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.

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