The CT Scan Report

Is this for real? Please, somebody, pinch me!

Hah! I get to use that opening after all.

May 5, 2017 CT Scan Day 11:30 a.m.

Being with the One-Man-Band Onc also known as Team Smiley, I did not know exactly what to expect.  But with all my CT Scan experience at 4 university hospitals, I figured, there would be the 4-hour fast before the CT Scan procedure, which normally takes 5 to 8 minutes.  I had been told to report at the hospital at 9:30 a.m. for processing.  I surmised if the CT Scan started at 11:30 a.m. I should be out of the hospital by 11:45 a.m.

Surprise!  Right after completing the insurance paperwork at 10:45 a.m., a twentysomething female nurse assistant escorted me to the Radiology department.  A male technician, 30’s, in hospital blues, led me to a tiny room separated from the rest of the world by a colorful curtain and handed me two bottles of barium berry-flavored drink. He said, Start drinking the first bottle at 11:00 a.m. Drink it over a 30-minute period, which means ending the drinking at 11:30.  Take a 30-minute break, then start the second bottle. Drink it slowly for 30 minutes, or until 12:00 noon.

I did everything according to the instructions.  After drinking all the berry-flavored yuck, I went outside the curtain to turn over the empty bottles and hopefully get started with the CT Scan. There was not one soul in the room.  I had been abandoned!  With the two empty bottles in my hands, I paced the floor frantically, like a wino needing her fix badly. Finally, a tall Anglo man, wearing a hospital mask, entered the room.  He asked, Can I help you?  I answered, What do I do with these empty bottles? I’m done and ready for the CT Scan.  He said, Put them in the trash can.  I asked how about the scan? He replied, Someone will get you.  Sure enough at 12:30 p.m., the technician in hospital blues reappeared.  He led me to the CT scan room and worked the CT Scan machine.

CT Scan is CT Scan in any hospital.  I have already memorized the instructions: Take a normal breath, hold……….Carry on with your breathing.  I am always happy to hear that I have the permission to breathe again.

May 8, 2017  Result Day 

Dr Smiley’s Registered Nurse left a message on my smartphone, giving the result of the CT Scan, and telling me to call her if I had any questions.  I returned her call. At first, she could not remember who I was because she had made many calls to various patients.  I asked her questions to which her answers were, I don’t know.  Finally I asked her, Is the information in the Patient’s Portal? Her answer: I don’t know.

The information is in fact in the Patient’s Portal. Here it goes:

The latest CT Scan images were compared to those of  January 2017, done at UCI.

Lungs: Overall improved relative to the January 2017 images. The main pulmonary nodule, the “flying saucer” at the lower left lobe, was 4 mm x 9 mm, reduced from 7 mm x 25 mm.  No new or enlarging nodules.

Tagrisso came through for the Tagrisso Tiger! That’s the new title given to me by a fan.

Innards:  Mild intrahepatic biliary dilation with prominent common bile duct dilation Stable. No evidence of metastatic lesions.  Liver function tests are slightly elevated. Normal bilirubin.

I remember having that intrahepatic biliary dilation when I was in the CO-1686 trial. It resolved. Here it is  If the link does not work, it’s in the February 2015 post in the archive.

Dr Smiley wrote that he will request the insurance company to get an MRI of the liver anyway, regardless of the radiologist’s statement of No evidence of metastatic lesions.  Isn’t he sweet!

There was no mention of the occupier of the adrenal.  It must have resolved.

That’s it.  No After-CT-Scan consultation with Dr Smiley.  It’s kind of different from what I’m used to.

Go Tagrisso!











One-Man-Band Onc

Is this real? Pinch me, please!

I was hoping that would be the dramatic opening salvo of this post.  But noooo! The CTscan and blood tests have not yet happened at this point.

The confusion on the day of the Onc appointment started when I received a phone call from my insurance company.  Since my smartphone is always on “mute” I never heard the call.  I had to listen to a recorded  message.  A woman’s voice said she is from my insurance company and is happy to share a news about the approval of the authorization of a requested procedure.  I was perturbed.  I was unaware of any request for a procedure, a word that sends me shaking in my toe socks.  I have always associated the word procedure with surgery, chemo, or radiation.  I returned the call.  After a few minutes of saying yes or no to a computer voice, I gave up.

So to the one-man-band Onc’s office I shuffled for my appointment.  I thought the good doctor was going to direct me to a laboratory for blood draw then to a radiologist for CT scan.  But nooooo!  A young male technician checked my blood pressure, weight, temperature, and oxygen.  Everything was good, including oxygen which was 99!  He then directed me to sit at a certain chair and wait for the Onc, who joined me shortly.

The Onc, a middle-aged Anglo male, had been born with a smile permanently plastered on his face.  His closed mouth forms a line of thin lips like the “smile” emoticon.  When he asked me, How are you doing? I caught myself smiling at the smiling face.  Then he asked if there was any change in my health.  I answered, Nothing has changed.  I still have lung cancer. And of course, the questions Any shortness of breath, coughs, fatigue, and other symptoms followed. I said the only changes I notice are my bushier eyebrows and slightly longer eyelashes. Those are good ones for you, he said. I smiled and froze my face in smile mode to  match his for the duration. He added, It seems like Tagrisso is working for you.  I would hope so, I responded.  He countered, the CT scan will tell us the whole story.  I said, I thought that’s what we’re going to do today.  What happened?  He said, I’m going to write the request for blood tests and CTscan today.  The consultation ended with the stethoscope motions to listen to my heart and lungs, sounds of which, he said, were good.  He dug his fingers on the area around my throat, obviously looking for swollen lymph nodes, which he did not find.  I must mention Dr Smiley’s warm hands that brought back memories of my favorite gynecologists of yesteryears.  Dr Smiley pressed hard on my belly, perhaps expecting me to scream if there was pain. There was none.

What was that consultation about? It sure seemed unnecessary to me.  I wondered, What if I had gone in there with a hacking cough, complaining about pain, shortness of breath, etc.  Would he have not ordered blood tests and CTscan anymore? Would he have simply recommended hospice? Or maybe it was important for him to see me in person to make sure I was still breathing.  After all, it had been three months since our last consultation.  But couldn’t a phone call have taken care of it?

The following day, I visited the Patient’s Portal and read Dr Smiley’s entry about the consultation, as follows:

Female, NEVER SMOKER, lung cancer, Stage IV, EGFR 19 mutation, T790M mutation. She was originally diagnosed in 2012 with her only biopsy.  The report shows adenocarcinoma with the EGFR exon mutation and T790M mutation also. She received Tarceva daily at various doses between 2012 and October 2014 with change over to clinical trial “Clovis Study” with eventual progression of disease in January 2017. She started on Tagrisso 80mg daily on 1/18/2017. She is doing well and asymptomatic without any physical exam findings of concern.  I will check labs at this juncture and repeat CTscan imaging with an attempt for comparison to January 2017 CT scans.  If stable, I will see her back in 3 to 4 months.

The paragraph left much to be desired.  The Onc’s description of the female could have been more picturesque.   The words “gorgeous” and “bubbly” could have helped him to humanize the cancer patient.

As I was writing this post, a radiology office left a message in my smartphone.  A male voice said that Dr Smiley had ordered a CT scan and the radiology office would like to schedule the appointment.  It became clear: It was the approved authorized procedure about which the insurance company had called me earlier!

The blood tests and CT scan have now been clearly scheduled.  Anticipating the results starts all over again.