It’s Tuesday, five days after The News.
CT Scan Day
The CT scan with contrast of my chest, abdomen and pelvis was done at PAMF Mountain View. PAMF, part of the Sutter Health network, has several locations throughout the Bay Area, with the Mountain View and Palo Alto locations being convenient for me.
I’ve never had a CT scan before and was rather curious what it involved. It turned out to be rather anti-climatic. You lie down on the table and they start an IV with contrast dye. The technician said I might feel a bit warm, like I was going into a hot tub whole the scan was being done. And I might feel like I’m going to pee. (She quickly added that don’t worry, I won’t. I suppose thankfully she was right.) Other than that, just follow what the machine said. And the machine basically told me when to hold my breath and when to breathe normally. The whole thing didn’t take more than a few minutes. Afterwards the technician said to drink lots of water since it would help to flush the contrast dye from my system, and that the results would be available in one to two days.
While I was undergoing the CT I received a number of calls from PAMF. This is becoming a common occurrence. I suspect they KNOW when I’m on the phone with another PAMF department or undergoing a procedure and pick that moment to call. These calls were from the office of a surgeon. They received an urgent referral and were holding a Monday 9 AM slot for me. I called them back and discovered this was in Burlingame, 20 miles from my home. Was there any way to reschedule and/or have the appointment closer to Mountain View? Answer: unfortunately no, they had created this slot due to the urgency of the referral and the surgeon would only be available in Burlingame. Ok, so be it. [Note to self: really need to have my chart updated to indicate I’m a vampire.] I have a fuzzy recollection that the gastroenterologist who did the colonoscopy said she had a specific surgeon she wanted me to see (or maybe it was the person doing the EUS – right after you’re coming out of sedation isn’t the best time to get information!). In any case, on the off chance this surgeon is a special pick I certainly want to get to know him.
Now I’m rather confused since the nurse navigator mentioned that I should get a call to meet with a medical oncologist and that the medical oncologist would be the hub of activity with surgeons, radiologists, and whichever other specialists would be involved. So why am I meeting with a surgeon before the medical oncologist? Shouldn’t the treatment protocols be discussed first?
So I sent a note to the nurse navigator. She quickly replied that she saw that the referral for medical oncology had been placed and I should have been contacted already. She’d follow up to see what was holding the up. Still not sure what the surgeon visit is, but I’ll just chalk it up to things happening quickly.
I wandered around a Best Buy next to the PAMF Mountain View facility and then ran some errands. At some point, about two hours after the CT scan appointment, I got a notification on my iThings: a new test result had been posted. Curious, I got out my phone and sure enough, the CT scan results were already in! That was fast. I wonder if they were coding things “stat” or the equivalent?
The first summary line wasn’t too exciting: “Question of slightly eccentric wall thickening along the left aspect of the rectum, possibly correlating with the reported history of rectal mass.” Sounds like its expected.
The second summary line was an eye-opener: “There are numerous small hypodense foci in the liver measuring 5 mm or less, too small to characterize definitively by CT attenuation measurement. These could potentially represent small cysts or hemangiomas, but in light of the history of suspicious rectal mass, metastases cannot be entirely excluded. Consider dedicated hepatic MRI for further evaluation.”
Metastases. I was already mentally prepared for a stage 4 (metastases to distant areas) diagnosis. But it’s still not exactly a welcome observation. I can guess that a “hypodense foci” is an area of tissue that’s less dense than the surrounding area. Could a rectal tumor appear that way? And could liver issues explain how I had felt back in March with a a bit of fatigue, shortness of breath, and lightheadedness? I thought those were symptoms of a mystery ailment I’d get every few years. I’d even told my PCP that at my physical a couple months ago, and he shrugged it off. In 2016 (the last incidence of that) I had a cardio workup done, since these episodes are inevitably accompanied by heartbeats I can feel are irregular. But could it be a liver issue? On the one hand, since I’ve been experiencing these episodes since 2005 or so those hypodensities could represent some other problem and not metastases. On the other hand I suspect cancer treatment is hard on the liver – do I really want to have something else going on at the same time?
For whatever reason I was able to review the results with more of an academic interest and not panic over them. I’ll admit I was even looking forward a bit to having them explain the mystery ailment. I started thinking maybe I should have had a CT scan done earlier just to have my body checked out. There are places you can go to have them done. Of course your insurance won’t pay for it, but in context it’d cost about the same as a month’s rent in the Bay Area (which is ridiculously high).
Or maybe liver hypodense foci naturally occur in homo sapiens vampirus? Maybe they’re a holdover from homo neanderthalensis vampirus, an adaptation to extracting nutrients from blood, back in the day before we discovered wine and had to chase after screaming humans for an aperitif? (I really think that must’ve ruined the mood for a good meal. No wonder neanderthalensis vampirus is always on the thin side.)
Side Bar: The Car Wants In
While leaving home for the CT my car’s low tire pressure indicator came out. Got out and examined the tires. They looked fine. Drove across the street where there’s a gas station with a tire pump and all the tires read at slightly over 30 psi. Well nothing more I could do but hope I’d make it to the appointment and back. Although I’ve been in executive and management for a while I’ll ever be an engineer. I have no issue understanding and dealing with electronics or machines. Cars are an exception. They’re magical, temperamental beasts.
After the appointment and running a some errands I returned home and again checked the pressure on all the tires. Still 30 PSI. Now I know how the doctors and dentists feel when I say “it hurts” but they can’t find anything wrong.
The first available slot at the Lexus service center is Saturday at 10:40. I’m beginning to think the universe is conspiring to ensure I don’t sleep in. JT has suggested that my car just wants some TLC after not being driven much during the pandemic. But it got new shiny new tires last year and had service just last August! Which was….ok, 11 months ago. How time flies when you’re sheltering in place. Maybe it is time for it to see the doctor too.