The PET Scan is Complete

Joan had her PET scan and is finally done with the testing phase... At least for now.

The last test was certainly the easiest except for the start time (we were there at 6:30 am) and the paperwork. Thankfully Joan called the treatment center yesterday and did the preliminary screening information and paid our fee. But there were still tons of questions to be answered before she could begin the procedure. As she looked over the hundred or so blocks that needed to be filled in about her medical history she said

"Remember when you used to be able to check "No" on all of these without even looking?"
Yes, faintly Joan I do seem to remember that. Are there more blocks now or are our medical histories gaining some texture... Something for everyone to ponder.

We were admitted into a receiving room which was approximately 16 degrees below zero. Every room in the country where you could potentially be asked to disrobe is kept at a temperature that would probably bother Happy Feet. I can only assume that the medical community is looking out for us all and maintaining a room temperature where no organisms can survive longer than a few minutes. The nurse of course recognized that it was very cold (he was wearing a coat for crying out loud) so he immediately brought Joan two warm blankets and put her in the most comfortable lounger that I have ever seen. Unfortunately I was dressed inappropriately and I neglected to fill out the correct paperwork to receive the warm blankets. I was also asked to sit in a plastic torture device that the nurse called a "chair".

Anyway, Joan drank a nasty liquid, received an inoculation of irradiated sugar water and took a one hour nap. At the end of the waiting period she was placed into the scanner and took another nap wrapped in her wonderful blankets until the scanner was done.

That's it.

We received no information from the technician nor any paperwork or photos of the scan. Joan gave the blankets back and we left.


Our next appointment is one week from today where we will gain some understanding of the tests that have been done the last two weeks and I or Joan will be sure and report the findings to each of you. I will be bringing blankets to that appointment...

Joan's Bone Aspiration

We had Joan's first session today to get more information on how much cancer she has in her body. We will not get the results for a week but this visit was tough and we knew it was going to be tough.

Basically a Bone Marrow Aspiration can be one of two procedures. Either way the Nurse Practitioner (Ours was Lauren) uses a small hand operated drill to drill into your pelvis. Once they are in there they will either extract only fluid through a narrow cannula, which is not too painful; or they extract the fluid, plus a sample of the marrow itself, plus a small bone fragment. That second one hurts and that is the one that Joan had done.

The procedure was done in a regular examination room with little fan fare. Lauren came in told Joan to lay on her side and expose her hip. Then the entire area is bathed in betadine or some antiseptic. After that a topical anesthesia is applied. None of this was scary of course but watching the nurse use a small hand operated drill to get into Joan's bone was excruciating for me. The nurses expected this and warned me that it was tough to watch. Joan seemed completely comfortable through the entire ordeal. While the topical anesthesia offered Joan some comfort initially, there is no way to numb the bone or marrow and she felt every bit of that.

After the drill had reached the correct depth Lauren transferred different needles into the cannula and withdrew all the fluid, marrow and even a small bone sample (see the picture). Finally, they slathered some of the marrow and fluid onto several slides and sent them off to pathology. For the rest of the day today and perhaps tomorrow Joan's hip will probably feel like she fell off the roof and on to her butt, but she is still an incredible trooper. The nurses both were blown away that she never winced while they drilled into her bones.

Tomorrow Joan has her PET scan which is pretty simple. They crank some sugar water into her veins and then follow it with a scanner much like an MRI. It will be a piece of cake for her to deal with that procedure after today! Both preliminary results will be available at her next appointment with Dr. Capone the Oncologist on Thursday April 5th.

I will be sure and send another update tomorrow about the procedure, but we will not know Joan's treatment options until the results of both of these tests are back. So keep praying for Joan, and while you are at it say a prayer for Tony Snow and Elizabeth Edwards too. By all accounts they are two of the nicest people inside the beltway, an area known for chewing nice people up and spitting them out. Joan and I pray for each of them everyday. We hope you will too.

Joan's First Appointment

Joan had her first Oncologist appointment today since her being diagnosed with Lymphoma. Despite the surroundings, today's visit was a really good one. Joan has been diagnosed with a type of Lymphoma called Follicular Lymphoma. That means that it is a very slow growing lymphoma, in fact, the Doctor believes that Joan has probably had it for a couple of years. The best news of the day was that Joan caught this so early because of her persistence, that we are not discussing chemotherapy, but discussing less dramatic treatments.

So here are the details. We now know what Joan has - but we still need to find out how extensive it is. Therefore we are scheduling two more tests: a PET Scan to determine the current speed of the cancer growth and a Bone Marrow Aspiration to determine the progress of the cancer. A PET Scan or Positron Emission Tomography (PET) is a powerful imaging technique a lot like an MRI. They will shoot some radioactive glucose into Joan's vein and then track it. Quickly growing cells (like Cancer) love to suck up glucose so it is easy to spot the fastest growing cells and see exactly how fast they are growing. The second test is a little more painful I am sure. A bone marrow aspiration is basically getting a huge needle pushed through your flesh and into the middle of your pelvis where the doctor can then remove a sample of Joan's bone marrow. That sample will offer the doctors a view of how much the cancer has impacted Joan's system. Both of those procedures are scheduled for next week.

A little more detail on follicular lymphoma if you are interested... Dr. Capone tells us that FL can wax and wane for a person's whole life. The cells can grow and even regress on their own. There is some evidence that this may have already occurred in Joan's body as three years ago she had some lymph nodes in her bikini area grow and then seemingly disappear. The Dr. says that is very typical of FL. The proper way to begin treatment is to step back and decide if it even needs treatment. Many patients that suffer from FL in actuality never suffer. The nodes may grow and shrink on their own and never require any treatment because they do not affect any other functions of the body. That is kind of what Joan and I are shooting for.

When Follicular Lymphoma does require treatment there are two very different treatments available. One new method is what the Doctor called smart bombs. These treatments are still undergoing medical trial but have shown incredibly promising results so far. They are generally a protein strand that only interacts with certain types of cells, like those cancer cells in lymph nodes. If these treatments are smart bombs, the other treatment is carpet bombing: Chemotherapy. Joan is not scheduled for either of these treatments until we receive the results of the two tests that she will be going through, but unfortunately Chemo is still a possibility for her. We will discuss that when and if it appears to be a possibility.

Doctors have been taught for years that Follicular Lymphoma has no cure. There is no treatment or medications that can remove these cells permanently from your body. That sucks, but as Dr. Capone also said today, Joan, while very likely to die with Fallicular Lymphoma, will almost certainly not die because of it.