Today was my third PET scan, and for some reason, I was more worried than usual.
I'm a nurse; I know how to do this. I'm also a patient who knows what to expect.
I had my first scan upon diagnosis last May, and a second one on October 9th that showed I was cancer-free. It's an easy test: much less confining than an MRI, but much longer than a CT.
Still, it's a breeze.
There was no reason to be scared, but I could feel it bubbling beneath the surface as today came into view.
I had to fight to keep my appointment since it had already been cancelled once due to an insurance issue, then I stayed on top of the issue until it was resolved and today's appointment was made. I wanted this test done.
When yesterday's snowstorm blew through our state, I was worried that my scan would again be postponed.
But as I cautiously eased my car out of my snow-packed driveway this morning, I was also wishing that I would not be able to make today's appointment.
I wanted a good excuse not to go. "Sorry, my car couldn't make it up the hill due to ice" I would say to the receptionist without having to lie.
Instead, I could go to work and not face the inevitable, at least not today.
But my car did make it up the hill, then through town on snow-mixed-with-ice laden streets, then to my appointment. I even arrived thirty minutes early.
So I puttered around in my car until my appointment time, and to my surprise, I had to fight back tears as I watched my smoky breath in the frigid air.
What was I so afraid of?
The chill of the car quickly became unbearable, so I dabbed my eyes with a Kleenex, grabbed my bag, and went inside where I updated my medical history, then asked for a copy of my labs. I had arrived with a mission to check on my LDH level that had been drawn a week ago.
LDH stands for Lactate Dehydrogenase, an enzyme that can be found in almost every cell in our bodies. When LDH levels are increased, it's a sign that there is tissue injury or a disease, such as cancer, brewing somewhere in the body. Normal range of LDH is 100-190.
My initial LDH level last May was 261, which was deemed a "mild increase" by my oncologist. Within a month, and after Non-Hodgkins's lymphoma was officially diagnosed by biopsy, my LDH shot up to 331.
After an excellent response to several months of chemotherapy and radiation, my LDH level was down to 201 just eleven days after radiation ended in November. My oncologist expected it to be a tad elevated (above 190) since radiation had just damaged my tissues during the previous 21 treatments.
Today my LDH level was 209, an 8-point increase from November. I wasn't sure if that was good or bad, considering it had gone up since last time. It was expected to be elevated after finishing radiation, but what about now, almost three months later?
Does an increase of 8 points signal that the cancer may be returning, or does it confirm that my body is still healing from the trauma of chemo and radiation? (And shingles, to boot!).
My first instinct when I read my lab results was a positive one, that at 209, I was still in remission. I felt it as I smiled in relief. It was only when my mind started wandering with questions because of my rising fear that I began to doubt myself.
I decided not to second-guess my intuition and I settled into the lobby seat as I browsed through the newsfeed on my phone. I was called into radiation where I cozied up in a recliner under several warm blankets while my nurse (whom I had last time) inserted an IV into my arm, checked my blood glucose level, then injected radioactive sugar into my vein.
Then she left me in the dark for an hour, my favorite part.
The reason for this, you ask?
Cancer cells feed on and attract sugar, so as the radioactive substance began to disperse within my body, cancer cells lie in wait, hungry to eat up the sugar. I was left in the dark so that I wouldn't move about the tiny room, causing my muscles to take up the sugar and use it for fuel. Instead, it was free to be taken up by cancer cells, or to be eliminated from my body should there still be no cancer.
Thirty minutes in the PET scan machine would determine if any cancer remains in my body. If so, all the places that have cancer would light up banana yellow on the screen; if no cancer remains, the screen will remain black without any hint of color. I will get those results next week when I see my oncologist.
In the meantime, I figured out why I felt so shaky about today.
When I'd had my second PET scan in October, I'd already had six chemo treatments. If my scan turned banana yellow anywhere in my body at that time, I would've continued with two more chemotherapy treatments for a total of eight. If nothing turned up on the scan (which is precisely what happened), I would go right into four weeks of radiation.
And I did.
But on that day, October 9th, I was deemed cancer-free!
Had it not been that result, however, I still would've had a "back-up plan" to continue to rid my body of cancer. I still would've had the option of more chemotherapy, followed by radiation.
But this time?
If this scan shows cancer at all, there will be no chemotherapy or radiation available as "back-up" options.
In fact, if I thought chemotherapy and radiation treatments upended my life in a big way, then the next course of treatment will surely blow my life out of the water, because the next step would be stem cell transplant.
At least that's what was explained to me when this whole event started last May.
No wonder I was close to tears this morning. The next step is too monumental for me to consider. Too scary to think about, and too overwhelming to wrap my head around.
Especially since I have felt so well. I have made peace with the cancer that needed to take up space in my body for a while, and am grateful that it eventually left.
So instead of giving into the fear that wants to rise up and think the worst, I will choose to put faith in my God-given intuition that reminded me today how I remain cancer-free.
The same intuition that told me last May that I would heal through this bout of cancer quickly and relatively easily, with no residual cancer remaining once last year's treatment was over.
And so far, that has been my beautiful story.
"...You won't even be sure, in fact, whether the storm is really over. But one thing is certain. When you come out of the storm, you won't be the same person who walked in."