Radiology 101

Here is an exact replication of a radiology textbook used in a local medical school for your entertainment and edification. Well – not really. But I am very suspicious that they use something like this. I have nothing against radiologists, except that they have a tendency to scare the bajeezus out of me, even when they're giving "good" news. Like, "congratulations, you don't have cancer in your jaw anymore, but there might be some cancer in your tibia; or there might not be; maybe it's just the way that you're lying on the table - I'm not really sure." I know it's not their fault, because they want you to be fully-informed. And if you have an ambiguous scan (I've had a couple), they should make sure you are aware. But gee, I just want them to tell me "Everything is A-OK!" (doesn't everybody?) Anyway, on with the blog entry.

Chapter One: What do radiologists do?

As a radiologist, your goal is to professionally play Where's Waldo? and find "spots of doom." Spots of doom = bad. No spots of doom = Good. So what does a spot of doom look like? Take a look at this technetium contrast bone scan:

Did you find the spot of doom in this scan? Good! Remember, spots of doom are bad.

What are some common causes of spots of doom? Let’s examine the above scan. Perhaps the patient was attacked by a rabid llama. Or perhabs a rabid moose. These are all good guesses. In this case, the patient had an exotic form of bone-cannibalizing cancer, which munched her right lower mandible.

In this scan, the spot of doom is gone and replaced by Michael Bolton. Can you find the Michael Bolton? Good!

Now that the cancer appears to be gone but mysteriously replaced by Michael Bolton, we must write the scan summary to explain this to the patient. “Increased uptake of prior scan is resolved,” is a very good start. This means that the spot of doom is gone. However, we cannot leave it at just this. It would defeat the radiologist’s goal of simultaneously informing and confusing the heck out of their patients. And thus, we must randomly add “ambiguous,” “subtle infiltration,” (of what?!) and “but no definite evidence of disease” to the scan report. The goal is to communicate to the patient, “You might have cancer MAYBE, but you might not.” The patient will be like, “Gee, thanks for clearing THAT up!” and will probably proceed to bang their head repeatedly into nearby walls or furniture. You may want to keep a tranquilizer gun handy, in case it becomes necessary to subdue a confused patient who is ramming their head into a table or you just want some target practice.

Have fun with your summary reports – be creative. Maybe you could add “if you hold the scan ten inches away from your head and squint, you can see a lytic osseous lesion resembling a zebra holding an umbrella.” Or perhaps you could quote George Washington randomly. You are only limited by your imagination!

Once you have added enough nonsensical statements and informed them of the presence of Michael Bolton on the scan, be sure to conclude with “otherwise normal.” This is basically saying, “You may or may not have cancer, but otherwise you’re healthy!”

Congratulations! You have just completed Radiology 101! Now go scare the heck out of some people for no reason!

I'm Not Dead Yet

In the movie Monty Python and the Holy Grail, there is a scene where the overtaker is wheeling around a cart of dead bodies from the plague. He comes upon an old man who is near-dead, but he refuses to get on the cart because he is still alive. In his immortal words: "But I'm not dead yet! I think I'll go for a walk! I feel haaaapyyy!!!" And then he gets bonked and put on the cart. After eleven rounds of mustard-gas derived chemotherapy (seriously, Cytoxan is chemically intravenous mustard-gas and I totally believe it based on the side effects) and being maxed out on all the radiation that my cranium can ever get in a lifetime - well, "I'm not dead yet!!!"

(Me getting on the modern-day plague cart after all. I'm wearing my wig because you have to look good on the ambulance!)

So I have only three chemotherapy sessions to go. If I can go without a blood transfusion or a platelet transfusion or hydration or a dangerously high fever or my stupid kidneys deciding to stop working or chemotherapy-induced mucositis (don't ask). I should only have two weeks left in the hospital, along with weeks in between each session to recuperate. Then one more surgery to get my central line out. This will put me done October-ish. After almost a year lost in cancer land, it will be over!

(This is my central line. It saved my life, but it made me take sponge-baths for almost a year because you can’t get water on it. I have never forgiven it for that.)