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Grex > Health > #87: Sindi Keesan's Lymphoma Journal |  |
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| 25 new of 480 responses total. |
keesan
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response 145 of 480:
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Oct 21 15:53 UTC 2003 |
Re 144, No. I can look up which barium solution it was. Fruit flavored.
I should also read about how CT scans work. THe technician watched the
injectin then left the room to run the machine so something must be
radioactive. Also Jim had to wait outside. I did not notice anyone shaking
the solution to suspend anything. What was so bad about the solution when
you drank it, goose? They said some people get nauseous. My big problem was
the coldness and the volume.
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keesan
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response 146 of 480:
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Oct 21 16:03 UTC 2003 |
Computed tomography (CT) a method of body imaging in which a thin
[74]x-ray beam rotates around the patient. Small detectors measure the
amount of x-rays that make it through the patient or particular area
of interest.
A computer analyzes the data to construct a cross-sectional image.
These images can be stored, viewed on a monitor, or printed on film.
In addition, three-dimensional models of organs can be created by
stacking the individual images, or "slices."
How the test is performed
The patient will be asked to lie on a narrow table (gantry) that
slides into the center of the scanner. Depending on the study being
performed, the patient may need to lie on his/her stomach, back, or
side. If contrast media (dye) is to be administered, an IV will be
placed in a small vein of a hand or arm.
Much like standard photographic cameras, subject motion causes blurred
images in CT. Therefore, the technologist operating the scanner and
supervising the patient will give instructions through an intercom
when to hold one's breath and not move.
As the exam takes place, the gantry will advance small intervals
through the scanner. Modern "spiral" scanners can perform the
examination in one continuous motion of the gantry. Generally,
complete scans will only take a few minutes, however, additional
contrast-enhanced or higher-resolution scans will add to the scan
time. The newest multidetector scanners can image the entire body,
head to toe, in less than 30 seconds.
How to prepare for the test [76]Return to top
The patient may be asked to drink oral contrast either immediately
prior to, or 4 to 6 hours before, the CT scan. The contrast may be
composed of non-reactive (inert) chalky-tasting barium sulfate, which
will eventually pass in the stools, or absorbable clear Gastrografin
solution. The health care provider may also advise fasting (no solids
or liquids) for 4 to 6 hours if contrast dye is to be used.
The CT scanner has a weight limit to prevent damage to the mechanized
gantry. Have the health care provider contact the scanner operator if
you weigh more than 300 pounds.
Since metal is very, very dense, the x-ray beam has difficulty passing
through it and results in errors in the involved constructed slices
(artifact). Therefore, the patient will be asked to remove jewelry and
wear a hospital gown during the study.
How the test will feel [77]Return to top
The x-rays are painless. The primary discomfort may be from the need
to lie still on the table.
If intravenous contrast dye is given, the patient may initially feel a
slight burning sensation within the injected arm, a metallic taste in
the mouth, and a warm flushing of the body. These sensations are
normal and usually reside within a few seconds.
Why the test is performed
CT provides rapid, detailed cross-sectional imaging of the patient
which can then be reconstructed into three-dimensional models, as
needed. Intravenous contrast enhanced scans allow for evaluation of
vascular structures and further evaluation of masses and tumors.
CT is often utilized in the trauma setting to evaluate the brain,
chest, and abdomen. As well, CT can be used to guide interventional
procedures, such as biopsies and placement of drainage tubes.
What the risks are
CT scans and other x-rays are monitored and regulated to provide the
minimum amount of radiation exposure needed to produce the image. CT
scans provide low levels of ionizing radiation which has the potential
to cause cancer and heritable defects. The risk associated with any
individual scan is small; however, the risk increases as numerous
additional studies are performed.
During pregnancy, an [80]abdominal CT scan is usually not recommended,
due to risk to the exposed fetus, including developmental
malformations and childhood cancers. Patients who are or may be
pregnant should speak with their health care provider in order to
first take a pregnancy test or choose an appropriate alternative
imaging modality without risk to the fetus, such as ultrasound.
The most common intravenous contrast dye is iodine based. A person who
is allergic to iodine (such as those with seafood allergies) may
experience [81]nausea, [82]sneezing, [83]vomiting, [84]itching, or
[85]hives. If contrast administration is essential for a patient with
any of the prior reactions, the health care provider may choose to
pre-medicate the patient before the scan with a short course of
immune-suppressing steroids and/or Benadryl. Alternatively, other
contrast media or other imaging modalities (such as ultrasound or MR)
may be used.
Rarely, the dye may cause [86]anaphylaxis (a life-threatening allergic
response), usually manifested by swelling in the airway. The patient
is instructed prior to the scan to notify the technologist via the
intercom if he/she has difficulty breathing. If such a rare reaction
does take place, the exam will be stopped, and the patient will be
rapidly treated with special medication and closely monitored by a
physician.
Iodine-based contrast is primarily filtered out of the bloodstream by
the kidneys, and thus patients with diabetes or renal disease will
require continuous hydration and close monitoring of kidney function.
Diabetics on certain a glucose-lowering medication
(glucophage/metformin) and renal dialysis patients should speak with
their physician regarding stopping the medication, and the proper
scheduling of the scan in conjunction with dialysis, respectively.
Consent from the patient or designated guardian must be obtained prior
to the use of intravenous contrast.
63. http://www.nlm.nih.gov/medlineplus/ency/article/003330.htm#Alternativ
e%20Names
Apparently the IV solution can also cause nausea, not just the barium.]
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keesan
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response 147 of 480:
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Oct 21 16:20 UTC 2003 |
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CT Scan
What is a CT Scan?
A CT (Computed Tomography) scan, often called a CAT (Computed Axial
Tomography) scan, is a painless examination that gives the physician
an unobstructed, cross-sectioned look at organs and structures that
cannot be seen clearly on conventional X-rays.
How does CT scanner work?
The CT scan combines a sophisticated X-ray system with a high-speed
computer. The scanner obtains slices (blocks of image data that can be
viewed on an end to end projection) of information that will assist
the patient's physician in making a diagnosis and planning a
treatment. This combination produces a picture of the body, allowing
the physician to see tissue and bone structures in fine detail. The
imaging procedure and the images are best described thinking of a loaf
of bread. The entire loaf being the part of the body that is scanned.
Anywhere in the loaf of bread a single slice can be picked out and
looked at end to end.
Why is CT important?
CT offers a non-invasive way to obtain information about the patient's
body that may otherwise not be as easily seen. It can lead to early
detection and treatment of disease and pathology by a physician. CTs
can make it possible to see various types of tissue and can provide
important information about the brain, spine, joints and internal
organs. The CT scan is a "window" into the body.
What can I expect?
When your physician refers you for a CT exam, it is important to talk
to him/her about all of your questions or concerns. It is important to
tell your doctor if there is any chance you could be pregnant or
trying to get pregnant. You also need to inform your doctor if you are
allergic to iodine or presently taking a medication for diabetes
called glucophage. If abdominal imaging is planned, tell your doctor
if and when a previous barium exam was done. A recent barium exam
could interfere with a CT procedure.
When you arrive, a technologist and or nurse will ask you certain
questions pertaining to your medical history and explain your
procedure. You will be asked to change into a hospital gown and be
given a secure place to store your clothing and valuables. Any metal
or plastic objects will need to be removed before your scan.
[Nobody asked questions, it was just a sheet of paper. No hospital gown
was needed. They just checked that I had no metal snaps or buttons or
anything else metal. I wore loose knit cotton pants, and long-sleeve
t-shirt that pushed up above my elbow for the IV, and Jim's sweater
because mine would not push up far enough. I had no valuables but Jim.
I had no buttons either.]
Some CT produces require two sets of scans. The first scan will be
without IV contrast and the second scan will be with IV contrast. This
is a normal CT technique that helps differentiate tissue types. The IV
contrast is injected into a vein in your arm. For abdominal /pale CT
procedures, you will also be asked to drink an oral contrast (liquid
barium). The oral contrast will highlight and abnormal in your
digestive tract.
[This did the procedure twice for the abdominal scan, before and after
injecting the iodine dye solution. These people should have proofread.]
Must I do anything to prepare for the exam?
Yes. All contrast exams require that you do not eat or drink anything
4 hours before the procedure. You can take your prescribed medicines
if needed, under the direction of your physician. This can be
discussed when your exam is scheduled.
[6 hours, or 4 if you are diabetic.]
What happens during the examination?
In the scanner room, there is a patient table and a structure with a
big round hole in the middle called a gantry. Before the scan, a
technologist will assist you onto the scanning table. Depending on the
type of CT exam being performed, you will be positioned either head of
feet first and in your back or abdomen.
[on not in, or not of. I would not have needed assistance had I been able
to use both arms, but the left one was not able to bend and it hurt.]
When you are comfortable, the technologist conducting the examination
will move the table into the gantry opening until you reach the first
scan position. You will be given specific instruction about how to
breath during the scan, depending on the type of scan you are having.
At that point, all you have to do is relax and remain still while each
scan is being taken.
[And hold your arms stiff vertically for the whole procedure. The machine
had a recording telling me when to breathe. You have to hold your breath
so that your diaphragm does not move, spoiling the picture.]
You can think of the CT scanner as a fancy X-ray machine. Other than a
sound like a clothes dryer, you won't even notice when the system is
on and taking pictures. Several scans are taken while the table is
moving; when the table is moving it is allowing for a different scan
location.
[The machine makes noise when it is on. When the noise stops you are
done.]
How will I find out the results?
When the exam is complete, you may leave the facility. If IV and or
oral contrast was used, it will be necessary to drink additional
liquids, preferably water, throughout the day of the examination to
help eliminate the contrast from your system.
[They never mentioned that I should drink anything so I did not drink
anything for a few hours afterwards. I should read up on tests before
going to them. I drank 1/2 glass of water at supper.]
All procedures will be read by the Radiologist on staff after the scan
is completed by the technologist.
The final report will be available for your physician within 24-72
hours.
[Read the same night, available in 2-3 days.]
Last Updated October 1, 2002. Unauthorized reproduction of this
material is strictly prohibited.
Copyright 2002, St. Paul University Hospital
References
8. http://www.stpauldallas.com/index.htm
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klg
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response 148 of 480:
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Oct 21 16:32 UTC 2003 |
CT Scan (or other x-ray exam) Tip-
If you need to disrobe for the procedure, you'll probably be given a
locker for your stuff. However, it probably won't have a lock. So,
unless you are accompanied by a relative/friend who can hold your
valuables it's a good idea to bring a padlock for the locker to
safeguard your possessions whilst in the procedure room.
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scott
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response 149 of 480:
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Oct 21 16:41 UTC 2003 |
Depends on the facility, probably. When I had my shoulder scanned a few years
ago the UM hospital had lockers, with locks, and the locks used brass keys
so you could bring it into the lab with you.
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rcurl
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response 150 of 480:
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Oct 21 16:57 UTC 2003 |
If all that is a CT scan, what is a CAT scan? (I had what was described
above, with an IV contrast agent, for a renal examination. I think I
had a CAT with a californium injection for a bilary inspection. The
latter was detecting the radiation from the californium and the former
was using x-rays from an external source. Is that the substance of the
differences, or is there more?)
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goose
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response 151 of 480:
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Oct 21 17:15 UTC 2003 |
RE#145 -- It kind of tasted like warm yogurt, mixed with chalk. Even thinking
about it now induces a nausia...I really would have appreciated it if it were
cold, but I drink cold things all the time.
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keesan
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response 152 of 480:
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Oct 21 19:47 UTC 2003 |
I think CT and CAT are the same thing - computed tomography and computer
assisted tomography. The former name is preferred now, at least that is what
they call it at U of M hospital. Maybe goose had the unflavored stuff. My
first time in July my urine smelled like the stuff I drank for 10 days
afterwards but this time I don't notice any smell in it.
I had a MUGS exam in which they took some of my blood and added something
radioactive to it and injected it back. I don't know the details as I was
half asleep at the time. It was done by Nuclear Medicine dept.
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keesan
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response 153 of 480:
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Oct 21 19:50 UTC 2003 |
CAT - computed axial tomography. I could not find MUGS so perhaps I got the
term wrong (unless you want a mug from a company called nuclear). MUGA?
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keesan
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response 154 of 480:
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Oct 21 19:59 UTC 2003 |
The MUGA scan
The MUGA scan (MUltiple Gated Acquisition scan) is an extremely useful
noninvasive tool for assessing the function of the heart. The MUGA
scan produces a moving image of the beating heart, and from this image
several important features can be determined about the health of the
cardiac ventricles (the heart's major pumping chambers).
How is the MUGA scan performed?
A MUGA scan is performed by attaching a radioactive substance,
Technetium 99, to red blood cells, then injecting the red blood cells
into the patient's bloodstream. The patient is then placed under a
special camera (a gamma camera), which is able to detect the low-level
radiation being given off by the Technetium-labelled red cells. (The
level of radiation to which a patient is exposed during a MUGA scan is
felt by experts to be minimal - it is in the same general range as the
level of radiation received with a chest x-ray.) Since the red blood
cells (including those that are radio-labelled) fill the cardiac
chambers, the image produced by the gamma camera is essentially an
outline of those chambers. With some fancy computer manipulation, the
the final product is a movie of the heart beating.
What can be learned from the MUGA scan?
Several important features of cardiac function can be measured from
the MUGA scan. If a patient has had a heart attack, or any other
disease that affects the heart muscle, the MUGA scan can localize the
portion of the heart muscle that has sustained damage, and can assess
the degree of damage. But more importantly, the MUGA scan gives an
accurate and reproducible means of measuring and monitoring the
ejection fraction of the cardiac ventricles.
The left ventricular ejection fraction (LVEF) is an excellent, and the
most commonly used, measure of overall cardiac function. The ejection
fraction is simply the proportion of blood that is expelled from the
ventricle with each heart beat. So, for instance, if the left
ventricle ejects 60% of its blood volume with each beat, the LVEF is
0.6. (A normal LVEF is 0.5 or greater.)
[Here is why they did this scan on me. Adriamycin is what is causing my
laryngitis. They only did the MUGA once while I was in the hospital,
after the first chemotherapy. I was wondering about the purpose of it.
Nice to know my heart is okay, even though my pulse still goes way up when
I bend over.]
A common clinical situation in which repeated MUGA scans are useful is
in following a patient's cardiac function during the delivery of
chemotherapy for cancer. Some chemotherapeutic agents (adriamycin
being the most notable) can be quite toxic to the heart muscle. By
measuring the MUGA ejection fraction periodically during chemotherapy,
oncologists can determine, on an ongoing basis, whether it is safe to
continue with the therapy, or whether certain medications need to be
stopped. The MUGA scan is accurate and reproducible enough to detect
subtle, early changes in cardiac function that might easily be missed
by other techniques. It is a highly effective, noninvasive means of
monitoring one of the worst side effects of chemotherapy, and allowing
that therapy to be delivered more safely and effectively than would
otherwise be possible.
~ [76]Richard N. Fogoros
63. http://results.about.com/health
I am starting to find out what other tests were done in the hospital as the
bills come in. I think they checked my lymphoma cells to make sure they were
displaying the correct antigen before treating with Rituxan.
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klg
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response 155 of 480:
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Oct 22 01:50 UTC 2003 |
Are u gettin a PET?
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keesan
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response 156 of 480:
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Oct 22 13:48 UTC 2003 |
klg: No PET that I know of. Did you get one and if so why?
My good news for this week:
Date: Wed, 22 Oct 2003 09:07:07 -0400
To: keesan@cyberspace.org
Subject: Re: CT scan
Your CAT scan shows a very nice response.
Enlarged lymph nodes previously seen in the chest have resolved. In
the abdomen the lymph nodes have also pretty much resolved and the
spleen has returned to near normal size.
Looks good!
Judy
>>> Sindi Keesan <keesan@cyberspace.org> 10/21/03 12:04PM >>>
Please can you let me know the results when you get them today or
tomorrow. The scan was Monday evening.
Sindi Keesan
--------
Sounds like I still have some abnormal lymphocytes (tumor cells) but less
of them in fewer places. Hopefully the next three treatments will shrink
everything back to normal size. I wonder why the Rituxan does not get all
the cells on first exposure. The other drugs only get cells while they
are dividing, which they must not do every day.
Yesterday's walk was around the neighborhood. It was too close to rush
hour to cross the main streets but today we might try to get across
Liberty for a walk. Just a block down Jim's street he nearly stepped on a
large garter snake on the sidewalk adjacent to the yard where they do a
burn every year and plant prairie vegetation.
The hand where they put the IV last treatment has finally stopped hurting
again. It started to hurt again about the 10th day of the cycle, maybe
from scars forming? I asked the CT nurse to spare my hand as I needed it
for infusion. Anyone know why the infusion people insist on using hands?
(It is more convenient as I can keep my shirt rolled down to stay warmer.)
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keesan
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response 157 of 480:
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Oct 22 15:35 UTC 2003 |
Now that I have been pronounced okay (moving in the right direction) Jim
accepted a couple of translations for me this morning. I still have the
problem of pain in the sit bones if I try to work for long, but my brain seems
to have recovered at least. The shaky hands are less shaky while typing but
I still make more mistakes. The first job is something interesting about a
gadget to help heal broken bones, which I hope I never need to use. It is
not clear from the drawing or the text whether something is a plate or a strap
- maybe Jim can figure it out from the other drawing. Got to get to my
apartment somehow for a better dictionary.
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tod
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response 158 of 480:
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Oct 22 15:41 UTC 2003 |
This response has been erased.
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jiffer
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response 159 of 480:
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Oct 22 22:43 UTC 2003 |
A lot of cells go through a "lag" period before starting the "log" period
(division), so you may not always catch cells via their method of
reproduction. You are also dealing with "immortal" cells (which cancer cells
are). I should research how Rituxan is supposed to attack these cells. It
is difficult to attack eukarotic cells that are attacking the body because
you are made up of eukarotic cells, bacteria (prokarotic cells) are much
easier to deal with.
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keesan
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response 160 of 480:
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Oct 22 23:59 UTC 2003 |
Re 158 - Russian.
Re 159 - the body is set up to attack abnormal body cells because they put
out a sort of distress signal in the form of a protein on the surface which
Rituxan helps the body to recognize by binding to it. Some cancer cells
probably stop making this signal - I hope I don't have any of those.
Anyone know how often cancer cells reproduce and how long the drugs are in
effect?
Today's exercise was a car ride downtown and some walks around the bank and
farmer's market. We ran into friends twice, one of whom had gone to Croatia
for tests when she got sick because one test here costs more than a bunch of
tests there and airfare both ways. One farmer told me about her sister who
died of cancer in her nose, but only after 18 years of treatments. We then
visited a friend who isolated me in a room behind a glass door. His resident
child and her two friends kept coming by to wave at me. They know all about
white blood cells because they studied AIDS in elementary school.
I had better get back to translating before the next one arrives. There is
a sideways view of the thing that is either a strap or a cover plate and it
could still be either one.
The funny taste that I notice when I eat fruit was also there when I tasted
a tootsie roll at the bank (Jim ate it for me) so maybe it is the sugar in
the fruit that is tasting sort of sour. Odd. Water also tastes funny.
We have two buckets of grapes to clean and juice after this translation. Lots
to accomplish before Monday when I am out for a week again. Another apple
tree to pick Saturday when they have scheduled warmer weather again. Are
there any stores near Briarwood that sell cheap writeable CDs? A friend will
trade us a working CD writer (probably antique) for a package of them.
It is such a pleasure not having to take any pills or gargles for a whole
week. Or move over 12" every time I roll over on the new 3' wide mattress
pad. We stopped for a receipt for the first one (I must have lost mine) and
got a tour of the future Sleep Shop next to the birkenstock store - bare walls
and a just-sanded floor that will unfortunately need to be covered. Grand
opening Dec. 5 (just before my last session).
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keesan
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response 161 of 480:
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Oct 23 13:39 UTC 2003 |
Today I can taste the cider and my finger has stopped bleeding next to the
nail. I have 5 fingers and a thumb with shredded skin or healed bleeding,
one of which was bleeding just last night. And the big news is I slept 8
hours only waking once in the middle (which probably means I am not forcing
enough fluids but it is nice to sleep more than 2 hours at a time).
My doctor friend sent me a copy of the actual CT scan report, which says that
ALL my lymph nodes are back to normal size. The formerly huge masses in the
spleen are greatly shrunken. The fluid is gone from around my right lung but
it is still there around my left lung and is consolidating (which is not
good). I also still have sore ribs due to pleural effusion on the left side.
My friend listened to my lungs by tapping on them while I breathed in, and
you could hear the difference in pitch between them.
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klg
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response 162 of 480:
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Oct 23 16:06 UTC 2003 |
I was so whacked out by the chemo I used to sleep 12 hrs at a stretch.
(Still woke up tired, tho)
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keesan
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response 163 of 480:
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Oct 23 16:37 UTC 2003 |
During what part of the cycle? The first week the prednisone keeps me from
sleeping more than 3 hours at night. Were you as bony as I am?
I am still getting hot every once in a while, which I don't think I found as
a side effect of any of the drugs. Perhaps this is hot flashes due to my
period stopping in July when I lost weight down to 103. It is distinct from
the night sweats I had in July which were caused by the tumor, where I was
sweating all night without even any blankets or top sheets, in just a t-shirt,
at 78 degrees. Those stopped with therapy. But I have to take off blankets
or clothing once in a while for a couple of minutes to cool off, then I get
cold and put it all back. It is still 65 degrees in Jim's house and I am
wearing a thin wool sweater, wool vest, and fuzzy bathrobe, with cotton long
underwear and thin wool socks and wool cap. I wore a wool sweater at 73
degrees. Still no body fat - I wonder where the 12 pounds went.
Back to looking up the structure of a thigh bone for my translation. Boy am
I glad I don't need to fix any broken bones.
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klg
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response 164 of 480:
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Oct 23 16:44 UTC 2003 |
all during the cycle, from about December - March
thin, but not bony
never had any of the classic lymphoma symptoms
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keesan
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response 165 of 480:
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Oct 23 16:48 UTC 2003 |
Did you find that you were sleeping more after the last few therapy sessions?
I slept a lot during the day during the first session (2-3 naps) and have
needed to nap during the first two weeks of this session, but don't sleep more
than 8 hours at night.
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klg
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response 166 of 480:
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Oct 23 16:53 UTC 2003 |
no
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keesan
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response 167 of 480:
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Oct 23 19:12 UTC 2003 |
Today we walked across Liberty and then back, and around some new areas. We
found a rose tree with large fruits which Jim sampled, and nearby a large
paper wasp nest high in a tree. Still no frost.
Jim says he is getting out of shape as I get into shape because he is not
biking many places, or working on the house. These short slow walks with me
are not exercise for him. He wants to go dig up the yard (burdocks). First
he is looking over my translation to help figure out if things are slots or
notches (I apparently have both), explaining the use of a cam, and pointing
out that the drawing of the gadget is missing a few lines and could not
possibly work as drawn. I finally sent the insurance company receipts for
the mattress toppers (but forgot to include a copy of the prescription).
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keesan
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response 168 of 480:
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Oct 23 21:18 UTC 2003 |
Jim helped me turn a socket fork wrench into a spanner wrench and then went
to bed complaining he felt sick. I feel fine and am about to start a second
translation, also medical. Finally sent off two receipts and a prescription
for mattress toppers.
We discovered that if someone sends something on the superfine setting to a
fax machine without this setting it reverts to standard setting. You learn
something every day. So we plugged in another 'broken' machine from the same
friend that does superfine. He did not want it back after Jim got it going.
I am back on vacation starting Monday. If anyone wants to visit do it before
then.
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keesan
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response 169 of 480:
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Oct 24 02:40 UTC 2003 |
Jim's brother the radiologist tells me that lymph cells divide as often as
once a week and that it would take 20 weeks for one abnormal cell to grow to
a 1 cm tumor. In July I had a mass (tumor) in the spleen 8 x 13 cm which is
now down to 4 x 5 cm, implying that the tumors started at least 6 months
before that CT scan was done, back in the winter or before that. He says good
CT scan results are necessary if a cure will be possible. What is a cure?
5 cm is 2 inches. When this was larger I did not feel like I had much space
in my stomach. The spleen lies on top of the stomach (from the front view).
Jim and I have been trying to make sense of a translation where they kept
changing what was 'down' or 'under' depending on the viewpoint.
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