May 31, 2024
David had a PET scan today at Piedmont Imaging in Atlanta. He was called back and given the Dotatate tracer just as he was for the PET in February. He went into the little room to wait an hour before the scan. I waited in the little area outside of the door in the same chair where I have waited twice before. I tried to read but mostly looked out the window at the traffic. People coming and going and the construction across the highway that was just starting when we were there in September looked almost complete. A sort of frail older lady was waiting a few chairs down for someone who I presumed to be her significant other. When he came out, he told her he was “quite ready to go”. They both were elderly and seemed to have trouble walking. I watched them walk arm and arm down the hall and out of the nuclear medicine suite. Watching them hold on to each other so tenderly while shuffling along while he told her about his experience was very sweet. It was also sad. I often have the thought while waiting in these areas that absolutely no one comes into these places for anything good. The reason you are there is not good, and often times, the results are not good. At least that has been our experience through all of this. I catch myself wondering if David and I will make it too shuffle around in our old age. I then have to immediately shift my thoughts to other things or risk succumbing to thoughts that doesn’t do anyone any good. Another lady came through the doors escorted by one of the techs. She was telling the tech how frightened she was of the scan and of being in the machine. She explained a bad experience with an MRI. The tech told her she would gladly let her see the machine and show her how it worked to ease her mind as soon as the current scan was complete. She patiently reassured her it would not be the same experience. The rooms have windows and there is a good bit of sunlight in the area including the hallway where I always wait. From what David has described about various other scan locations, this is one of the nicer ones. There aren’t a ton of places in Georgia that offer PET scans. After the hour wait, David was in the machine about 45 minutes and then he was done and also “quite ready to go”. He wasn’t feeling well and he didn’t want to stop for lunch, so we headed back south. I always pack a protein snack bag so he was content with that today. We usually look forward to eating someplace, so I knew he really didn’t feel well to opt out of that. We stopped off to walk a dog on the way home and David got a notification that the results were ready. We decided to wait until we got home to read it. We grabbed take out, and I know I drove slower than usual just because I didn’t want to read it. I had a bad feeling about this scan despite offering prayers, begging, pleading, bargaining and trying to manifest it to be a positive outcome this time. Once home, we opened the report.
1. No definite dotatate PET/CT evidence of somatostatin receptor positive metastatic disease. Meaning no neuroendocrine or other somatostatin types of tumors showed up which is good.
2. Hypodense liver lesions appear to be new or increased in size from dotatate PET/CT of 2/29/2024 without radiotracer activity on the current study however suggest progression of adenocarcinoma versus poorly-differentiated neuroendocrine tumor metastatic disease. This confirmed what we knew from the MRI in May and why we have an ablation procedure scheduled. Radiotracer uptake would have shown if the tumors were more neuroendocrine so this indicates it is the same cancer as the colon tumor which is addenocarcinoma. The liver tumor biopsy in February showed they had neuroendricne features. Basically, it would mean there were two cancer types if these had lit up on the scan using the Dotatate.
3. New 6 mm left upper lobe pulmonary nodule compared with 1/27/2024 concerning for metastatic disease. Additional small 5 mm right lung pulmonary nodule is unchanged since 9/22/2023. This is new and it is this month’s devasting news. It appears to have spread to his left lung. The right lung nodule appears to be unchanged and has been there since initial diagnosis. Oncologist has continued to believes the initial one to be benign and unrelated since cancer changes rapidly in the lungs.
4. Stable appearance of the rectal tumor. This is good and confirmed the MRI in May.
So, once again…bad news.
How do radiologists read these things all day? I know they don’t know the person. It isn’t personal. They don’t have a connection. But they have to know this person is someone’s person. Someone’s life. Someone’s reason for getting out of bed and putting one foot in front of the other every single day when it seems too hard to face the reality of this terrible and unfair situation. It cannot be easy to see these scans day after day knowing you have to write a report that will change someone’s life. I would think you would have to hold tight to the knowledge that, without this, effective treatments would be nearly impossible.
June 3, 2024
As of this evening (Monday), we have not spoken to the oncologist, but he is aware the scan results are available. We did hear from Dr. N the liver surgeon this morning and he wants to see David in the office. We aren’t sure what the purpose of this visit will be and will just wait to see instead of making assumptions about what it means. The liver ablation procedure is still a go for 6/12 as far as we know right now.
