A Cautionary Tale 

Ignoring the other ‘Findings’ on your CT could be deadly.  As an advocate I am always telling people to collect copies of every test, every report, every piece of medical information generated about you, your disease and your treatment.  With each follow up CT I happily accept my copy of the report and skip down to the section that indicates findings and impressions and read what my oncologist just told me, ignoring the rest can be deadly.  A recent medical scare taught me an important lesson.

At what was supposed to be my ‘last ever’ PAP test my gynecologist discovered some cells in the cervix that might be a precursor to endometrial cancer. This prompted an ultra sound and a biopsy. The biopsy, which was done in his office proved to be inconclusive. So a second biopsy, a hysteroscopy and a D & C was performed at the hospital. Fortunately, that biopsy proved negative.  But what was perhaps not such a wonderful outcome was that the following day I experienced dizziness, nausea and blurry vision.

A friend drove me emergency department. In the ED the doctor ordered a CT to rule out a pulmonary embolism or progression of the cancer. Good news! 1-No pulmonary embolism; 2-post therapeutic changes of the lower left lobe are similar to previous. There is no evidence for lung cancer recurrence when compared to previous. 3-Aneurysmal dilation of the ascending thoracic aorta is stable and does not show acute complication. Patient is dehydrated. Whew. A relief.

Wait. What?
Aneurysm? What aneurysm? Ah.ah.ah.

No one has ever said anything about an aneurysm before. Reviewing the document the doctor told us that it was in previous CT reports. I went home and beat myself up. How could I have ignored such a finding? I would never have ignored it! Those reports are the reason I knew there were signs of emphysema and requested pulmonary rehabilitation. How did I miss this when reviewing my my reports? How? My cousin Deb and my sister Jan had attended every appointment with me. THEY never heard it either.

Self flagellation is never productive to the body or mind. Action is called for. Aha! I remembered I had CT reports going back 6.5 years I would learn when this newest condition manifested that way.

2017-CT to rule out cancer progression and pulmonary embolism- The thoracic aorta is tortuous. The ascending aorta measures up to 4.8 cm but show no dissection or acute complication. Is similar to previous. (Previous? What previous?)

2016– nothing x2 (Shows on CT but not remarked upon or noted-surgeon showed it to me)

2015– nothing (normal aortic arch) x2 CTs

2014– still nothing x2 CTs

2013– nothing x3 CTs, 1x CT mild dilation of aortic arch.  Okay.

2012-nothing x4 CTs

2011-nothing x4 CTs

2010-Oh, my initial CT says mild dilation of aortic arch.  (What the what?) Is that the same as an aneurysm? (It is. It really is).

Fast forward a couple weeks. This is scary shit. Every bit as scary as cancer and I have to digest this privately. Also, I want to meet with the thoracic surgeon and learn more before I blog.

This week: No recriminations,  I just want to know where we go from here. Where the Medscape paperwork the ED doc gave me said that at the size of my ascending aortic aneurysm (4.8 cm) it should be examined by a thoracic surgeon, the thoracic surgeon says based on my height we can let that go until it reaches 5.5 cm. before surgery is warranted.  He wants to avoid surgery as long as possible, With my medical history it’s much more difficult.

My history? Stage 4 adenocarcinoma with primary on the left,  mets to right lung (maybe second primary),  mets to the visceral pleura, lymph node involvement throughout the center of my chest (mediastinum and hilar nodes).  Combined chemo and radiation for the lung cancer on both left and right sides of the lung. A left side breast cancer for which I received radiation, pleural and pericardial effusions (fluids in the sacs that surround the lungs and heart -preventing them from working to their capacity-can crush the organs), and pneumonitis.

Apparently, all that left side involvement and radiation has caused scarring and managed to fuse the organs to each other making this surgery riskier for me.

Pictured two awesome caregivers-Deb Letterman and Jan Finkbeiner
In the meantime? We play the same game I’ve been playing with the lung cancer for the past 6 years ten months.  Its a game I’m very good at.- the old Watch and Wait game. There will be CTs with contrast every six months until it’s big enough that they are forced to do surgery or I have a massive heart attack manage to live long enough to make it to the hospital to have it surgically resected.If I am allowed to choose between dying a slow painful death from cancer or a swift painful one from the aneurysm, I’d prefer the quickest route. My life the last couple of years has been productive and interesting in ways I might never have dreamed. I’m just not ready to die yet and I don’t plan on going anytime soon.From now on every word gets scrutinized, even those that have nothing to do with lung cancer.
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