Billy Bob's Wild Ride: October 2010

Friday, October 22, 2010

Jumping the Gun

Well, we got ahead of ourselves. The radiologist reading the ultrasound felt that this "suspicious mass" thing was just a big wad of liver (regeneration macro-nodule)which had developed a covering of scar tissue around it, and there was no reason for concern. The Hepatologists of the University round table did not feel like taking a chance, so they have NOT ruled out a cancer, and there will be more CT scans at the very least. The interest here is that this mass is the perfect size,were it to turn out to be malignant to indicate for a liver transplant. The liver doctor of great fame said that he hoped that he would never have to drop me into a bucket of formaldahyde, something I also hope, and Bobby and Sharon too. Status quo will do just fine , thanks. Repeat CT scans. Nice boring CT scans. Boring is good. Just a suspicious mass. To quote Ahnohhld in kindergartner cop, "It's NOT a TOOMAH!"

Wednesday, October 13, 2010

The Chilean Miners and Billybob's Ultrasound report

Bob got the CT scan report a day before his 4 year sobriety birthday, Sept 14, 2010. None of his previous test results have ever suggested metatastic cancer as a possible out come . I mean after it spreads, you ARE pretty screwed , right? Maybe if it is caught just as it begins to spread, but by the time it starts eating your bones, you are doomed, right? Who knows. I dont. For I am a liver. I am the liver in question, and tonight as they pulled the last of the miners out of the doom below, we got more good news: that there is no reason for concern. The ultrasound results show no reason for concern. There is no cancer in here. Now they just need to find out what is eating holes in Bobby's rib. Pass the pain receptors. OW.

Sunday, October 3, 2010

Recent CT scan results

IMPRESSION:
1. Findings consistent with cirrhosis. No evidence of cellular carcinoma. Patchy hypodensity in the right lobe of liver and a more focal subtle lesion with mild mass effect lateral segment left lobe liver measuring 3.1 cm in diameter, more conspicuous and slightly larger compared to 6-16-10 when it measured 2.8 centimeters in diameter. Recommend correlation with ultrasound and dynamic MR.
2. Slowly enlarging lytic lesion of the anterolateral left seventh rib. Considerations include fibrous dysplasia, aneurysmal bone cyst, myeloma and metastasis. Recommend further evaluation
Kind of scary. Metastasis?!?!?!?! WTF!!!!!

Solitary plasmacytoma

Solitary plasmacytoma is a large solitary focus of plasma cell proliferation.

This tumor has a median patient age of approximately 10 years younger than multiple myeloma.

Pain is the most common symptom. However, if the myeloma occurs in the spine, it will usually present with fast developing paraplegia and gibbous deformity due to the vertebral collapse.

Complete Information on this Tumor

Introduction and Definition:

Solitary plasmacytoma is a large solitary focus of plasma cell proliferation. This tumor is extremely rare and is found in the proximal femur, vertebral bodies, and pelvis in order of descending frequency. Solitary plasmacytoma occurs 70% of the time as an osseous lesion, and the rest of the cases are non-osseous lesions usually found in the upper respiratory tract. Approximately 70% of the patients with solitary plasmacytoma develop multiple myeloma.

Incidence and Demographics:

This tumor has a median patient age of approximately 10 years younger than multiple myeloma, and affects men more than women.

Symptoms and Presentation:

Pain is the most common symptom. However, if the myeloma occurs in the spine, it will usually present with fast developing paraplegia and gibbous deformity due to the vertebral collapse.

X-Ray Appearance and Advanced Imaging Findings:

Radiologically, solitary plasmacytoma appears identical to multiple myeloma.

Differential Diagnosis:

Most authors agree on a strict diagnostic criteria for solitary plasmacytoma. There may be no other radiological identifiable lesions, and bone marrow at another site must have no abnormal plasma cells. There may be no serum abnormalities and no Bence-Jones proteins in the urine. Some authors believe that the diagnosis can only be made if no other lesion is found for a period greater than 1 year.

Preferred Biopsy Technique for this Tumor:

Bone marrow biopsy

Histopathology findings:

Microscopically, solitary plasmacytoma appears as well to poorly differentiated sheets of plasma cells. These cells produce the same osteoclast stimulating factors found in multiple myeloma.

Treatment Options for this Tumor:

Treatment of solitary plasmacytoma includes radiation or en-bloc surgical resection. If abnormal serum or urine findings are present then the patient must be treated as if they have multiple myeloma with chemotherapy and bone marrow transplant 2.

Outcomes of Treatment and Prognosis:

Patients with solitary plasmacytoma have a better prognosis than patients with multiple myeloma, but 70% of solitary plasmacytoma patients develop multiple myeloma, and usually die within 5 years.

Graduation Day

LINAC U

You'd think that 25 radiation treatments wouldn't amount to much of anything. It doesn't sound like a lot.

...25 trips to the hospital. We were wrong. We started the week before Thanksgiving after a month long delay because of a bad bad flu like cold I developed. They wanted a commitment, with as few absences as possible, so we waited. The coughing up blood and fevers subsided, then we started, and got our groove. I say WE because Notbillybob's wife, Sharon drove most days. I was just along for the ride. Well, after 10 treatments, the tiredness set in. Especially for her. Like a new part time job. Notbillybob feeling like a roast ham most days. Kind of like a sun burn inside your guts. He made a big mistake in eating jalapenos one night. Ooh, the burn. So, they asked the doc if the stomach was getting radiation. They said "lets pull up your treatment plan... Yes, see here, inside this red line. The treatment plan showed that it was. The innermost red line is the most radiation, the outer one is the least. The green one is in the middle. A good part of the stomach is even inside the blue line.

The pain was accounted for. They told us that they were also concerned with his platelet count. It was going down again. Down to 37! (Low is 150) It has since stabilized at 40. The thing is that the white cells, red cells, hematocrit are all low. Way low. Bilirubin is elevated. INR is elevated. Not billybob began wearing a mask to treatments. Don't need cooties at a time like this.

Then the really cold weather set in. I know, I know- it doesn't really cause colds and "death of pneumonia" like our moms used to say, but when you have cancer of the immune cells, and then your white cell count goes in the toilet as well...

Notbillybob is going to stay a hermit for the foreseeable future.

But SMILE!

New Years eve was treatment number 25. Graduation day! Graduation from LINAC U!

(LINAC is a Linear Accelerator, an IMRT radiation therapy machine)