Some mixed results from a peripheral blood flow cytometry report, some enlarged lymph nodes, and my worry over the darkest, most malignant self-interpretations, which can be the most dangerous kind, resulted in Hemosapien ordering a CT scan with contrast. The results of the scan are back, and it could have been a lot worse. We are always thankful for what we get when we realize that it could have been worse. As it is, it’s not-too-shabby. Not-too-shabby is like a breath of spring air and sunshine after two months of rain, influenza-like-illness, and a household of ill-tempered, ill-feeling, illness-suffering women.
We have passed what the CDC refers to as an “influenza-like-illness” around my household since the week after Thanksgiving. Now, we are all on the mend, thankful it was not the real influenza. As bad as whatever this is, the real flu would no doubt be much worse. Dealing with influenza-like-illness had my already compromised immune system in a state of shock, doubtlessly contributing to the enlargement of some lymph nodes, which were the cause for some alarm.
Hemosapien scheduled me for the CT scan early last week. The night before, I opened the bag containing the CT-contrast material I was supposed to drink. I’ve had it before. It is the most outrageously mislabeled, falsely advertised, “Berry Smoothie”, plaster-of-paris concoction consisting of a suspension of Barium Sulfate formulated, in name only, to approximate a berry flavored smoothie drink. “What is a smoothie, anyway, and what is its relationship to the bottle of Quickrete I hold in my hand?” I asked myself. There was none, I decided as I vigorously shook the bottle, removed the cap, tore off the tamper-evident seal, and proceeded to drink all eight ounces down in a series of the largest swallows I could muster. It took eleven gulps to get it down, and Herculean effort to get it to stay down. I gagged at the taste, thinking I might have preferred the flavor of chalk to the feeble mask of berry, which did not mask or disguise, but had merely insinuated itself into the middle of something that completely overwhelmed it, rendering it more than useless, even counterproductive. I gagged again as I threw the empty bottle in the trash and turned to go out on the front porch lest my gags become more urgent than my ability to suppress them could handle. I broke out into a cold sweat, sat down in a chair, waited until my systems returned to normal, then returned inside.
“One more to go in the morning,” I sighed. It was one of those sighs that my Debbie would find impressive, working its way up from the tips of my toes. I have learned this from her, since I have been the precipitate for so many of those sighs. “Huhhhhhhh!!!!” I sighed again. The next morning, I went through the same ritual rather than having my morning coffee. Barium infused “Berry Smoothie” is not an acceptable substitute for morning coffee. Off to the hospital I drove, the barium suspension setting up in my intestinal tract like the plaster-of-paris it resembled.
I have been through the hospital admission procedures before. This time I got a veteran clerk in admissions who had helped me many times before. She asked for my ID and insurance card. I handed them over, reminded myself that I have to show an ID to receive medical treatment but do not have to show one to vote, remained silent on the issue which caused me to mentally wander off in a fit of self-congratulatory admiration of my superior powers of self-control, when I resurfaced as a patient and asked the veteran clerk to look up my name and not to start a new account, as they so often do. She pulled up an existing account, asked me to confirm my birthday and address (which was plainly visible on the ID I had already handed her, though I did not say this . . . again, I marvel at my self-control), and then she asked me if anything had changed. I told her no.
“What is your social security number?” she asked.
Any hint of my five-seconds ago self-congratulatory self-control just vanished right out the window like dust mites stirred up in a March wind. I was powerless to stop myself at this third provocation. “Aren’t you looking at it?” I drolly asked.
“Yes,” she cautiously answered, suspecting, perhaps, that the step she was about to take was a bit higher than her first estimation.
“You just asked me if anything had changed and I said not. My social security number certainly hasn’t changed,” I said. She quietly proceeded through the rest of the forms, perhaps afraid to ask any more questions. Then, something unusual happened which has not occurred before. I am not sure whether this next event was caused by some new implementation of the ACA, or whether it being January and a fresh, new insurance year they do this all the time, or whether some recent fraudulent insurance cards furnished by patients caused it, but the clerk called the number on my insurance card and verified it with a clerk from my insurer on the other end. I’m sure they have done this before, but they’ve never done it with me sitting there. Then the clerk made copies of my ID and my insurance card and the photos of them appeared on the screen. In the future, she wouldn’t have to ask for my ID, when she called up my account, she could look at the picture she took of my ID and see that it was me. Somehow, I think that this won’t happen. They will ask for my ID and compare it to the ID they already took a picture of. If that is the case, she will actually be comparing IDs. Would she bother to look at the picture and then compare the ID to me, or was the ID itself the only thing she would compare? I decided it would be counterproductive to raise this issue with the clerk at this time, since she was not a hospital policy maker, but swore to myself that I would wear a disguise next time and see if she would be satisfied with the ID comparison versus the comparison of the ID with the real person seated across from her desk. I suppose they don’t really care as long as the insurance pays.
As we were seated there waiting for the computer to do whatever it was doing, someone in the ER waiting room was as violently nauseous as I was when I was taking chemo. They just kept on retching, loudly and repeatedly. She remarked, “My goodness, someone is sick out there.” I laughed at my memories of violent nausea, more to myself than out loud, but apparently loud enough for her to be offended by my apparent callousness. She chided me, saying, “Someone else’s sickness is not something to laugh at. There’s a bug going around that has the ER full of people with violent nausea.”
I bit my tongue, reflected a minute, and decided that she needed the whole story, gently, so as not to chide anyone else who may have seemed callous to her. “I’m sorry. I hope it’s only that stomach bug he’s got and not a chemotherapy induced nausea,” I said softly. “I was not laughing at him, but at myself and my memories of feeling the exact same violent nausea he seems to be having while I was taking chemo. Maybe it’s just the bug that’s got him sick and not chemotherapy. I’d trade a cancer and chemotherapy nausea for a stomach virus any day.” I then wished the stomach virus on the nauseated man, hoping that was the extent of his troubles and that he would recover in a day or two. The clerk said not another word, peering intently into her computer screen, slightly red-faced, but otherwise giving no sign of having heard me. I think she was mentally chewing on her foot. I think that because I have chewed on mine many times, feigning interest in something other than the person across from me to whom I made comments that I wish I had not made. Maybe she thinks I am an asshole. She could be right, though she didn’t say, playing her cards closer to her vest this time.
She put the hospital ID bracelet on my arm and sent me off to with an escort to Radiology. The escort was a new development. My escort insisted on walking me to the door of the Radiology Department, though I knew exactly where it was. This must be some new policy. I speculated, then wondered about that. Maybe some folks never notice these things. Maybe their memories are focused on things that are more important to them. Maybe they have no memory, or maybe mine is just better than theirs. Maybe it’s that my memory seems to be better because I am here, now, experiencing and recording in my memory whatever it is that I am experiencing. I cannot be certain that this process works the same for every human being. The more I speculated, the more I wondered . . . all as I was being escorted the two hundred feet to the door of radiology.
My escort opened the entrance door, the one that had the huge sign on it that said, “Give your admission papers to the clerk at the window and have a seat until called.” On the inside, a huge sign said, “Give your admission papers to the clerk at the window and have a seat until called.” My escort, holding the door open for me, said, “Just give your admission papers to the clerk at the window and have a seat until they call you.”
I could not help myself. “You mean you want me to give my papers to the clerk at the window and have a seat until I am called, just like those two large, impossible to miss signs say?” My escort hung his head and shrugged his shoulders, said nary another word, and walked off to find others in need of an escort. I decided I would give my admission papers to the clerk at the window and have a seat until I was called, but there was no clerk at the window. I just had a seat in the empty waiting room.
A few minutes later, the clerk came in. She opened the window and asked me if I had given her my admission papers yet. “No,” I replied, “You weren’t there to receive them.” I got up, walked over and handed her the papers. She gave me a questionnaire to fill out and I returned to my seat.
“Have you ever been here before?” I checked YES. There were lots of other questions, to which I checked YES or NO, leaving many of them unanswered just to see if anyone was going to actually look at it. I think the most relevant question for them, in my case, since I was not likely pregnant, was “Are you allergic or ever had a reaction to IV contrast?” I checked the NO box.
“Why are you here, today?” I thought over this question. Did they not know why I was here? Did Hemosapien not have orders for them, or were they relying on me to tell them what it is that he had ordered? Was this a trap? Was it to see if I was paying attention? I wrote in the blank, “Don’t YOU know?” I gave the questionnaire back to the clerk and resumed my seat. A few minutes later, the Radiological Technician came into the waiting room and seeing that I was the only person in there asked, “Mr. Sharp?” I got up and went with him back the CT room.
Computerized Tomography, X-Ray Computed Tomography, Computer Aided Tomography (CAT Scans), and CT scans are all the same thing. Click HERE for a Wikipedia article on CT scans.
CT scans are remarkable diagnostic tools in the hands of radiologists. The cross-sectional X-rays produce clearer 3-D images which reveal dramatically more than traditional 2-D X-rays. One of the drawbacks is that they introduce significantly more radiation exposure to the patient than traditional X-rays, and CT scans are themselves thought to produce cancers in as many as 1% of the patients exposed to them because the increased radiation causes some DNA damage at the cellular level. The benefits versus the risks are always to be considered in any medical procedure, as none of them are without some risk. I had declined a CT scan earlier, but the way I felt and the fact that Hemosapien and Gooday had noted some enlarged lymph nodes made me ready to submit. When Hemosapien suggested it this time, I agreed. Perhaps the radiation damage I avoided was the previous CT scan that I had declined.
The first theories of working CT scans were proposed in the early 1900’s, but they did not come into widespread use until the 1970’s. They were as expensive then as MRIs (Magnetic Resonance Imaging) are now. The price of them has come down since the price of the equipment has fallen, mainly due to their widespread use. The more of anything a manufacturer can make, the less its cost is likely to be. This is the nature of manufacturing. The nature of hospitals is that they don’t want to have to send you somewhere else for diagnostic services that they can offer themselves. The backlash is that once they buy expensive equipment, they urge their affiliated physicians to make sure that the machine is used enough to pay for itself and to return a profit. This increase in their ability to serve our diagnostic needs, which is substantial, results in an increase in what our insurers have to pay out. It is a never ending cycle, but who is to say that we are not being served?
The Philips CT machine whirred and buzzed, its rotating X-ray tube traveling about 100 RPMs. I know this because I counted them and sort of figured it out in my head. The table on which I lay was raised to the right height as the technician injected the IV contrast into the vein in my left arm. As it traveled around my body, I felt the flush of heat and the metallic taste in my mouth, which is typical. After a minute or two the technician left the room, to insulate himself from the radiation, and a voice as metallic as the taste in my mouth said, “Take a deep breath and hold.” The table carried me through the donut of the CT machine. In a few seconds the metallic voice said, “Breathe.” They did this about three times, then I was allowed to get up and go. High-frequency radiation is funny . . . you can’t feel it a bit when you are getting it . . . but if you get too much, all kinds of bad things can happen. We feel the infrared radiation from the sun because it is heat. We sometimes can tell the UV radiation from the sun because it makes our eyes dry out and smart, and our skin starts to turn the slightest pink, though by that time, you are already sunburned. The infrared radiation occurs at frequencies lower than visible light, and UV radiation occurs above it. X-rays and Gamma-Rays occur at frequencies far, far above our ability to sense them in any way, though if we get enough of them, we can tell, later, what their effects have been. I hope that the only evidence they ever see of my CT scans is the pictures the radiologist was able to read.
I left the hospital to their work and I got on with mine, heading to Covington, Tennessee, for a meeting the next morning with some business associates, and from there to Gleason, Tennessee, for another meeting the next day. I was feeling bad, and it was cold, cold, cold. The weather was made colder by my wondering what the radiologist would find. Some new, sinister, malevolent manifestation of the CLL, or worse, an evil cousin. I drove for hours with this on my mind. One can try to force it off one’s mind, but it is easier to talk about than it is to do. I don’t wish it on you so you can see if you are any better at it than I am. It is easy, when one is left alone with one’s own dark thoughts, for them to become darker, and darker. It is easy to throw the dark thought off for a moment, or a minute, or even a day when we are able to get distracted by challenging work, or fun, or mere diversions . . . but in moments of silence, the dark thoughts come back like a midnight raccoon to your garbage can. The house dog barks and roars that the raccoon is out there, but all it can do is bark; were it face to face with the raccoon, it would, hopefully, be simply ignored, not having its courage really threatened; the wizened lap dog knowing better than to approach too close to the sharp raking claws and the rapier teeth of the raccoon. In the meantime, the garbage just gets scattered everywhere, the neighborhood dogs join in the cacophony of barks, and a big mess is left to clean up the next morning. I think that was me the next morning. After I got on with business and was distracted with other things, the dark thoughts did not affect me until my long drive home, then on through the weekend. The longer I waited, though, the better I felt. Soon enough, I was certain that the evils over which I had brooded were phantoms since I had not gotten the call.
“Unremarkable,” I thought of my CT scan. Had it revealed anything really alarming, the radiologist would have alerted Hemosapien. I shot off an e-mail.
Since I have not heard from you, I suppose the results of the CT scan were unremarkable.
There were some other things in the e-mail, but they had everything to do with deer and hog hunting and nothing to do with CLL. I won’t trifle you with them here.
I heard back from Hemosapien yesterday, and he sent me a copy of the radiologist’s report. It could be worse. It could be much worse. It could be far worse. Actually, it’s not too shabby. The radiologist’s impression:
Residual enlarged axillary nodes with fatty hilum. Several of the axillary nodes appear smaller in size in patient with CLL. No progressive lymphadenopathy is identified. The spleen remains minimally enlarged with stable left adrenal mass and 2mm nonobstructing right renal calculus.
Let this layman try to interpret what the radiologist said:
- Residual enlarged [lymph] nodes. The key word is RESIDUAL. These are left over. They are not new.
- Several [lymph] nodes appear smaller. Some of the residual nodes have decreased in size. This is a good thing.
- No progressive lymphadenopathy is identified. Nothing about my lymph nodes are worse than they were before.
- The spleen remains minimally enlarged. The key word is REMAINS. The enlarged spleen has been around ever since I was diagnosed. It is smaller than it was before chemo, but it still has a minimal enlargement. This could be worse.
- Stable left adrenal mass. Uroman knew about this. He said it was a benign growth on my left adrenal gland. He said they would not check it again unless I had some symptomatic reason that it needed to be checked. The radiologist reports that it has not changed. This is good.
- 2mm nonobstructing right renal calculus. A kidney stone! I knew it was there. It has been identified more than one way before: a previous CT scan, and an occasional nagging pain that I am all too familiar with. “Persistent” is the word the radiologist used earlier in the report. He’s seen this kidney stone before. I’ve felt it before. Perhaps I should give it a name since I’ve had it for so long. Hello, Stoney, Jr.
There were a couple of other new things of note that were in his details but not in his impression. Calcification in the wall of the abdominal aorta. I read up on this and opted to eat some Cheerios for breakfast instead of bacon, and take my fish oil capsules loaded with those Omega3 Fatty Acids. If I do this again tomorrow, instead of choosing the bacon, I may be starting a heart-healthy trend. Small fat containing umbilical hernia. I read up on this. I suppose all the coughing I have done since Thanksgiving has contributed to it. Lots of people have these. I have not noticed it and had the radiologist not seen it, I would have no symptom of it. It is new, but it is not something that needs any attention at this time, unless I was referred to a general surgeon who is trying to put two kids through college while paying some hefty alimony, who would, no doubt, immediately recommend it be repaired, as much for his own benefit as for mine.
The net result! I laugh at myself, in wonder and awe, thankful for the opportunity to explore myself and my own journey through the process of CLL, and am THANKFUL that I have the kidney stone. I may change my mind about that later, when it starts on its inevitable journey south, but in the meantime, I am rejoicing.
I never thought I would be able to say that about a kidney stone. I reserve the right to change my mind, later . . . but today, it is welcome . . . provided it stays put.
Hello, Stoney, Jr.