PET scans and excisional biopsies: steps on the path to treatment

I had a PET scan this week.

It was rather pleasant, really. I walked into the PET scan department where they led me into a quiet room with a comfy chair (nooo! Not the comfy chair!) and then poked me with the soft pillows (wait, I mean IV). The friendly girl gave me a list of cds to choose from and told me that I would have to sit back and relax for 45 minutes — no reading my book, no playing with a phone, and no using muscles that would want to eat the tracer. Some people, she told me, nap in the reclining chair while they wait.

I chose an appropriately mellow album by Delirium, and she wheeled a tray in containing the radioactive sugar tracer to be injected into me. The tracer takes a while to circulate through the body, and gets eaten up by the active tumours. After injecting it into me and making me effectively RADIOACTIVE WOMAN, she left me in the room with dimmed lights and Delirium playing.

So I napped. It was pleasant.

After the 45 minute wait time, she took me down the hall to the PET scanner room. There, I had to lie down on the fancy table with my head pillowed on both sides and another pillow between my knees. They told me to lie still and breathe normally, and that the scan would take 15-20 minutes. I put my arms up over my head, closed my eyes, and I may have napped again while the table moved me through the scanner in stages.

Overall, I felt nothing from the tracer, the IV was one of the best I’ve had put in in recent days, and I got to nap. And then I couldn’t go home until after the kids were in bed, because I was radioactive enough that they recommend you avoid small children for six hours after the scan.

PET scan is best scan. Still no superpowers to report, however.

Excisional Biopsies are not great for naps

Today I had an excisional biopsy on the lymph node/tumour near my clavicle — the one that you can see and touch. It’s still frozen, but I know it’s going to hurt when it isn’t anymore.

It went a little bit like this:

11:10
I’ve changed into a gown and I’m lying on an operating table in the minor surgeries unit at Burnaby General Hospital. Bored, staring at the ceiling, watching the seconds tick by on the wall clock. I have a mild headache, probably because I haven’t had any coffee yet.

11:20
The surgeon arrives and sets up. I lie with my neck exposed, looking to my left, while he preps the area and gets his tools out.

11:30 am
My neck and clavicle area are frozen, and I’m still looking to the left. The surgeon and I discuss random things like children, and mountain biking, and other easy subjects, while he draws lines on my neck and waits for the freezing to take. I ask him if I can see the piece he takes out of me. He says yes.

11:35 am
I can’t actually see the clock anymore, and I’m starting to lose track of time. He’s made some kind of incision, not that I can see it. He’s also using an electro-cautery surgical tool. From his description, I envision a tiny spinning power-saw type of blade that also happens to use electricity to burn things. This is to prevent bleeding, of course. The smoke smells weird. It reminds me of the dentist.

Some time later
I’m still lying there. He’s alternating between various cutting tools, and possibly some clamps to hold things in place. At one point he uses the cauterizing tool and I feel the muscles in my shoulder twitch. It is not entirely pleasant, although it doesn’t hurt really. Just a little internal electrical jolt. He adds some more freezing. I notice that my hands are balled into tense fists; I force myself to slowly relax them, focusing on individual muscles and telling them to drain their energy into the ground.

Still later
I’ve completely lost track of time. The surgeon and I still chat about things in between his efforts to remove my lymph node. I ask him how big the growth is; he tells me it’s about the size of an acorn. The lemon, apparently, is the one in my chest closer to my esophagus. It’s good to know these things.

More time passes
The surgeon has been struggling with my tumour — it doesn’t want to come free. He tells me that it’s deeper than it seemed on the surface and doesn’t want to let go of me. I chuckle and think to myself ‘aww, my tumours love me so much they don’t want to leave.’

More than an hour later
He spends more time digging and cutting and putting pressure on various parts of my clavicle and neck, still fighting with the tumour, trying his best to remove the whole thing. It is rather unpleasant, and I feel my hands balling up into fists on more than one occasion while he scrapes and digs and pushes and pulls on tissue. Over and over I tell my muscles to relax, force my hands to loosen their grip. I haven’t moved my neck in a very long time, and I can feel how stiff it’s getting. The small talk continues.

Time? What is that?
I know he’s been poking, digging, and cutting around in there for a long time now. I don’t know how long. I’m fairly uncomfortable, and I can feel twinges of the future pain I will have when the freezing wears off. The surgeon warns me that I might be feeling what he’s doing now, because he’s pretty deep into it; he’s right. I can feel it, and it’s a little painful. I take my brain to other places; the Laurentians in fall, the access road up to Pseudo-Tsuga in Squamish, the peak of Mt. Seymour. I take my mind to high up places with lovely views and don’t feel whatever he’s working on for a while. I’m ready, though, for him to be finished.

View from above Gastown
Sending myself to high places in my mind is a trick I learned a long time ago…

Two hours? I don’t even know…
He decides, after finally getting underneath the node on one corner, but seeing it start to tear and losing grip on it, that he just isn’t going to be able to remove the whole thing. Instead, he decides to just cut a piece of it off for the lab to process. This proves challenging as well — the tissue is rather dense and hard to cut through, it seems.

And then he gets his sample and closes me back up with stitches, telling me that I had very little bleeding, but I’m going to bruise. I would have assumed as much, considering how much pressure he was putting on me. He shows me the piece he fought so hard for; it is whitish and lumpy, and smaller than a fingernail bed, but it is enough for them to figure out exactly which lymphoma I have.

12:50 pm
I sit up and feel how stiff my neck is, then walk out of the operating room to find Adam waiting for me. We leave the hospital and get lattes at Caffe Artigiano, then make our way home via the pharmacy for my prescription.

3:50 pm
Sitting at home, still waiting for the freezing to come out. Still have that headache, more from tension than anything else. Two hours of minor surgery is not the most fun I’ve had this month. I’d rather get irradiated and have another PET scan.

But now it’s done. The biopsy wasn’t to remove the tumour; that’s what chemotherapy is for. So his inability to get that tenacious thing out of me is not a failure. I am just glad to be done with it.

Here’s my recommendation: don’t have biopsies for fun. They aren’t fun.

Chemotherapy incoming!

I spoke to my oncologist this morning before the biopsy. All of the scans and tests are coming together to move me into chemotherapy. I will be starting chemo late next week, it looks like. It’s time to move onto the next step. I both am, and am not looking forward to it.

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