November’s Ultrasound

I had an ultrasound on 11/11/13.  Both John and Judi went with me.  It’s taken me a while to write about this scan because the experience was upsetting and because I wasn’t happy with the findings and needed time to process both issues.  (Oh yes, then there were the holidays, some travel, and then another health development…)

The procedure itself was upsetting because I felt the radiologic technologist violated professional boundaries with her comments and questions.  I’m over that now, but it took a lot of journaling and conversations with Judi and John to calm down.

After all, what really matters is what the R.T. found out and the radiologist on call verified:

Tumor #1 (The Fish), is now 37x27x33 mm (from June’s MRI measurement of 28x27x34 mm).  It looks more like a star than a fish now. This is the ductile tumor.

Tumor #2 (The Ghost), has also changed shape.  It’s almost completely spherical, and it’s 15 mm (from 9x8x11 in June).  It’s rounder than it’s earlier shape.  Up until this ultrasound, it had been stable in size and shape.  I wonder if the ghost busting got this lobular tumor to budge.

Tumor enlargement comes before the healing crisis, so I remained confident that I was on track for the cancer clearing phase of treatment.  There’s a pulse quality on the right wrist that indicates metastasis, and neither Brendan nor I have detected this quality.

When she called to follow up on this ultrasound, Kari (my surgeon) told me that she was worried about me but would continue to support my treatment plan.  I reminded her that Tumor #1 started out at 33 mm, so the net growth from March 2012 to November 2013 is approximately 4 mm.  Tumor #2 was 14 mm in March 2012 and is now only 1 mm larger.  We agreed that, given the slow growth overall, I could skip the March 2014 ultrasound and not measure again until the annual MRI in June, especially since my lymph nodes were still clear at the 2013 MRI.

In the meantime, I needed to deal with some persistent low back pain.

Results are in

I haven’t actually seen the MRI report, but Kari, my surgeon, emailed me the executive summary yesterday:  the smaller tumor remains the same size; the larger one, which was 21-23 mm in February, is now 34 mm (approximately its size at the time of diagnosis).  The lymph nodes all look normal.

I have to admit I had some moments of doubt when I got Kari’s email.  Of course.  But they really were just moments.  Doubt morphed into respect when I remembered that Brendan changed his treatment strategy about six weeks ago to precipitate this healing crisis because he judged, from my pulses and presentation, that I was strong enough to clear the Fire Toxins.  We were expecting the tumors to grow.  Still, having my Heart Vaporize the Phlegm (spontaneous remission) would have been so much easier (though less interesting, I suppose, as blog material).

Subjectively, I’ve known that The Fish is growing.  It’s now closer to the skin and seems much bigger than it was.  It does seem softer, though.  Biomedicine cannot measure the density of a tumor, just it’s size.

The smaller tumor, The Ghost, has remained fairly stable in size.  I can’t speak for its probable density, since I can’t palpate it.  I’ve been puzzling over why the treatments haven’t had the same impact on this tumor as they have on the The Fish.  After reviewing all my class notes, I think I now have the answer.

Last summer I attended Jeffrey Yuen’s annual retreat for his advanced students.  These retreats aren’t focused on one topic like his regular seminars.  Instead, he addresses concerns and questions that arise when experienced practitioners want to go deeper into their understanding of classical Chinese medicine.  One of the days was devoted to questions about the seldom used secondary acupuncture vessels known as the Divergent Channels.  Divergent Channel treatments focus on serious chronic diseases.  Divergent Channel treatments require nuanced pulse diagnostic and needling techniques that are difficult to master.  Since cancer is clearly a serious chronic disease, Jeffrey used me as the class’s case study.

In the course of interviewing me, taking my pulses, and working out a possible treatment strategy, Jeffrey talked to us about breast cancer in general.  He said that ductal tumors are problems of the jin-ye fluids, especially the ye (don’t worry about that) and are usually related to the Triple Heater and Small Intestine (Fire organs, the yang aspects of the yin Pericardium and Heart).  In his experience, these tumors resolve faster than lobular tumors, which he believes arise from Dampness and Phlegm, terrains that create the most stubborn pathological states.  The Fish is ductile, The Ghost is lobular.  That explains why one tumor is responding more quickly to the treatments than the other.

(A few months ago, for a different reason, I started a 100 day Daoist regimen for exorcising ghosts.  More on this later.)

Now that I have proof that the healing crisis is upon me, I need to adhere more closely to my diet, exercise (gotta get back to qigong), and detox bath regimens.   I don’t want to give those cancer cells any excuses to linger.  “Get off my plane!”

It looks like I might have to go through a second healing crisis down the road to clear the lobular tumor, unless my Heart can vaporize The Ghost’s Phlegm.  All things are possible!

Prognosis

The MRI a couple of days ago went smoothly.  For one thing, I’m not claustrophobic, and the other thing is, I kind of enjoy the clanging and banging sounds when I have ear plugs to blunt the noise level.  I spend the 40 minutes or so trying to discern a rhythm and make up songs to fit, a bit like composing melodies to accompany jack hammers.  This time I didn’t even mind the IV (for sending contrast dye into my veins).  The best part, of course, was the post MRI celebratory lunch with John, Judi, and her husband Stan.

I don’t know why I felt the need to celebrate, except that an annual MRI represents a milestone of sorts (may there be many more in my future).

Unlike ultrasound scans, which give feedback in real time, MRI pictures need to be analyzed, then the report is sent to the surgeon before I get to see it.  I don’t remember from last year what the time lag is, but I think it’s about a week.

In truth, I’m not sure what results to hope for.  No matter what I learn about the size of the tumors, interpretation will be open.

The general prognosis for the Clearing Fire Toxins stage of cancer treatment in Chinese medicine goes like this:  as the fire toxins cool down and lose strength, all the cancer cells in the tumor are forced to mature without reproducing, and then the mature cells die because their environment no longer supports them.  The body mops up the dead cells and excretes them out through increased urine, feces, sweat, and/or (not this one, please) skin eruptions.  The expected healing crisis is tumor enlargement followed by some personal hygiene problems for a while.

So, although it’s been gratifying and reassuring that my tumors have been shrinking, it won’t upset me to learn they are growing.  The surgeon has been warned.

Yet, this will be the time when I’ll need a lot of support and self-confidence to keep from freaking out that the tumors are growing oh my god are they metastasizing am I doomed?

“Do I contradict myself? Very well, then, I contradict myself; I am large — I contain multitudes.”  (Hmm, did Walt Whitman have cancer, too?)

If the tumors continue to shrink, that’s also just fine.  That could indicate a more relaxed manifestation of spontaneous remission: “The Heart Vaporizing Phlegm in Slo-Mo”  (my contribution to Chinese medical metaphors).  There’s no explanation for this in Chinese medicine to my knowledge, but I would guess that my wei qi (immune system) is nibbling away at the cancer cells.  Or, it could also mean that my cancer cells have had a change of heart and are giving up their rebellious ways and returning to normal, thereby achieving a different type of cell maturity, so to speak.  (That’s what I’ve been visualizing.)

Should it turn out that nothing’s changed, that outcome would provide me with another great opportunity to practice the virtue of patience.

So, each of the possible MRI results (larger, smaller, the same) could be a winner.

The envelope, please.

Quick Update

It turns out that changing your life can take up a lot of time, so writing here got shoved to the bottom of the list. Now that some of the dust has settled on the (re)construction site, I’m ready to resume this story.

Just so you know, the tumors are retreating. Tumor 1 (which Judi nicknamed “The Fish” because of its shape) was 32-34 mm and Tumor 2 (“The Ghost”) was 14 mm at the time of diagnosis (March 31, 2012).  Last week’s ultrasound roughly estimated that The Fish is now 21-23 mm (and the length of its spicules about half) and The Ghost is 12-13 mm.

My surgeon, who has to authorize my ultrasounds and MRI’s, met with me a week later with huge smiles on her face.  The best she had hoped for me, she confessed, was for the tumors to remain stable.  She’d never heard of tumors shrinking before, nor could she imagine I’d have such dramatic results so quickly.

The next look-see will be an MRI, which gives a more accurate measurement, in late June.

In the meantime, I’ll fill in what’s been going on since my last post, almost 6 months ago.