November 30, 2004

• False Alarm ...

  or a Miracle?

  When Delia's CAT scan results proved negative, her doctor recommended she begin the process that would eventually lead to radiation therapy. Dr. B sent her to Dr. D of the Radiation Oncology department.

  I went with Delia for her meeting with Dr. D, a friendly young lady who explained everything much better than the others had. Treatment, if warranted, would consist of 26 two-minute exposures to a beam of accelerated particles done once a day, Monday through Friday. Unlike some forms of radiation treatment, it would not render her radioactive, so she would not have to shun the company of others. It would also not affect her mouth, unlike radiation received by friends of Delia's, so she wouldn't have to worry about avoiding problems that would cause her to consult a dentist; she could have dentistry done while receiving the treatments, though it would add to her discomfort. There would be some localized pain and she would have to avoid using cosmetic creams or powders on the skin where it was radiated until the treatment was concluded. The radiation was extremely unlikely to stimulate the growth of other tumors.

  Before proceeding (and without delay), the first step was to get a PET (Positron Emission Tomography) scan. Tumors, being fast-growing tissue, show up particularly well in PET scans. The radiation therapy itself could be postponed unless the PET scan showed a major problem to exist, unlikely with the negative CAT scan. The PET scan is as particular to tumors as chemotherapy is and would show any kind of tumor, whether breast cancer, lung cancer, skin cancer or lymphoma.

  A PET scan shows metabolically active tissue, tissue that greedily absorbs certain material from the blood. For it to work, the material to be detected must be made radioactive. This is done at places like the Lawrence Livermore Accelerator in Los Angeles, and the material remains radioactive for a very short time. It must be irradiated and shipped just hours before use and it quickly becomes useless and harmless. A small tube of radiated material costs about $5,000 and is flown in just in time for its use. The scan begins 35 minutes after the material is injected in a vein and takes about 40 minutes to complete. If the very tight schedule from irradiation to scanning fails, for any reason, they have to reschedule and make a new batch.

  The morning of the scan, Delia had one of her migraine headaches and was in such pain that it had her vomiting. She still managed to arrive on time. The nurses found her a bed in a quiet place until they could begin the procedure. They couldn't give her any medication because the test required that she be fasting. When asked if she wanted to come back another day, Delia decided that the cost of missing the scan, which we would still have to pay for, was too high and she would rather go ahead with it.

  The scan didn't require Delia's active participation. Once she received the injection, they wanted her to relax and to sleep if possible. She actually managed to fall asleep and to remain asleep through most of the scan. The additional hour of rest helped reduce her headache. When she was done, she felt better than when she started.

  That was last Wednesday. This afternoon we got the results from Dr. D.

  The PET scan will detect even microscopic tumors. There weren't any. This led Dr. D to suspect a false positive on the biopsy of the supposed tumor, a needle biopsy. The material removed from the lymph node was scanned by a machine that checks for certain markers associated with cancers. When the markers are present, cancer is almost always present. The usual procedure is to follow up a machine positive result with microscopic cytology to see if there was cancer there or not. This wasn't done until Dr. D questioned the machine's results. Microscopic examination did not discover any cancer.

  So now we have a confirmed false positive on the biopsy and a series of tests and scans that show Delia to be completely free of any kind of cancer from her ankles to her brain.

  Dr. D advised Delia against having radiation therapy or any other treatment. She suggested that we take no other action than to have another PET scan in six months to a year. If the lymph node swells up again (it has shrunk to a very small size), Delia should have it removed for biopsy rather than having a needle biopsy done on it or any other suspected tumor. Apart from that, we should just relax and take it easy.

  Delia has sent the tests and pathology slides to her friend, Dr. R in Houston (they went to school together and share close friends). Dr. R will give Delia a second opinion. I doubt if it will differ from that expressed by Dr. D, who seems to be very much on the ball, particularly in following up when others have dropped the ball and accepted results at face value.

  My reaction is that it was a big false alarm. Delia's is that the prayer of her friends has brought her a miracle.

  Many people in several countries have been praying for Delia. In Panama, requests for prayer for her have been broadcast on the radio. Here and in Mexico the prayer efforts have been much more local, organized by her friends at several churches.

  If it was a miracle, it came just in time for Christmas.

  • 01:35
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