life changed.  When cancer creeps in, so can fear.  But Dan,  my best friend, my true love, my partner in life since I was 15, has faced these new challenges with such courage and strength. Together, like we’ve done since we were teens, we’ll face this one together too.

2017 was the year we learned to live with lung cancer.  We’ve had a marvelous year, especially since I was able to stop working in May. (A silver lining?)   We gardened, enjoyed our annual trip to Spencer Pond Camps with all our children and grandchildren, played at Camp Gramma, loved our 3 little dachshunds and the “girls” Dottie and Matilda.    While Dan works, I do what I feel like doing!  And that’s okay with him.  I volunteer in my dear friend Kathy’s classroom, go on outings with my free-ranging sister and a friend, play cribbage with my son, go on walks with my daughter, read, or whatever I may feel up to doing.  This time of year there’s alway a basketball game to go to with four grands playing and Dan coaching.  Finding joy in the everyday every day.

And don’t forget!  Climb every mountain you can while you can.  The climb and the view are always unique.

Welcome 2018!  (If you even exist since you are a measure of “time”!)

Thursday, December 28, 2017 Update

Great news, again!  Right up there with some of the best news I’ve had since beginning this journey.  Writing this in our hotel room, a block from the most wonderful cancer institute in the world, Dana-Farber Cancer Institute.  Wonderful: inspiring delight, pleasure, or admiration; extremely good; marvelous.  Yes, wonderful! Regardless of the news I might receive from them, they certainly have inspired admiration from me, data shows their work is extremely good, and the people we’ve met there are delightful and quite marvelous in their treatment of patients and caregivers.

Back to my news!  Stable from the neck down, AND (drum roll please) an 84% reduction of the nasty beast in my brain meninges since beginning my second wonder drug Lorlatinib in July.

Today was another long day for us.  We stayed in Portland last night to make sure we would arrive at Dana-Farber for a 10:30 AM start.  At 10:30 PM the fire alarm went off in the hall of the motel last night.  Some kid had burned his popcorn in a microwave.  We didn’t have to go outside luckily. Today began with “free” breakfast at 6:00 AM, followed by a very quick 2.5 hour drive to Boston.  No morning traffic – unlike any other day we’ve gone.  Vacation I guess. We even parked on P4 instead of P6 of the underground parking garage!

My appointments were all the “usual”:  IV in, blood draw, CT scans of chest and abdomen on L1 in the Dana Building, brain MRI and IV out on Dana 3 , grab some lunch (Yawkey 3), check vitals, EKG, Dr. appointment (Yawkey 10), and wait for medication (Yawkey 2). Done at 4:00 PM. Nothing to it!

Here’s more great news – I am scheduled to return to Dana-Farber on March 1, 2018.  Nine weeks!!  Yes, nine.  That is the longest between appointments in the 23 months I’ve been a patient at Dana-Farber.  Wow! Now, will I be nervous about that? I don’t think so.  I know my body, and the difference between symptoms and side effects pretty well now.  And, my clinical trial nurse and oncologist are just a phone call or 5 hour drive away!

Hey, I forgot something very important in my post about Procedures and Tests !  When they put the contrast dye in your IV during scans, you get the warm feeling and would think that you wet yourself if not forewarned.  Thought about that one today when…

For me, 2017 has been the year I began to learn to LIVE with metastatic lung cancer, helping to create new statistics, and bring hope to those diagnosed with this disease that still currently kills 433 Americans every day. We can, are, and will continue to do so much better. There is great hope for the newly diagnosed.

Happy New Year to all our family and friends, new and  not so new!  Your positive thoughts, love, and prayers continue to help give me the strength needed for this journey.  Please test your home for radon this year if you’ve not yet done so.

Looking forward to us going home to the dachshunds and goats, comfy and cozy for the winter, feeling grateful, and finding joy in the everyday every day!

 

We’re off to see the Wizard!

For Christmas I received a family outing to see The Wizard of Oz performance in April.  All of the Camp Gramma “campers and counselors” are going!  The “givers” know I love The Wizard of Oz.  Without intending it to be so (I think), it was also a gift of hope and of a feeling, a statement, that we’re not letting this cancer interfere with our family life.

I love The Wizard of Oz – did you know that? A few weeks ago I saw that the performance was going to be about an hour away in April. I thought about getting tickets and inviting someone to go with me, but…  But I didn’t because there were too many “but”s in my way. But it’s late, but it’s expensive, but…  Honestly, I let cancer get in my way.  But someone will have to drive me.  But what if I don’t feel well?  It’s too far away (in time, not distance), I can’t spend $ on something 5 or 6 months away.  Who knows what life will be like then?  But in reality, no one knows, for anyone.

So I’m excited!  Excited to see the performance, and with all my campers!  There’ll be seven of us.  We’ll go together, and maybe we’ll go to dinner first.  It’s a school night and I know the campers will be tired, but they’re young!  And me?  I can rest the next day.

It’s a strange thing, this life with metastatic lung cancer.  Since it’s not going away, and some wonderfully talented people have figured out how to contain or control it for now, we are filled with hope and making plans – not just setting goals – making plans for events that are months away.

I remember the first time I saw The Wizard of Oz on a color television at my aunt’s home as a child.  Wow!  And, I saw Wicked on Broadway when I went with my daughter and her daughter to NYC for my oldest granddaughter’s 16th birthday.  That was spectacular, and a special outing for all of us.  This time will be special and spectacular before we even see the performance, because we are doing it.  Making memories.

Here I am – living life, feeling grateful, trying to express that gratitude, and finding joy in the everyday every day!

 

Privileged

Privilege, privileged – the word has come to my mind a lot lately as I think about my treatment and healthcare compared to others’. The “others” I speak of in this case all have access to healthcare, so I guess they too are ”privileged“: a special benefit that is available only to a particular person or group.  (macmillandictionary.com)  Many people in our world do not belong to the Access to Healthcare Club at all.

My mind begins to confuse the definitions and ways the word privilege is used as I consider my lung cancer treatment. The definition above doesn’t tell anything about the person or group, but in this case privilege feels good and not so good.

I definitely feel it is a privilege (something nice that you feel lucky to have) to have qualified for a clinical trial at Dana-Farber Cancer Institute.  It feels really nice and lucky to be there.  We work(ed) hard to get there (years of employment earning health insurance, paying fully for that health insurance now that I can no longer work, driving to Dana-Farber (250 miles one way), and on and on…  But it is a privilege that even someone WITH health insurance living in some regions of THIS country cannot access.  Clinical trials for my targeted therapy drug Lorlatinib are only available in a few places in the country. This drug targets only two very specific gene mutations/drivers(more on how cancer cell mutations happen), ALK(in 3-7% of NonSmall Cell Lung cancer) and ROS1(1-2%). We are lucky drugs are being developed for such a small number.

Today Lorlatinib may be available for Compassionate Use (Expanded Access), but it was very difficult to acquire in this manner until recently (now that it is near FDA approval.) I know this because not long ago one of the “others” with ROS1 developed resistance to crizotinib, the only FDA approved targeted therapy drug for ROS1. (Have I ever said that because of this mutation, standard treatments don’t work?) So, after crizotinib stops working, a ROS1 lung cancer patient has little hope unless she can get into a clinical trial. This patient lives in a region where there was not access to a trial.  Drive to one, fly to one you say! Not if the person is not well enough to do so or hasn’t the financial resources to do so. Maybe she doesn’t quite meet the criteria.  How about compassionate use you ask?  Not available in this case. What?!!?  Time’s running out.  In this instance, the last I knew lung cancer patient advocates began reaching out to the drug company and the ROS1 experts in an effort to acquire treatment for this patient.  I was not able to learn if help came in time.

Privilege: a special benefit that is available only to a particular person or group

I belong to a FaceBook group for ROS1 patients from all over the world.  Nearly all are lung cancer patients. We are able to share information and learn from one another.  I’ve found it immensely helpful in my search for understanding of this disease.  This group is available only to ROS1+patients and their caregivers. A privilege that is available to anyone who would need/want it, if they have internet access, and can read and understand the information.

Even those with the education, reasonable financial resources, and health care access cannot assume the privilege of receiving my level of treatment.  Lorlatinib isn’t available in all parts of the world.  And, the newest of these drugs ( Tyrosine kinase inhibitors)that treat ROS1, entrecinib, isn’t available even through clinical trial right next door in Canada, according to an “other”. (That will still make only 3 drugs, 1FDA approved, to treat ROS1, and those pesky cancer cells really know how to build resistance to the drugs.)

I know what it was like before my first targeted therapy drug.  I was dying.  I did not build resistance to it (but had brain progression).  I am privileged to be treated in a facility where I have scans regularly, where I know when I have a symptom (such as with the brain progression) it will be looked into quickly, where treatments are known and available, where a plan is ready if cancer overpowers the drug.   I know of an “other” , living in another country, who died while waiting for treatment to arrive.  I am so sorry this happened.

Without the many privileges I enjoy I wouldn’t be here, drinking tea by the Christmas tree, wood fire warming the room, still trying to sort the good and bad of the definitions of a word as it applies to my experience with healthcare.  I know the circumstances of my life (from childhood and education to the love and support of Dan and our family)  have equipped me to access the best level of treatment.  But does that mean I should be privileged, should belong to the club when “others” with the same needs are allowed to die because they can’t access the correct treatment?  A treatment that IS available, but not accessible for that person.   I can’t change the world, but gosh, at least in our country, it seems like access to known lifesaving healthcare should not be a privilege.

And, by the way, have you heard me say lately that LUNG cancer research is way underfunded?  It is the deadliest (433 Americans per day) and least funded when compared to the other common cancers.  I’m making my voice heard to my representatives, and urge others to do the same.  Oh yes, and radon is the second leading cause of lung cancer – just thought I’d get that in there.

I’m privileged to be able to serve on the Family and Patient Advisory Council of the Maine Lung Cancer Coalition MLCC.  More on this work later.

Finding joy in the everyday im my cozy home, making memories, and loving life with Dan, family, 3 little dachshunds, and 2 Nigerian dwarf goats – that’s me, living a life of 

 

Procedures and Tests, so far so good

LONG POST- NOT URGENT.  Information sharing!

Since January 3, 2016 I’ve had a few procedures and many tests (scans, MRIs mostly).  I thought it might be helpful to describe these from the perspective of a person who doesn’t really get too worked up about things like this. Me.

You can read the description of any procedure and test online, and I think that’s a pretty good idea.  I mean, how is one to know if you have any questions if you really can’t picture what’s planned?  I imagine we’ve all had the experience when the technician or doctor asks if you have any questions, and you’re still stuck on the first thing they said about what was about to happen. But, if you prefer just going with it, no need to check it out first online.  And, when you’re desperate for the information the procedure or test might provide, you may truly want to just go with it.  In either case, if you do go online to check out how the procedure is done, don’t  get stuck on the risks.  You’re going to have this done, the doctors (and you by consent) have determined that the benefits way outweigh the risks.  And seriously, in my case, it’s been a “no brainer”.  I know some of what I’ve had done can cause cancer, but I’ll take living long enough to participate in a study on that when it does catch up with me.

So I’ll try to do this chronologically, beginning with the lifesaving x-ray. The one that showed my tumor was done at a walk-in clinic on a winter Sunday afternoon.  It’s an “electromagnetic wave of high energy and very short wavelength, which is able to pass through many materials opaque to light” that’s used to take photos of what you can’t see. You lie on the table, the tech leaves the room (to protect themselves) and click, click – that’s it!  Quick, easy, painless, and oh so informative.  Why, it can find broken bones and lung tumors!

Got a “cough, cough” for months?  Ask for an x-ray just to be sure it’s not a tumor.  Low dose CT scans are available too, especially if you are “at risk” for lung cancer.

CT scan (sometimes called CAT scan) “A computerized tomography (CT) scan combines a series of X-ray images taken from different angles and uses computer processing to create cross-sectional images, or slices, of the bones, blood vessels and soft tissues inside your body. CT scan images provide more detailed information than plain X-rays do.” (Mayo Clinic)  Well, I guess it’s just a fancy x-ray that gives more detailed information. Mine are all “with contrast” – an intravenous and/or an oral  “dye” is used to enhance the scan/x-ray. My first one in this journey was at my local hospital.

I’ve had many CT scans of my chest and abdomen at a few different clinics/hospitals.  At Dana-Farber they trust you to come clothed in “NO metal” clothing.  Sometimes they ask about underwire bras, zippers, or pocket contents, just to be sure and safe.   Here’s how my CT scan appointments have gone.  Nothing to eat, and only clear liquids for two hours before.  If you are having oral contrast and haven’t gotten it ahead of time, you arrive an hour early, check in and get your tasty drink. (It’s not so bad, sometimes seems like a lot.)  At some point a nurse/tech will take you to put in an intravenous catheter (unless you have a port) in your arm/hand.  It is a small, flexible tube put into the vein so the contrast can be Putin or blood can be drawn out.  The vein inside my right elbow is great, so mine go there, get taped on, wrapped, and are used for the CT and any other tests, blood draws, etc. that day.  Nearly painless, just a little jab.  Next! At some places I’ve had to undress, leaving just my underwear, socks, and shoes on, and put on a johnny (short gown fastened in the back) for the scan. Then you go into the scan room (which is probably cold) and lie on a table/bed with a big machine shaped like a donut around it.  It’s very open.  You lie still and move to the donut, hold your breath for about three seconds, and move out.  A couple pictures and then the technician comes back in to start the IV contrast,  He/ she returns to safety, two more pics, and then they flush out the IV or take it out if you don’t need it again that day, and you’re on way. Drink lots of water that day to flush the contrast out of your system!

This explanation from radiology info.org is great for understanding CT scan, MRI, and PET scan process.  “The CT scanner is typically a large, box-like machine with a hole, or short tunnel, in the center. You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes the imaging information is located in a separate control room, where the technologist operates the scanner and monitors your examination in direct visual contact and usually with the ability to hear and talk to you with the use of a speaker and microphone.”

Bronchoscopy That first CT confirmed that I had a tumor, so I went to a pulmonologist (lung specialist) who decided to do a bronchoscopy: “an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth.”  This was a relatively easy (for me) day surgery procedure.  I was given something for anesthesia – “In the practice of medicine anesthesia or anaesthesia is a state of temporary induced loss of sensation or awareness.” ( I don’t remember this, I guess it worked!)

A tube, with an instrument in a smaller tube inside the larger tube, was put in my mouth and into my lung.  The doctor used the instrument to look around and to snip some tumor tissue for pathology.  I think this process took less than an hour.  I woke up in recovery, was told I may have a sore throat and to call if any coughing up blood, and home I went. After sleeping off the anesthesia, I was fine (from that anyway), no sore throat even.

The pathology report took many, many  days (from this facility anyway), and the sample ended up being sent on to Brigham and Women’s because it was “inconclusive, rare, abnormal” and need further examination.  (What?!?  Now you begin to understand why we took ourselves to Boston.)

After seeing the tumor, the pulmonologist decided it was a good idea to have a Brain MRI and  PET scan (To see if I “lit up” anywhere else. Places where there are cellular changes “light up” in the image.)

Brain MRI (Magnetic Resonance Imaging) “Magnetic resonance imaging (MRI) of the head uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of the brain and other cranial structures that are clearer and more detailed than other imaging methods. This exam does not use ionizing radiation and may require an injection of a contrast material called gadolinium, which is less likely to cause an allergic reaction than iodinated contrast material.” (compared to CT scan with contrast) radiology info.org

I’ve had about 10 of these now, so here’s a description from an earlier post, with additional thoughts. “This means taking off everything but my undies, putting on a johnny, having an IV put in . Then into the cold room, and getting up on the table in the right spot, cushions beside my ears, a “hockey mask” clamped over my face, and into the tube I slide. Oh yes, you can choose music or earplugs to slightly deafen the sound.  I choose earplugs now.  (Music on that first one.) And, you are given a bulb to squeeze if you need anything (because of course the techs are safe away in another room watching you). The techs talk some to let you know how much longer, etc.  Probably if you’re not still, they tell you.   Halfway through I’m slid out to put the contrast dye in my IV. After listening to some pretty strange and very repetitive noises for 40 minutes, I get out of the tube, have the IV removed, dress, and go.” Some people have difficulty with the idea and feeling of having the open mask over their face, the closeness of the “tube”, and the noise.  Luckily for me, I don’t.  I can only say that the techs are just a squeeze away, however snug it is when you go in won’t get any snugger, focusing on breathing slowly is calming.  I count the repetitions of the different sounds to pass the time!

PET scan (Positron Emission Tomography) “Positron emission tomography (PET) uses small amounts of radioactive materials called radiotracers, a special camera and a computer to help evaluate your organ and tissue functions. By identifying body changes at the cellular level, PET may detect the early onset of disease before it is evident on other imaging tests.”radiology info.org  I’ve only had one of these.

For a PET scan you can have nothing to eat and only clear liquids for a few hours before. You can wear no jewelry, and they’ll ask about metal in your body (true for all scans, MRIs).  You CAN leave your wedding ring on! You are asked to remove all clothing except undies and put on a johnny.  This procedure requires an  IV for the radiotracer.    The radiotracer is injected and you need to just sit and relax for about an hour, I guess while it travels through your body. Then you go into the room for the scan, and as  I remember,  it is like a CT scan (above)  from there, except it looks at your whole body (not your brain) instead of a specific area.

Because the PET scan showed enhancement in my liver, one of the first things that happened after I went to Dana Farber was a liver biopsy to make sure that it was lung cancer metastasized to my liver and not another cancer or something else.

Liver Biopsy This procedure was much easier than I thought it would be. It is done as outpatient/day surgery. I had mine at Brighams. No food or drink after midnight, undressed/wear johnny, IV put in.  For this I was sedated, but fully aware. ( If I had been too nervous, talkative, agitated- I’m sure with the push of a button, I’d have been asleep.)

The liver biopsy is a needle biopsy.  The procedure is ultrasound guided. “Ultrasound imaging uses sound waves to produce pictures of the inside of the body.  After you are positioned on the examination table, the radiologist (a physician specifically trained to supervise and interpret radiology examinations) or sonographer will apply a warm water-based gel to the area of the body being studied. The gel will help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The transducer is placed on the body and moved back and forth over the area of interest until the desired images are captured.” radiology info.org

So, while you are lying on your back, the doctor doing the procedure is standing very close to your right side, and does the above process to your abdomen to get a clear look at your liver.  Then he/she cleans the area (just below the right rib cage) and gives you a shot or two of novocaine to numb the area.  Next he makes a small incision for the needle.  You hold your breath (no, really) while he inserts a long needle and gets what he needs, and pulls the needle out. You then go to the recovery room where you have to lie still on your right side (due to bleeding possibility) for several hours.  Then, when we were done I was tired, a little sore where the incision was, and couldn’t lift over 10 pounds for a week.  Really much easier than anticipated and quite painless.

Okay, in trying to think about what else I’ve had for procedures, I think the only other besides radiation treatment, which you can read about at length in an earlier post, is a lumbar puncture (aka spinal tap) which I needed after the cancer crept into the meninges.  This was done to see if the beast had spread into my entire central nervous system by looking for cancer cells in the spinal fluid. (The fluid that’s drawn is lab analyzed.) It is a test that isn’t too effective (reliability, 41% sensitivity), but I guess it is a simple way to look for cancer when there’s that concern and no related symptoms.

Lumbar puncture I had mine done at Dana Farber. No special prep, just changed into a gown (I like the idea of wearing a gown better than johnny.) Here’s a good description of the procedure from mayoclinc.org . “You lie on your side with your knees drawn up to your chest, or you sit and lean forward on a stable surface. These positions flex your back, widening the spaces between your vertebrae and making it easier for your doctor to insert the needle.Your back is washed with antiseptic soap or iodine and covered with a sterile sheet.

During the procedure

  • A local anesthetic is injected into your lower back to numb the puncture site before the needle is inserted. The local anesthetic will sting briefly as it’s injected.
  • A thin, hollow needle is inserted between the two lower vertebrae (lumbar region), through the spinal membrane (dura) and into the spinal canal. You may feel pressure in your back during this part of the procedure.
  • Once the needle is in place, you may be asked to change your position slightly.
  • The cerebrospinal fluid pressure is measured, a small amount of fluid is withdrawn, and the pressure is measured again. If needed, a drug or substance is injected.
  • The needle is removed, and the puncture site is covered with a bandage.”

I was sitting, leaning forward.  The doctor did spend quite a bit of time at the start tapping my spine with her hand and marking me with a marker.  She wanted to find just the right spot to slide the needle to withdraw the fluid.  While the needle was in I did feel quite a bit of pressure, but not pain.  When all done I laid still for 20 mins and then was pretty quiet for the rest of that day and evening.  I had no lingering effects from this.  And, when lab results were back – no cancer cells were found in my spinal fluid.  (Since then I’ve been put on the targeted therapy drug Lorlatinib and SHE has reduced the cancer in my meninges by 75%!

I know I’ve said this before, but it is true – I’m lucky.  An acquired cell mutation caused my cancer to take off and spread, but it is because of this that I can take a targeted therapy drug – a pill(s) once or twice per day.  The drug acts as a guided missile, attacking only those mutated cells, not all cells like chemotherapy does.  So, I know that I’ve not had some of the tests, procedures, and treatments that many lung cancer patients have to endure.  I hope that this field is changing so rapidly that soon we all will be able to treat lung cancer as a chronic disease, not a terminal one, until a cure is found.  At just under two years since diagnosis, I’m am blessed to feel well enough to enjoy life with family and friends.  Feeling joyful and filled with gratitude daily.