How I evicted the worst uninvited overnight guest and took back my life
Chest X-ray on October 2, 2013 – showed some shadowy figure, “…recommend nonemergent follow-up CT to further evaluate.” Nonemergent my ass!
CT scan with contrast of chest on October 8, 2012 – confirmed shadowy figure’s existence. Quite large. Ominous. “Large anterior mediastinal mass with vascular invasion into the superior vena cava and extending into the right atrium. Lymphoma should be strongly considered although other malignant process such as germ cell tumor or malignant thymoma cannot be excluded.”
Fine needle biopsy of said shadowy figure on October 9, 2012. Confirmed shadow figure is cancer. “Findings are most consistent with diffuse large B-cell lymphoma, non-germinal center origin. This can be subclassified as primary mediastinal (thymic) large B-cell lymphoma…”
PET scan on October 12, 2012 – “This is difficult to measure given morphology but is approximately 9.6 x 4.0 cm maximum transverse diameter superiority, 8.9 x 4.4 cm transverse diameter inferiority, and extends just under 13 cm craniocaudal diameter. Max SUV is 22.5-23.5…There is prominent hypermetoabolic material that is contiguous with the tumor extending into the right atrium, concerning for malignant involvement…There is a small right hilar lymph node on image 86 with max SUV of 10.4. A large likely right hilar lymph node is seen on image 94, with max SUV 6.5. A likely hyper metabolic small internal mammary lymph node is seen on the right on image 119, with max SUV 14.6. These lymph nodes are not enlarge by CT size criteria.”
Echocardiogram of heart on October 12, 2012 – confirmed shadowy figure in heart and no blood flow through superior vena cava. “A large mass is seen within the right atrium that fills almost the entire atrial cavity. It measures 3.9 x 2.5 cm. Point of attachment cannot definitively be determined on this study…small pericardial effusion.”
Muga on October 13, 2012 – Heart ejection fraction of 74%.
Bone marrow biopsy on October 13, 2012 – confirmed no shadowy figures in bone marrow. Yay! Right backside sore for days.
Echocardiogram of heart on October 18, 2012 – awesome birthday present.
MRI of brain on October 18, 2012 – confirmed no shadowy figures in brain. Yay!
CT scan with contrast on October 21, 2012 – confirmed, no pulmonary embolism. Discovered shadowy figure shrunk in half after first round of DA REPOCH. “Again identified is a large anterior mediastinal mass consistent with patient’s recent diagnosis of lymphoma. This mass measures 6.9 x 5.4 cm which has decreased in size when compared to prior exam. There is extension of the mass into the SVC and right atrium. The component the right atrium occupies much of the atrium although contrast is seen to flow around the mass into the right ventricle…No evidence of pulmonary embolus.” The chemo is working!
Lumbar puncture on October 25, 2012 – confirmed no shadowy figures in cerebral spinal fluid. Yay! Center backside sore for days + spinal headaches. Thanks first year resident!
Echocardiogram on December 11, 2012 – confirmed no shadowy figure in heart and blood flow through superior vena cava.
PET scan on January 2, 2013 – 4 cm non-reactive tissue with 2 cm spot with SUV uptake of 2.4. Happy new year! I’m in remission! Need to watch 2 cm spot.
X-ray of chest on February 10, 2013 – ruled out pulmonary embolus. Woke up with shortness of breath.
PET scan on February 25, 2013 – 2 cm spot remains with SUV uptake of 2.3-2.4. Doctors split. Some say scan is negative. Others say likely negative but should re-scan in six weeks. Fucking Deauville Criteria.
X-rays of knees, legs, and ankles on March 27, 2013. Looked normal but may not be picking up early signs of avasuclar necrosis. Thanks Prednisone!
MRI of hips, knees, and lower legs on April 4, 2013 – confirmed no avascular necrosis, but disuse osteopenia present. That’s what happens when you stay in bed for six months.
PET scan on April 8, 2013 – Negative! No sign of active disease. Cancer free!
Ultrasound of abdomen on June 17, 2013 – Normal! No sign of problems with my liver, which would be one reason why my bilirubin has been high in the past few months.
Genetic test for Gilbert’s Disease on June 18, 2013 – Negative.
CT Scan with IV contrast on June 26, 2013 – Negative! Still in remission! Bilirubin is still elevated. Also discovered a-typical 9 mm filling defect in my SVC which communicates with remaining dead tissue and a-typical filling defect in small intestine. On to a complete auto-immune work up to see if there are any answers for elevated bilirubin and consults with GI and vascular surgeon.
PET Scan on July 9, 2013 – No a-typical filling defect detected in intestine. Confirmed 9 mm filling defect in SVC with SUV of 2.8, which is greater than April’s scan which had an SUV of 2.0.
MRI of chest on July 12, 2013 – confirmed 9 mm filling defect but cannot differentiate between blood clot, scar tissue, and lymphoma.
MRI of chest on August 13, 2012 – 9 mm filling defect still present. Size unchanged.
Ultrasounds of abdomen on August 23, 2013 – normal. Bilirubin is back to normal levels.
PET Scan on August 27, 2013 – Stable disease. Filing defect present with SUV of 2.8.
PET Scan on November 21, 2013 – Negative. Filing defect still present with SUV of 2.1.
MRI of chest on January 13, 2014 – Filing defect still present. Twenty percent decrease in size, 0.7 x 0.6 cm at the junction of the SVC and right atrium.
PET Scan on April 29, 2014 – Negative!
CT Scan on February 3, 2015 – Negative! Last scan!