CR 827: Another good CT scan (I think)

On Tuesday I went into Kaiser for another CT scan. Drank the banana smoothie-flavored barium contrast 4 hours and 2 hours in advance, got my blood drawn for my labs, then had three more sticks as a rookie CT tech fished in my arms for a vein. I wish that Kaiser could just use the same needle and vein for my CT as they do for the labs, but that would take planning, coordination, and concern for the patient. I have never quite mastered the art of patience while nervous techs try multiple times to properly place an IV. I am not your pincushion.

Once everything was in place, the CT took seconds. Following injection of the ionic iodinated contrast, I felt the familiar feeling of warmth as it triggered an increase in intravascular osmolality, causing a shift of water into the veins. This increase in blood volume caused vasodilation that spread throughout my body in seconds, lodging in my pelvis. Cancer has significantly improved visibility with iodinated contrast. 

I've long gotten over "scanxiety" -- the fear of what a CT may reveal -- since I've accepted that a CT is purely retrospective: it shows what has already happened. Plus, I'm utterly at peace with the fact that I don't control my cancer, and learned long ago not to worry about things I can't control. I have, however, thought about the frequency of my CT scans -- I've had nearly 30 in the past 6 years -- and whether the 20+ milliverts of radiation exposure is worth the risk. I've shrugged my shoulders and assumed that its far more likely that my mets BC likely will kill me before any CT-induced cancer could manifest itself and willingly laid down on the scanner.

After the scan was done, the fisherman tech reminded me to drink lots of fluids, which I consistently interpret as medical orders to go to McDonalds for some sausage and egg burritos and several liters of Diet Coke. I slurped my soda as I drove down to Lake Anna to get another load of stuff from our lake house, which is finally under contract. It will be good to unload that -- we had lots of good memories there, but with our nest empty it's time to let someone else enjoy it. 

As I was returning home, a nurse from Kaiser called me with the results of the CT. She said that the radiologist had not seen any signs of new metastatic activity. Yay! However, the radiologist detected a new scar on the upper right lobe of my lung, about 13 mm long and 3 mm high. She could not determine what caused the scar, but did not see it as a cause for concern. "We'll continue to watch it," she said. Humm. I was glad that I was scheduled to go up to Hopkins on Thursday to check in with Dr. Hahn as part of my follow-up for my clinical trial. I wanted his thoughts.

Yesterday I drove up to Hopkins with the CD of my scan. Dr. Hahn spent some time studying the CT scan, and could not make out what the Kaiser radiologist had reported. He said he'd have the Hopkins radiologists study it, but saw no cause for concern. 

We also discussed the latest durability data. He said that the longer term data from immunotherapy patients in other trials with other malignancies (mets melanoma, kidney, lung) continued to suggest that patients who got to 24 months of remission lad a low risk of recurrence. From a biological standpoint, he thought that it was highly likely that all of my cancer cells that had the PD-1/PD-L1 interaction had been destroyed by my body's immune system. There was always a possibility that I had some stem cells harboring that type of cancer, but as time goes on it becomes less and less likely that it would manifest. The bigger question is whether another mutation would start growing. Dr. Hahn had previously told me that was the most likely thing that would happen. But as time goes on, the likelihood of that happening decreases. These thoughts continue to be assumptions built upon extrapolations built upon suppositions, since "I am the data" for metastatic bladder cancer durability. 

We also discussed the frequency of future CT scans. Dr. Hahn wanted me to have another scan in 12 weeks, which would bring me to one year after ending my infusions of nivolumab. He could not remember if the clinical trial protocol contained guidelines for the frequency of CT scans following 1 year of completion of treatment, and would look into it. He suspected that at some point, he'd want to shift from 12 week intervals to 16 week intervals, and eventually to 26 week intervals between scans. I'm ok with that. 

Today, I received the report from the Hopkins radiologists. They compared this scan to the 13 earlier scans that I have had since February 2015 (when I started the clinical trial), and saw no new lesions. My target lesions -- the tumors that they used to determine the success of the Opdivo -- continued to be totally undetectable. My non-target lesions (other tumors of note) also continued to be undetectable. So what did the Kaiser radiologist see? To quote Shakespeare in Love: I don't know. It's a mystery.

October 9, 2017 addendum: Dr. Hahn sent my CT for a second opinion, and today that reading was posted by Hopkins in my chart. The radiologist saw no evidence of any metastatic activity or other abnormalities, other than "patchy bilateral ethmoidal mucosal opacification" e.g., some solid mucus in my sinuses. Woot.