But that's not the full story. The PET scan did show a "lit up" area, the remains of my left high cervical lymph node that was the most swollen (presumably the largest tumor) and that motivated me in late July to make an appointment with the ear, nose, and throat physician who ordered my original biopsy in Costa Rica. Being "lit up" means that it contains tissue that was absorbing the radioactive glucose injected into me for the PET scan and that positrons were being emitted and detected by the scanner. PET is short for Positron Emission Tomography, and involves injecting the patient with a solution of a glucose analog containing radioactive molecules that get released when metabolized by rapidly dividing cells, a key characteristic of cancer cells. During a PET scan, these cells release positrons detected by the PET scanner. By Hopkins' criteria, the level of positron release was well below the threshold indicating the presence of cancer, hence the finding that I have no cancer. My Hopkins doctors believe that the lymph node that "lit up" was still somewhat inflamed from my radiation treatment that ended on Dec. 5. However, they want me to return in two months for another PET scan to see whether it no longer lights up or if it lights up more. If the positron absorption level is above the threshold indicating the presence of cancer, they'll consider removing it surgically. The lymph node shrunk greatly during treatment but remained palpabl at the end of treatment. I was told that it might continue to get smaller and disappear; however, it was still palpable and apparently the same size at my 6-week follow-up appointment at Hopkins on Jan. 17, when they told me that it would not be unusual for scar tissue to remain after radiation kills the cancer cells in a greatly enlarged lymph node.
In my last blog entry on January 14, I shared my strong desire that my PET tube would be removed at my follow-up appointment on the 17th, but I was greatly disappointed that Dr. Gourin had recommended that I wait for my PET scan to make sure that no cancer remained that might require surgery affecting swallowing. If the PEG tube had been removed, and I had eventually required surgery preventing me from nourishing myself orally, a new tube would have had to be placed, a surgical procedure. So I had resigned myself to waiting for my PET scan, hoping the results would convince my doctors to allow removal of the tube. However, the tube fell out by itself early in the morning of my PET scan as I was giving it its required daily rinse. On Saturday after my airline flights north, I had possibly displaced it during extended dry coughing, apparently collapsing the inflated balloon that kept the tube in my stomach and possibly tearing some stomach wall muscles. So one way or another, the PEG tube is out, which also makes me happy. My stomach muscles are recovering and my tube incision is healing fast.
My blood tests at Hopkins showed that my hemoglobin, hematocrit, and red blood cell count have all increased considerably since January 16, and my indicators of kidney function remain excellent. My other blood constituent levels are also within normal ranges.
It's great being able to spend time with Raquel, and visiting Flor de Liz, Leroy, and Bibi Snyder, where we're staying in Huntingtown, MD. Now that my appointments at Hopkins are over, Raquel and I will enjoy spring weather in Washington DC tomorrow.
I'm attaching an image of my throat and the top of my voicebox, taken from above in my larynx by Dr.Quon with his new Olympus endoscope and copied by him from his system's image logger to my flash drive. He says that my throat has recovered to the point that there's no sign that the tissues have been irradiated. My vocal chords are "clenched" because Dr. Quon had askd me to say "eeeee." The base of my tongue is at the bottom of the image.
