Scans, explained

Today was a scan day for me. I get scans  every 10-12 weeks. What are scans and why do I have them? Why are they both bad and good? What's it like to hang out in an MRI tube for an hour and a half? Read on, friends. All will be revealed.

So, there are a number of different ways to take pictures of the inside of your body. We all know about x-rays, which use a quick blast of radiation to give a look at whatever it is targeting - a broken bone, pneumonia, and so on. Dense things - bones, tumors and so on - show up white on an X-ray but soft tissues are grey. But x-rays only give a single image at a time, and the result of an x-ray is 2-D. It's flat. You can't peer around inside of an organ or anything like that. It's just surface shots. If you've never had an X-ray, you basically just stand in front of a little white board, or stick your arm of leg or whatever in front of the board, and the technician positions you, runs out of the room, flips a switch and then comes back. You feel nothing (even though you've just been exposed to radiation) and you walk away and they have the results immediately, because it's just a picture. You used to get the actual picture but now it's all done digitally and you can ask for a copy or just keep it in your files. I had an X-ray last Thursday because I was really sick with a cold and could feel it moving into my lungs, which is bad because my lungs are delicate little flowers - I have reduced lung capacity due to a) small cancerous nodules scattered around both lungs, b) scarring on my right lung due to radiation, c) a small effusion - a little pocket of fluid - on my right lung that has been hanging out there for over a year for no reason anyone can discover, d) a slightly collapsed lung probably stemming from all of my broken ribs, e) four broken ribs stemming from the aforementioned radiation therapy (I haven't broken any new ribs recently, thank goodness, but broken ribs don't really heal well, esp when there are four in a row - they just sort of settle into a new place). This is not multiple choice; I have all of the above. Anyway, the X-ray last week didn't show any pneumonia or clear signs of established bronchitis, but my lungs being what they are and knowing that I was about to start a week of chemo, which would lower my ability to fight off immune system threats, the dr gave me a broad spectrum antibiotic. I'm really glad she did, because I am feeling MUCH better and have about 40% of my voice back. Good job, dr! And keep on trucking, little lungs! 

 

The X-ray was last week and not scheduled. I already had on my schedule this week a set of scans: a CT scan of my lungs and an MRI of my liver and lower abdomen. I've been getting CT scans since diagnosis, but the MRIs are more recent additions. I'll explain in a minute. First, what is a CT? A CT or CAT scan combines the power of radiation with a computer, and takes a bunch of different X-ray type pictures and inputs them into a computer, which puts them all together to make a 360 view of the target. You climb onto a little surgical table and they put you in the CT "tube", which isn't a tube at all but rather really just a fat circle (picture a tiger jumping through a flaming ring but then replace the flame and ring with a giant metal donut and the tiger with me, wearing scrubs and those lame-o hospital socks). I'm very claustrophobic and it's not scary at all. You can see around the scanner and out both sides and nothing comes close to you. As it gets going, you hear a humming noise that whirs around inside the circle that you're in, which I assume is the little camera taking pictures from all angles. This reminds you that you're being exposed to about a zillion times more radiation than you are during an X-ray so you contemplate the irony that tracking your cancer is actually increasing your risk of future cancers...but you don't have long to panic about that because the process only takes a few minutes - about 20 minutes when I had three areas to scan and had to get the contrast. CT results can look at bones, soft tissue and blood vessels all at the same time. When you have cancerous lesions or spots or tumors (all the same thing - I hate using the word tumor; it creeps me out and don't judge me), you look at the scan and compare it to an earlier scan and you can see whether the spots have disappeared, gotten smaller, stayed the same, or grown. When I say you, I don't mean you you, I mean a radiologist. They're trained to look at scans of all kinds and they write up a report for you and your doctor to read and discuss. Because I am neurotic and an information junkie and so is Nick, and also because I am anxious and impatient and demand to have my scan results ASAP, my oncologist looks over the scan with us, often even before the radiology reports are finished, and we evaluate the new pictures while waiting for the official report. Once we see the report, we discuss and examine what has been "called out" or noted to be important in the report. Nick and I have both gotten pretty good at reading CT scans. 

For a long time - until about 9 months ago - I would just get CT scans. They would do a scan of my lungs, liver and abdomen. In order to be able to see all we need to see more clearly, I would drink a bottle of, basically, glucose (sugar) and then they would inject me with a dye during the scan process. The sugar and the dye helps light up areas of concern on the scans. This is called a CT scan with contrast.  Early on, I wound up with a slight rash a day or two after one of my CT scans with contrast, and to be on the safe side, my medical team decided I was mildly allergic to the dye and made me premedicate for them - take a bunch of steroids and Benadryl prior to any scan so I wouldn't have a reaction to the dye. That worked for a couple of years and frankly, I thought they were overreacting and considered secretly not premedicating (but always did!) - and this is why I am not a doctor. Because after my scans one day, I left the radiology center but suddenly felt very flushed, got short of breath and began itching like crazy. Luckily, I was still at the hospital and was heading over to my oncologist for an appointment, and luckily I realized what was happening, so I quickened my pace and jogged into the GI clinic (my oncologist's office), where announced I was having an allergic reaction to contrast dye and they needed to fix me up double quick. Everyone started rushing around, they threw me in a room, pumped me full of more Benadryl and some extra steroids and gave me oxygen. It was very exciting and I like to keep my medical team guessing about what emergency I'll have next, so we all had a good laugh over that one once I was sure I wasn't going to keel over (!!). After that adventure, my dr decided no more CT scans with contrast. 

So now I get a CT scan of my lungs without contrast, and an MRI of my liver and abdomen. MRIs - well, they suck, to be honest. You get on the little surgical table and this time, they sandwich you onto the board by putting big bulky hard plastic covers over the parts of you not being scanned, to protect you from all the invisible rays that want to kill you/help you. Sometimes they strap those plastic boards to the surgical table and sometimes not. As far as I can tell, it just depends on how sadistic the techs are. Then, they cover you with a nice warm blankie, because those damn rooms are cold! After you look like a human burrito or a very unhappy kitten stuck in a sock up to its neck, they hook you up to a machine that injects dye (different kind of dye than the CT scan) into you at certain times, they tell you good luck and usually give you big noise canceling headphones or earplugs, and they move you into the MRI tube. This IS not a donut or a flaming ring - it's a tiny, narrow, very low ceilinged tube that has a blue line running down the inside of it, to help make sure you're evenly positioned, I can only assume. I am not a big person but my elbows brush against the sides of this tube and the ceiling is about, at most, 6 or 7 inches from my face. The end of the tube is open (think cannoli), but my head doesn't get anywhere close to the end of the tube. So I try to stay calm and just keep my eyes closed because claustrophobia. When I start to panic, which happens about a dozen times per scan and more if I've forgotten to take my Xanax beforehand, I can open my eyes and tilt my head back a teeeeny bit and see the open end of the tube and reassure myself that I'd be out the end of that thing in a flash if necessary. Even though that's probably not true, especially if they've secured the boards.

Now the fun begins! You lie in there and the technician, who has fled to the next room and confiscated your phone and locker key, tells you to get ready. MRIs use giant magnets, radio waves and a computer to make an even MORE detailed set of pictures of your insides. But it takes much longer than the CT and involves a series of activating the magnets and radio waves over and over to make the pictures, for which I must hold my breath - they don't care if you have crappy lung capacity or startle easily; the show must go on - so the picture turns out clearly. The magnets are REALLY REALLY REALLY LOUD and they go in patterns. Sometimes, it sounds like a fire alarm or something like that. Okay, sure. Often, there are a series of "big rocks in a dryer" cycles. A number of the scans sounded like a pac-man game tonight - like I was right inside the game! I would have laughed if I weren't so busy holding my breath for minutes at a time and trying not to pee myself because I was so anxious. Have I mentioned my sh*tty lung capacity? Because it makes holding my breath really hard; sometimes, I fail and sneak a breath (sneak is relative - they can see when I've failed to do my duty) and then I feel guilty on top of everything else. Tonight, at the end of the scan, they sprang something new on me: a 30 count breath holding combined with what can only be described as how I imagine it feels to be inside an up-armored Humvee while it is being riddled with bullets. The entire thing shook and pinged around and got so loud that my eyes couldn't focus - and that was with the headphones! I did NOT succeed in holding my breath as required with that one. Afterwards, I hit the alarm button and said, what the HELL was that? Oh, the tech answered mildly, yeah, sometimes they have to do different patterns. Are your feet hurting? Because I can see you moving them around. I assured him that my feet were fine but I was a little on the anxious side. Gah! 

Soon after the ambush bit, they let me out. And I just couldn't shake it off right away, probably because I hadn't taken any Xanax beforehand and also because I hadn't eaten since 9 am (finished scans a little after 8 pm), because I had to give a lecture downtown at 1:30 and then go directly to my son's class musical (super adorable!!) and then from there directly to the hospital for an after hours scan. You're not allowed to eat or drink for at least four hours before an MRI, see, and by the time I finished my lecture, I'd missed my window. Then radiology was running behind - over an hour behind, and of course I couldn't exactly take a water break.

So! Now that the scans are done, I get to meet with my doctor tomorrow and go over the results. It's going to be a long night. Scanxiety is real and it's awful, because you have no power to do anything at all but wait until you see your team and they walk you through what's going on inside your body. Fun, right? Good thing several beloved people sent or dropped off chocolate (also, dinner twice this week and cookies! I know the most awesome people in the world!) so I can at least cope before I go to sleep - I mean, while I wait around all night wild eyed with fear and anxiety. 

If you see me at the school thanksgiving lunch tomorrow, please just pretend I look normal. Even though I will likely be a hollow-eyed and shaking like I just had four shots of espresso. 

That concludes today's lesson in scans and my Wednesday. I'll be in touch soon! 💙❤️