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Friday, December 30, 2011

Zen Radiology: What Is The Ultrasound of One Hand Clapping

I haven't had anything to report and things are still "normal."  But I recently had an experience that was worthy of blogging.  All of the events are true.  Some are slightly embellished to make a better story.

One of my friends warned me about this shortly after I started radiation and chemotherapy in the summer of 2009.  "When you've had cancer," she told me, "any slight abnormality in a test and they'll strip you, throw you on a cold table, and probe you like an alien abduction."

After Thanksgiving, I went in for one of my every-three-months routine follow-up with my oncologist.  I describe these checkups as a social visit with a blood draw because, after the phlebotomist has taken two or three tubes of vampire juice, I see the oncodoc and we spend more time talking about non-medical issues.  My oncodoc did his clinical fellowship at NIH, where I did my research fellowship, so we're fellow alumni - but without the booster club, Saturday tailgates, and phone solicitations for donations. 

Everything at this visit went well and, after we talked about my recent family vacation, I walked down the hall to the infusion room to say "Hello" to the wonderful nurses.  I'm always happy to see them as I have fond memories of my time in the recliner with an i.v. dripping poison into me - seriously.  Despite the reason I was there, it was a very tranquil place for me.  The nurses create a cozy, comfortable setting for patients.  I'm sure they're pleased to see me and other chemotherapy "graduates" too because we are the fruit of their labors.

So anyway, a few days after the appointment, I'm at Home Depot and I get a call from the onco-office.  Some people might answer the phone with trepidation, but I wasn't worried.  I didn't have a scan or a CEA test, so they couldn't tell me that I had a recurrence.  Well, it could have been their billing department, calling to tell me that the insurance company denied some claims and that I owed them $200,000.  So maybe I should have been afraid.

But it was the onconurse calling.  "The Doctor saw the results of your blood tests and the liver test can back a little above the normal range.  It's probably nothing, but he wants you to have an upper abdominal ultrasound."

Now, had I been a regular patient - well, I wouldn't have been in the oncologist's office if I were a regular patient, but just play along - but had I been a regular patient, the Dr would have said, "Come back in three months and we'll do another blood test.  If it's still high we'll do an ultrasound."  But, because I'm not a regular patient, oncodoc ordered an ultrasound immediately.

One of the blood tests detects levels of alkaline phosphatase (AP).  Yes, that alkaline phosphatase that is linked to antibodies and other molecules and is used in diagnostics and research assays.  Come to think of it, that's probably bacterial AP in those assays, not human.  Anyway,  in humans AP is made by the liver, specifically, the cells that line the bile ducts.  High levels of AP levels may indicate bile duct obstruction.  An image of the liver will let the radiologist and oncologist know whether anything is blocking the ducts.

If you've been pregnant, or have accompanied a pregnant woman to the OB-GYN's office for an ultrasound/sonogram, you know that the poor woman has to drink a lot of water and lie on a table while the pressure of the baby pushes down on her engorged bladder and she's holding back tears and other fluids to get a blurry black-and-white image of something that's going in the scrapbook that only she and her mother will ever look at.  I write that in order to say that my experience was not at all like that.

I could not eat or drink for six hours before the ultrasound.  Now the appointment was at 11AM.  That means nothing after 5AM. That practically means no food between dinner the night before and the end of the ultrasound.  If you know me, you know that 16 hours without eating is impossible.  So I was up before 5 AM to eat breakfast.  Actually, I finished breakfast at 5:30, half an hour after the no-eat deadline.

"Don't tell me the sex of the baby," I said to the ultrasoundologist, "I want to be surprised."  She gave me a muted giggle.  Either she had no sense of humor or she's heard that joke 10 times a day from men since she started her job.  I prefer to think it's the former.

"When was the last time you ate?" she asked.
"About 4:30 this morning," I lied.  I wasn't about to give the the chance to say that she couldn't do the test today and that I'd have to come back another time.

I had to lie on my side, with my arm over my head (out of the ultrasoundologist's way).  She grabbed a bottle that looked like a white version of the cheap squeezable ketchup bottle you see at a hot-dog stand - you know, the red one with the conical nozzle - and squirted a bunch of room-temperature lube on my stomach.  She then had me inhale and exhale at various times while jamming the blunt probe into my abdomen as if she were trying to image my spine. "Take that for your stupid, unoriginal joke!"

Later, when I tell this story, I'll say that I spent the morning in a dimly lit room with a woman who rubbed lube all over me.

The prodding went on for about 10 minutes with the occasional replenishment of lube.  When she was finished, she kindly handed me one paper towel to clean up.  I put my shirt on, somehow managing to track the remaining lube all over my back and neck,  I had planned to go to work after the ultrasound, but I had to go home and shower.  Who wants to go to work smelling of K-Y?

A day later, the onconurse called to say that everything was normal.

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