Wednesday, November 28, 2012

Not That Easy

So later that week, I go into the ENT, expecting to get a lymph node biopsy. Not so fast. I don't know what differentiates all the different acronym medical types I've been seeing, but this time I get an NP, Nurse Practitioner. She asks me why I'm there which is kind of surprising because I'm expecting her to just stick a needle in my neck and submit samples for testing. So we go through the whole case history again, she plays around with lymph nodes in my neck, finding another much smaller one on the right side, and then tells me that they won't do lymph node biopsy using just a needle, no one in town will. She said that 9 out of 10 times the results come back saying insufficient material to do the analysis and you just wind up wasting time and money. In order to get a definite answer, you need to pull a lymph node for biopsy which is a surgical procedure (ie expensive) and shouldn't be done unless necessary.

She says I need to get a CT scan of my neck and chest. That will show more detail of what is going on with the lymph nodes in those areas and if that dictates that a biopsy should be performed.  Great, more waiting. It'll be a few more days until I can get in for the CT scans.

Monday, November 26, 2012

The Follow-Up

Monday after Thanksgiving was the follow up with the doctor I had yet to actually meet to discuss the results of my bloodwork and lack of response to the anti-biotics. I approached this appointment with much intrepidation.

Turns out we didn't discuss the blood work other than to say that "it didn't show us anything" but we did have an extensive discussion about other potential diagnoses. Some sort of viral infection including cat scratch fever (yes, it's a real thing) was still on the table but this was the first time that the C-word was explicitly dropped.  Obviously I had already stressed on that one quite a bit so it wasn't a surprise. What was a surprise were the cancers she chose to list as possible candidates: stomach and pancreatic. Again, no medical or cancer expert here but I knew those where not good things to have. She mention did that these were a very remote possibility and for some reason, I had to ask if lymphoma was still on the table. She said it was and I was wondering why she hadn't started with that one instead of the big, bad scary guys.

We then discussed the best and quickest way of getting a determinate answer on the cancer questions. This was getting more stressful due the fact that on top of this potential cancer issue, I was sitting on a nice new job offer from Conoco Phillips how to factor this medical issue into that decision process. She said a lymph node biopsy would get us a definite answer on the cancer issue and setup an appointment with an ENT doctor to have this done. She said it was non-surgical, they could just stick a needle in it, pull out some cells, and do the analysis.

I went home after the appointment and again went into Google research mode to find out about pancreatic and stomach cancer and was relieved to see that there are very definitive symptoms associated with both of them and I was exhibiting none of them (lack of appetite, aversion to eating meat...NOPE). I don't know what the hell she was talking about but thanks for the 5-minute thrill.

Friday, November 16, 2012

What the Hell is a "Mediastinum"?

Two days after the lymph nodes on the left side of my next popped out, I was back at the Dr's office, this time seeing another PA. She was young and seemed fairly new but also very competent. As I described my symptoms again, she asked me a bunch of new questions and didn't seemed particularly thrilled with the answers. She didn't say as much but here body language was a giveaway. She ordered up a more thorough round of blood tests, a urine analysus, and a chest x-ray. All of this was done in house so we could get immediate analysis of the x-ray.

To my surprise, there were some concerns with the x-ray. She said my mediastinum was showing signs of enlargement. My what? At this point, I've heard a lot of medical terms but that one was completely new to me. She explained that it is the "mass of flesh" in the chest that includes the heart, blood vessels, esophageus, and lymph nodes. It could be enlarged due to infection but since I was showing no other symptoms of upper respiratory issues (coughing, congestion, etc) it could also be something more deviant. She consulted with another doctor and the recommended getting a CT scan of my chest. Since that is an extremely expensive test ($1700) and it would have been entirely out-of-pocket, we agreed to run a course of 5-day antibiotics to see if that cleared things up and to follow up with the doctor after that.

Then I went home and Googled "mediastinum" and began to freak out a little bit. nearly every link involving mediastinum and enlargement referred Hodkin's lymphoma. This was the Friday before Thanksgiving and I was unable to set a follow up appointment with the other doctor until the Monday after Thanksgiving. This prove to be a LONG week of sleepless nights and Google research. When I complete the antibiotics the day before Thanksgiving and my symptoms had not changed, I really began to worry. Worst Thanksgiving weekend ever.

Tuesday, November 13, 2012

First Signs of Trouble

This all started with some wierd chest discomfort I was experiencing back in early November. It wasn't really pain but more like the pressure you feel in your lungs like when you've been in the pool too long. It wasn't really affecting me, just something that was obviously off and after 2 weeks of no improvement, I decided to go to the Dr. There'd been a lot of sickness in AK in the fall with many people suffering from upper respiratory infections and one friend even had walking pneumonia so I figured it was something a quick phase of antibiotics would take care of.

I went in to see the PA I usually see on 11/13 and despite some possible signs that it might be an upper respiratory infection, he thought it was acid reflux and gave me some sample to try, instructing me to call back if things got worse.

Two days after that visit, I was sitting at work scratching some irritation on the left side of my neck and noticed that whatever it was, it was quite swollen. I went into the bathroom to take a look and what I was guessing were lymph nodes were visibly enlarged. Not painful, but definitely popping out.

As I was aware that swollen lymph nodes are a sign of infection, I was not too worried but it was also obvious that this was not acid reflux so I called in and scheduled another visit for the following day.  Gotta get me some antiobiotics!  ...or so I thought.