Is it weird that this song was my earworm during my PET scan last Thursday? I think it was appropriate in some weird way. You can bring a CD to play during your scan, and next time I will bring an entire CD of Pet Shop Boys to see if the radiology technician picks up on it.
Part of the reason I started this blog was to chronicle as many of the typical cancer experiences, from exams to chemo treatments to hair loss and anything else I go through during treatments. When I was diagnosed, I found plenty of websites that clinically describe procedures and plenty of message boards on which patients briefly describe their experiences but I had a lot of trouble finding blogs where patients described what each procedure was like for them. When I could find any first hand accounts, they took a lot of mystery out of the process, which is a great thing.
Warning: I’m going to get all science-y on you for a little bit here to describe what a PET scan actually is and what it is designed to detect.
Before my scan, I found this website to be particularly helpful in understanding the process. PET is an acronym for Positron Emission Tomography and is often used in concert with a CT (Computerized Tomography) scan. The CT scan is probably more familiar. It essentially detects changes in internal anatomy, like the presence of a mass of cells that should not be present (i.e. a tumor). As you go through chemotherapy, the hope is that the tumor(s) you have will shrink and as it does, it may leave behind scar tissue. Since a CT scan can only detect the presence of abnormal masses as a change in internal anatomy but not whether that mass contains living, malignant cells, a PET scan is used to detect the presence of cells that have a higher metabolic rate than normal cells (the cells metabolizing at a higher rate are cancer cells).
Before the scan, the patient is injected with a radiopharmaceutical that is essentially glucose (a sugar) attached to a fluorescent tracer that can be detected by the PET scanner. This material spreads throughout the body, is absorbed by the tissues and the tracer will emit gamma rays for a short period of time. The PET scanner will detect the emission of these rays. Cells that are metabolizing (consuming glucose) at a faster rate will then emit more/stronger rays than those metabolizing at a normal rate. The scanner puts the CT scan images and PET scan images together to form a PET/CT image where the PET portion will show where cells are metabolizing at a higher rate and the CT portion will show where these cells are located in the body. This website shows some images that might be useful to get a sense of what the scans look like.
If you zoned out for the past two paragraphs due to boring science speak, here’s where you can tune back in.
So what is it like to get a PET/CT scan?
First of all, I got a six page booklet of instructions prior to coming in for my exam. Because the PET scan essentially is detecting cells that are consuming glucose at a faster rate, I was asked to stick to a low carb diet on the day prior to the scan. This really isn’t an issue as Jeff is on this type of diet all of the time, as was I until I let cancer be my excuse to eat whatever I want whenever I want, but at least I had a good handle on what to eat that day. I’m assuming they ask you to do this so that you don’t get a false positive on the day of the scan and/or the cells will be more likely to take up glucose if they’ve been “starved” of it the day before, thus giving you a more accurate scan. You’re also asked not to consume alcohol (no problem) and no caffeine. Oh, the horror! Chemo still has me exhausted and while I realize I probably shouldn’t be drinking coffee, it’s the only way I can make it through the day without passing out.
Getting the scan was actually a pretty easy process, although it was long (about 2.5 hours). When I was brought back to the prep area, I sat in a recliner next to another patient. The PET tech placed my IV (woohoo!!) and had me drink a half liter of barium solution, which is not exactly my first choice in a drink. It actually isn’t so bad, so long as your tech/nurse has the forethought to chill the stuff as much as possible. It is not tolerable at room temperature. The other trick is to chug it, quite honestly.
After I drank the first half liter, the tech came back in and injected me with the radioisotope. I don’t know why I thought this but I assumed he would come in with a gallon full of fluorescent green liquid to pump into my veins. In reality, the tech came in with a small heavy metal container that contained a small syringe of clear liquid that didn’t look like anything special. I was hoping to gain some superpowers, like X ray vision or invisibility, but no such luck.
The solution has to work its way through your system for 75 minutes before you scan. About an hour in, they ask you to drink another half liter of barium solution and “evacuate your bladder” before entering the scan room. This was no problem – I had to go to the bathroom so badly by this point, I could barely sit still.
The aforementioned instruction booklet asks you to wear warm clothes but nothing with metal as this will interfere with the equipment. This means no jeans, zip up hoodies, pants with snaps or buckles, and no bras with metal clasps or underwires. If you don’t follow these directions, you have to wear hideous paper scrubs in the scanning equipment. No, thanks.
At my hospital, the CT and PET scanners are in line with one another so I lay down on the moving board and went feet first into the CT scan first. If you’ve had one of these before, you know it is essentially a good sized tube, well above your head (not like an MRI where the scanner is about a millimeter from your face and you feel enclosed in a banging, clanging coffin). I was in there for maybe 15 seconds for that scan.
I was the pulled completely out of both tubes and then suddenly moved through the first and into the second so that only my thighs down were in the second tube. I didn’t really see or hear too much going on but every few minutes the board moved down about six inches so the next section of my body was in the tube. This was done until my head was in the PET scanner, thus completing what the techs called a “thighs to eyes” scan. It was really painless. In fact, I almost fell asleep at the end.
When you’re done, the tech, who has to stay in the room behind the glass and observes your scan files on the computer to make sure they’re getting clear images, comes in to get you. You know that, while they may not have a technical medical understanding of your scan, they know for sure whether areas of the scan are lighting up more than they should be, thus indicating a cancerous mass. They will help you get up off the board and collect your things before you leave.
I was so tempted to say, “Come on, buddy. Please just tell me if you saw anything abnormal on there. I know you know what’s going on. Just tell me whether my life will go back to normal or if I’m stuck with this disease for another few months. Do me a solid.”
I knew though that he wouldn’t tell me anything, even if I asked with a pretty, pretty please and a cherry on top. There’s way too much of a liability risk there. So, I just collected my things and left.
The really cool thing about being there though is that I met four other cancer patients while I was in there. We were all done with chemo or radiation and were getting scans that would determine if the cancer was completely done. We joked with each other about having to drink the barium solution. Carl, a gentleman in his 80’s, asked our tech if he could get a shot of Jack Daniels with his barium. No chance, Carl. We all thought it was ridiculous to make magazines like Self and Weight Watchers the only magazines available to cancer patients waiting to get their scans. It just felt good to commiserate with patients who were in the same place as me. I don’t think anyone really understands what you’re going through like other cancer patients.
So, now I’m waiting until my appointment with my oncologist tomorrow morning to get my results. Jeff is going with me tomorrow, so my oncologist will know I am actually married and not just making it all up. By this time tomorrow, I will know if I’m cancer free or if I need to undergo radiation. Honestly, I’m not all that nervous. I can’t control what that scan will show. There’s nothing I could have done differently to affect the outcome of this scan. It’s entirely dependent on whether the chemo killed the last 5cm of the mass. If I still have cancer, I will get the radiation to zap the rest of it. It will be a pain in the neck but I will do whatever I need to do to rid myself of this disease.
I’ll be sure to contact folks one way or another and if I feel up to it, I’ll post tomorrow or the next day with the results. Please send me all of your prayers, thoughts, good juju, and vibes tomorrow morning!