Brainiac

I'm currently suffering from my first cold since I started doing the Neupogen several months ago and, well, it sucks. My nose is getting increasingly stuffy, and my throat is at that obnoxious scratchy stage that keeps me up at night. Fortunately, I have some Tylenol 3. It will be my friend this evening when I go to bed. Dr Jason looked in my mouth to make sure that it was a cold and wasn't another yeast infection, and I informed him that I'd gone through thrush twice already and this was not it. "We'd really rather not have you self-diagnose," said Dr Jason, "but in this case I think you've done a pretty good job." But colds are not particularly blog-worthy, so on to the interesting information: my brain.

I had another MRI this morning, and I tried to tell if the sounds I was hearing were recognizable from previous scans or not. I mean, will I eventually remember the sequence of sounds well enough to know where I am in the line-up? I don't think I will, because I don't think they're the same all the time. I really need to ask how the MRI works next time I have one. What I do know, from experience, is this: in the 35 or so minutes that I am being scanned, there are multiple mini-scans with durations anywhere from 45 seconds to about 4 minutes. I do about 2/3 of the full scan without contrast, then they add contrast for the last 11 or so minutes. There is one particular mini-scan which *is* pretty recognizable from time to time—it has this low down click click click click click etc part and then this high-powered MAAA MAAA MAAA MAAA MAAA etc part. I remember from the past hearing the clicks 16 times and the MAAAs 8 times, but today the clicks were 25 times and the MAAAs were 10 times. Also, the scan that has rattled my ribcage in the past wasn't around today. I don't really know what to make of it all.

Anyway, the initial reading of the picture, by Dr Jason, not the official radiologist, showed that the larger tumors have continued to shrink or stay the same (nothing is growing), and that some of the littler spots have disappeared altogether. It has finally come home to me that my internal body is not going to look the same, even when the cancer is all dead and gone, in any area that has been affected. I will have sclerotic patches in my bones, which probably weaken them. I will have nodules in my lungs, which fortunately don't seem to have any effect on my breathing anymore. And I asked—will I therefore, also, always have stuff in my brain? And the answer is, of course, yes. And one of the difficulties in the brain is that active cancer and scar tissue pretty much look the same on an individual scan. The main difference is that scar tissue shrinks or stays the same, and cancer grows, so you have to keep doing scans to see what, if anything, is happening.

I asked whether the PET scan at the end of the month might be useful, and the answer is, really not so much. The PET measures the uptake of glucose, which the brain sucks in at a faster rate than the rest of the body anyway. So PET imaging to the brain is usually not done.

Nevertheless, the PET and the bone scan and Dr Jason's MRIs will all help to create a picture of what might next be an appropriate step for me. I'm feeling a bit like one of those Magic Eye pictures, where, if you can cross your eyes in just the right way, you can get the answer and see an image in 3-D. One possibility is that I'll continue along as I am, watching the quarterly MRIs and the monthly blood tests and the occasional CTs, until the non-brain involved cancer is gone or something else happens to make chemo untenable. Another possibility is that Dr Specht and Dr Jason will decide that my best bet would be to stop chemo (otherwise known as systemic treatment) for a while, and do gamma knife stuff on what's left in my brain (which of course leads again to swelling, and it is, again, more activity in my brain, which is risky). Or maybe that will happen after my lungs and bones are "clear." Or maybe my brain scans will start to change and we'll have to make a snap decision.

So we don't really KNOW anything conclusive (but then, in life, when do we really?), but both Dr Jason and Dr Specht have been at least open to me asking about "After". I was also warned that I might still lose some cognitive function—that is, I am still in a position to lose some short-term memory, or some multitasking abilities. Aside from forgetting where my keys are (or, in today's case, knowing they were in the pocket of a particular jacket, but not being able to locate said jacket), I haven't noticed anything.