Monday, September 8, 2008 2:23 PM, CDT

Hello,
I met with Dr. Uy today to discuss my scans and my options.
The first thing Dr. Uy said to me is that he has spent a lot of time reviewing my scans and remains perplexed. He told me that if I lived in a third world country, he would be convinced that I have TB.
Apparently there are hundreds of these tiny spots on my lungs (that’s what I’m calling them now) and the doctors just can’t even begin to guess what they are. For obvious reasons, they’re assuming they’re cancer until they can prove otherwise. I guess this is a case of guilty until proven innocent.
However, Dr. Uy did say it is an extremely unusual presentation (Deja-Vu—haven’t we heard those words spoken before??!!). He admitted that it would be very odd and rare if this is cancer and is spreading in an entirely different way that it had before. Apparently, when cancer comes back or spreads it acts very much in the same way it did the first time it occurred. So we know that cancer is reliable! J
We asked if it could be a different kind of cancer; could it be lung cancer perhaps? Dr. Uy answered by telling us that first of all it doesn’t even look like lung cancer. He’s only seen one other case that looked like mine in a man who had recovered from lymphoma years before. Dr Uy told us that lymphoma can be a crazy thing in that it can come back as a cancer in a different form and can have a different presentation than normal (don’t quote me directly on that. Greg and I didn’t take notes so I’m going on memory).
Ok so we’re assuming it’s cancer but with a great big asterisk. First of all it doesn’t even look like cancer. Second of all it would be extremely odd if it is cancer. Again, let’s review my story from January-March of 2007 and many of the same words were used.
However, I will take time to pay myself on the back for once again stumping the doctors. God it would be funny if it wasn’t so damn scary!
What if it isn’t cancer? Well, it could be some sort of infection or what’s called interstitial lung disease. If it’s interstitial lung disease, it’s probably a side effect of chemo.
What are my options? I need to have these spots biopsied. I can either have what’s called a Bronchoscopy or a Video Assisted Thoracic Surgery (VATS for short).
The Bronchoscopy is what I had for the first biopsy back in January 07. It’s an outpatient procedure where they insert a bronchoscope down my airway (there’s a great diagram on Wikipedia if you’re really interested). The bronchoscope has a camera on it so Dr. Uy will be able to see his way around and then he can cut pieces off my lung.
The accuracy of the bronchoscopy will be less than 50% based on the fact that these spots of mine are so small. The first time I had it done, Dr. Uy was able to grab a big piece of tumor. I will need to be under general anesthesia.
The VATS is a more involved procedure and will require three full days of hospitalization after the procedure. Dr. Uy will make three small incisions in my lung area. The first incision is to partially collapse my lung (Dr. Uy actually used the word paralyze my lung—semantics Dr. Uy—semantics!!!) and he will insert a camera into this incision. The next two incisions will allow him to insert surgical instruments in order to grab a section of my lung. The section will about the size of a finger.
They will sew up two of the three incisions but will use one of the incisions to insert a tube into my lung to collect any leaking air or fluid (is this disgusting or what????).
The lab will be able to determine immediately if they can see any cancerous cells. If they can’t determine immediately if it’s cancer, the section of lung will be tested for infections and disease and mold and fungus and all kinds of things.
These diagnostic tests will take up to one week. Another disadvantage to the Bronchoscopy, in addition to the fact that it is less than 50% accurate, is there will be no ability to do any immediate testing because the specimen Dr. Uy will be able to grab will be too small.
So as you can see there are pros and cons to each procedure and ultimately it is my decision. I’m leaning toward the VATS because it will be the most thorough and most accurate--even if it is the most invasive. I could opt to do the Bronchoscopy and if they can’t conclude anything, I can have the VATS done at a later date.
I’d rather opt for the bigger procedure and know that I only have to go under general anesthesia once. Big sigh…..to tell you the truth I’m petrified of the procedure itself. And then when I wake up, I’ll know whether or not they could determine if it’s cancer and that scares the ever-loving life out of me as well.
I will have one more CT scan before my procedure, will meet with Dr. Uy to review the results, will inform him of my choice and schedule the biopsy.
I have a lot to think about and a lot to decide. I feel like asking everyone I know if they think it’s cancer. I’ve said this before but if any of you are psychic and want to give me your opinion, I’d love to hear it!! J
On a lighter note, we wrapped up our summer and the kids headed off to school. They are happy with their teachers and their new routines. Soccer and dancing started up so we’re getting into the full swing of things again. This is our first full week of school and it’s still weird that they head out every day.
We did lose our kitty Sophie last week. She was intended to be an inside kitty but loved it so much outside. For those of you who are familiar with where we live, you know the road is dangerous. Sadly, we found out just how dangerous when she was hit by a car (didn’t I just say on a lighter note…?).
We jumped right back into the fray and got another kitty this weekend. She’s all gray, full of spunk and we’ve named her Misty.
I think that’s all I have for today. I hope my rendition of what happened this morning makes sense to all of you. As always you can feel free to ask questions!
I’ll talk to you soon.
Love,
Kim