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My CT and a PE

Posted by Frederick Wasti
May 04 2012

Midday today we went in to Dana-Farber so that I could have a CT scan (a "cat scan") of my chest, abdomen, and pelvis. This was necessary in order to see what is happening to my lymph nodes and spleen, which tend to become enlarged due to CLL, as they fill up with incredible numbers of leukemic lymphocytes. Although some lymph nodes can be palpated from the outside of the body in some places, and although an enlarged spleen can sometimes be felt just below the left ribs, it really takes a CT scan to see just what most of the lymph nodes and the spleen are really like. (In fact, my original diagnosis for CLL started out with a radiologist who, while examining an MRI of my left hip area, preliminary to eventually having my hip replaced with an artificial hip joint, found that "there are partially enlarged lymph nodes along the external iliac chain".) So, knowing what the lymph nodes and the spleen are doing is important information for judging the extent of CLL in the body.

The good news is that today's CT scan, the results of which we already found out about this afternoon (more about that below), showed that most of my lymph nodes are now quite small, and that my spleen is (in medical terms) "unremarkable". Well, that news is actually quite ~remarkable~ in that, at the time of my diagnosis with CLL (in the summer of 2010), a CT scan showed that "the spleen is enlarged, measuring 16 cm in long axis" (whereas a spleen normally is only about 11 cm long in adults), and, on another CT scan made only two and a half months ago, my spleen was judged as being "slightly larger than it was on the prior exam". So, this is all really good news, showing that my lymphocytes have not only declined in the blood (as shown by blood counts over the past few weeks of treatment), but have also declined in the lymphatic system, allowing the lymph nodes and spleen to shrink in size, and where referring to them as "unremarkable" is actually a compliment - <g>.

The bad news is that a "PE", a "pulmonary embolism" - a blockage in an artery in my lower right lung caused by a blood clot - was also found in my CT scan today. Obviously this is a serious issue, so, when this was first discovered by the radiologist this afternoon, we received a phone call at home, shortly after reaching there, asking us to return to Boston to the D-F, so that I could start immediate treatment for it. The CT scan report noted a "pulmonary embolism involving the segmental branch of right lower lobe pulmonary artery" and recommended that "immediate clinical action should be taken" for it. Uh-huh...

As it turns out, the treatment for this PE will be a daily subcutaneous injection of "Fondaparinux Sodium", which has a trade name of "Arixtra". (Most web sites say Fondaparinux is pronounced as "fon-DAP-a-rin-ux", but a few say it is pronounced as "fon-dah-PAH-rin-ux", and I find the latter easier to say - <g> - I was given two leaflets about this anticoagulant this afternoon at D-F, and one pronounces it one way and one the other.) So, I had my first injection of Fondaparinux while I was at D-F this afternoon, given to me by a nurse. However, the rest of the injections (remember that they're ~daily~ injections) will be self-administered by yours truly. I was taught today how to properly give the injections, and I will start doing so tomorrow (<gulp>). "Fun", to be sure...

Finally, I note that, while we generally pronounce "CT scan" as "cat scan", it seems to have lost its original spelling. There was a time when "CAT" stood for "computerized axial tomography", but now the term is generally shortened to "computerized tomography" and abbreviated as "CT" - but we still pronounce "CT" as "cat" for convenience, I guess. Such is progress in medical imaging... :-)


Categories: Leukemia