Daily Archives: December 30, 2009

Four millimeters of anxiety

On Monday morning I drove to Boston for my monthly meeting with the trial team.  The roads were largely empty, as many people are yet on holiday.  When I arrived at the tolls, there were actually more vehicles in the northbound lanes, likely filled with skiers, boarders and snowmobilers.  This meant I had a commute minus the usual stop and go, which is undeniably a more pleasant trip.

After my labs, I met with Dr. Shaw to go over my latest scans.  Although some people are under the impression that I am now disease free (a notion that the media has perhaps inadvertently encouraged), medically my situation has never been characterized that way.  My response to the trial drug was indeed dramatic, but it was a partial response. This is due to the fact that there are still areas of abnormality in both lungs.  The radiologist’s report describes these regions in the following language:

“The patient is status post left lower lobectomy.  There are stable postoperative changes.  Again noted are persistent and unchanged focal areas of interlobular septal thickening with micro-nodularity/irregularity.  There is biapical scarring. There are multiple pulmonary nodules which measure up to 7 mm which are stable relative to the study of 2/24/08.”

Before I went on trial, my lungs were carrying a heavy cancer burden.  Much of what is seen on the scans now may represent inflammation or scarring, not an unreasonable scenario given the amount of disease that was present previously. What the radiologist is really looking for is stability or the lack thereof.  Whether the presenting nodules are benign or cancerous, stable is the next best thing to resolved.

This report noted one nodule that appears to have increased in size:

“In the left lung…there is a 4-mm nodule which first appeared on the study 3/13/09 where it measured 2 mm.  It has gradually increased in size over the multiple consecutive studies.”

Well.  What does this mean?  Undeniably, it could be suggestive of recurrence. However, there are other possibilities as well.  It is a tiny, 4 millimeter red flag. There is nothing to do at this point but watch and wait.  I don’t deny that it makes me anxious, but I have to remind myself that whatever this nodule represents, it is very small and apparently not very fast growing.

Following my appointment, I met up with my good friend Sally, who was visiting family in Brookline.  I joined Sally and her relatives for a preemptive celebration of the New Year. Our champagne toast to the good health of all gathered was particularly poignant, as one of Sally’s sister-in-laws is in treatment for Burkitt’s lymphoma.

After dinner Sally and I retired to the Marriott for a sleep-over, as I had an appointment scheduled for yesterday morning with the orthopedic department. My ankle is healing very well, and I even got a tentative thumbs up for a few runs on the ski slope.  As long as it is a gentle slope, there are no children or other people around, and I don’t fall…I’m good.  I might give it a shot.

I drove back to New Hampshire in a fierce wind and single digit temperatures.  It had snowed overnight, and I’d missed out on a serenade by a pack of coyotes in our backyard.  In addition, David found moose tracks in the woods.  It is always comforting to come home to this rather wild and wooly place where nature is simply going about its business.  My own worries seem inconsequential compared to the daily struggle for warmth and food that is part of being a wild animal.  We, each of us, are striving to get through another day; another night.  I have heard that one of the purposes of the cacophony of birdsong at first light is a roll call of sorts.  Each bird is singing to its neighbors:  “I am here, I am here”. And so we are.