Jumping To Conclusions

It's not even winter yet, officially.You know, technically it’s not winter yet. Just thought I’d mention that. And there’s this global warming thing they’ve been talking about in Copenhagen. So, imagine our surprise — and by “our,” I mean most Americans living east of the Mississippi — when we looked out our doors over the last few days to see two feet of snow. Two feet. Twenty-four inches. Give or take an inch or three. Call it about fifty-five centimeters, for those of you who are metrically-inclined. Yeesh. Winter doesn’t officially start until tomorrow, by the way. I’m just saying.

Meanwhile, I don’t know about you, but I’ve just had a really tough week. Or two. Or month. Or year. Remember all that coughing I was doing? Well, it got worse before it got better. And remember that chest X-ray that didn’t show any “gross acute findings?” Here’s a little piece of advice about any kind of test results, especially for diagnostic imaging. Never hang your hat on the conclusion, usually referred to as the “Impression” on the report. The purpose of the Impression is frequently just to state whether or not you face immediate death if you don’t get something stitched up or taken out right away. Most of the time, you are not facing immediate death when you get an X-ray or an MRI or a mammogram. Thank goodness. However, you may have symptoms — like chronic coughing and shortness of breath, for instance — for which you are seeking an explanation. And, as luck would have it, the explanation is usually somewhere in the report. It’s just not in the conclusion.

In my day job, I read diagnostic imaging reports from time to time. And I swear to god, radiologists seem to enjoy soft-peddling things, making you hunt down the nuggets of pertinent information which are invariably buried among misleading verbiage like “insignificant,” “unremarkable,” and “mild.” It’s as if they are utterly bored with your innards unless they find something really interesting — like a massive brain tumor. “Oh, ho-hum, your shoulder is full of arthritis but don’t worry about all those little pointy things we call ‘spurring’ that stick into your rotator cuff tendon and rip it to shreds, because it’s only ‘mild spurring.’ I mean, you can still sign the check for the co-pay, right?” Yeah, sure. Just remember, radiologists don’t have real patients. A radiologist might spend his or her entire career without actually having to talk to anyone who’s not wearing scrubs.

contrasting X-rays
Since I no longer trust anybody anymore, including the people I do trust, if you know what I mean, I got myself my own copy of the X-ray report. And once I backtracked from the “incidental chronic findings” mentioned in the Impression, I discovered that my real problem was that I had “some mild scattered fibrotic changes” in my lungs. So, here’s the thing. “Fibrotic changes” comprise one of those bloody euphemistic medical phrases which make me completely insane. It’s not quite as onerous as “breast-sparing surgery,” which is about as sensible as saying “jumbo shrimp,” but it’s right up there. Remember my post about what radiation actually does (The Gift That Keeps On Giving)? Remember that business about how it destroys cell DNA, etc.? When our normal cells try to fix the damage from that, they tend to replace the original tissue with stuff that’s more fibrotic and less stretchy than the original stuff. These fibrotic changes, when they show up on the outside of the body, are commonly known as scars.

And so, ladies and gentlemen, I have scars in my lungs. From radiation. Huh. That’s not good, you know. You can’t fix scar tissue. You can work with it maybe. But you can’t make it go away. After I got that happy news, I asked for and got a copy of my X-rays, including the ‘normal’ chest X-ray I got five years ago during my pre-op work-up before surgery to remove a herniated disk. I also asked for a prescription for an inhaler with a steroidal anti-inflammatory, because oral prednisone, good as it is, was not doing the job. Now I knew why, at least. Turns out that the radiation pneumonitis, or lung inflammation, that may develop six to nine months after radiation, often goes undetected and goes on to form pulmonary fibrosis. This fibrosis occurs typically about a year after breast cancer radiation is received. Bingo. Right on schedule.

I’m happy to report that Flovent works very well. I haven’t stopped coughing altogether, but I’ve been able to breathe deeply a good deal of the time without having a coughing fit. Which is good because when I got up today, I was facing the prospect of digging my way out. There were snow drifts at all three of my doors. My dog took one look out the patio door, and turned right around to go back to bed. I’m also happy to report that some of the clinical advice I’ve been dishing out to my pulmonary patients is actually useful. To wit, carefully-paced cardiovascular exercise is good for stretching the fibrotic tissue in one’s lungs, when it is done with a proper warm-up and cool-down. Thus, duly warmed up and cooled down, I was able to shovel out part of my driveway today so that I can go to work tomorrow and keep my health insurance. I also discovered that hot cider is a lovely way to keep from coughing one’s brains out after one has stretched one’s fibrotic lungs by way of shoveling, then come back inside, whence they shrink back and restrict one’s breathing again.

If I stop and think about the fact that no one discussed with me the possibility that I could develop pulmonary fibrosis before they got me to agree to let them zap me last year, I fear I shall not be able to maintain the proper holiday spirit this week. So, instead, I shall focus on the fact that in spite of the above, I was able, slowly and methodically, to clear two feet of snow out of about fifteen feet of driveway in a swath just wider than my car, which works out to be about 200 cubic feet of snow, without making my fibrotic right armpit and shoulder sore, and without coughing up my fibrotic lung afterward.

Joy to the world.Besides which, I’ve already enjoyed several satisfying and cleansing sessions of righteous verbal outrage about this nonsense with my girlfriends. Thank goodness for girlfriends. Joy to the world.

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This entry was written by Kathi, posted on Sunday, December 20, 2009 at 09:12 pm, filed under Fatigue, Health & Healthcare, My Work Life, Radiation, Survivorship and tagged , , , , , , , , , , , . Bookmark the permalink . Post a comment below or leave a trackback: Trackback URL.

3 Responses to “Jumping To Conclusions”

  1. It is an amazing post from you Kathi.. I am sorry that you were not well informed the problems that you would face after radiation…
    I love that sticker you have put up… goes well with your spirit.. Love and hugs to you Kathi.

  2. It is making me cold just looking at your pics. I am dragging around here becasue it is in the low 30’s. No snow. I hate the cold…especially since I am going to have to work outside in it. But it is to get to the mid 50’s today they say.

    Love the note….Cancer you picked the wrong bitch.

    That was a lot of snow you moved. Too bad you couldn’t get a very safe flame thrower and zap it all away in minutes.

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