Thursday, August 13, 2009

Bone, PET, and CT Scans - 8/11/09

I've been having new pains in my right foot and in the groin (for lack of a better term) of my left leg. I don't know what the area is called on a woman where the upper thigh meets the pubic region, that area that folds in when one sits down. The entire foot hurts from the foot pad to my heel and looks puffy compared to the left foot. The big toe seems to be crammed into the toe box, and my running shoes and loafers feel a little snug. It hurts to stand in one place too long, and walking and running aggravates it. After 6 or 7 hours in a race, the whole foot is one unsettled nerve.

Although the foot pain is bad, the groin pain is worse. I would rather stand for hours than to sit for 15 minutes at a time. When I stand after sitting, I can barely move. The start of a walk is an exercise in patience. I start off limping, placing most of my weight on the sore, right foot, until I work out the kink in my groin. After a few steps, the pain eases off until it is barely noticeable. Laying flat on my stomach or back doesn't cause any problems with the groin, but the foot protests. Pain relievers have done little for the foot or the groin.

I just assumed that the new pains meant that I had new cancer sites. That's how it's been in the past 2 years. And I just knew that my scans would show that the bone cancer was continuing to spread. My oncologist recently switched my scans from every 3 months to every 4 months, so it's been a while since we've discovered any new sites.

On Monday, I had the bone scan. I went to the hospital to have a radioactive substance injected into my arm. For whatever reason, we can never use the port for the radioactive substance, so as usual, this turned out to be an ordeal for the medical technician. She couldn't find a good vein, missed the one that she thought she could get, and then proceeded to move the needle around inside my arm, trying to find it again, before finally giving up. She pulled the needle, found a "child's" needle, and mumbled something about injecting the radioactive substance slowly due to it's smaller size. I'm so accustomed to medical personnel missing my veins that it doesn't bother me at all. The medical technician is more distraught than I'd ever be. I guess they feel that they are the professionals and that they should get it right on the first or second try. I always try to assure them that it's not their lack of skill but the lack of cooperation of my small veins.

She now looks at the back of my hand. When they give up on my arm, they always go to the hand next. In the past, I have even been asked to be prepared to take off a shoe, because that would be the third place to try a needle stick - in the top of my foot. She asks if I've had lymph nodes removed from my left arm. I tell her that I have. She nods and jokingly says that's probably where I'm hiding my good veins. I agree with her, even though prior to lymph node removal, no one could get those veins in that arm to cooperate either. I am never to have needle sticks or a blood pressure cuff applied to my left arm due to the removal of lymph nodes. It has something to do with the inefficient transfer of fluids through the body with fewer available lymph nodes, which could cause swelling and a build up of bacteria in the arm.

She finds a vein in my hand that she likes, sticks the smaller needle in, and misses. She again starts to fish around for the vein. I then feel a slight pinch. I look down and see the blood return. She's found one. Did a look of relief just run across her face? She now injects the substance (slowly, as she stated before), and once the tube is drained, she removes the needle and applies a bandage. She tells me to drink lots of fluids, to urinate as much as possible, and to come back in 3 hours. That means that I can go back to the office and work for a couple of hours.

Bone scans take about an hour. When I return, I am immediately taken back to the nuclear medicine area and asked to empty my bladder one more time. The medical technician then takes me into the room with the scanner, and I lay on my back on the table, resting my head on a pillow. She binds my feet together and places a hard cushion behind my knees so that my legs are elevated and slightly bent. For the first part of the scan, my arms rest along my side, and for the second part, I will raise my arms above my head. The machine is very quiet, unlike an MRI machine, and slowly scans and takes pictures, starting from my lower body and finishing at the top.

On Tuesday, I have the PET and CT scans. I really hate these because of the two bottles of contrast that I have to drink prior to my appointment. I've had all of the different flavors (apple, berry, plain, and vanilla). Banana is the exception. I cannot stand the taste and smell of bananas. No matter the flavor, however, the stuff is still nasty. I often wonder what drinking barium is doing to my body. It's probably causing as much damage as all of the radiation, but I can't argue with a necessity. I sip one bottle while getting dressed and sip the second bottle on the drive to the medical office, finishing up as I park the car. I sit there for a couple of minutes, trying to keep from throwing up 2 bottles of contrast. This is always a struggle.

There are a lot of people in the waiting area, and it's not even 8:00 a.m. I learned years ago to always have something to read while I wait. That way, I don't feel like I'm wasting time. I have stood in long lines for various reasons, and while everyone around me was grumbling about having to wait, I was perfectly content reading a good book. I never get to the level of being anxious, and I can pretty much tune out everything around me while I'm reading.

I'm finally called to the back, so that they can start an IV and inject another radioactive substance. Again, they can't use the port. My arm and hand are bruised from the prior day's attempts, so the medical technician searches for available veins in the forearm. He finds one, but of course, he misses also and thus begins the fishing around for the vein. I feel the familiar pinch, see the blood return, and watch the substance go into the vein. He tapes the needle down so that it can be used again during the scan. I'm asked several questions about surgeries, my breast cancer, my mastectomy, chemotherapy, radiation, blood disorders, and a list of other medical problems, that I'm grateful to not have. It's a new facility that they've sent me to, so it's like starting all over with the medical history. I'm wondering why they just didn't forward over my records from the other PET/CT facility, but I don't ask.

At the other facility, I'm usually left alone to lie quietly with the lights off, while soft music plays in the background. They give me a pillow and blanket, recline the chair, and tell me to relax for 30 minutes. I am not to read, I'm told, when they notice my book. However, this does not happen at this facility. They leave me for about 15 minutes (no pillow, blanket, or music), and I am free to continue to read.

A different medical person comes in and tells me that I need to drink some more contrast, since I've had to wait a little while due to all of the patients they've had this morning. I groan. He apologizes. It's okay, I tell him. He gives me a big cup of what looks like lemonade, none of the thick, chalky white looking substance that I had that morning. And to my surprise, it tastes like lemonade. It's actually pretty yummy. Now why can't they give me 2 bottles of that to drink instead of the other nasty tasting contrast? Do I sound like a 4 year old child, lol?

A few minutes later, a war begins in my tummy. The two different types of contrast are fighting for position. My stomach is essentially empty except for the contrast because I am not to eat or drink anything else for 8 hours prior to my appointment time. This is not good.

A female medical technician comes to take me to the scanning room. Normally, I am taken to a restroom first to empty my bladder because, just like the bone scan, the PET and CT scans take about an hour. She tells me that the scans work better with a full bladder. I am shocked. I've never been told that before. She also tells me that if I could hold it 5 or 10 minutes, we would be done. Again, I am shocked. This is totally different from the PET and CT scans that I've had in the past. I'm all for this - the less time, the better. I try to ignore the sounds coming from my tummy, and I hope that she can't hear them.

I lay on the table, and we start the first scan, from feet to head. I am never sure which scan is which, so I always assume that the first scan is the CT. Once that's done, she injects a die into the needle in my arm. Usually the die burns so bad that tears come from my eyes. The technician would then massage the area until the vein settles down. Today, there is no burning. I still feel the warm, tingly substance entering different portions of my body, but it doesn't hurt today. I am again amazed at the difference between this new facility and the other PET/CT facility. I tell the technician that it doesn't burn and that it normally does. She responds that if it's injected slow enough it shouldn't burn. So the other facility had been rushing this substance through my veins?! Shame on them, lol!

The table again starts to move me through the machine. A couple of minutes later, it's over. She proceeds to remove the needle and to place a bandage over my forearm. That's it? I am so used to being there much longer that I'm actually giddy. I tell her that I want to come back there in 4 months when it's time for the scans because it was much quicker. She said that it should not have been since they use the same procedure that their sister facility uses. I know better and wanted to argue the point with her, but I didn't really want to take the time, and she didn't really have the time, so I kept quiet.

Now I had about a couple of hours before my next appointment. But first, I had to take care of my tummy issues. Once that was over, I ran a few errands until it was time to see the oncologist for my monthly treatment.

By the time I saw my oncologist, she had received and reviewed the results. The bone scan showed that there were no new cancer sites. The good news was that there appeared to be a lot of scar tissue which indicates that the Zometa is still working. The PET and CT scans were also good. So, what were the new pains? I described them, and the oncologist nodded her head. It's the Femara, she said. Unlike with the Tamoxifen, my bone cancer had seemed to be arrested with the Femara. She wanted me to continue to take it as long as I could tolerate it. She would give me another prescription pain reliever that I would take twice a day, every day, if the Aleve was not working. My hydrocodone prescription had run out a long time ago. She really did not encourage Advil. It didn't really matter because neither the Aleve nor the Advil was working on the new pains; they barely helped with my old pains. She wanted me to take the Aleve at the onset of pain and to not wait until I couldn't tolerate the pain any more, which is what I had been doing all along. Pain management is a difficult science, and it's a lot of trial and error. Since I hurt all day, every day, I really don't want to take that much pain reliever. And I really didn't want to be on another prescription pain reliever. I told her I would stick with the Aleve and if the pain became worse (not sure how it could get any worse), I'd come in for the prescription.

The next thing on the list to discuss was the anemia. My port had been assessed, and the nurse had filled up the little tubes with my blood. The good news was that my counts had neither gone up nor down, so I wouldn't have an IV iron infusion today. I was to continue with the iron pills and B and D vitamins. She also wanted me to add some calcium pills, since the Zometa seemed to be pulling the available calcium from my body to repair the bones.

In addition to the Zometa, I would have a booster shot of Lupron today. Lupron prevents my ovaries from producing estrogen. When I first started the Lupron shots, I would get them every month. When the tests came back that my ovaries were completely shut down, I was given a Lupron injection that would last 4 months. The 4 months was up today. I was required to reduce the weight on my hip by lifting my leg behind me and bending over as they pulled my pants down to inject the thick substance into my butt muscle. The injection site remains sore for a couple of days afterwards, and the small lump dissipates over the same time frame.

So another month of treatment was done, and I wouldn't be due for scans for another 4 months. It was a relief that the groin and foot pains were not new cancer sites. I would have loved to hear that the tumors in my back and pelvic bone were completely gone, but all of the reading I've done about bone cancer over the last year and a half says that will never happen. To know that the tumors are stable and not spreading is the next best thing. Now that I knew that the foot and groin pains were a result of the Femara, I could deal with it. I had been dealing with the pain in my back and hips for so long now that they were my friends. I just have new friends to entertain from now on. It would scare me to death to wake up one morning and be able to hop out of the bed pain free, rather than to ease out stiff and sore.

It was time to go back to work and get back to my every day life. But first, I had to take care of my tummy issues again. It had to be the mixing of the different contrasts. I would be in the restroom several more times that day before I finally had some relief, lol.

1 comment:

  1. Hi Angela,

    I am so sorry you have new pain friends but am SUPER glad they are not any form of cancer.

    You are really tough! Please know I am cheering you on and sending you all sorts of positive thoughts from the sidelines.