Friday, May 29, 2009

A Visit with Dr. K

I saw my oncologist, Dr. K, yesterday. We talked mostly about the lung spots on the CT scan. He even showed me the CT scan, which was kinda cool. Here were the questions I asked:

1) How likely is it that the lung spots are metastases if my tumor markers are low? He said that it is "less likely" than if my tumor markers were going up. We then looked at the history of my tumor markers. The CA15-3 was as high as 36 in March 2008 and that was when we found that it was in my skin and my bones in February 2008. It was 18.4 last month. Anything above 33 is suspect. But this is just a gross measure . . . sometimes it happens that you have active cancer but the markers are still low. Still a low tumor marker is usually a good thing.

2) The CT scan also found that I had one or two enlarged axillary lymph nodes in my left arm pit. I've been able to palpate one of them and when I do, it moves around quite a bit. I told him that I'd read that if those lymph nodes are enlarged and, generally, if it is cancer, those lymph nodes are hard and stationary - they don't move very well because the cancer causes a fibrous mass in the node. Or something. He wasn't able to palpate it very well. Lymph nodes can become enlarged with any kind of infection. He agreed that generally nodes with cancer do not move, so the fact that it moves quite a bit is a good thing.

3) Would those lung spots cause the coughing that I've been experiencing since I found out about the lung spots? He said that those lung spots are "so small" that I wouldn't notice anything in terms of coughing or breathing. He asked if I experienced shortness of breath when exercising. I haven't really. His guess is that my coughing and slight wheezing that I have is related to allergens. The Willamette Valley is notorious this time of year for hayfever. Lots of pollen in the air. However, I still had this slight cough while in northern Norway, which was pre-pollen season there. On the other hand, I did eat a lot of processed sugar while in Norway which can cause some phlegm and a cough.

4) Where are the lung spots? My spots are nodules inside the lungs, not on the pleura. They were located at the outside of the major blood vessels, more on the periphery. The major blood vessels were well lit up and on the CT, I could see them get bigger and then smaller out at the ends of the vessels. These spots were located beyond the ends of the vessels, so they weren't blood.

5) What is the likely progression of disease? I said that it was in my breast, then in the skin and the bones. He stated that cancer like mine, which was spreading via the lymph and the blood, would be somewhat more likely to go to the pleura, and then it would be easy to go to the lungs. I also mentioned that it seemed strange that my cancer was in the right breast, but that the spots showed up on the left side. He nodded because it would seem logical that the cancer would go to the right lung first. However, he does know of examples where the cancer was in one breast and they didn't find cancer in the lymph nodes on the same side, but in the opposite side. He asked, "so why did it pass through all of these other places and then decide to stay there in the opposite side? We really don't know enough about the biology."

6) When would cancer go to the liver and the brain? He said that different varieties of cancer cells like to grow in certain environments. So, cancer that's in the blood and lymph is more likely to go to the lungs, but that the cells would have to "change their code" (which I assume meant genetic code) in order to want to invade the liver and the brain.

7) What else could cause the lung spots? He admitted that it could be a lot of things. He mentioned fungal infections and gave me several names of different diseases caused by fungi. One is histoplasmosis, which I've heard of before when I worked as an assistant for a retinal doctor. He said that people in certain regions, like the Ohio River Valley, have high rates of fungal infections, like 50%. These fungal infections can lodge in the lungs but people never have any symptoms, other than the nodules in their lungs. Lots of people in the Ohio River Valley (I think) have CT scans that look like mine.

8) Those spots weren't there in August 2008, and 8 months later, they are there and one is 1cm. My first cancer was 2cm and they said that it had been growing for 8-10 years and was "slow-growing". This cancer was "medium-growing", and while it was more aggressive than the first one, it wasn't the fastest growing tumor. So, how likely is it that a tumor would grow to 1cm after just eight months? He said it was certainly possible that it could grow that quickly, but when I said something about slow or medium-growing, he just shrugged his shoulders and said that there was much that they don't know about the biology of the disease.

And, finally, given all that we discussed, I asked 9) what is the likelihood that these spots on my lungs are cancer? His answer? A 60/40 chance. I asked, "do you mean a 60% chance that it is cancer?" and he said, "yes". I replied, "Well, with what you've told me, I think it's more likely to be 60/40 that it isn't. Even, 80/20 that it isn't cancer". He smiled, which implied that he liked my positive thinking.

He suggested that I start doing visualizations and visualize those spots shrinking. He doesn't want me to change my meds at this point - so I'm still taking Tykerb and nothing else. I'll have a CT scan in early July and then another appointment with him on July 9th. We'll see what happens then. Next week, I have another Zometa treatment and then will have my tumor markers measured.

So, the past few nights, I've been trying to start a visualization routine. I go through these relaxation breathing exercises and fall asleep before really starting to do that. I got a bit farther last night. I imagined every breath I took in as a cleansing breath. Sometimes, I held the breath and imagined the air as a kind of "roto-rooter" cleaning out anything bad, like a fungal infection or little tumors. Then, when I let out the breath, I let it all go. My goal is to take a lot of breaths like that everyday, imagining something similar. Sometimes, the "roto-rooter" was a cleansing light (which was something I read within the last week in one of my books).

I really would like to get hypnotized - two of the books I'm reading by Andrew Weil and Brian Weiss talk about hyponosis. Visualizations are easier under hypnosis . .. but how do I find a hypnotherapist that I can trust?

Well, that's something to work on. In the meantime, reading rough drafts of student papers (this class did a great job on Wednesday doing skits, where they pretended they were aliens observing American culture; they did a great job!) and making some final revisions to an article. I will also meet with my incoming Ph.D. student today. This week-end - finish the mosaic and more putzing around the house. I think we're going to have a garage sale next week-end.

How am I feeling? Happy and content. It's sunny outside. I'm getting my work done, both at home and at work. My son is in good spirits. My partner is having some issues with his daughter, so he's stressed about that, but he seems to be enjoying massage school. I have a job and the rhodies and roses and irises are blooming. What more can one ask for? (Well, other than being free of cancer!)


Daria said...

Interesting stuff.

Dee said...

Thanks, Daria. It's all in the effort to figure out just how much I need to worry about this .. . my acupuncturist and healing friends would probably say not to worry as that might help the disease. So, I guess .. . not worry is what I should do!

Carver said...

Hi Dee,

I like the methodical way you approach the questions and answers. I have made lists of questions before. I did that prior to appointments, particularly when I had suspicious issues on scans some time back which fortunately ended up getting smaller, smaller, gone (including lung nodules for that matter). However, I never went back over the answers to the questions after an appointment. I think that's a great idea.

I'm glad that you are feeling happy and content. I'll be visualizing your lungs spots gone too! Cheers, Carver

Teresa Hartman said...

Visualizing like crazy over here in Omaha, Dee. Thank you for listing your questions and the doctor's answers. Since my cancer goes (generally) next to the lungs, I figure I will be having that type of conversation with a health professional in the future - thanks for showing me the way.
Thinking of you, and very glad you are back from your trip and in your home. -Teri

Liz Kreger said...

Sounds like you had a thorough discussion with your doctor, Dee. You're fortunate that he is the type of doctor who has the time to answer all your questions as thoroughly as he did.

Guess you'll have to take this one day at a time. Keep visualizing those cleansing breaths and get those lungs clear.

Doug said...

Hi Dee:

Your courage and strength are amazing! I continue to lift you up in my prayers.


Dee said...

Hi Carver,
I like the visual you gave - the spots getting smaller, smaller, gone! I'm going to visualize that, too. And, thanks for the visualizations!

Hey Teri! I didn't realize that about ACC - that it could go to the lungs. Now, I'm sure that you would've thought of all those questions, too, but am glad that you found them helpful! I also appreciate you visualizing like crazy!

Hello Liz,
I chuckled a little bit because of your Cancer Warrior post this week when you asked "are you a "research everything about your cancer" person? or a "as little info as possible" person?" I guess my post shows where I fall - research everything and try to know as much as possible! I'm visualizing for you, too.

Hi Doug,
Thank you for thinking of me. I don't think the courage and strength I have only comes from me - all of you out there thinking about me, sending me prayers, visualizing spots away, etc., add to my strength. It's the support of all of you that really helps!

Thank you all, for visiting! You're all great, you know.