Oh the fun of survivorship……

“How are you doing?”… a seemingly basic question. But is it really? Think about it. When someone tosses this your way, do you filter the response accordingly for the audience? I’m not saying we’re all a bunch of liars with pants on fire. I’m just saying that at some point, we learn who wants/needs a full dump legitimate response, and who is just making small talk. To a cancer survivor, “How are you doing?”, might be taken to an extra level.

Friend/Acquaintance: “Hey! How have you been?”
Survivor: **mentally processing level of friendship, inquirer’s true level of give a shiz, how much time there is to answer questions, how the day has been to this point, when the last time scans were, when the next time scans are, how clear and accurate the last scan was, how much sleep was had last night, desire to ‘truth bomb’ shock, current level of hunger, bladder fill status, whether or not there is a desire to think about any of this right now, etc…**

RESULTING ANSWER GUIDE:

“Good, good.” = Too short and sweet. For whatever reason, they don’t want to fully share right now. Respond with “Nice to hear. It was great running into you.”, and walk away.

“I’ve had better days. I’ve had worse.” = You have their trust. Now you need to decide how much you REALLY want to know, because sh** may or may not be about to get real. Proceed with caution.

“I have scans next week” = Throw chocolate and run away. Scanxiety is in full swing, and they are one more question away from fully and openly dropping a crazy ball of irrational on you.

“Eh. Not 100% sure. I need a repeat scan.” = Throw chocolate and back away slooooowly… keeping your eyes fixed on them until you are at a safe distance. They have recently manned up to scanxiety and did not get a solid comforting answer. This is an unsafe situation for you. Do NOT proceed with a follow up remark or question.

“I have a new lesion” = Throw chocolate, pee your pants or vomit (whichever one you can more easily do upon voluntary command), then run like the devil himself is chasing you. TEXT (do not call) friend later, after they have had time to consume the chocolate.

Kidding aside, I am a lucky individual. For whatever reason, I am one of those folks who is innately rational and calm. Those of you who just began to laugh hysterically… wipe away the giggle tears, take a deep inhale, and allow me to be more specific. Yes, I do have exceedingly high expectations when it comes to work ethic, the way dishes are stacked in the dishwasher, and the cleanliness of a bathroom sink. But, I’m not the type to get angry if something is accidentally spilled or broken. Am I going to laugh wildly when you trip, bump your elbow, or otherwise suffer some mildly painful incident? Yes. Probably louder and longer than anyone else within a radius of several miles. I don’t mean to be mean… I just… Wait… how did I hit this tangent, and where was I going with this? Oh right… calm… and rational… I am innately chill. If I am smiling, you’re probably safe to ask “How are you doing?”. Probably. But just so you’re prepared, should we run across one another anytime in the next month, below is the latest “news”…….

BODY:

I haven’t had a full body CT since March 2021. It looked good last year, with only a small pancreatic cyst that has been around forever. Next follow up is late March of this year. **see reference material above for “I have scans next week”.

Skin check was all good last August. Nothing unexpected or looking odd to me as of this morning. Doc checks things over again at the end of February. **see reference material above for “Good, good”.

BRAIN:

Let’s just say that you probably don’t want to ask how I’m doing, unless you’ve got a pocket full of chocolate and you’re skilled at walking backward without tripping. You just searched the reference responses above, didn’t you? LOL! Please note that I will laugh should you fall during your escape attempt. I will also rummage through your purse and/or pockets for chocolate.

The sciencey words and stuff:

The gist from the ever diligent genius doc (yes, he certainly meets and exceeds that “work ethic” thing I referred to earlier.) ——>
NEUROIMAGING: an independent review of the MRI of the brain shows no evidence of any new or persistent brain metastasis or FLAIR abnormality, except for a
tiny punctate 2 mm lesion located in the left frontal lobe, best seen on the coronal images on image 139 series 101. This is located at 8.75 mm from the falx. This lesion cannot be appreciated on the T1 axial post-contrast images nor can it be appreciated on the associated T2 FLAIR scans. I am inclined to think that this is an artifact and have conferred with neuroradiology, who believe this is indeterminate and further interval followup is warranted.

From the official report ——>
Reason For Exam: (MRI Brain w/ + w/o Contrast) Brain Metastases; Brain Tumor
ADDENDUM:
Status Modified
There is question of a punctate new lesion measuring 2 x 1 mm seen only on the coronal
3-D T1 post-contrast acquisition in the left superior frontal gyrus (image 139, 140 of
series 101). Because it was not seen on a prior exam, it remains indeterminate and
short interval follow-up is recommended.
***** Final Report *****

So what does this mean in plain blonde English? It’s probably nothing, but we’re going to do a new scan in 3 months rather than the 6 month span I was at. What is “probably nothing”? I knew you were thinkin’ it… so here is the definition of “artifact” —>
“An MRI artifact is a visual artifact (an anomaly seen during visual representation) in magnetic resonance imaging (MRI). It is a feature appearing in an image that is not present in the original object.” <— Still confused? Are you old enough to remember when photos were printed on paper? Good. Now imagine you want to share that old school style photo on your social media. You set it down on the table, and take a picture of the picture with your cell phone. Still with me? Good. You upload the pic to your Instagram, only to notice that your brother has a big giant ghostly cell phone covering his face and chest. Was there really a giant semi opaque cell phone lurking in front of your brother in 1972? No. Stop freakin’ out. That’s a reflection of your Apple 13. It’s a weird something you can see in the digital image, but it isn’t (or your image snapping case, wasn’t) there in the original scene/photo.

What causes an MRI artifact? Good question. I like your inquisitive mind! —> Physiologic artifacts are caused by patient movement, including breathing, heartbeat, and blood flow. Artifacts can arise from the inherent physics of the MRI, such as the presence of metal or chemical shift. Finally, the hardware and software involved in constructing MRI images can cause artifacts.

Aaaand finally… What makes you and your incredible doc believe this is more likely an artifact than a new brain tumor? You guys are full of good questions today! This brain MRI took “image slices” (yes, like cutting a ham or cheese) of the brain in two planes. The coronal slices are every 1-2 mm going from my face, to the back of my head. The axial slices do the same, but from the top to the bottom of my head. If this “little white thing” (that’s what it looked like on the scans… a little white spot) showed up in one of the slices going from the front to back, but did NOT show up in the same area in the slices that intersect that region when going top to bottom. Sooooo, it’s probably not really there. “Probably”, because there is a small chance, that it may be between the image slices of the axial plane. That small 2 mm gap of “no mans land” that went unexplored in this particular MRI session. Adding to the unlikelihood of anything actually growing in that 2 mm gap, is the fact that there was also set of image slices taken before contrast was injected into my arm. The odds of that first set of images perfectly overlapping exactly where the other set did, are astronomically low. Soooo… that 2 mm gap between slices, would be narrowed even further, by looking at the combined set of images.

And there ya have it! Do you feel better educated? You kind of want to go talk brain MRI’s at a party now don’t you? Show off your new knowledge a little. Uh huh. I know you do. I get it. Pity the holidays have passed, and your party talk opportunities are limited now. Ahhh well. It never hurts to learn something new! #scienceiscool

What else is going on —>
There are at least three people close to me who could use some good juju or prayers. Whatever your preference is, they need all the positive vibes. So go forth as a good human, and just BE NICE. The universe will sense your shining light and send it where it is needed the most. Take care of yourselves. Enjoy all of the stupid wonderful little moments that make life what it is!

Niki News January 2022