It Might Get Messy

It is an incredible, awesome, damned near unbelievable time to be alive. On Thursday, the imaging technician handed me a CD on my way out the door. Actually, he handed me two CDs. One was the audio track he had playing while I bounced back and forth in the scanner. On the way in he asked me what kind of music I wanted. I told him Scandinavian death metal. He said ok. Then he said he lost that tape but he had some good dinosaur rock if that would suit. Stevie Ray Vaughn and Kenny Wayne Shepherd together blasting some seriously slick electric blues. I have no idea why the guy was so insistent that I take a CD of the stuff he played as background music while he did his job. But what the hell. It’s good music.


But these are not the droids we’re looking for. The astonishing CD is the one that has 239 computer aided tomography images of my body on it. These are 239 transverse slices of me from roughly hips to skull. There are sagittal and coronal planar views as well, but these are for navigation. In fact, they generate a cool set of 3-D figures that let you click on any location you want to see the detailed information. The heart of the matter…the meat, so to speak…is in the transverse sections. There seems to be about a meter of me in total in the images. That makes the resolution of the transverse slices better than half a centimeter. I imagine there are possible tumors smaller than that. But half centimeter resolution via completely nonintrusive technology (except for the radiation that of necessity is at the base of the imaging) is pretty damned comforting to me. 


Before they passed me into the imaging machine, they did an intravenous injection of fludeoxyglucose. Which is a radiolabeled analog of glucose sugar. The radioactive moiety (now THERE’S a word you don’t see very often) allows a positron detector (PT scan) to pick up the places in my body that are most metabolically active—places that take up the sugar rapidly and massively. Simultaneously, they recorded x-ray computed images—CT scans. In roughly half an hour they sliced me into 239 conceptual segments and recorded two high resolution images of each slice, one PT, one CT.


Then they burned me a disk with the image data and the software necessary to process the images. Oh yeah. Plus the Kenny Wayne Shepherd disk.


Anyway. A few years ago, the hardware, software, ethical, liability, legal, and social contretemps associated with handing a patient a package of kick-ass diagnostic material on his own condition would have tied the system up in knots. At GBMC on Thursday, they just handed me the disk with a smile. At home, my computer recognized it, loaded up the data, accepted the software, and let me dissect myself 239 * 2 times as often as I want to. Is this a wonderful universe or what!?!?


In Manhattan, east and south of Madison Square Garden and Penn Station, around 30th to 33rd streets, there is a string of Korean hotels and restaurants. This is not a tourist neighborhood. There are no “little Korea” shops. This is a hard-core Korean language business neighborhood. There are few Anglos in the restaurants. The wait staffs don’t really like to serve white people. 


In the 90s, I braved the gruff and uncomfortable service to eat in those restaurants a few times. There are no menus in English, and the staff offer no help when they hand you the menu card in Korean. It has only a few items on it. I simply pointed at random at what seemed to be main dishes and awaited my fate. All the food seems to be variations on the same theme. You get a cup of soup, then a plate of kimchi and one of pickles. After a while, a bowl with bright and crisp whole lettuce leaves is set out, followed by a huge platter. The platter contains a veritable museum’s worth of laterally sliced organs. All kinds of organs. From all kinds of animals. I’m a Ph.D. biologist, for crap’s sake, and I couldn’t identify the phylum most of the organs came from, much less what the organs are. The idea is you roll up some of the organ slices in one of the lettuce leaves and eat it. The exercise is of more biological than culinary interest, I must admit. 


I’m reminded of those restaurants when I sort through the data on the PT/CT data CD. Let’s play “Name That Organ”!!!

Let’s start with slice number 126. Low down along my back, you see the paired kidney shapes of my…uh…kidneys. They’re hot with radiation. They are metabolically active, doing their kidney thing, separating the salvageable and useful from waste liquid and passing it on to the bladder. To the left and above the kidneys is the generally well-lit mass of my liver, sequestering or detoxifying potentially destructive molecules—including the radiolabeled sugar, I presume—at its plodding but effective rate. 

Wanna see my heart? Slice 155 here runs right through. Four chambers and some chemical glow—hard working heart muscle. 

Now, let’s go to the crux of the matter—the base of my tongue, where the primary tumor was and presumably where the potential for formation of new tumor tissue is high. This is slice 203. You can see the void of my windpipe, forward of that the mass of my tongue. I think what we’re looking for is small, single, hotspots—that is, unpaired. The paired spots mostly match up with anatomical knowns. I suppose it’s not impossible to get paired tumors, but I’m relying on the docs to know the wheat from the chaff in that context. I note that the software comes with a helpful zoom function in the icon of a magnifying glass, but I haven’t figured out how to capture the zoomed image in a jpeg. But in fact you can get the important stuff from this figure. No oddball unpaired hotspots. Thus, no visible tumors. 


That’s the punchline. The radiation oncologist called on Friday to say the PT scan output is “fabulous”. Quote. This is the big-personality Romanian woman, who takes no prisoners and offers no bullshit. Especially she doesn’t do premature or unjustified positives. So I’m taking her at her word—fabulous it is. I believe that means I have only to get through some pro forma surgery (the team meets on Wednesday to discuss active cases, I expect they’ll propose a scope and date for surgery then and call me afterwards) and the difficult discipline of getting over my incredible weakness and regaining my strength—pretty much on me, I’m afraid, and you know how “Mr. Discipline” I am—and I should be back to full health a year later and a shitload wiser. 


We’ll see. 


Those of you with a weak stomach or delicate constitutions should turn away for just a few seconds now. That heavy dark streak low in my torso in all those 3-D images? Fecal mass, awaiting excretion. Oh well. My only actual innate “skill” is taking a good dump, no reason detailed whole body imaging shouldn’t pick up on that theme!


Anyway. There’s a new short essay up at http://theresaturtleinmysoup.blogspot.com/,  the other sites— http://docviper.livejournal.com/ and http://sustainablebiospheredotnet.blogspot.com/ have yet to be updated. Thanks for stopping by!