It's been a long while since I did a dKos diary. Been fighting a few things over here that kind of came to an interesting sort of head last week -- plagued by what I thought was a swollen gland condition, that wouldn't go away after four separate rounds of antibiotics, and three different medical facilities, including two trips to the ER -- I finally got into see a doc at the local elder care facility. I hit 60 last 3/17. That was my ticket in.
He took one look at the "swollen glands" and sent me for a CAT. Read about it and my reactions to entering "the system" below the fold.
What’s in a CAT Scan?
I’m ordinarily not one for Gallow’s Humor, but apparently my now 60 years of days are numbered here on Planet Earth. I’m not entirely sure what it is that I am fighting but from the looks of the following I’ve outlived my own death by some weeks. Pretty serious potential cancer diagnosis upcoming here, methinks. Anyway for the benefit of any who are curious, who are long-distance healers, or who just want to send good wishes here is my CAT scan, soon to be followed by my biopsy results (due next week). Treatments, if any, will be blogged here, as will my reactions, etc.
I’m a self-pay. That means we don’t have insurance because we can’t afford it. It also means that I have to go through charming conversations with office people who ask "can you leave a check today?" at the end of a procedure — and with doctors who say "I didn’t do the test you requested because I knew what it was and it would have wasted your money", and a whole host of other things done to discriminate against people who have no insurance. This is all about having enough vs. relying on what can be provided if you have nearly nothing.
By all lights, according to this I should be six feet under yesterday. I’m not. Ergo, more things are happening here than people understand. This thing reeks of CYA, IMHO. Cancer, and this whole national medical nightmare, like everything else in this country, is motivated by FEAR. This is the same FEAR that has kept us trapped, prisoners of our own devices, for over 20 years, while those with power took even more power, and let the "private sector" determine the flow of everything from care to justice in America.
Further, it’s a protection racket. You’re gonna die if you don’t let us protect you. Frankly, if you’ll pardon the cynicism, I’m going to die anyway — and I could be hit by a car tomorrow.
We should have had this cancer issue solved forty years ago. We haven’t, and the AMA and organizations like it are no where near breaking the field open to provide enough practitioners to tend to the population. Never have been interested in that, oh no, save the big bucks for them that matter.
After three bouts of pneumonia since 2003, including other CATS, countless trips to the ER and Immediate Physicians Care facilities both in Texas and Oklahoma, and primary care internists, its inconceivable that all this could be missed. We need preventative exams, up front, baseline scans for everyone, and full internet access to medical records. NOW.
We need national health care with a computerized link up so that every patients records, no matter how MINOR can be seen by doctors up the road. In my case, just a few months ago, my "swollen glands" were ultrasounded, and well, were, "swollen glands". I'll be interested to see what the biopsy report shows on Wednesday next, and what's in line for treatment.
Social Security disability may be open to the likes of me with the "right diagnosis" several months after the fact, if the "right steps" are followed. Following through their links the other day was even crazier than dealing with the offshore billing companies for the doctors offices, who want to set up payment plans but don't yet know the amount of the doctor's visits.
It's Alice in Wonderland meets the Matrix.
Anyway: Here is the CAT Scan, verbatim.
FINDINGS:
- There is a large mass involving the right neck base, right lung apex and right axilla. These have approximate maximum diameters of 9, 7 and 8 cm respectively. This is likely metastatic adenopathy.
- There is resultant obstruction of the right subclavian and right internal jugular veins. The superior vena cava fills through right chest wall venous collaterals.
- The airway is displaced to the left but not obstructed.
- There are other smaller individual right axillary and mediastinal nodes. These measure up to 2.8cm.
- The breasts are incompletely imaged. The right breast appears engorged with skin thickening. There are 1.4cm right and 1.7cm left breast nodules.
- There are diffuse subcutaneous metastatic nodules. These measure up to 2 to 2.5cm. The largest lesions are seen at the left lower paraspinal, epigastric and right lower chest wall regions.
- There is a large right pleural effusion.
- There is suggestion of a 3.4cm right middle lobe mass. This may represent a bronchogenic primary.
- The right lower lobe is completely collapsed.
- There are no adrenal masses.
- There are no adrenal masses.
IMPRESSION:
- Large right neck base, right apical and axillary mass, likely
metastatic adenopathy.
- Chest wall and breast lesions, likely metastases.
- Large right pleural effusion.
- Possible right middle lobe mass.
- Right subclavian and internal jugular vein occulsion.
- Right hydronephrosis.
Update 1 -- April 8, 2009 The Biopsy
Wednesday, April 8, 2009
When I failed to look impressed, the primary doctor did volunteer that this was a Stage 3 cancer, but they weren't opting to do a bone scan yet. No one was committing to which breast it was either, because this kind of breast cancer isn't the normal kind. In a way I'm lucky, because if this tumor didn't form and didn't get analyzed, this cancer could have been totally missed. It's on it's way up in the world, with more cases being reported every year. And, yes, it metastisizes anywhere it damned well pleases. Just a few pdfs online about it...
Mayo's got a great definition of it here. Anyway, on to the biopsy. I may need hormones, or hormones and chemo...in any event the appt. with the next step on the food chain, the "cancer doctor" isn't until the 16th of April.
Diagnosis
---------
Soft tissue, right supraclavicular area, needle biopsy --
poorly differentiated carcinoma, morphologically and immuohistochemically
consistent with lobular carcinoma of the breast (see microscopic
description).
Microscopic Examination
-----------------------
Sections are of fibroadipose tissue containing an infiltrate of relatively
discohesive epithelioid cells containing small to moderate amounts of
amphophilic cytoplasm and mildly atypical nuclei. Small numbers of cells
with signet ring-type formation can be identified. The morphology on H and
E stains is consistent with an invasive lobular carcinoma of the breast.
Immunohistochemical stains are performed for further evaluation. In
addition to the stains below, a mammaglobin stain is also performed and is
positive. The results of the stains, in conjuction with the morphology,
support the diagnosis of metastatic lobular carcinoma of the breast.
Immunohistochemical Results
---------------------------
Antibody Specificity Result
-----------------------------------------------------------------
HER 2 (4B5) c-erB-2 protein results pending
KERATIN AE1/3 pancytokeratin strongly positive
CDP breast ca marker positive
E.R. estrogen receptor positive
P.R. progesterone receptor negative
E-CADHERIN cell adhesion molecule negative
Both positive and negative immunohistochemical controls have been examined
and are found to stain appropriately.
Gross Examination
-----------------
Needle biopsy:
number of fragments/cores: 4
length/range: approximately 0.1-0.9 cm
description: tan fibrofatty tissue with fragment of blood clot 0.6 cm
in length
The specimen is entirely submitted in one cassette for microscopic
examination.
Specimen
--------
Needle biopsy, right supraclavicular area