Hello everyone,
Caryn here, back from the long ordeal! :-) I'm happy to say that I'm enjoying the holiday season with friends and family. I've decorated the house, we've put up our tree, I've made some gingerbread cookies and presents are under the tree. All of this is so much more enjoyable after what I've just been through. Since you've heard various pieces or read Peter's descriptions I'll keep this update short.
On November 8th I had the second surgery in our plan to manage the Neuroendocrine tumors I was diagnosed with in October 2012. The surgery went well. Dr. Pommier at Oregon Health Sciences University (OHSU) performed the surgery and he removed the primary source of the cancer in the tip of the tail of the pancreas. He removed another small portion of the pancreas, removed the spleen, lymph node involvement and about an inch of my colon. Pain was managed well by an epidural. Later when that was removed we discovered I had an aversion to morphine at least in the dosage I received. I had hallucinations and nightmares resulting in my staying up all night one night to avoid the images that popped up if I closed my eyes. We found other pain solutions and it looked after a week in the hospital like I was ready to go home. Unfortunately, I had not yet had a fully formed BM. This ended up being a big deal. Two days after we got home I had to go into the ER with a bowel obstruction. I was throwing up and unable to have a BM even after drastic measures like suppositories and enemas. The pain was intense and they admitted me. I had an NG tube put up my nose and down into my stomach to pump everything out of my stomach. This ended up being very painful and the tube was in for several days. I had no fluids or food by mouth for a long time while we tried to get the bowels to "wake up". It ended up that I did not have an actual blockage, which was good, but that my bowels were "in shock" from the surgery and not functioning still. After a week I was having some BM activity and was sent home again only to return to the ER a few hours later. To make a long story short I spent another week in the hospital and was able to come home Thanksgiving afternoon.
I had a nice time visiting with friends and family who stopped by on and after Thanksgiving. I did miss having the whole family for Thanksgiving dinner at my house this year. We often have 2 dinners with 2 sides of the family because we can't really fit more than 17 people comfortably for dinner in our home. As many of you know I really like to decorate for Halloween and Thanksgiving and this year did only a little bit of decorating for those holidays, saving up my energy for Christmas decorating. We got our tree on Dec 1 and have been enjoying the house with all the holiday warmth. Peter put up the outside lights and they look really festive as usual. All 3 grandchildren; Kimani 3, Anyana 6 months and Paityn 7 weeks have been over to Grandma's house.
On December 2 we returned to OHSU for the post-op appointment and to have my GP drainage tube removed. I guess I forgot to mention that all this time, since November 8th, I had a tube coming out of my left side that was draining pancreatic fluid as the pancreas closed back up and healed. Due to the lengthy hospital stay it had been left in a little longer than is usual. Unfortunately the OHSU team failed to mention to me that the removal would hurt and that the hours to follow removal would be or could be very painful. The Sunday night before the appointment Peter got us a really nice hotel room in Portland. We had a nice dinner, watched a movie and enjoyed the room. If we'd known I'd be in such pain following the 8 am appointment on Monday we would have booked another night and brought the Oxycodone with us. Since I had been off all pain meds and was taking just IB Profin we were unprepared on the way home from Portland for my abdomen to begin to hurt; the pain was a level 9-10. The tube had evidentially adhered to some internal areas and the bowels and intestines were now moving around into the space that the 2 feet of tubing had taken up. Luckily we were able to stop in Olympia and rest at my mom and dads for house for a few hours before continuing home to Seattle. I was sore for several days as every thing adjusted internally.
This Wednesday (12/11) I had an appointment with my Group Health (GH) oncologist Dr. Feldman. He felt my recovery was going well. He examined me and decided that all looked good. Although it has only been a month since the surgery I am really well on my way to feeling normal. I have some continuing digestive up set and need to eat small meals frequently avoiding fried foods and high fiber items. I'm experimenting with what I can eat without getting a stomach ache. I met with a nutritionist at Virginia Mason (VM) Hospital and will attempt to create a diet in January that honors the contradictory messages I have from various sources about what to eat. My plan will need to be specific for me. As a side note I forgot to mention above that the VM staff; nurses and doctors were fantastic. Luckily they have a partnership with GH and all 2 weeks was covered. GH has also been wonderful about covering the surgery at OHSU and visits to Pommier.
My future plan as outlined by both Dr. Pommier and Feldman (although they still disagree about some aspects of my care) includes labs and CT scans every 3 months. Due to the radiation from CT scans they will eventually go to every 6 months and then annually. We are adding a new drug to my monthly injection of Octreatide (LAR 30 Sandostatin). A reminder, Octreotide is a synthetic version of a naturally occurring hormone we produce called Sandostatin. These Pancreatic Neuroendocrine tumors (P-NET) I have are hormone producing. Sandostatin in large doses tells the body to stop producing or secreting insulin to handle sugar consumption among other things. It basically tells the tumors there is no reason to grow (emit hormones). For many of us with P-NET Ocreotide not only keeps the tumors from growing or slows there growth, it manages symptoms like diarrhea, hot flashes and night sweats. I am currently symptom free and do not show signs of carcinoid syndrome which is where these symptoms are present. So the new drug that will join Octreotide in my monthly regimen is Zolodex and it is part of the bis-phosphonate drug family. Dr. Feldman said it is also called Zometa acid. Monthly I will have a 15 minute infusion through an IV at GH central of it at the same time I get the Octreotide injection. In 1-3% of people it can cause dental problems so I will be going to my dentist first and not start it until late January. Any dental work needed will have to be completed first and a note from the dentist stating my dental condition is required. It can also compromise the kidneys which must be monitored monthly prior to the dosage. It is controversial. Pommier thinks it positively affects survival rate while Dr. Feldman thinks it only affect quality of life issues. It is given to establish a strong bond around the areas where there are bone metastases. I have bone metastases in my left iliac crest (hip) and in my back lumbar spine. In addition to affecting kidney function it can cause low calcium levels. It is so strong and long lasting you can only be on it for 2 years and it will stay in your body for the remainder of your life. However, pain from bone metastases can be really severe. This is supposed to prevent, reduce and post pone that pain. While meeting with Dr. Pommier he let me know that a NET patient we both knew was currently dying. He thought she was dying of an inability to eat due to pain from bone metastases. If she'd been on this drug she might have survived. Dr. Feldman, who also knew her seemed to completely disagree. They had both met with her and treated her. She was the coordinator and founder of the NET support group that meets quarterly. I met with her in person, saw her at meetings and emailed and talked by phone. Her funeral is this Saturday. Another member of the support group died this last month. They both had NET's for 10-15 years. Finding doctors that understand NET's and who know and understand what drugs to use, when to do surgery and how to treat NET's is still very challenging for people newly diagnosed. I met a man with NET's from Olympia who just finally was able to get on Octreotide over a year after his diagnosis because no oncologists understood the need. He is meeting with Dr. Feldman next week and may have him as an oncologist since he can't find a GH doctor in Olympia or closer to him who has ever treated NET's. My research really helped initially and then my solution was to have a permanent second opinion with Dr. Back at Seattle Cancer Care Alliance (SCCA) along with Feldman and Pommier. I consider Pommier my main oncologist and doctor; even though he is a surgeon he is by far the most knowledgeable when it comes to NET.
Now that I've done the hard work of the surgeries I should have a much better survival rate. Although the mean average survival rate is listed on-line as only 5 years many people are living longer. I have had the NET for probably 7 years before being diagnosed in October 2012. Most people with NET die of liver failure due to liver metastases. That is why we took all the larger tumors out of my liver in June. The tiny ones remaining would take many years to grow at this very slow rate or could possibly not grow at all. There is evidence that after the removal of the primary existing tumors grow even more slowly. There should also be no more metastases with the primary removed. That is why we have taken out the primary in the pancreas. I have NET's in my liver, bone, pancreas, lungs and Thyroid but all are very small. One of the main ways to keep an eye on tumor growth is the measure Chromogranin A in labs. This basically is a way to measure serotonin (a hormone) level in the body. If the tumors are active it measures high. In October 2012 the Chrom A was high but since I started Octreotide in Nov 2012 it has been in the normal range.
Now that I've lowered stress by retiring and increased joy by having time to see all my loved ones, exercise and decide what to eat I've got a healthy road ahead of me. Attitude is huge and while I had some down moments in the hospital I'm very excited about life and living. My husband, kids, parents, brother and sister in law and friends Louise and Sally were ever present during the hospital stays. Many cards, visitors, flowers, gifts, texts, emails and prayers kept me in good spirits. I am so truly blessed to be on this journey and living this life of mine. I am very thankful for all that I have in my life.
Thursday, December 12, 2013
Wednesday, November 20, 2013
Virginia Mason Hospital - Day 3
Hallelujah!! The horrible NG tube was removed from Caryn's nose/throat/stomach around noon today. Her nose and throat are still very raw and sore but getting better every hour. She started a clear liquid diet and has been instructed to go very slowly as they monitor her ability to take in liquids and watch for any bloating. So far so good.
She's looking forward to restarting the long road to recovery and leave the bowel problems behind. Thank you so much for your love and support.
She's looking forward to restarting the long road to recovery and leave the bowel problems behind. Thank you so much for your love and support.
Monday, November 18, 2013
Most likely not obstruction
Met with her surgeon around noon. He feels strongly that this is an Ileus (sleeping bowel) rather than an obstruction. He says its common after this type of surgery. Her family doctor also came in at the same time and concurred. He also explained that the doctors at OHSU probably felt they saw enough positive signs that the bowel had awoken that they released her. In fact they were not woken enough causing this backup in her stomach. The surgeon felt confident this condition would resolve itself. It just takes time. Plus walking would help too. I liked the surgeon and liked what I heard.
Unfortunately resolving itself means keeping the tube in her nose/throat/stomach which has been very painful to Caryn. If it doesn't resolve itself and is indeed an obstruction, then surgery to clear the blockage would be the next step. And not for another couple of weeks due to the fact that she just underwent surgery. But as I said above, he's leaning towards it being an Ileus. If so, lets hope it resolves in the next few days so she can come home and get better. Thanks for hanging in there with us.
http://medicine.med.nyu.edu/conditions-we-treat/conditions/ileus
Peter
Unfortunately resolving itself means keeping the tube in her nose/throat/stomach which has been very painful to Caryn. If it doesn't resolve itself and is indeed an obstruction, then surgery to clear the blockage would be the next step. And not for another couple of weeks due to the fact that she just underwent surgery. But as I said above, he's leaning towards it being an Ileus. If so, lets hope it resolves in the next few days so she can come home and get better. Thanks for hanging in there with us.
http://medicine.med.nyu.edu/conditions-we-treat/conditions/ileus
Peter
Update - Monday 11/18
The recovery got progressively harder last week as she valiantly tried to have a bowel movement. Despite laxatives, suppositories and enemas, her bowel was slow to wake up. Her spirits were still high, especially on Thursday in anticipation of going home. They tried pumping her with all of the above to get her bowels moving so she could be released Friday. She had a few very small BM's but nothing substantial since the surgery. She developed a lot of bloating and gas pain in her abdomen area while unsuccessful with having a BM. Nevertheless, they felt she was ready to go home on Friday despite her not having a substantial BM. The car ride home was very uncomfortable due to the gas pains and bloating.
Saturday and Sunday got progressively worse as she was still unable to have a BM. Her pain got worse, she was unable to eat or drink much. Although she had a fairly substantial BM early Sunday morning (5:00 am) with the help of an enema, she got progressively worse rather than better as we hoped. Finally at approximately 7:00 pm Sunday , we brought her to Virginia Mason Hospital emergency. She was given a CT scan to ascertain if she had a bowel instruction. It was found that she does have a small obstruction, probably due to scarring or inflammation from the surgery but they are not completely sure. She had to have a procedure called a NG tube where a clear plastic tube was inserted through her nose, past her throat and down into her stomach so that her stomach could be drained. It is extremely painful and uncomfortable for her. The worst part being we don't know how long it stays in. Could be today or a couple of days. It just depends on when the obstruction clears. Please pray that it is removed soon and her bowels resume ther natural function. She will remain at Virginia Mason until the situation is resolved. We are hoping it resolves with the NG tube rather than surgery.
Thank you all for your thoughts and prayers. We're hoping and praying for a quick resolution to this small but painful complication so that she can resume the path to good health and a high quality of life.
Peter
Saturday and Sunday got progressively worse as she was still unable to have a BM. Her pain got worse, she was unable to eat or drink much. Although she had a fairly substantial BM early Sunday morning (5:00 am) with the help of an enema, she got progressively worse rather than better as we hoped. Finally at approximately 7:00 pm Sunday , we brought her to Virginia Mason Hospital emergency. She was given a CT scan to ascertain if she had a bowel instruction. It was found that she does have a small obstruction, probably due to scarring or inflammation from the surgery but they are not completely sure. She had to have a procedure called a NG tube where a clear plastic tube was inserted through her nose, past her throat and down into her stomach so that her stomach could be drained. It is extremely painful and uncomfortable for her. The worst part being we don't know how long it stays in. Could be today or a couple of days. It just depends on when the obstruction clears. Please pray that it is removed soon and her bowels resume ther natural function. She will remain at Virginia Mason until the situation is resolved. We are hoping it resolves with the NG tube rather than surgery.
Thank you all for your thoughts and prayers. We're hoping and praying for a quick resolution to this small but painful complication so that she can resume the path to good health and a high quality of life.
Peter
Monday, November 11, 2013
2nd Surgery - updates
Peter here.
As you all know Caryn had her second surgery, the goal to remove the primary tumor in her pancreas, meaning parts of her pancreas and the entire spleen would be removed. The medical team led by her surgeon Dr. Rodney Pommier took extreme precautions to avoid any repeat of the complications Caryn had during her first surgery. He had a team of anesthesiologists at the ready in anticipation of any difficulties.
I am happy to report that her surgery went very smoothly and was deemed a success. Her blood pressure only had one small dip which they were able to control and the only unplanned action they needed to take was the removal of a one inch section of her colon, which is not considered serious. Plus the surgery took a minimal amount of time, probably 2-1/2 hours. Dr. Pommier was quite pleased and ebullient when he reported the results of the surgery to myself and to Caryn's parents Shirley and Ed Swan.
Recovery
Caryn was assigned to a regular hospital room after surgery, not ICU as in the first surgery. That was a surprise to us. It turns out this was indicative of the success of the surgery that no complications arose that would have necessitated recovery in the ICU. She was pretty sedated Friday night. On Saturday there wasn't major pain or discomfort like there was during the first surgery. Her disposition and mood was great and her skin color was rosy and eyes bright. She did experience rough patches as expected during the first two days after surgery but as you all know, she's a trooper. Sunday night and Monday morning were rough for her as she experienced nausea and flushing. By this afternoon (Monday), she finally experienced a breakthrough in that she had her first bowel movement. Since then she has been feeling much better and has been able to sleep comfortably the last few hours, a good indication of her feeling better and worry-free. The doctors told her if she continues to progress, she may be able to leave by Wednesday. We'll see
In any case, this surgery and recovery has been a little easier than the first surgery and recovery. But I don't mean to mislead by thinking it's been pain and worry-free. She's still having her challenges as recovery is a very slow process. But relatively speaking, it has been a little better than the first surgery so far. I'm hoping the trend continues and we will be home safe and sound later this week. Thanks to all of you for you words of love and support throughout this ordeal. I want to send a special thanks to Shirley and Ed for their unconditional love and support during this challenging time.
The next report will either be done by me or better yet by Caryn upon her return home.
As you all know Caryn had her second surgery, the goal to remove the primary tumor in her pancreas, meaning parts of her pancreas and the entire spleen would be removed. The medical team led by her surgeon Dr. Rodney Pommier took extreme precautions to avoid any repeat of the complications Caryn had during her first surgery. He had a team of anesthesiologists at the ready in anticipation of any difficulties.
I am happy to report that her surgery went very smoothly and was deemed a success. Her blood pressure only had one small dip which they were able to control and the only unplanned action they needed to take was the removal of a one inch section of her colon, which is not considered serious. Plus the surgery took a minimal amount of time, probably 2-1/2 hours. Dr. Pommier was quite pleased and ebullient when he reported the results of the surgery to myself and to Caryn's parents Shirley and Ed Swan.
Recovery
Caryn was assigned to a regular hospital room after surgery, not ICU as in the first surgery. That was a surprise to us. It turns out this was indicative of the success of the surgery that no complications arose that would have necessitated recovery in the ICU. She was pretty sedated Friday night. On Saturday there wasn't major pain or discomfort like there was during the first surgery. Her disposition and mood was great and her skin color was rosy and eyes bright. She did experience rough patches as expected during the first two days after surgery but as you all know, she's a trooper. Sunday night and Monday morning were rough for her as she experienced nausea and flushing. By this afternoon (Monday), she finally experienced a breakthrough in that she had her first bowel movement. Since then she has been feeling much better and has been able to sleep comfortably the last few hours, a good indication of her feeling better and worry-free. The doctors told her if she continues to progress, she may be able to leave by Wednesday. We'll see
In any case, this surgery and recovery has been a little easier than the first surgery and recovery. But I don't mean to mislead by thinking it's been pain and worry-free. She's still having her challenges as recovery is a very slow process. But relatively speaking, it has been a little better than the first surgery so far. I'm hoping the trend continues and we will be home safe and sound later this week. Thanks to all of you for you words of love and support throughout this ordeal. I want to send a special thanks to Shirley and Ed for their unconditional love and support during this challenging time.
The next report will either be done by me or better yet by Caryn upon her return home.
Thursday, November 7, 2013
To Portland for surgery 11/8/13
We will soon be leaving for Portland. I'm ready and packed. The kids and many friends have spent time with me over the last few days in preparation for this. I imagine I've gathered up all the love sent my way in a blanket and wrapped myself in it. I feel so forcefully surrounded by prayers and well wishes. It is true that I believe in prayer and that many people want me to do well. I've never been more aware of how others think of me. I treasure all my relationships.
"We are most alive in those moments, when our hearts are conscious of our treasures." Thornton Wilder
"Love this moment, and the energy of the moment will spread beyond all boundaries." Corita Kent
"Life, even in the hardest times, is full of moments to savor. They will not come this way again, not in this way." Paula Rinehart
The CT Scan showed some tumor growth in the left lung and a new nodule in the lung. It commented on bone metastases in the hip, pelvis and back. It showed that the Octreotide has not completely kept all tumors from growing, which is disappointing. On the other hand the tumors continue to be very slow growing and very small. The lung nodules were 3 and 5 mm. There is some evidence that removal of the primary (which is what we are doing in tomorrows surgery) slows the growth of tumors.
Even with this somewhat disappointing news I fell joyful for life and grateful for all that I have. Illness can make you take stock of what you have and what you would loose if you transitioned out of this life now. I am amazed at what I have discovered since taking stock of all that I have and how absolutely wonderful my life has been and is right now. I have had a very good life. I have loved and been loved. I am secure in this moment with the knowing that I will be all right, what ever happens.
"Joy is what happens to us when we allow ourselves to recognize how good things really are". Marianne Williamson
"Abundance is something we acquire. It is something we tune into." Wayne Dyer
"If the world is to be healed through human effort, I am convinced it will be by ordinary people, people whose love for this life is greater than their fear. People who can open to the web of life that called us into being, and who can rest in the vitality of that larger body". Joanna Macy
"The Universe Funds me with Strength
In times of adversity, I remember I am equal to every situation, a match for every difficulty. Sourced in the power of the Universe, I allow that power to work through me. I meet calamity with strength. I have stamina. Rather than draw on limited resources, I draw on the infinite power within me that moves me to accomplish its good. I am fueled by all the love, all the strength there is. Loving strength melts mountains. I am ever partnered and supplied by Universal flow. Knowing this, I do not doubt my strength. I am strong and secure". Julia Cameron
Thank you for all the support. I will ask Peter to post how I'm doing following the surgery.
Happily grateful,
Caryn
"We are most alive in those moments, when our hearts are conscious of our treasures." Thornton Wilder
"Love this moment, and the energy of the moment will spread beyond all boundaries." Corita Kent
"Life, even in the hardest times, is full of moments to savor. They will not come this way again, not in this way." Paula Rinehart
The CT Scan showed some tumor growth in the left lung and a new nodule in the lung. It commented on bone metastases in the hip, pelvis and back. It showed that the Octreotide has not completely kept all tumors from growing, which is disappointing. On the other hand the tumors continue to be very slow growing and very small. The lung nodules were 3 and 5 mm. There is some evidence that removal of the primary (which is what we are doing in tomorrows surgery) slows the growth of tumors.
Even with this somewhat disappointing news I fell joyful for life and grateful for all that I have. Illness can make you take stock of what you have and what you would loose if you transitioned out of this life now. I am amazed at what I have discovered since taking stock of all that I have and how absolutely wonderful my life has been and is right now. I have had a very good life. I have loved and been loved. I am secure in this moment with the knowing that I will be all right, what ever happens.
"Joy is what happens to us when we allow ourselves to recognize how good things really are". Marianne Williamson
"Abundance is something we acquire. It is something we tune into." Wayne Dyer
"If the world is to be healed through human effort, I am convinced it will be by ordinary people, people whose love for this life is greater than their fear. People who can open to the web of life that called us into being, and who can rest in the vitality of that larger body". Joanna Macy
"The Universe Funds me with Strength
In times of adversity, I remember I am equal to every situation, a match for every difficulty. Sourced in the power of the Universe, I allow that power to work through me. I meet calamity with strength. I have stamina. Rather than draw on limited resources, I draw on the infinite power within me that moves me to accomplish its good. I am fueled by all the love, all the strength there is. Loving strength melts mountains. I am ever partnered and supplied by Universal flow. Knowing this, I do not doubt my strength. I am strong and secure". Julia Cameron
Thank you for all the support. I will ask Peter to post how I'm doing following the surgery.
Happily grateful,
Caryn
CT Scan result
CT SCAN chest, abdomen and pelvis - Details
Narrative
[HST]: neuroendocrine tumor of pancreas
[SAS]: restaging
Exam: CT chest, abdomen and pelvis with contrast
History: Restaging neuroendocrine tumor of pancreas
Comparison: CT Chest, 10/17/2012. MR Liver, 3/22/2013. CT Abdomen,
4/17/2013.
Technique: CT scan chest, abdomen and pelvis with 100 cc Optiray 320
IV and oral contrast, without event in both arterial and venous
phases. Coronal and sagittal reconstruction images were viewed on
the viewing station. However, due to small PIV used 22 G restricted
injection speed and venous phase is in more delayed phase.
Findings:
Chest:
There is minimal right basilar atelectasis.
Previous pulmonary nodule in the right posterior lung base (image 58,
series 6) has increased in size measuring 5 mm (previously measured 4
mm) when compared to 10/17/2012. New subtle 3 mm ground glass nodule
in the left apex (image 8, series 6).
Subtle 3 mm groundglass opacity in the left pulmonary fissure (image
30, series 6) and right minor fissure (image 33) may represent
intrafissural lymph nodes.
Left node located in the anterior upper thorax just below the
clavicle (image 10, series 5) has slightly increased in size
measuring 11 x 10 mm (previously measured 10 x 5 mm). Similar
appearance of subcentimeter axillary lymph nodes. No new mediastinal
or hilar lymphadenopathy.
Heart size is stable. No pericardial effusion.
Abdomen:
Patient has undergone resection of the left hepatic lobe. Previous
metastases in the right anterior inferior and right hepatic lobe are
similar considering differences in technique when compared to
4/17/2013, but are better appreciated on the prior MR abdomen from
3/22/2013. No definite new hepatic lesions, but limited due to timing
bolus. Small calcified granulomas again noted in the liver.
No hypervascular enhancing lesions within the pancreas or new ductal
dilatation. As before, patient is status post cholecystectomy. The
spleen, adrenal glands and kidneys are unremarkable in appearance. No
hydronephrosis.
The aorta is normal in size and caliber. No new retroperitoneal
lymphadenopathy.
Bowel loops are unremarkable in appearance. No small bowel
obstruction.
Pelvis:
Bladder is normal in appearance. The uterus is unremarkable. Adnexa
are not well visualized. No free pelvic fluid. No pelvic or inguinal
lymphadenopathy.
Again noted is severe disc height loss at L2-L3 and minimal Grade I
anterolisthesis of L4 on L5 with moderate disc height loss. Stable
sclerotic lesions within the bilateral iliac wings, sacrum, pelvis,
right acetabulum, T12, L1, L2 and L4 vertebral bodies when compared
to 4/17/2013. No pathologic fractures.
[SAS]: restaging
Exam: CT chest, abdomen and pelvis with contrast
History: Restaging neuroendocrine tumor of pancreas
Comparison: CT Chest, 10/17/2012. MR Liver, 3/22/2013. CT Abdomen,
4/17/2013.
Technique: CT scan chest, abdomen and pelvis with 100 cc Optiray 320
IV and oral contrast, without event in both arterial and venous
phases. Coronal and sagittal reconstruction images were viewed on
the viewing station. However, due to small PIV used 22 G restricted
injection speed and venous phase is in more delayed phase.
Findings:
Chest:
There is minimal right basilar atelectasis.
Previous pulmonary nodule in the right posterior lung base (image 58,
series 6) has increased in size measuring 5 mm (previously measured 4
mm) when compared to 10/17/2012. New subtle 3 mm ground glass nodule
in the left apex (image 8, series 6).
Subtle 3 mm groundglass opacity in the left pulmonary fissure (image
30, series 6) and right minor fissure (image 33) may represent
intrafissural lymph nodes.
Left node located in the anterior upper thorax just below the
clavicle (image 10, series 5) has slightly increased in size
measuring 11 x 10 mm (previously measured 10 x 5 mm). Similar
appearance of subcentimeter axillary lymph nodes. No new mediastinal
or hilar lymphadenopathy.
Heart size is stable. No pericardial effusion.
Abdomen:
Patient has undergone resection of the left hepatic lobe. Previous
metastases in the right anterior inferior and right hepatic lobe are
similar considering differences in technique when compared to
4/17/2013, but are better appreciated on the prior MR abdomen from
3/22/2013. No definite new hepatic lesions, but limited due to timing
bolus. Small calcified granulomas again noted in the liver.
No hypervascular enhancing lesions within the pancreas or new ductal
dilatation. As before, patient is status post cholecystectomy. The
spleen, adrenal glands and kidneys are unremarkable in appearance. No
hydronephrosis.
The aorta is normal in size and caliber. No new retroperitoneal
lymphadenopathy.
Bowel loops are unremarkable in appearance. No small bowel
obstruction.
Pelvis:
Bladder is normal in appearance. The uterus is unremarkable. Adnexa
are not well visualized. No free pelvic fluid. No pelvic or inguinal
lymphadenopathy.
Again noted is severe disc height loss at L2-L3 and minimal Grade I
anterolisthesis of L4 on L5 with moderate disc height loss. Stable
sclerotic lesions within the bilateral iliac wings, sacrum, pelvis,
right acetabulum, T12, L1, L2 and L4 vertebral bodies when compared
to 4/17/2013. No pathologic fractures.
Impression
Impression:
1. Previous right posterior lung base nodule now measures 5 mm
(previously measured 4 mm) with new 3 mm nodule in the left apex. Two
new 3 mm subtle nodular opacities in the left pulmonary fissure and
right minor fissure may represent intrafissural lymph nodes.
2. Lymph node in the left upper anterior thorax just below the
clavicle has slightly increased in size measuring 11 x 10 mm
(previously measured 10 x 5 mm) when compared to 10/17/2012.
3. S/P resection of the left hepatic lobe with multiple hepatic
metastases in the right hepatic lobe similar compared to 4/17/2013,
but better appreciated on the prior MR abdomen from 3/22/2013.
4. No new hypervascular enhancing masses within the pancreas or
ductal dilatation.
5. No new retroperitoneal or intraperitoneal lymphadenopathy.
6. Multiple sclerotic osseous lesions within the spine, pelvis,
bilateral iliac wings, sacrum and right acetabulum are similar
compared to 4/17/2013 and some of which are likely due to metastatic
disease.
______________________________________
Electronically signed by:SUNG E LOGERFO, MD
Date: 10/30/2013
Time:11:49
1. Previous right posterior lung base nodule now measures 5 mm
(previously measured 4 mm) with new 3 mm nodule in the left apex. Two
new 3 mm subtle nodular opacities in the left pulmonary fissure and
right minor fissure may represent intrafissural lymph nodes.
2. Lymph node in the left upper anterior thorax just below the
clavicle has slightly increased in size measuring 11 x 10 mm
(previously measured 10 x 5 mm) when compared to 10/17/2012.
3. S/P resection of the left hepatic lobe with multiple hepatic
metastases in the right hepatic lobe similar compared to 4/17/2013,
but better appreciated on the prior MR abdomen from 3/22/2013.
4. No new hypervascular enhancing masses within the pancreas or
ductal dilatation.
5. No new retroperitoneal or intraperitoneal lymphadenopathy.
6. Multiple sclerotic osseous lesions within the spine, pelvis,
bilateral iliac wings, sacrum and right acetabulum are similar
compared to 4/17/2013 and some of which are likely due to metastatic
disease.
______________________________________
Electronically signed by:SUNG E LOGERFO, MD
Date: 10/30/2013
Time:11:49
Component Results
There is no component information for this result.
General Information
Collected:10/30/2013 10:34 AM
Resulted:10/30/2013 11:49 AM
Ordered By:Eric Martin Feldman, MD
Result Status:Final result
Resulted:10/30/2013 11:49 AM
Ordered By:Eric Martin Feldman, MD
Result Status:Final result
Saturday, November 2, 2013
Pictures
Jerome, Lauren, Caryn, Peter
Subscribe to:
Posts (Atom)