PET-CT scan today

I have had another PET-CT scan today morning in the Bangalore Institute of Oncology (BIO), which is the only center in Bangalore to have such facility. Given the number of patients lining up for the scan, one needs to always take an appointment at least three or four days prior to the scan day. So, I took the appointment last week (Nov 30), when I had my chemo session.

Today's scan was my seventh in the last one year of my treatment for cancer! Nevertheless, I would like to share with you my experiences of the scan process for a couple of reasons: (a) Most of us might not have heard about what PET part of the scan is, though some of us might already know what CT scan is. (b) I did not share my scan experiences in a public platform such as this blog until now. Thus, I give below more details of the PET-CT scan in the form of FAQs. Hopefully, this might give a few of the readers what a scan process might be! :)

1. What is PET-CT scan? Why should a CT scan be combined with PET scan?
PET is an acronym for Positron Emission Tomography, while CT stands for Computed Tomography. A CT scan usually gives us an idea of the structural changes of the parts/tissues/organs in the body. Thus, CT will give us what is called anatomical imaging. However, CT cannot give us the details of the metabolic activity going on in the specific part/tissue/organ in the body, which can be achieved by PET. Thus, PET will give us what is called functional imaging.
Let us take an example of a cancerous growth in Liver. CT will show the images of the liver with its shape, changes in the size and any other properties such as color, which might be due to the presence of cancer. PET will capture how these cancer tissues or cells are moving or spreading. So, a combination of both PET and CT images of the body not only gives the anatomy and changes in the structure of the part, but also how the part is functioning.

For more technical details on PET-CT scan, interested readers might want to see the following web resources:
(a) PET-CT
(b) Positron Emission Tomography
(c) What is PET-CT scan?

2. Is PET-CT scan the only technique available for effective diagnosis of cancer in the body?
PET-CT scan is the widely used technique world-wide to detect the nature and extent of the cancer in the body. Though there are other kinds of tests used to detect the cancer, such as mammography test (for breast cancer), Pap smear to test (for cervical/uterus cancer), and various others, they only detect the cancer in a specific area of the body. PET-CT scan detects the abnormal activity in any part of the body thus helping an oncologist in effective diagnosis.

3. Is PET-CT scan a painless process?
Yes, the PET-CT scan is mostly a painless process since the actual scan will be performed in a machine where the body is exposed to a painless radiation, similar to that of an X-ray machine.

4. How expensive the scan is?
Given the logistics and investment of the tools and equipment required for the PET-CT scan, it is usually expensive. For instance, BIO charges anywhere between Rs.12000 to Rs.20000, depending on the reference of the doctor and whether you are an internal or external patient. (Of course, one can negotiate always for a discount with the help of your doctor :) )

5. What the process for a typical PET-CT scan is?
The process for a typical PET-CT scan might be as follows:

(a) The patient should be on fasting for at least eight hours before the scan! He can only take water during the fasting period. (In my case, I had my dinner at around 9 PM yesterday and did not have any thing later to that until my scan was complete at 12 noon today.)

(b) The patient when reports to the PET-CT center, is checked for his vitals, such as blood pressure level, sugar level, white blood cell count, weight and height. If any of the first three are abnormal, the scan will not be done on the day and will be rescheduled. (For example, the fasting sugar level should be less than 200 mg/dl i.e., 200 milli grams of glucose per deci liter of the blood.)

(c) An intra-venous (IV) needle will be injected in one of the veins of the patient, usually in one of the hands, which would later carry the radioactive tracer before and during the scan.

(d) The patient is then administered with a small dosage of fluorodeoxyglucose (FDG) through the IV line. (FDG contains the radioactive tracer as fluorine-18, a radioactive isotope of Fluorine, with half-life of around two hours! This tracer is absorbed by the abnormal areas of the body and emit gamma rays, which are captured by the PET-CT machine.)

(e) The patient is quarantined from others since now he carries the radioactive tracer in his blood.

(f) The patient is then asked to have one liter of liquid, usually water, with soluble FDG. This is to ensure that the body will have enough dose of FDG to absorb. The intake of this fluid, also called oral contrast, should be slow and even and should be over a period of 45 minutes to one hour.

(g) The patient is then shifted to the PET-CT machine, where the actual scan of the body will take place. It usually takes 15-20 minutes for the scan to complete. The whole process of scan can take any where between 1.5 - 2 hours.

Once the scan is complete, the patient is advised to be in observation for another couple of minutes before he is let out. (Once he is let out, of course, he is free to break his fast now! :) )

Now that I have had my scan, I am eagerly waiting for its report, which would be available to me tomorrow morning! Hope there are quite positive results in the report and my recovery is complete without any further chemo sessions! :)

Chemo-18 today.

I have had my eighteenth dose of Cetuximab today. This is the last dose as originally recommended by my doctor. Like I did last week, I went to the hospital today with (a) severe pain around the edges of my feet which were split in several areas thus affecting severely my walk and (b) lot of inflammatory abscesses in my face and both the legs which were a major irritation.


A few highlights of today's chemo session:

• Blood counts have only marginally improved with the white blood count going up from 2.44 last week to just 2.85 today! This value still is below the minimum value of the preferred range of 4 - 11. Nonetheless, it was fine for the infusion of the Cetuximab.
• After a couple of trials, the nursing staff found a vein in my right hand.
• My weight has gone down marginally from 89 kg to 87 kg!

Though my doctor Dr.Niti did not visit me, her junior Dr.Smita did so and advised me having a PET scan next Monday (i.e., 30th Nov) and consult Dr.Niti with the scan report. The scan will show the latest status of the disease inside my body and it is the only known way currently to detect cancer in the body. So, I have one more week of rest and one more good thing of not having Capecetabine this week! Phew!

Chemo-17 today.

I have had my seventeenth dose of Cetuximab today. I went to the hospital today with (a) severe pain around the edges of my feet which were split in several areas thus affecting severely my walk and (b) lot of inflammatory abscesses in my face and both the legs which were a major irritation.

A few highlights of today's chemo session:

• Blood counts have again dropped with the white blood count going down from an amazing 8.49 last week to 2.44 today! Though the value of 2.44 does not fall in the recommended range of 4 - 11, it is fine for the infusion of the Cetuximab.
  
• The ordeal of finding a vein in my hands for the infusion of the chemo drug was again back. Finally, after a couple of trials, the nursing staff found a vein in my right forearm.
• My doctor, Dr.Niti Narang, did not visit me today for the simple reason that by the time the intra-venal (IV) infusion had started, it was again already 3 PM and that was the time when my doctor usually completes her duty. However, the assistant doctor Dr.Smita visited me and enquired about my health condition in general. When I told her about the rashes on my face and legs, she told me that these were the side-effects of the chemotherapy, especially, the infusion of the Irinotecan, and were expected. She assured me that they would go away over time.
  
• My weight has improved marginally from 84 kg to 89 kg! Though my father, who accompanied me today, was at discomfort with the abnormal weight, he left a sigh of relief when the doctor and I reassured him that it was a good sign given that chemotherapy is going on now.
  

Redotting the past!

Recently, I was trying to peep into the past and was emboldened by the fact that life has given me enough to rejuvenate and rejoice! Though there were and have been moments of disappointment and distress, the times of happiness and bliss, though ranged for a short-time, were permanently etched in memory and reliving these times would give tremendous re-happiness and re-bliss!


(Photograph on top: Me in 7th standard fresh after the annual public exams; Photographs from right: during B.Tech., 3rd year, 1992, in the lawns of KSRM College of Engineering, Kadapa; at home in the world of books, 1996)

Connections of the heart.

I touched the warm parapet that looked sapped out of the continuous radiation for the day from the scorching Sun. In the western horizon, a large whitish cloud was shielding the Sun despite the heavy metallic rays beaming out from all the angles from the surface of the cloud. The birds of summer fly past the cloud as though they were going to report the happenings in their part of the globe with haste. The routine breeze was absent and missing. There was no movement in the trees and all the branches were as though they were waiting for some mysterious event to happen in the Nature. The buzzing sounds of the vehicles and the people in the not-so-distant road was echoing in my ears like the sound of trumpet echoing in the middle of a deep valley in the coarse hills. The roaring sound of the starting of the unknown train was clearly audible. Two squirrels in the corner of the floor were fighting with their pranks. The squirrels climbed upon a tree with one of them menacingly looking at the other down from the zenith of the tree. The lower one was shouting at the higher one with some sudden movements in its head. The higher one responded with the similar movements in its head turning wide angles in the opposite directions. Suddenly, the lower one took a leap into the top branch and both were still for a moment!

That was a day with a set of mixed feelings on life's different perspectives. Earlier in the day, I had met my doctor with a scan report and she suggested me continuing the chemotherapy for nine more weeks. Though the line of treatment was simple to execute and follow, the enablers of the treatment such as money,family support and my willpower, decide the success of it partly.

As some advertising tag proudly says,'There are a few things beyond money; but they all cost money'. Though money cannot buy everything in this world and beyond, it's role is definitely important when it really matters most. My train of thoughts on that evening meandered through the financial position I was in to take on the challenges of the treatment and my fight against the disease. I was not completely prepared to make it with the expected expenses touching more than Rs.10 lakhs for nine more weeks of treatment! I was thinking of the various options to raise money since for all of us who are single-income sourced humans, working with the cash flows running into lakhs of rupees over just a few weeks is a daring thought!

Sreenivasulu Yaparla aka Seenu called me up incidentally on that night inquiring about my health and general condition of my life. Seenu has been a friend ever since I had come to Bangalore. After a couple of failed attempts at entrepreneurship, he made it into IT and now is into active IT consulting based in Hyderabad. I was swallowing my words when he questioned on my financial preparedness in dealing with the disease and after recognizing my feelings, he offered me having some money to start with the treatment. Had he not offered the money in that moment, the history would have taken a different course. The defining moments in one's life would come totally unexpected, and once they happen, they define the moments!

A few days later, my childhood friend, Raja Reddy, who is now in US called me up with a proposal to help me in my financial needs. His idea was to raise the charity funds in the form of donations for me so I could keep on continuing the treatment. Though I was skeptical about the idea (because I was not sure who the target group was and whether they would really be interested in donating!), I kept on discussing the idea with him for over a couple of days. Meanwhile, I had applied for a personal loan from a bank to supplement my financial needs.

Raja should be thanked a lot on giving me another decisive moment in my life! He worked with one of my engineering classmates, Suri, who had been another active resource and inspiration in making the idea of donations a huge success! They both took the task to their shoulders with a real zeal and fervor that is truly unprecedented! Later, a few of my MBA friends shared my agony and came forward to help me in fight against one of the deadly diseases in this world! I should thank all of them who had given me continuous moral, emotional and financial support!

Every mortal in this world understands the significance of the money in its capacity to satisfy their various needs and provide a cloud of security for their future. Parting the things which you would need for yourself in your life entails big heart and a strong feeling of empathy. That feeling wins which would think of the real feelings of the person receiving the money as a receptor. The heart must beat for the person's situation which coerced him to act as a receptor. The mind should be ready to take a decision and act!

And the donors, both in US and in India, responded; they just did not react! With all the donations trickling in as diverse amounts as $50 to $3000, I felt as though the hearts in this world still do not wither in the tough situations as these. The connections of the heart have been so strong as to overcome all other biases and feelings. All donors who were part of my life now did not just donate money; they shared a part of life with me. They donated minutes of thoughts and feelings to me! They shared some of the finest moments with me, thus helping me in getting tremendous courage and conviction to fight against my disease. More than any thing else, I feel now my heart is connected with all of their hearts! I am beholden to all of you, Donors! Merci, donateurs!

(Despite donations, I am deeply touched by a few heart-warming asides that took place in the process of donation over a period of time. Though they might just sound as events, they definitely would have defined the scope of feelings of the respective donors in their decisions. I give below a few touching and interesting asides in the process of donation:

• Sumana, daughter of Raja Reddy, had decided not to have her regular birthday gift from her dad. Instead, she preferred to donate the money to my cause!
• Ramesh Nagarajan, who had only spent one year with me in my Engineering (he changed his college later), was kind enough to help me through his donation. Given that it has been around sixteen years since I completed my engineering and given that I and Ramesh had not been in contact for all this long, his donation really makes a feeling of a real connection of the hearts!
• Some of the donors do not know me personally or directly. Nevertheless, their donation for my cause shows the greatness of their eloquent kindness and my tributes to it, however high it might be, do not match with the greatness of their hearts!)
  

Given that most of the donors were out of my contact network for more than at least ten years, it has been a great feeling when some of them visited me personally at my home and shared their support for me.

All these events and incidents aroused a new hope in me. A hope, though fragile and frail, that would make me strong enough in my fight against the odds and emerge stronger and smarter with unwavering confidence in myself and in my abilities to take forward all the connections of my heart to new levels.

Post-Chemo-16 effect

Today, I am feeling a bit feverish with rashes spread across my thighs and legs - some of the rashes carry pus, which might be a sign of minor infection! I had called up the doctor today and she had suggested me applying Betnovate ointment for the rashes.

After a long time, I had slept for around two hours in the afternoon! Probably, my body felt strained because of the toxins inside flowing through the blood! I have a feeling of dullness and loss of concentration which made me cancel my reading of business papers of the day. I spent calmly in the evening in the darkness of the room mooning about the good days ahead!

Chemo-16 today.

The recurrent and progressive thought of having a chemotherapy session every week is so powerful that the day before the session would be highly impacted by that thought! Such is the power of the chemotherapy!

I have had my 16th dose of Cetuximab and 6th dose of Irinotecan today as part of this week's chemotherapy. Though the last week is relatively a good one for me, the infusion of the Irinotecan can change the course of the next couple of weeks!

Some of the highlights of this week's session:

• the white blood count was 8.4 which is on higher side of the prescribed range of 4.0 - 8.0! This was the first time in my entire chemotherapy sessions that white blood corpuscles' population reached the higher limits of the prescribed ranges. This would have a positive effect on the immunity, though the infusion of Irinotecan and the use of Capecetabine for the next two weeks would again eat into the counts!
• there was a huge delay in getting the oral report of my weekly blood test today. It took almost three hours for the nursing staff to get the report from testing lab! This had a ripple effect on the treatment and discharge times. (I was discharged at around 7:30 PM instead of the usual 5 PM!)
• the nursing staff had a tough time this week too to get a proper vein, which would be used for the infusion of the drugs. After two pricks, each in left and right hands, they managed to get a vein in my left forefinger, which was a point of high inconvenience!
  
• my medical oncologist, Dr.Niti Narang spoke to me and was feeling positive about my body responding to the chemotherapy drugs. Of course, talking to her has always been an experience for me given her positive reinforcing words for me! :)

I reached home at around 8:45 PM today after getting discharged. I am feeling now terribly tired with my colostomy bag roaring since I had not much food today, and feeling drowsy and dull after the day's session! I wish the next couple of weeks would be smooth for me! :)

(Attached is a simple and video of my getting infused with chemotherapy drugs. I smiled in the video not because of the joys of getting the painful infusion but because life has given me more surprises! :) My mother was lost in her thoughts as well in the video!)

Chemo-15 today.

I have had my fifteenth dose of Cetuximab today. This marks the completion of fifth cycle out of six cycles proposed until now at Bangalore Institute of Oncology(BIO). I went to the hospital today with (a) severe pain around the edges of my feet which were split in several areas thus affecting severely my walk and (b) lot of inflammatory abscesses in my face which were a major irritation.

A few highlights of today's chemo session:

• Blood counts marginally improved (primarily, the white blood count increased from 3.70 last week to 3.84 today, which is a marginal increase given that the minimum still has to be 4.0)
• Nursing staff was literally on their toes in finding a vein in my hands for the infusion of the chemo drug. Finally, after a couple of pricks in my right hand causing severe pain for me, they had found a vein in my right forearm (See the attached photograph)
• My doctor, Dr.Niti Narang, did not visit me today for the simple reason that by the time the intra-venal (IV) infusion had started, it was already 3 PM and that was the time when my doctor usually completes her duty. (Of course, the duty doctor, Dr.Kartik had a look at my blood report and inquired about my health in general)
• Waiting time for the admission into the recliner was more than one-and-half hours, which was way beyond my limits of patience!

One good news for me is that I need to take a one-week break from the Xeloda tablets until next monday :) These tablets usually are affecting my appetite and general sleeping patterns. Of course, stopping them for a week might not make a major impact on my lifestyle though it is a welcome relief for me!

(The photograph shows two-plastered areas where pricks were made for the intra-venal (IV) infusion. The first prick on the little finger did not give a good vein and the second prick in the forearm was successful in getting a good vein. One can observe that the area below the fingers was black and a bit swollen because of the multiple needle pricks that were done in this process of getting a good vein for the infusion of today's chemo drug.)