CAT Scan and Ultrasound Results

5 p.m. Before my doctor's office closed shop for the weekend, they called me with the results of my CAT scans and Ultrasound done two days ago at Medina Hospital. Some good news and possibly something less than good.

1. No sign of a straying gallstone lodged somewhere in the area of the biliary tract and pancreas.
2. No nodule or other mass in the lung. (Guess the earlier x-ray picked up something left over from the almost-pneumonia.)
3. No problem with kidneys.

4. "Enlarged duct on my liver. Biliary ductal." No mention of cyrrhosis of the liver, so that's good I hope. All of these results help confirm my suspicions that Dr. B. was hasty in his supposition that my problem was cirrhosis, possibly hepatitis, and a roving gallstone blocking the tubes. No x-ray or scans were ordered. Now I feel that his sexist remark actually saved me from going ahead with the invasive procedures he scheduled for a few days later Instead I decided to go for a second opinion at the Cleveland Clinic.

My doctor's office staff member who called me with the scan results was unable to elucidate further on enlarged liver duct condition, but I'll check with my him on Monday. Not being versed in these particulars, I did some exploring online. I had no idea what a duct on my liver looks like, how many ducts there are, how large or small, or what is their function. Trouble with many patients is they're lazy and leave the doctors to fill them in. I avoided science in college as much as I could. But I think I got a definition of sorts: the biliary ductal is the tube through which bile is moved from liver to the small kidneys. The pancreas is involved too.

So far I've looked for definitions of enlarged duct or ductal, but what I've found is mention of blocked ducts. So, does an enlarged duct do blocking? Or, is a blocked duct an enlarged one? I browsed Johns Hopkins website and Wikipedia (it posted a number of other links). Unfortunately (for me) they are mostly concerned with cancer. Frequent mentions of abdominal pain and jaundice. But I don't have these. No pain and I'm not yellow. One article gives some clarity. . I haven't taken it all in yet, will read it over tomorrow. and probably post part of it.

Adult Stem Cells and Cancer

The following from Daily Kos today is so clearly stated I'm putting it into this blog for my own reference point.

When Good Cells Go Bad

by DarkSyde

Fri Mar 23, 2007 at 04:21:01 AM PDT

Scattered throughout the body’s tissues are hordes of exquisite cellular machines called Adult Stem Cells (ACS). Each of these marvelous little cells is endowed with the power to perform astonishing works of biological magic.

When your skin is broken, adult skin stem cells at the affected site swing into action. They divide, and morph along the way. Some become sheets of cells, the precursor of new layers of skin. Others form sinuous filaments that wind through and in between the sheets, soon to conduct nutrients and oxygen; these will serve as capillaries. A similar process repairs other organs and tissues, liver, stomach, bone, etc. The process is regulated by untold thousands of biochemical handshakes between each microscopic player, as they grow from individual ASC to tissue containing many different kinds of cells. It’s an amazing phenomenon, and one made all the more fascinating as it happens without any conscious thought or direction. But sometimes, it can take a sinister turn ...

If, in the journey from ASC to new tissues, a few key genes are garbled, the cell may never stop dividing. Worse still, the body’s defenses are fooled by the errant cell’s outward appearance and chemical signature. Nearby quickening cells still dutifully build blood vessels and supporting tissue to nourish the growing collection. The owner will be unaware of the tiny malfunction, until they notice a lump, or until it affects the proper operation of an organ. At which point they consult a doctor, learn the chilling diagnosis, and the battle againt cancer begins.

For some time, researchers have suspected that Adult Stem Calls might play a role on the early development of the disease. More recently, there is some evidence that not only can the malignancy be triggered by an ACS, the cancer itself can arise from a mutated stem cell, a cancer stem cell, which produces only cancerous tissue. Needless to say, even if most of the tumor is removed or shrunk, just one cancer stem cell can give rise to a new tumor. And if those cancerous stem cells drift away from the original tumor, the new cancer appears in whatever tissue the malignant cells settle:

Three years ago, Weissman discovered that mutations and rearrangements of the genomes of stem cells that give rise to all the cells of the blood can lead to some forms of leukemia. Weissman proposed that these changes could underlie the development of cancers in many tissues.

Over one-million Americans will be diagnosed with some form of cancer every year. In some cases, the struggle they will endure, the courage they will summon, is simply unimaginable. If you’ve witnessed or experienced the devastating emotional and physical roller-coaster that makes up a cancer patient’s life, you understand all too well. If not, I hope you never do.

Cancer is second only to cardiovascular disease as the leading cause of death in the US. And yet, the outlook for survivors like Elizabeth Edwards has never been brighter. New treatments are being developed and refined, and insight into the role of adult stem cells, viral infections, and other possible causes holds great promise for future generations. The disease is slowly, ever so slowly, becoming less a death sentence and more a chronic illness which can be managed, especially when caught early. Here’s to hoping that one day, in the near future, with enough funding, research, government leadership, and perhaps most importantly, affordable access to quality healthcare, all the victims of this disease can look forward to a long, healthy, and full life.

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Ultra Sound and CAT scans were performed today

Today I spent the morning at the radiology lab of Medina Hospital. First, at 8 a.m., I was given an ultra sound--the technician spread some jelly on my tummy and then went to work pushing buttons on a futuristic-looking machine while I followed instructions to hold my breath at times. My job was to lie still. The procedure took about 30 minutes. They reminded me I'd had an ultra sound my the second visit to the ER. It must have been simplified because I was sedated and didn't know a thing.

Next I moved on to the CAT Scan department where I was given a huge plastic container of liquid (half a gallon?) with the order to drink it down. The more I took the worse it tasted, a metallic taste overcoming the lemonade flavor that's supposed to make it palatable. Finally I told the tech I felt nauseated--one of the conditions that brought me to emergency in the first place.

Two CAT scans were necessary for the upper and lower torso. I'm familiar with such machines from watching House and seeing Hugh Laurie and assistants looking on. It's a huge donut. Instructions came in a recorded male voice, perhaps a robot, but his grammar had not been perfected. First he said, 'breathe in." Then he said, "breathe normal." He was not programmed to know that the adverb normally should modify the verb breathe. Adverbs modify verbs; adjectives modify nouns.

All was done by 10:30. I called Paul on my cell and he came to the hospital within 15 minutes. We had some soup and rolls in the cafeteria (I hadn't eaten anything since 6 p.m. the day before), followed by a little shopping.

CAT Scans Tomorrow

Have to be up early tomorrow. Three procedures await at Medina Hospital beginning at 7:30.. Two CAT scans of my upper and lower torso and an ultra sound will look at my lungs and everything else. Should be done by 12:30.

Goodbye Local Specialist: Hello Cleveland Clinic

March 15, 2007
I've dismissed that awful doctor, canceled his appointment to do an endoscopy and am now a patient of the Cleveland Clinic. They already had me on file even including my teaching career (if you can call it that!). They must have a rule that a person accompanying a spouse to their facilities is a prime possibility for also becoming a patient in the future. Good old American hustling! First I talked to a practitioner who took down facts about my case and she was warm and sympathetic. I included the little anecdote concerning my Medina specialist and his unprofessional behavior and told her that at first I couldn't really believe what I'd heard. She said firmly, "Oh yes, he said it!" Went on to say that no doctors at the Clinic would ever say such a thing. If they did, they were outta there.

She told me to ask my family doctor to order up two CAT scans and an ultrasound at Medina Hospital, and that's what I'll be doing on Tuesday. My fam m.d.said today he'd call the clinic and try to get me earlier dates. He was shocked to hear of Dr. Bashour's outrageous remark. From now on he should refer only men to that man.

Paul's local lung man has confirmed a cancerous nodule in his lung. Very gruff about it and didn't tell him that surgery can do marvels these days. Paul came home looking very grave. "I have cancer," he said as he came through the door. Since then he's talked to his doctor at the Cleveland Clinic who was positive. "We'll snip that thing out and you should be fine," he said. Tests are scheduled for April 2 at the Clinic.

I'm now clear of the lung infection that plagued me for the last 12 days. It really laid me low. Awful congestion in lungs and nose.

A "Funny" thing happened at the doctor's office

Thursday, March 15, 2007
A "Funny" thing happened at the doctor's office

March 15, 2007
I'm seeing Dr. Hoynes tomorrow after a week of antibiotics. Seem to be getting better though.
Paul had a fruitful talk with his Cleveland Clinic specialist a couple days ago. He was upbeat and told dad they will cut the growth out and the prospects were good. Dad felt so relieved, and became his old self again, because the Medina specialist gruffly told him he had cancer and sent him on his way without any positive words. He did suggest though checking back with the Clinic. Paul came into the living room looking grave and told me, "It's cancer." Downer! Immediately the lights came on blinking "Second Opinion" and he was so relieved after talking to Dr. Gildea and getting his take on the problem. They are scheduling him for a battery of tests in Cleveland next week.
Like Philip says, you've gotta be proactive. As for me, I too am getting a second opinion from Cleveland. The gastroenterologist in Medina left me with some very bad vibes. He seemed opportunistic--too eager to stick those probes down my throat, didn't listen to me when I said I was developing a cold and might not be ready for the hospital probes, and didn't order an x-ray. His finding seemed so extreme that even my family doctor raised his eyebrows when I told him. And his suggestion that if everything didn't go quite right, he'd "call in the gurus in the North," was weird. But not only that, he made an outrageous remark when he was examining me. He commented on my bra!! Said it was pretty. paulwas in the room but the doctor spoke softly and dad didn't hear it. I wondered if I may have misheard, but I couldn't substitute anything else, and that's what he said. When I was giving the expert who took down my info at the Clinic I told her about not quite believing what I heard. She said, "Oh yes he did!" Then said, no doctor here at the clinic would say such a thing--he'd be outta there in a hurry. She said to ask the fam doctor to order a CAT scan and ultra sound. Good thing I'll be seeing him tomorrow.
I'll be having tests too at the clinic and also seeing two sub-specialists (that's the beauty of the clinic--they micro-specialize)--one in gastroenterology and the other in the liver field.

And oh, Betty Hutton died at 86. Doubt if many boomers know of her, but her performance as Annie Oakley in the movie Annie Get Your Gun lit up the screen. She once was the most popular screen star of the year, and Time magazine had a cover story on her. Apart from fleeting fame she had a sad life, but was rescued and actually went to college late in life (had dropped out in fifth grade to go to work) and became a drama teacher. She was beautiful, sang and danced well, and was funny. Robert Osborne ran an interview he did with her a few years ago. Brought tears to one's eyes.

Blood Test Results

Phone calls this morning from primary physician's office and specialist's office that blood tests show no Hepatitis A, B, or C is present. Liver enzymes are mildly high. Continuing with one a day Avelox until Friday--mucus ssstill present in lungs..

Cleveland Clinic: Second Opinion

On March 7 the sore throat was developing into a cold but by Friday, March 9 I returned to my primary care physician PCP who sent me to the hospital for a chest x-ray and gave me a course of antibiotics to take for seven days. (Avelox). I waited at the x-ray center after the pictures were taken and results faxed to my doctor. He called me on the x-ray office phone and said the diagnosis was a lung infection that would become pneumonia if not treated--and I could not possibly have the surgery scheduled for the 12th. The date has since been changed to Thursday, March 22nd.

Now it's March 15, ten days from when my sore throat developed. The Avelox seemed to be very slow working and during that time I felt very little relief from nasal and chest congestion. Yesterday pcp gave me another prescription and today (whether it's just my body recovering or the new prescription) I'm feeling an improvement.

Called Cleve Clinic Gastroenterology today 1-216-444-6521 to request a second opinion on Dr. Bahsour's opinion and spoke to a woman named Lynn at the Call Center. .I told her Dr. B suspected a gall stone and liver cirrhosis based on evidence, and he gave me an appointment for the 12th for EROC and an endoscopy. Later postponed because of lung infection). She asked if he ordered x-rays and other tests, and told her he ordered blood tests but not an x-ray. Swelling, yellow skin and eyes, etc). She requessted that Dr. Hoynes order an untra sound, cat scan of the bile duct--he will clearly know what's required. After they have received the records, they will make an appointment to see a sub-specialist as quickly as possible. She advised me to hand carry the records to their department.

She made an appointment to see Dr. David Barnes on June 7 at 9:45 a.m. He's a liver specialist. I'm also on the wait list. Will send me a reminder of the appointment. I'm already in their computer with SS number and even my professional bio!

A Diary of Maladies

Sunday, March 11, 2007

Senior Citizen, having enjoyed good health all her life, finds luck changing at age 75. Memory is good but perhaps can be boosted by keeping a diary of maladies that have shown up lately. So here goes.

First, frequent insomnia now after formerly being someone who could go off to sleep at the drop of a hat. It's 3:24 a.m.this morning (first day of the change to daylight savings time,) and here I am wide awake. Instead of tossing around in bed with my thoughts refusing to settle, I'm up and on the computer. Usually when I return to bed I get 3-4 good hours of sleep.

Second, since late December I've been twice carted off to the ER around midnight after suffering severe intestinal attacks. Just after Christmas a slight nausea turned into violent vomiting followed by uncontrollable shivering. My primary care physician (PCP) decided I was I was suffering from a virus. A second attack came on Sunday, March 1 when after midnight another series of even more violent vomiting and this timediarrhea as well I was emptied out and left dehydrated and empty. Another trip to the ER resulted in numerous tests including an MRI. The relaxants piped into my veins put me into a deep sleep and I didn't become aware until the next day at 11 a.m. This emergency prevented my spouse from keeping an appointment for lung biopsy surgery in the self-same hospital Two days later, my PCP said he suspected something other than a virus and referred me to a local gastroenterologist (GE). He gave me an appointment for March 6.

On March 6 I woke up with a sore throat, but the GE examined me, asked numerous questions about my medical history and general health. His working hypothesis is that a straying gallstone has lodged itself at a junction preventing the juices flowing properly. This amazed me because my gall balder had been removed in 1974. Other evidence presenting itself at that interview suggested to the specialist that I also may have a liver problem, and he mentioned cirrhosis of the liver.

The upshot was to set a date for exploratory surgery--Monday, March 12.
On March 7 the sore throat was developing into a cold but by Friday, March 9 returned to my PCP who sent me to the hospital for a chest x-ray and gave me a course of antibiotics to take for seven days. (Avelox). I waited at the x-ray center after the pictures were taken and results faxed to my doctor. He called me on the x-ray office phone and said the diagnosis was a lung infection that would become pneumonia if not treated--and I could not possibly have the surgery scheduled for the 12th. The date has since been changed to Thursday, March 22nd.