The humor board

I concluded chemo in early September. With one exception, my second PET scan came back clean this Thursday. My left groin, where this all probably started, seems completely clear.

There is one small lymph node adjacent to the left lung that showed increased but relatively minor activity–a Standard Uptake Value (SUV) of 4.4 over 3.2 from two months ago. For purposes of understanding the scale of things, when I started treatment the lymph nodes in the left groin had a SUV of 31. Oncologists don’t worry themselves at all until a SUV consistently exceeds 3.0. So, a value 4.4. is not a big deal. It is helpful to remember that a PET scan cannot tell if cancer is present–it can only tell the extent to which tissue is using sugar at rate from which a doctor may infer the possible presence of cancer.

The increased activity in the small lymph note adjacent to the left lung may mean nothing, a slight non-cancerous infection, lymphoma, or another type of cancer. Normally, my oncologist would simply order a biopsy of the lymph node, but that cannot be done easily given the location.

Here is another complicating factor. I suffer from histoplasmosis in the left lung, confirmed by a biopsy at UNMC in March of this year. This is an infection from a fungal growth (mass) common with farmers and others who have worked outside in the upper mid-west, particularly in Ohio where I grew up next to a river. Riverine habitats are where the spores for the disease flourish. It is not cancerous and is frequently left untreated, but since it is an infection it may also be impacting the lymph node discussed above.

On the advice of Dr. G., my oncologist, I consulted Dr. M., the pulmonologist who treated me when I was hospitalized this summer when one of the chemo drugs decided to play hell with my lungs. Yesterday morning, Dr. M. advised that he could not get to the lymph nod to biopsy it using a bronchial scope, and that to do so would require the services of an interventional radiologist or a thoracic surgeon.

Dr. G. and Dr. M. consulted yesterday afternoon. They agree that I basically have three options: (1) do nothing, and wait to see what a third PET scan shows in several months; (2) biopsy the lymph node; or (3) surgically remove (a) the mass caused by the histoplasmosis and (b) the entire lymph node and (c) then do a biopsy of both. They have also agreed that the most conservative approach is to take my case to the “tumor board” (rhymes with “humor board”) at the hospital to get the advice of the board members.

The tumor board consists of doctors who have not treated me and are therefore entirely objective–peer review if you will. The tumor board will meet in early December. The board consists of oncologists, radiologists, interventional radiologists, thoracic surgeons, and other specialists. The tumor board will provide me with a written opinion regarding their advice. In short, I await the advice of the tumor board.

I am continuing with my plan to go back on the case assignment “wheel” December 1, 2014. My stamina is sufficient to do so. The only residual problem I have is with numbness in my left hand and both feet as a result of the chemo. That problem is not debilitating, although I walk like a drunk and can’t type worth a damn. Moreover, since I am no longer receiving chemo, I can no longer claim to be suffering from “chemo fog.”  While I really never suffered from that problem, the inability to use it as an excuse is a real bummer!*

RGK

*In a terribly sad but related matter, Joan no longer allows me to play the “cancer card.” For example, I have to take out the trash and she refuses to bake me apple pies.

16 responses

  1. I can certainly understand the trash schlepping requirement, but no more apple pies? Sounds excessive to me; perhaps even “cruel and unusual”!

  2. Jonathan,

    Absolutely true. After all, I’m a “survivor” and that entitles me to claim moral superiority over just about everybody. (Forget the fact that she had her own cancer to deal with it–that is simply not relevant.)

    All the best.

    RGK

  3. Judge – good luck with tumor board. They are a very helpful creation. My BFF is in chemo right now for breast cancer, and she also has inflamed nodes around her lungs. Her doctors have also said that it is probably “just histoplasmosis.” It seems odd to me that everybody with cancer also has the bird poop infection in their lungs? She has always lived in the city and has never lived around rivers. She does however put bird food on the bird feeder. IDK but based upon evil much older sister Mary, the triple-boarded pathologist, I lean towards knowing the answer, hence the biopsy is my pick, but more surgery is just not attractive I am sure. And because I feel guilty for thinking that, I am going to bring you a Wheatfields apple pie up to chambers, if I can get it through security.

  4. Continue recovering.

    My unlicensed self recommends against the lymph node removal if it’s at all avoidable. Those nodes play a major role in fluid transport in addition to your blood circulatory system. A co-worker of mine had a radical mastectomy some years back (radical==they took the lymph node in her arm pit on that side, too), and that arm swelled up from lack of adequate fluid drainage. Sometimes that’s reducible; in her case it was not. The lack of proper drainage isn’t at all life threatening, but I don’t see it as the peak of comfort.

    My offer remains open to have out the mass on my kitchen island. Being unlicensed, my rates are low, too, and for you, one-time good deal, chee-eye. I still have those knives….

    Apple pies: here’s the deal: no pie, no garbage hauling. By order of the court.

    Eric Hines

  5. I remember my days as a young gearhead back in the 1960’s. Drag-racing and stock car racing were big summer attractions here in Nebraska. The drivers and the mechanics had an expression for their cars — “Run WHAT brung ya!” I think they borrowed the phrase from square dancers who instructed us to “dance with WHO brung ya.”

    In the different but similar context of what we each should do with the “equipment” which God gave us, the same rules apply If your ticker gives out, you’re probably pretty much done dealing. A similar result is even more likely if your brain deactivates.

    But what if we are dealing instead “only” with the medical equivalent of rust, rot, premature aging, or similar afflictions? I contend that — in these situations — our “original equipment” will probably carry us through for some more quality time. This is only true, however, as long as we don’t give up, and for so long as our medical care insurance coverage is still there for us. ..

    So I will venture to offer here these simplistic homey suggestions to you, Judge Kopf. First , stace in the race and “run what brung ya.” Second, endure the medical procedure(s) which are most likely to give you best odds for continuing to “dance longest with who brung ya.”

    Let’s see how this works for you for next several years, okay? Methinks Joan would be okay with this approach, too. Just keep taking out the garbage.

    Jim

  6. Judge I wish you the best.
    Some friendly advice. Find a good tai chi (or chi kung) teacher, learn one of the forms of one of the main systems, do it every single freaking day and give it some time to work. If you can’t find one do a search for the BBC series Stand Still and Be Fit and try the standing he recommends. I can’t promise that it will be a cure-all, but it will help you as much, if not more, than anything else you could do.

  7. Dear Guest,

    One of the most interesting experiences I ever had was watching a bunch of old folks do tai chi one early morning in Xi’an, China. We met an old man who was leading the group, a former engineer. He spoke fairly good English, and he took us on a tour of the zoo near where we first observed the tai chi group. It was one of those unplanned experiences that makes traveling to far away places especially special.

    All the best.

    RGK

  8. The humor board sounds much more entertaining than the tumor board. Also, the process that you described sounds like it was taken from the legal system, so you should be able to navigate it quite well.

    As to the issue of pies, what about pumpkin for Thanksgiving? Perhaps Joan’s large family will have pie bakers, so you will get your pie!

  9. Tai chi lessons to start promptly at 8 am on the Murray River @ February 22, 2015. Milan has some sweet moves to teach you which will be sure to improve circulation.

  10. Pingback: When a quasi-sick sap sentences a really sick controlled substance seller « Hercules and the umpire.

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