***Final Report***

Have you ever noticed that radiologists can't write?  I have read enough radiology reports in my life to know the difference between writing medically and plain old poor writing.  Radiologists either have so many reports to do that in their haste they make grammatical and word choice errors - or they purely can't write.

I'd love to see a Christmas newsletter from one of these guys:

"Insofar as Christmas went, it was a freely-flowing event, which is probably due to the unremarkable nature of the people incurred.  The weather was of minimal hazy density, and winter structures intact.  Facial rictus may represent Christmas cheer."

Anyway, I got excellent news on my latest scan, and I'm still kind of in shock as I no longer expect good news and me to be in the same place.

My bad.

I wanted to have my results sent to my oncologist, since the Infectious Disease Specialist, who ordered my scan "STAT," promptly went on vacation and was not available to go over it with me.  I had my Wednesday herceptin/doctor appointment yesterday, so with the help of my Case Manager, I got the paperwork sent to my "Onc" so he could go over it with me.  HIPPA does not make things easy.

I sat down with my doctor who read it in the exam room and went over the salient points with me.  He said I had some thickening in the wall of the colon but it is resolving well.  I'm healing.  I asked him if the thickening was causing the pain and he said "probably."  He said that there is fluid in my right lung but that he's not worried about it.  He thinks it may be leftover from the surgery, and it doesn't appear that cancer has gotten into my lungs, which would have alarmed me had I even considered it.  He did say they only imaged the bottom of the lungs, but I told him I'm not having any symptoms and didn't even know there was fluid in my lungs. I know breast cancer spreads to lungs but I don't think it has -  he doesn't either; he said it would have grown big by now.

I did say I can't cough because my colon hurts too much.  He didn't respond - maybe it's not that kind of fluid.

The most exciting thing he said - and I wish I could remember his exact wording - was, "There are no signs of cancer in your liver."  OR, he said, "There are no new signs of cancer in your liver" OR "Your liver looks good, no cancer."   I was very excited by my initial interpretation (no cancer period) and said that was a great relief since it had been so long since I'd been able to do chemo. I'd have expected to have a liver full of cancer again, and was thrilled I didn't.   He didn't dissuade me from my excitement so I assume my interpretation is correct.  Maybe they cured me after all, even with this setback.

His main concern is my weight.  He said at my appointment right before Thanksgiving I weighed 105, and now I'm 90.  A significant weight loss, yes.   He was concerned that if something "put me down" that I had no fat at all as protection, and I would get bedsores.

I thought that was a funny, if a typical, thing to worry about. People in the medical profession seem unduly concerned about bedsores.  When I was in the hospital I had to have regular bedsore checks; it was mentioned a lot by everybody, and they kept bringing me a foul-smelling creme that would help prevent them.  (Really, why can't they get a contract with Bath and Body Shop or Origins or some company that makes a  less industrial smelling creme - then maybe we'd use their bed sore preventatives).  I guess they are overly worried because it's something they get sued over, but maybe it's more dangerous than I would have expected.

Having no fear of bedsores at my age, but having a great fear of c-diff,  I told the doctor that we'd have to hope nothing would put me down for a while.  I told him I realized I was too thin, and I wanted to gain weight but eating makes me nauseous.  He suggested I try a compezine before mealtime.   If you look at what you are allowed to eat with colitis, it is exactly the opposite of the way I normally eat.  I am a fruit, veggie, high fiber girl, and those are not things I can eat right now without causing great intestinal pain.  So, not only do I have to eat carefully, I have to change my entire diet.  It does make me not want to eat too but I'll have to try harder.

I asked when I could start chemo again, and he said I'd know when I felt healthy enough.  He made an appointment for a month from now, so my goal is to somehow recover by then.  I need to gain at least five pounds, have this pain gone, not be nauseated when I eat and regain my physical strength. (ie., be able to go to Macy's and open their glass door.)

Anyway, out of all the myriad things that could go wrong with me, and that have gone wrong with me, being told I'm ten pounds underweight is about the best news I could have possibly heard.

I'll definitely be celebrating the New Year, even if it's with plain mashed potatoes and water.

So, here is the medical report.  I will mark in bold a confusing part.

FINDINGS ABDOMEN:  There is a new small freely flowing left basal pleural effusion.  There is minimal hazy density in the posterior aspect of the right lung base which is thought to be atelectasis rather than pneumonia.  The lung bases are otherwise clear as insofar visualized.  There are no definite pulmonary or pleural-based nodules or masses seen. What is seen of the heart is unremarkable. (Edit:  I would disagree with that statement; I have quite a remarkable heart.)  What appear to be right breast prosthesis and left breast implant are grossly intact appearing. (Edit: I would agree with the "grossly intact" statement; had he said grotesquely it might have been more accurate.)  What little is seen of breast tissues is unremarkable.  (Again, I agree.)

Liver and spleen are homogeneous without focal mass or enlargement.  (No mass!  Great... until you read the end, where it gets confusing.)  The patient has had resection of much of the left lobe of the liver apparently for neoplastic lesions in the interval between the current and August 2011 scans, and there is a linear band of low attenuation some 1.3 cm in diameter extending out obliquely through the anterior segment of the right lobe of the liver which is probably had treatment of a lesion in the central right lobe of the liver. (Edit:  this is where they did the ablation.)  When we look back at the scan of 08/08/11, there was a low attenuation roughly 2 cm in diameter area in the mid right lobe of the liver which has decreased to 1.5 cm.  There are no new liver masses or nodules identified. (Not knowing exactly what that meant, confused by the term "new" I decided that the area that was burned away in the ablation is now healing and is now 1.5 (or 1.3) cms. I found this sentence online that backs me up: "On CT scans, complete ablation is seen as a low-attenuation area devoid of enhancement or nodules, as described earlier.)

If you have a better idea, or you are a radiologist,  let me know.

Gallbladder, pancreas, adrenals, and kidneys are grossly unremarkable.  The same is true of GI, vascular, and skeletal structures in the abdomen except that there is a question of colitis with wall thickening seen in all of the loops of the colon.  Perhaps the patient is recovering from pseudomembraneous colitis.  I do not see any ascites or lymphadenopathy in the pelvis.

PELVIS:  Ureters and bladder, and uterus and adnexa (I have a body part called an adnexa?) are unremarkable appearing as are vascular and skeletal structures.  GI structures are notable for mild wall thickening throughout the colon which as discussed above might represent resolving pseudomembranous colitis.  There is no abscess or free intraperitoneal air.

In the interval between current and most recent comparison study, the patient has developed a small freely flowing right pleural effusion (didn't it say left in the first sentence?), apparent mild right lower lobe atelectasis, has apparently had treatment of central right liver nodule that has decreased in size from 2 cm to 1.5 cms (wait - it's a nodule now??? or I had treatment for a nodule and the space is 1.5 cms......) and has had resection of at least some of the left lobe of the liver.  There is no new metastatic breast cancer demonstrated in the abdomen or pelvis.

Mild pancolitis may represent resolving pseudomenbraneous colitis.  Clinical correlation recommended.

So, it appears to be almost great news, except for the mild ambiguity on the report about the area in my right lobe, no doubt caused by poor writing skills, and hopefully not poor interpretation skills on my end.  Until otherwise notified, I am choosing to believe there is no cancer and concentrate on healing my colitis.  Considering how I feel, the fact that it is healing is fantastic news; I fully expected to be told there was an abscess considering how much lower right quadrant pain I still have.  I guess it just takes time, and as we all know by now, patience is not my strong suit.

In any event.......

Happy Almost New Year!  Looks like you might have me around for 2012 after all!