Thursday, December 9, 2010

skipped my CT

I had a choice to make last Wednesday morning:

Get up at an ungodly early hour (unless you’re still out), have nothing to eat or drink (thus precluding the previous parenthetical), spend almost an hour on public transport (and then an hour back, unless something goes horribly wrong and you have to stay at the hospital – wouldn’t be the first time) to wait another hour in a room full of sick people (which could describe half the country right now), while drinking a liter of god knows what contrast solution… all just to get zapped with carcinogenic ionizing radiation over about 20 – 30 minutes in a tube (or longer – meaning twice, meaning up to six exams - if you or they screw it up – which also wouldn’t be the first time):

An abdominal CT delivers 2000 times more ionizing radiation than a dental X-ray. What’s wrong with that you ask? The New England Journal of Medicine says:

X-rays can also ionize DNA directly. Most radiation-induced damage is rapidly repaired by various systems within the cell, but DNA double-strand breaks are less easily repaired, and occasional misrepair can lead to induction of point mutations, chromosomal translocations, and gene fusions, all of which are linked to the induction of cancer.
They go on to say:
There was a significant increase in the overall risk of cancer in the subgroup of atomic-bomb survivors who received low doses of radiation, ranging from 5 to 150 mSv; the mean dose in this subgroup was about 40 mSv, which approximates the relevant organ dose from a typical CT study involving two or three scans in an adult.
So, I’ve been hit with countless atomic bombs already (including PET scans – which are worse and radiation therapy – which is much, much worse), when they were ostensibly necessary. What’s another gonna do to me? Or:

The chance to get paid €1000 to fly to Turkey for the weekend (-12º C vs. +22º C) with all expenses paid to act like a sleeping businessman in a Turkish Airlines commercial. Hmmm. Tough choice (or just look at the subject). So:
I got up at the ungodly hour of 6:30 AM, made some coffee (and hence my choice), opened the sealed hospital envelope looking for the number of the CT department. The report read: ‘Following complete remission…’ and was to involve three CT scans, but no phone number. I sent my oncologist an SMS and cancelled.
I went to the casting. I didn’t get it. Maybe it was my post-op passport picture of a skinhead with a black eye and stitches on his head - I have a lot of trouble with this and get to talk about my brain tumor at every border. Maybe my Turkish isn’t what it used to be. Maybe it was because I gave away all my ties when I thought I was dying and didn’t look much like a businessman. Maybe I just slouch too much when I pretend to be sleeping. Whatever the reason, it was still the right decision:
No one knows better than you how YOU feel. That’s why the doctor asks you, “How do you feel?’ or “Does this hurt?” etc. Just remember that. I feel better now than I have in over fifteen years and I’d like to keep it that way.

That said, diagnostic testing is important, but can be overdone and results misinterpreted (that story appears elsewhere). I neither want nor need another expensive (that I don’t even pay for) radioactive exam every six months, especially when so many (actually in need of them) don’t have access to this technology. Blood tests for cancer markers are simple, cheaper, less invasive, and not carcinogenic, but also not entirely accurate (depending on the type of cancer, its marker and individual physiology). Still, it seems to me a better interim alternative to ionizing radiation - and the possibility of new (unrelated) cancer.
My oncologist, bless her, called me Monday morning; she didn’t mind that I’d cancelled, she understood my reasons, and we rescheduled for the end of February. I think I can take it: as my radiation biologist says, “After radiotherapy, you could walk into a reactor without much added cancer risk.” She also hooked me up with an expat cancer survivor group. We’re to meet next Monday and I’m looking forward to it. I’ve got a lot to say.