Tag Archives: needle core biopsy

As it turns out, not quite enough (of me)

The word from the lab looking for the PD-1 protein in my biopsy is that there weren’t enough cells (cancerous or otherwise) for a thorough analysis. If it is determined that enough tissue was ‘banked’ after the biopsy, a sample will be resubmitted. Dr. Shaw is not particularly optimistic.

So, the plan for the moment is to watch and wait. We will rescan in November and as long as I don’t become significantly more symptomatic, my situation will be reassessed at that time. In lieu of a PD-1 antibody, I could potentially return to one of the ALK inhibitors which I previously benefitted from:  LDK378 or Crizotinib—although as the LDK is still in trial, I’m not sure how that would work. Chemo remains an option but given the slew of side effects, I would say it is the least attractive choice. What I’m really hoping is that I can hold out until the next ALK inhibitor comes to trial (rumored to be end of this year or beginning of next)—the timing could be just right for me.

In the meantime, my plate is plenty full. I’m looking for a place to live as well as a means of support. I realize that statement implies much and answers little; I’ve got a lot to process and when the time seems right, I will discuss this new chapter in my life.

The biopsy went down well

The surgeon/radiologist was Dr. Gilman, the Associate Director of Thoracic Imaging and Intervention at MGH and someone already familiar with my lungs, having performed at least one (and possibly two) of my previous biopsies. He is kind, calm and possesses the sort of delicate and fine boned hands that seem entirely apt for the precise operations he performs.

Prior to the procedure, a needle core biopsy, Dr. Gilman explained that there were two feasible locations within my lung from which to extract a sample. One of them, which could be accessed through the side of my chest, posed a greater risk as it was uncomfortably near to my heart. The better choice was a region of consolidation that hugged my pleural lining. In order to maximize the area from which the sample(s) would be taken, it was necessary to approach vertically rather than horizontally. And that meant that the needle would have to first pass through my left breast.

An IV with twilight or a lightly sedating dose of anesthesia was started, with a bit of Xanax thrown in to stave off any possible nausea. My left side was propped up until I was lying at a vertiginous tilt, and I was securely strapped in place.

As they prepped the skin around my breast, I began to feel the effects of the sedation. Usually, I’m easy when it comes to anesthesia, however, I managed to hover on the edge of awareness for much of the procedure. I knew I was moving in and out of the CT scanner and also recall seeing the CT image displayed on a screen; the outline of my breast pierced by a long needle reaching into my lung. Surprisingly, I was also occasionally cognizant of pain, and even flinched once–not something you want to do when undergoing a needle biopsy. After that, I focused on holding still, and, perhaps because I was rather emotionally detached, found it easy to do.

At some point the nurse asked if I’d like additional Xanax–I believe I mumbled yes and then immediately nodded off. I stayed asleep until it was time to take me for the first post procedure x-ray. The next couple of hours were less comfortable, as I was now wide awake and needed to lie on my stomach without speaking. The orderly who brought me back from radiology had forgotten to hook up my call button and I really, really had to pee. David popped his head in and I whispered my urgent need. A bed pan was brought; a less than optimal solution under any circumstances. This one proved to be of inadequate volume, and a change of bedding was required. Oh, the indignity.

After one more chest x-ray around 3pm (checking for pneumo-thorax) I was given the all clear. Dr. Shaw had come around earlier to say the procedure had gone well, but as I couldn’t ask questions, I didn’t get a lot of information. However, Dr. Gilman stopped by before I checked out and explained that he had in fact been able to get numerous core samples–each a sliver of tissue but hopefully laden with cancer cells. He also said it hadn’t been easy as my breast tissue was exceptionally dense, something that I am well familiar with and that has posed a challenge at my yearly mammograms.

So home I went, groggy and sore of boob. Dr. Shaw called that evening and said that it appeared there would be enough tissue for gene sequencing and a mouse model as well—actual cells from my cancer would be implanted in live mice. Ethically, this causes me some pause. However, if a successful mouse model is established, potential therapies could be tested for efficacy before actually being administered to me, and that is hard to quarrel with.

Now, we await the results.

And this is where the road forks: 12/12/12

L1020594Tonight I will take my final dose of LDK378. At 7 am sharp tomorrow morning, I will report to radiology/surgery to get prepped for a needle core biopsy. I am hoping that it is uneventful (no pneumothorax), and successful: that sufficient cancerous tissue can be harvested and that the mechanism of my resistance will ultimately be determined. Also on the table–possible gene sequencing.

It’s been a good run; about fifteen months on LDK. I am exceedingly grateful for this deposit in my time bank, but I look forward to the possibility of ramping up my quality of life again. As it stands now, I will be starting chemo (carboplatin/alimta) next week, so it’s a given that I am going to feel worse before I possibly feel better. I’m taking the long view though…

My instructions for tonight include NPO after midnight. I know this means I should refrain from eating or drinking, but I decided to find out what the letters actually stand for:  Nil Per Os. That’s latin, but I’ll take a wild guess that it does in fact mean nothing by mouth (or NBM in english!).

Tomorrow’s date is 12/12/12. There will be more than the average number of weddings, induced labors (who doesn’t want a lucky baby) and lottery tickets purchased as well. I like to think it is an auspicious date. But it seems I almost blew it; my go-to-biopsy outfit was to be some black yoga pants. However, according to numerologist Swetta Jumaani in an article from the NY Daily News, “Black is a very inauspicious color,”……. “Something bad always happens.”

Out with the black, in with something colorful and not unlucky.