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So, I should probably expand a bit on last week’s ultrasound posting. It is indeed slightly premature for me to declare that Austin is three years cancer-free when we have yet to see his new oncologist (who we met for the first time in February) or to receive an all-clear regarding his lungs. All of that will happen at the end of next week, when we visit the Clinic for labs and a chest x-ray. But, since his lungs have always been far down on the list of things we worry about and since the abdominal ultrasound is what has revealed anything and everything suspicious or dangerous over the past four years, we nonetheless feel pretty darn good with last week’s news.
It’s funny how this one crept up on us. This three-year mark. So unlike last year’s anniversary, for which there was so much anticipation and excitement, all of it dashed with that horrible May 7 appointment. And then we plunged into that surreal in-between world, filled with only fear and dread but no answers or action. I do much better when there’s action. When I can see the mountain in front of me, even if it’s absurdly steep, I’m able to gear up, draw upon my strength and plan out exactly how I’ll scale it. But when it’s only fog I see, only vague warnings about a pending cliff or a jagged slope with nothing concrete or real, then I’m paralyzed. Last May, I felt paralyzed. Terrified beyond anything in memory (and there’s been much terror to remember). I had no idea what we were facing, couldn’t even begin to plan our attack — but I felt certain something was out there. Something deadly was lurking there in the fog, waiting for us to pass, waiting for him. And I was paralyzed.
Of course, it all passed as nothing. Those sixteen days a mere post-script to our crazy story. And I find myself back again, in the very same place I was when I wrote this on May 6 of last year, the night before his faulty “something” scan.
And I’ll say it again, with a slight edit to the number: Come what may, it’s been a damn good three years.
Austin had his two-and-a-half year scans today.
He went briefly to school to partake in the Grands Day celebrations, but I picked him up at 10:30 and we headed down to Rainbow for a long day of procedures. First an EKG and ECHO, because he needs clearance from cardiology before his December 7th surgeries (tonsillectomy and finger repair — more on those next week). Results from both were fine: The VSD that marked our first step towards diagnosis more than five years ago still exists but is so tiny that it poses no threat at all. The enlargement that caused concern during his second round of treatment is less pronounced, probably because his blood pressure is as normal as it’s ever been. His heart is functioning fine and, while we need to continue monitoring it well into the future, there is no current worry or need for action or cause for concern.
Then it was time for abdominal ultrasound, always the most significant test of the day. But that too was normal, no changes from last time, the ol’ inappropriately labeled “unremarkable” exam. Then a chest x-ray, which I haven’t actually seen results for but we’ve never had any real reason to worry about cancer metastasizing to his lungs.
And then it was off to see Dr. Auletta in the out-patient clinic. After labs and a quick physical exam, he sat talking with us and reflecting on the day he’d had so far (more on that tomorrow). Ever conscious of respecting patient privacy, he nonetheless commented that today he’d seen the “clinic of miracles.” The kids and their parents who happened to walk through the doors today were the remarkable one, the lucky ones, whose stories could have ended quite another way.
You know, a lot of children diagnosed with cancer in the twenty-first century have excellent prognoses right from the very beginning. Of course, it’s still a big deal and still terrifying for their families (all you hear on Day One is “Your child has cancer” and nothing else quite makes it through). But the doctors who see those kids on their very first days know, that as long as nothing goes horribly wrong, as long as science works as it’s supposed to, they’ll be alright. (Austin was actually in that category for about one day.) And then there are others who the doctors know, despite all they may hope and despite how hard they end up trying, that they won’t be alright. And then there are the kids in the middle, whose cases are tricky, whose cancers are unpredictable, but who still present with a shred of hope. They need a hell of a lot of work, they need vicious medicines and endless care and a ferocious internal fight. But those are the kids who can become miracles. And Dr. Auletta saw them today.
Austin among them.
Austin will have an MRI on Thursday afternoon. It took some juggling to get this scheduled because we were initially hoping for a morning slot, since he can’t eat before being sedated. But the next available morning slot was on May 31 and none of us (neither Mark and I, nor Austin’s doctors) were comfortable waiting that long. Turns out he can have clear liquids until noon and, lucky boy, popsicles count as a “clear liquid,” so the snack at school that day is settled and I’m not dreading the slow ticking by of the hours that morning.
We’ll see his oncologist after the scan and I imagine we’ll have some results to discuss before we leave that day. But it’s important to note that we don’t expect to get either good news or bad news out of Thursday. We simply expect to get more information. I know, now you’re all going, “Whhhhaaaaaattttt??” But here’s the deal: the MRI cannot tell us if what’s inside him is cancer. It also can’t tell us if it’s not cancer. The purpose is solely to get a good, clear image of the “thing,” its size and, especially, its location. We may be able to see if it’s filled with fluid or not (both of which could be Wilms tumor, so that isn’t terribly relevant either). Barring some bizarre turn of events, like if the thing has doubled in size since last Monday (which would obviously be very very bad) or if it has disappeared completely (which would be good, but confusing), we hope to walk away from Thursday with enough information to help us determine what to do next.
If we want to know definitively what the thing is — and, as of this moment at least, we most certainly do — then we have to biopsy it. The MRI will let us know if the radiologist can attempt a needle biopsy instead of having to do a surgical biopsy. If the thing is located in a spot that’s easy to reach with a needle, without having to go through too many other tissues or organs or what-have-you, then that will be considered good news. If it’s not reachable, then we’ll have to decide whether we move ahead and do a surgical biopsy, which is the more aggressive approach because it poses many risks to the kidney and his insides, due to the excessive amount of scar tissue they’d have to cut through to get there. Or if we take the dramatically less aggressive approach and “watch and wait,” by doing repeat scans more frequently to monitor the “thing,” without taking any action until it grows or changes.
It’s confusing, I know (as so much of this has been), but the MRI is really just a first step toward what will ultimately be either good news or bad news. Like we’ve done so many times before, this is a take-one-tiny-inch-at-a-time kind of deal. One tiny inch is about all I can handle right now.
I know that every time this happens, there are a zillion questions running through everyone’s minds that send you all scrambling through the blog archives and even to other online sources. “But wait, … what about that time three years ago when …?” I noticed on my Stats page yesterday that someone was directed to my blog after searching the words “3rd relapse Wilms cancer.” At first, I thought, “Huh, how ironic,” but then it occurred to me that it might have been one of you out there looking for reassuring information.
Well, you won’t get it. I just typed the same words into my search engine to see what would appear and it’s all old articles I’ve read before, some many times over, one from 1987 with (hopefully!) outdated data. The survival stats according to those studies fall in the 30 to 40% range … and that’s for the first relapse. Nobody really mentions another relapse and nobody seems to be talking about bilateral Wilms or what was once rhabdomyomatous Wilms or any of the other variations that make Austin’s case so ridiculously one of a kind. So, we’re just going to ignore all those and go with what we know about this specific child at this particular moment.
We know that, for all intents and purposes, Austin is well. His labs are steady, which means his body is not under assault and whatever may be in there right now isn’t causing any measurable harm. And he certainly, without a doubt in anyone’s mind, seems well. And that is worth something, both psychologically for all of us but also diagnostically.
We also know that the “thing” they’re seeing on the ultrasound is 1.4 centimeters in size and of an ill-defined shape. The radiologist went back to the two previous scans and, while he can’t rule out with 100% accuracy that it wasn’t there before, he did not and can not see it on any images prior to Monday’s. The official report labels it “new,” which is always bad, but they also say it’s “nonspecific,” and that an “underlying lesion cannot be excluded.” In other words, “We see something in here we haven’t seen before. We can’t tell what it is but we can’t rule out that it’s not a tumor.” Further imagining is recommended.
That’s all we’ve got. But we also have history. We’ve been down this road before, where we see something and can’t define it. First, in December 2008, we began to watch a “something” on his scans which we then biopsied in March 2009 and discovered was cancer. That was removed in April 2009 and turned out to be “old cancer,” all of which coincided with the launch of this blog. Then in October of 2009, we again began to watch another “something.” This was the one that we followed, on pins and needles, throughout that fall, finally deciding to ignore in November, before it doubled in size (“You will not ignore me,” it seemed to be saying) and turned out to be relapsed cancer in December. (Consider yourself warned before you go back and read all those linked posts because, oh my, they contain a lot of drama and a lot more f-bombs.)
Those are really the only “somethings” we’ve watched, except for the “something” in his liver (good god, what a stupid word, something something something). That something did appear on Monday’s ultrasound, unchanged in almost two years. The doctors have contented themselves with the fact that this thing never grows or moves, but will be happy to get a better look at it during the MRI. I consider that thing somewhat different because, 1) it’s in the liver, not the kidney and 2) it’s been there for a good long time without doing any harm.
So, that’s what we have and that’s where we are. I personally feel better today. Not for any specific reason, but just because it’s less raw than it was twenty-four hours ago. We carry on as we always have, because, you know, that’s what we do. Braedan had baseball last night and Austin swung across the monkey bars nearly the whole time. Then we took the troops to Sweetie Fry for treats and didn’t get to bed until well past 9. The boys both know that there is something there that might be cancer, but neither has much wanted to talk about it. Austin did say the first night, “But I don’t want to have cancer again,” and, oh, if it were only as simple as what we want and don’t want. Since then he tells me to “Shut up” with a slight smirk on his face every time I mention it, so I’m backing off. Braedan has sporadic questions but will only talk about it on his own terms and his own timing and otherwise sticks his nose in a book and carefully ignores the conversations going on around him. Oh, the child psychology of all this is sadly fascinating.
We have read and listened to all of your very lovely messages and, as always, they bring us strength and comfort. I am not in the mood for returning all your calls and will simply see and speak to each of you as time goes on. We do deeply appreciate the small acts of kindness directed our way (the boys were especially thrilled with the surprise delivery of Dunkin’ Donuts this morning, Ruppes!). And it did not go unnoticed that all the kids at Austin’s preschool wore their St Baldrick’s shirts yesterday. As I said before, the many offers will be accepted over time, especially if we end up with two-plus years of dialysis.
Oh, that brings up another joyless question I’ve heard too many times in the past three days: If he does indeed lose this kidney, when could he received a transplant? Well, if this is truly cancer, then the “two-years cancer-free” clock is reset. And it wouldn’t start ticking down until he was completely finished with whatever treatment (chemo or radiation) he might first require. So we’d likely be looking at two-and-a-half years of every other day dialysis. But you know I can’t quite bear to think of that right now. For those of you who have made the ultimate offer — one of your kidneys — I say (I mean, I shout while jumping up and down), “Yes, yes, thank you very much,” but we can’t even begin the pre-match testing until we’re much much closer to transplant. So just stay healthy and don’t disappear from the online universe. I will be calling!
You know how this goes. First I’m in disbelief, then I’m angry and sad and scared, then I grasp at something to hope for. Then there comes (or not) a reluctant acceptance of the ugly truth, followed by that well of strength that has been tapped too many times. Back and forth, up and down, over and over. The roller coaster ride has begun.
Thank you, all of you, for yet again stepping up and offering to walk this tortured path with us. Today was an emotional day as at every drop-off and pick-up and at several places in between, there were long hugs and inevitable tears and many many f-words. I hear and appreciate every offer of help (and I hear and appreciate every f-word). At this moment, there is nothing we need (save that magic pebble), but the time may come when we will accept all the meals and playdates and everything you’ve all given so many times before.
Nothing is certain. This is not yet the worst news. It is simply not the good news we had so fervently hoped for and so completely believed we’d receive. But we have many more steps before we can say for sure that this is cancer and before we know at all what any of this means for Austin’s future.
His oncologist is taking a surprisingly calm approach, considering he usually wants to do more and do it faster. After discussing the situation with Austin’s nephrologist, they now say we can skip the GFR. The fact that his kidney function has remained steady for two years pretty much guarantees a GFR result of 60 or greater. So that’s one small thing off the table. We will instead do an MRI in the next two weeks, perhaps Wednesday, May 16. Mark and I had been thinking we’d do it the week after that, but everyone I mentioned that to gasped in horror and said, “Why can’t they do it sooner?!” I think they probably can do it sooner (they’re working on scheduling it right now), but the truth is that Mark and I don’t really want to deal with the results any sooner than we have to. Usually I’m the one who believes everything will be alright and this time, I feel fairly certain that the next step will involve removing his kidney and I just don’t want to get to that step one single second sooner than we have to. Then there’ll be the chemo issue — which could push the start of the two-year countdown clock back by several months. Of course, none of this is certain, but I can’t stop it from going through my mind.
So, first things first and that’s the MRI, which poses no danger to his kidney and is expected to give us at least a good look at what’s there. Of course, a clear image is not the same as a biopsy, so even that won’t define the “thing” with certainty. But we’ll just take things one day at a time and make the next decision when it comes.
I feel an incredible sadness and a huge weight upon my shoulders. I look at this vibrant boy zooming ahead of me on his bike down the street and it seems impossible. But it’s seemed impossible before. Not ever, not for one minute of one day did having a child with cancer ever seem possible or normal or expected. I feel like we’re piecing his life together, buying snippets of time here and there. Trading in one surgery for three good months. Or twelve rounds of chemo for half a good year. Stitching together these ridiculous pieces, in-treatment time with non-treatment time, a bit of sickness here with a bit of health there, mixing the living in with the dying. Or the dying in with the living. A patchwork quilt of life, held together by a thread of hope so thin that it at times appears invisible, and yet so strong that it proves unbreakable.
It must be unbreakable.
I’m a cocky mother fucker. With my champagne chilled and ready to uncork. With my celebratory blogpost, not typed yet, but certainly drafted in my head. With every second of my month tied up with things completely unrelated to cancer.
A cocky mother fucker.
Let me start by saying that ultrasound imaging sucks. It’s simply no good. Blurry and blotchy and confusing to read. Yet that’s what we’ve been relying on for the past two years because it has no risks associated with it: no radiation exposure, no further damage to the already damaged kidney. So, today, on the ultrasound, it appears that something’s there. Something that wasn’t there before.
We’re not sure — of course. We’ll need to schedule additional testing. First a GFR, to see where his kidney function is so we can determine which test to do next. Assuming his GFR is above 30 (and his nephrologist estimates it’s at least 60), then he’s “well” enough to be able to have an MRI or CT with contrast (oh, the irony). Either of those ought to let us know if this thing is nothing or if it’s something.
But let’s be real here. It’s always something. Every fucking time this happens, we invent a thousand scenarios to explain why it might be nothing. We imagine every possible rare or random “nothing” it might be. But it’s never nothing. Every fucking time, it’s always something and the something it turns out to be every fucking time is CANCER.
It’s always something.
Two years ago, on May 3, 2010, Austin and I had an unexpected overnight at the hospital due to high blood pressure, described here in a post aptly titled The Wrong Side of the Window. We were stuck in that god-awful limbo between choosing to remove his kidney and continue with chemo or venturing blindly into the post-treatment world never certain when the kidney would fail or when the cancer would return.
And then, three day later, I wrote this one, (also aptly titled) Never-Ending. Read it because, well, it definitely captures the mindset I was in back then: the fear, the utter exhaustion and frustration and resignation I felt. What we believed was the inevitability of kidney failure and dialysis looming over us, the desperate feeling I got as I looked toward the future, Austin’s future, our future. It just didn’t seem bright. Yet, my god, it has been so very bright. These past two years have been wonderful, “normal,” right. He has had the chance the just be — which is all I ever wanted for him — to just be himself and be left alone by doctors, to live his life unencumbered by the burdens of disease and hospitals. And we’ve all had that chance: Braedan to be a regular kid, to fight with his little brother without worrying that he’s fragile, to be happy or sad or proud or scared or whatever, and not have any of it tinged by being the older sibling to someone we feared might die. Mark and I have had the chance to just be, be the parents we were meant to be (which is not to say that those parents are anything close to perfect — in fact, we were much more thoughtful and attentive parents when Austin was sick, but anyway …). But just to be normal parents who get annoyed with their kids and yell sometimes when they shouldn’t — and to feel lucky for that. We’re lucky for everything we’ve had in these past two years, every normal good or bad moment.
We read Sylvester and The Magic Pebble tonight and the last lines struck me, as they always do. It’s after Sylvester has been released from the rock and is reunited with his parents who lived, for almost a year, with the belief their son was dead: “When they had eventually calmed down a bit, and had gotten home, Mr. Duncan put the magic pebble in an iron safe. Some day they might want to use it, but really, for now, what more could they wish for? They all had all that they’d ever wanted.”
On the eve of tomorrow, we still have things to wish for (I sure would not be locking any kind of magic pebble in any kind of safe just yet). But it’s true to say that we all have all that we’ve ever wanted. And come what may, it’s been a damn good two years.
What’s that they say about the best laid plans? I sure wish they wouldn’t say it.
As you astute readers may have already guessed, I learned this morning that tomorrow’s long-awaited scans need to be rescheduled. And I’m not using that word “long-awaited’ lightly. We’ve been waiting for these since July 30, 2007.
The radiologist who does all of Austin’s ultrasounds is unexpectedly out of the hospital until Monday. Usually, some other doctor could take over that function but Austin’s kidney is so misshapen and, well, abnormal that we really need the one guy who’s familiar with it to do this all-important scan. Otherwise, we’d end up with a messy reading and wishy-washy results and then they’d probably want to do it again in a few weeks.
I’ve known for a few hours now and have stopped muttering swear words under my breath and am instead trying to view this in the grand scheme of things. Yet another slight detour on the endlessly curving road to wellness. Of course, it does not ultimately matter whether Austin has his two-year scans tomorrow or on Monday (which is when they’re now happening). But goddammit! I was ready. I was excited. We had the evening cleared (a rarity) so we could relax and enjoy a nice celebratory dinner as a family without one or the other of us needing to rush off to a meeting or practice or whatever we’ll have to rush off to on Monday. The day was set: Braedan was invited to a friend’s house, I’d given away Austin’s slot at lunch bunch so we could head straight to the hospital after his morning at school. And now? Maybe we’ll just all play hooky and go to the zoo or something.
And set our sights on May 7.
Sometimes it’s hard to get back into that old mindset . . . that old cancer mindset. I had two other, completely disease-free topics I was going to write about today, and then I doubled checked my calendar and was reminded that Austin has his 20-month scans tomorrow.
Twenty months . . . now that’s a significant chunk of time in the life of this small boy, who has battled cancer two and a half times in the past four-plus years. Twenty really really good months, of health and happiness and growth and energy and normalcy. But tomorrow we’ll go back to the hospital, after Austin makes a brief appearance for his first day back at school (which should give me just enough time to run and shower). He’ll have his regular bloodwork to check his kidney function, followed by a chest CT to look for possible metastasis to the lungs and then an abdominal ultrasound to look at the kidney, pelvis and liver (another favorite site for Wilms tumors when they decide to move around and, of course, the current home of that mostly unidentified “fatty tissue” we’ve been watching for the past year). Then a follow-up with his oncologist to go over the results.
The whole thing should last about four hours, with a break for picnic lunch thrown in and quite a bit of exercise moving from the sixth floor of the cancer clinic to the basement of another building and back again. If all goes well — which we certainly expect (not that our expectations mean anything in this game) — he’ll be free again until the end of April, when we have his eagerly awaited two-year scans. Those are the gold standard, although we are well aware that they will give no guarantee that his cancer will never return. Nothing will give that guarantee. But they will mean that he has reached a critical milestone and that the chances of his Wilms tumor recurring are extremely small. The two-year mark will also mean that, should his kidney fail, he can then be eligible for transplant without dialysis (or without too much dialysis; sometimes the time between failure and actual transplant can take some months due to many many factors, not the least of which is identifying the actual kidney that will go into his body). But those are discussions for another time.
For now we have this to buoy us onward: A neighbor of my mother’s attended an event at the hospital recently in which the Chief of Pediatric Oncology was talking about the importance of research and how it directly impacts patient outcomes. He presented three case studies as evidence, one of them about a boy named Austin with bilateral Wilms tumor (say, that reminds me. . . ) who he described as “cured.” I asked my mother several times if she was sure that was the exact word that was used and she was very very sure. “He said ‘cured,’ Krissy. That’s the whole reason Ann stopped to tell me about it.”
Cured. Well, that’s not a word we allow ourselves to use too often. Never, in fact, have I referred to Austin as “cured.” But after tomorrow, and after April, maybe we’ll just have to change our vocabulary. And our mindset.
A successful day all around.
Austin is good. Liver, kidney and lungs remain unchanged, heart has actually improved slightly, lab numbers good. He is now officially sixteen months cancer-free — the longest cancer-free stretch he has had in his entire life.
We should have two more sets of tests like this before he reaches the golden two-year mark. Then his scans move to every six months and some things, like the chest CT, get downgraded to a chest x-ray which exposes him to considerably less radiation.
He handled the day well, although it does get exhausting to be there for all those hours and he feel asleep in the car on the way home (with Mark, who had to relieve me at 2:50 so I could be there to walk Braedan home from his first day).
And speaking of that first day, he is thrilled. A way different reaction than he had last year when he came home and cried for three hours. (Not that there was anything dramatically wrong with his first grade teacher — she was perfectly nice — but he never felt a warm connection to her and Braedan is all about the warm connection.)
He asked tonight if he had school again tomorrow and when I said yes, he cheered, “Yay! I get to see Mrs. Nice-and-Fun Teacher!”
Now I just need all of today’s results to last and last and last.