The Cancer Diaries, Part 16

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Bone denstiy scan (not mine)Yesterday, I went for my second bone density scan — aka bone densitometry or dual-energy x-ray absorptiometry — the one that had been planned, but scheduled then delayed twice previously. My first bone scan, like my first CT scan, was done in June, before my surgery. This one was ordered by the oncologist prior to my radiation treatment.

Bone density scans are used for many types of diagnoses, including measuring bone loss and osteoporosis, but also to detect the spread of cancer cells. My previous scan showed the cancer had not spread into my bones (a tremendous relief). I hope the second one shows that same result; bone cancer is very nasty. Not that any cancer is good; some are simply nastier than others.

I arrived at the hospital — after my 60 km drive in the first taste of winter snow and wind — early, as usual, with several books to keep me occupied. I also managed to finally reach someone in the parking kiosk and buy a 30-visit pass for my upcoming radiation treatments. The kiosk sign says it’s open 8 a.m.-4 p.m., but in reality, they close at 3:45, which proves highly inconvenient for patients like me who have to stay later. I think I’ve spent more in parking at RVH than in any other aspect of the treatment to date (my usual fee is $15.25 per visit; it would be almost $20 if I wanted in-and-out privileges). I’ve also found the staff I’ve spoken to in the hospital seem unaware of, or confused about parking options, costs, or the hours the kiosk is open.

Waiting, as I’ve said before, is a big part of the process; this one starts with an injection, then a two-three hour wait before the actual scan. Or, if the nuclear medicine department is very busy, it could be even longer (one of the prior schedules for this scan had an almost five-hour wait!). I chose to get a coffee, sit in the open area, and read. I could have gone back to my car and driven somewhere to shop, but it has snowed that morning; not a lot (5-7 cm) but the streets were icy, the traffic slow, and I didn’t feel like fighting it. besides, what do I need to buy in Barrie? I preferred to read quietly. 

(Among the books I brought, I was almost finished re-reading Mexico Set, the second of the first Len Deighton Cold War spy trilogy, and finished it when I got home. As usual, I was working through several other titles I had brought along. My usual calculation is to bring a different book for every 20-30 minutes I have to wait, but to be honest, like yesterday I sometimes get drawn into fewer. Still, it’s nice to have options available.)

Unlike many processes and scans I’ve been through since my diagnosis, this one required no preparation and had no limitations on food or drink beforehand. I didn’t even have to change into the usual hospital coat and gown, nor have a full bladder. For which I was thankful.

The injection takes maybe three to five minutes, mostly in getting into place for it. And the nurse or technician finding a suitable vein, of course; I’ve had so many injections, blood tests, IVs, and so on this year that my veins are a bit bruised and reluctant to participate in more. The shot contains a small amount of radioactive tracer material. Not enough to make you glow in the dark (that could be fun…), but enough for the scanner to detect once it settles throughout the body. As the Mayo Clinic says,

Areas of the body where cells and tissues are repairing themselves most actively take up the largest amounts of tracer. Nuclear images highlight these areas, suggesting the presence of abnormalities associated with disease or injury.

I was led into the nuclear medicine department on time, given my injection (quite painless), then let loose to do as I saw fit for the next two-and-a-half hours. Not that there’s a lot to do in a hospital. There are a few small eateries in the building (including a Tim Horton’s in the atrium and a somewhat more upscale coffee shop near the main entrance), and a gift shop that seems geared to women, but sadly no book, newspaper, or magazine outlet (or even a section of a store for it). Just sitting staring at one’s phone for 150 minutes simply looks sad and lonely.  Hence my books.

I was a bit surprised at the number of junk food and pop dispensing machines in a healthcare facility. That struck me as either very hypocritical or simply venal. 

One thing I noticed is the dearth of clocks. There’s a large one above the atrium, and a smaller one in its lower level, but none to be seen in the halls or waiting areas. If you look for them, you can see some in rooms or reception areas, but not waiting areas. Was this a deliberate decision, something to do with the psychology of patient care and waiting? Or just some bizarre oversight in the design? I had to keep checking my phone to be sure I was back in the department on time for the scan.

Back in the department, after only a few minutes of reading, I was led into the scanner room by another of their friendly technicians and nurses. I should take a moment and comment again on how good I’ve found almost everyone at RVH: supportive, friendly, comforting, all of which matters when you’re in a stressful health situation like mine. I’ve only ever had one less-than-friendly contact there in my many visits.

The scanner they use at RVH may be a bit old because I could not find an image online of anything as bulky and mechanical. If it works, I suppose age isn’t an issue, but at least in online images there are many smaller, less 2001-Space-Odyssey-style scanners in use these days. This one has a long bed you lie on while the bed moves slowly (very slowly when imaging; imagine a snail racing past you) in and out, below the bulky camera suspended above you. When doing a 3D view (as they did of my spine), the camera rotates around your body taking images from many angles; a huge, sluggish machine. You just have to wait for it to do its work.

The camera is placed close to your body. When imaging your head, it is less than a hand’s breadth above your nose. Not comfortable for people with claustrophobia, but I was okay. And that was the shortest of the imaging segments.

The entire scan takes about 45-60 minutes to get every section (my time was the latter). They did my abdomen first, then my head, then my whole body, and finally my spine (in 3D). Since nothing touches the patient, there’s no pain or sensation of any sort. The hardest thing is to simply lie still for the duration. The spinal scan is about 15 minutes, the full-body scan about 20 or 25. The rest I had were about five-ten minutes each.

Muscles have a habit of twitching or tensing when you’re trying to lie still, and I got random itches I wanted to scratch, but couldn’t. I kept trying to relax, and recall the calming and breathing exercises I learned when I started to learn Buddhist meditation so many decades back. They helped, but my mind kept doing the monkey-wandering thing. It’s hard to believe I was more focused and controlled when I was in my 20s, but there I was, trying not to twitch and shift. I kept wanting to pick up a book and read…

It’s also difficult not to fall asleep while lying motionless for 10-20 minutes. There’s nothing to distract you, and the soft humming of the HVAC and the machinery is like the susurrus of waves on a shore: conducive to sleep. Not that sleep is bad, and the technician told me many do fall asleep during the scans, but I was constantly afraid I’d twitch or turn if I fell asleep. This would require starting that segment all over and likely get me disapproval from the technician. I have enough people in my life who disapprove of me these days (okay, some are room-temperature-IQ members of our local council, but still…)

Staying awake and alert was made more difficult this particular day because, several times in the night before, my dog had had an upset gut, and required me to wake up, get dressed, and take her outside a few times to relieve her bowels during the night (with a little flashlight so I could see to pick up after). But I suppose I managed to be still enough no re-takes were required. I was able to re-thread my belt, put my glasses on, and leave for the blustery 60 km drive home.

That’s it for a week or so. Next up: radiation treatment and whatever effects I have from the hormone therapy I’ve embarked on.

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