Figure A below is a MRI image of a sarcoma in Carl's neck as of Jan 5, 2011 with some added 'visual' information. In photo shop I added colors and labels, and drew a rough outline to help you orient the placement of the head, which hopefully helps you better understand the MRI.
In Figure A, the vertebrae (neck bones) are in green. The vertebrae part on the left in green (front of the neck) rings the spinal column and connects to the green part on the right (in the back of the neck).
The photo below shows a neck vertebrae bone as it would look if your were looking from the top of the head. You can see how the bone has a ring. The ring circles the spine.
The next visual labels different parts of the vertebrae.
In Figure A, the spinal column (in yellow) is protected by a fluid filled sack. Perhaps you can now see the bad news of Figure A.
The nasty sarcoma tumor (shown in red on Figure A) is impinging (almost touching) the spinal column. It is squishing the fluid filled spinal sack. Unfortunately, the sarcoma tumor has also eaten away and destroyed part of the bone in the back of the C2 vertebrae, and possibly others (C3?). Destroying parts of the bone of the vertebrae - Bad. Touching the spinal column (i.e. the spine) - Well, that would be way worse.
Below are images from a CT scan of Carl's head taken from the top of the head looking down. This CT scan is from January 5, 2011. CT scans show bone details clearly. You can see the vertebrae glowing in white. Instead of being shaped like the photo above, the white bone has been replaced on the right with ominous gray tumor material.
Below are three MRI images of the same cross section, again, from Jan 05, 2011. Above, CT scans, below MRI scans.
The three MRI images show different ways the MRI contrast can be adjusted to better see various types of tissues.
The final two images below are from a CT scan adjusted to show different structures. The views are a cross sections of Carl's neck from the back (image on the left), and a side view of the neck (on the right).
These images document why the sarcoma tumor in the neck had to be surgically removed. Carl had surgery to remove the tumor on January 24, 2011.
Click on any images to see it larger (and less blurry.)
When it comes to cancer care in 2011, in the United States, here in Wisconsin, the engineer and photographer in me is grateful and proud of the available digital diagnostic technology. The technology is improving exponentially.
Like the expansion of the Internet and the digital camera, diagnostic imaging is improving cancer detection, monitoring, and care. I don't like the fact that Carl has cancer, but if you have to get cancer, (and you can't delay getting cancer into the future), now is the time to get it over any other period in time, any other millennium, century or year. The 'technology', drugs, and care is improving. Teams of engineers, scientists, technicians and doctors have created the technology I am going attempt to show you below.
Don't let the fact that this technology is cool make you think I am in any way happy that my husband has cancer. The pep talk above does not make it any easier for me to use photo shop to try to document this tumor. I am doing this (originally) for my children; also my spouse, our relatives and friends; and others who may stumble across this post trying to understand cancer. I do not like spending time trying to make the images understandable. But I think I can use my time to help some people understand more about cancer, or Carl's cancer, where ever their interest might lie.
Below are some MRI images that show the tumor in Carl's neck as of Jan 5, 2011. MRI stands for Magnetic Resonance Imaging. See Wikipedia for technological information on MRI's. Basically, MRI's use a large machine, a lot of physics and a lot of engineering to take multiple cross section photos of a part of the body, in this case Carl's neck.
If you can't see how Figure 1 or Figure 2 are images of a view of a neck, see Figure 3 and 4 below for some added 'visual' information which may help you to be able to better understand the MRI's.
Figure 1 is a MRI of a sarcoma in Carl's neck as of Jan 5, 2011. This is a view as the doctor or technician can see it on their computer screen. On the computer, the doctor can manipulate settings like contrast.
Figure 2 is a MRI of a sarcoma in Carl's neck as of Jan 5, 2011 with different settings, as the doctor or technician can see it on their computer screen. Notice how the neck vertebrae (the bones) stand out differently then in Figure 1 above. In Figure 1 the vertebrae (bones) are gray, in Figure 2 the bones are dark and stand out more. The tumor is more visible in Figure 2 when the bones are dark.
Figure 3 is Figure 2 with some added 'visual' information. I took the Figure 2 above and in photoshop I added colors and labels, and drew a childish outline to help you orient the placement of the head, which hopefully helps you better understand the MRI. Figure 3 is NOT what the doctors see on their computer screens.
Figure 4 is Figure 2 with some added 'visual' information. It is my first attempt at showing what parts are what. I took the Figure 2 above and in photo shop I added labels, and drew a childish outline to help you orient the placement of the head. Figure 4 is NOT what the doctors see on their computer screens.
MRI's are good for showing tissues, and differences in tissues. Carl also gets CAT scans. CAT scans are good at showing bone and structures like veins. I hope to show you CAT scans on a different future post. Carl also gets some X-Rays, which are good for showing bones, although differently then in a CAT scan. The combination of MRI's and CAT scans give doctors knowledge (and a visual picture) of things inside the body that used to be able to only be seen once a surgeon cut the body open. Now, the doctors and surgeons learn much before any cuts are made.
My children find these photos interesting for several seconds, and then at some point the information creeps them out and they need to walk away. It is not just a screen shot, it is a tumor that once was in their dad. (Surgery removed almost all of the tumor in Carl's neck on Monday Jan 24, 2011.) I am telling you about my 11-16 year old children's responses so that you may be aware of and accept your own feelings. I find it easiest to view these images when I detach them from being my husband's neck images. (It is easier to view them 'clinically'.)
I waited months to post these images. Maybe you will understand why. Whatever.
The next blog post will talk about Carl's MRI more specifically.
Click on any images to see it larger (and less blurry.)
Wow, it has been a while since I have done an update. Perhaps no news is good news? It's been so long I'll do a brief summary of 2011 with regards to Carl's medical journey. I'll start with December, just 'cause.
Dec 27-Dec 30, 2011 Carl had inpatient Chemotherapy at Froedtert. They let him out one day early so that he could enjoy New Years Eve and Day with his family.
Carl had the hardest time recovering from this particular chemotherapy, and pain increased in his neck. The Doctors decided to operate on his neck to stabilize his neck and debulk the tumor, and the neck surgery was done on Jan 24, 2011. Carl was sent home from the hospital wearing a neck brace, which he wore for 23 plus hours a day, except in the shower, for weeks, and instructions not to drive.
After the surgery Carl was recovering (sort-of) but then the pain in his neck was getting worse. The surgeon saw Carl, took an X-ray, and determined that Carl's spinal fusion had failed, and included a screw pulling out. Carl had an emergency surgery on Feb 14, 2011 to repair the failed hardware. On this surgery they pulled out the screws and put in larger screws, used acrylic glue and more hardware, and fused Carl's neck from the base of his skull to C7.
Carl was released from the hospital on Wednesday, February 16, 2011. After a week or so, Carl felt good enough to start working again, although with reduced hours. Again, Carl was sent home from the hospital wearing a neck brace, which he wore for 23 plus hours a day, except in the shower, for weeks. He won't be able to drive a car for at least six weeks.
Life with the children, of course, continued, and the weekend of Feb 25-27, 2011 was particularily busy. Anthony (a freshman) was in a great musical for 4 days, Miranda (6th grade) was in forensics, and the three younger children had a piano recital, and poor weather made some things more difficult. We survived the activity, but Carl overdid it that weekend. The funny thing about overdoing things is that "hindsight is 20-20". After you overdo something, you know that hey - you overdid it, you shouldn't do that. But by then it is too late. Fortunately, Carl survived, with no ill effects.
The 2nd surgery's spinal fusion has lasted longer and worked better then the first surgery, so far. On Thursday, March 10, 2011 I took Carl to see the surgeon for a post-op appointment. Carl had an X-ray and the surgeon said things look great. He even said Carl could start wearing the neck brace less (an hour or two each day), and that Carl should start PT (Physical Therapy) next week.
This week, later today, in fact, Carl will meet with the radiation Doctor, and 'the doctors' will start planning the next link in the chain of treatment.
Wow. Is today only Tuesday February 15, 2011? The weekend seems weeks ago... Yesterday (only yesterday, really?) was Monday February 14, 2011, Valentines Day, which we celebrated by taking Carl to Froedtert Hospital for a surgery - for "Cervical Device Failure".
"Cervical Device Failure" - I just had to google that. We (almost all humans) have cervical vertebrae (vertebrae which are in the neck), and almost all women have a cervix which can get cervical cancer, which is a cancer south of the belly button. NO WONDER Doctors have to go to school for so long, these very different parts share a common name. How confusing. Can you imagine opening a catalog for Cervical devices? Spine things and cervical caps all on the same page. ( But I digress.)
We were scheduled to come to the hospital at 8:30AM for a 10:30AM surgery, but a nurse called and asked us to come earlier. Apparently one of the surgeries before us was going to be a no-show. Did they cancel out or did they die? We could only guess. [4-22-2011 note: Wow, in retrospect as I re-read this in April, that comes off very harsh. The humor did not work. I never for a minute really thought the patient might actually have died.]
Carl's procedure started at 9:45AM, and the surgeon's first incision started around 11:45AM. Before that the medical team put in a breathing tube through the nose while Carl was awake, put Carl out with a general anesthetic, established more IV's including something called an arterial IV, inserted a catheter, did positioning things and X-rays and more. I guess that's why surgery is called an invasive procedure. The surgery went longer then I expected. It wasn't over until about 2:30PM when Carl was moved to the recovery area, where the medical people keep him until they think he is responsive and stabilized, usually about two hours.
I went and shuttled my children around two counties, and came back to the hospital shortly after Carl was moved to his room in the spine injury area - 5SE room 6. They were giving Carl morphine (4mg) as I arrived, and giving Carl more morphine (4mg) as I left two hours later. Carl rated his pain at about a 6 on a 10 point scale. Carl walked several steps to earn the reward of the catheter being removed.
Interestingly enough, Carl's memory starts later. His memory starts with him waking up after the catheter was out. He didn't remember me being there, but then (when reminded) he remembered me saying to the nurse that I was going to go gather my children from a two county region.
I picked up three of the children from a nice Valentines Day dinner at their Uncle and Aunt's house (Thanks guys!), and then took them home to do homework and get them settled into bed. Miranda in particular missed her Dad, but I think we all wished Carl would have been home. Happy Valentines Day...
On Tuesday February 15, 2011 when I went to see Carl, he was mostly exhausted and tired. The nurse said he had rated his pain around 3 on a 10 point scale, where 4 was tolerable (to Carl). Just before I left Carl at around 2:00PM, Carl said he didn't really have pain, at the moment nothing "hurt" him, but he was drained of all energy. The procedures in previous weeks had drained his energy, and now what little energy he had remaining was gone. He didn't watch TV or anything, and when he talked he kept his eyes closed and didn't move or sit up. I brought him two pints of blueberries, and he ate one pint while I was there, mostly without opening his eyes. He didn't want any phone calls or any visitors, he just wanted to rest.
While I was there, I had 3 questions I was trying to ask him. 1. How do you feel? 2. How did he feel the surgery went? and 3. Did the surgeon come and talk to him? During the five minute time we were trying to talk about these three things, we were interrupted three times. The nurse came in, the pharmacist came in and 'interviewed' Carl, and someone else. (Maybe the nurse returning with something?) It was incredible. The pharmacist interview took probably 25 minutes alone. (Starting with the questions are you allergic...)
The surgeon came by and talked to us for a (very) brief time. He feels the surgery went well. We hope he is right. The surgeon did not see any sign of new tumor growth, which is really nice to know. The Jan 24 surgery was important (to me) for removing 90% of a not controlled tumor. In that alone, the first surgery was very successful.
I guess the important thing about today was that Carl's pain was under control, momentarily at least, and that he was already eating. After the last surgery he pretty much didn't eat for 2.5 days. So, Carl appears to me to be in significantly better shape after this surgery then after the one on January 24, 2011. Maybe he will recover faster.
Carl should be coming home tomorrow. Then he will be able to get rest. You don't get rest in the hospital.
Please keep Carl in your prayers, and hug your loved ones for Valentines Day.
Today is Saturday, February 12, 2011, and I am finally writing to bring this blog up to date. The last chaotic jumble of posts can be referred to or ignored, but I'll try to recap here.
Carl's Angiogram with embolization procedure done at Froedtert on Friday, Jan 21, 2011. It was a long day and a long procedure that attempted to kill off blood supply to the tumor in his neck, and the Doctors felt it went well. Carl remained in the hospital through the weekend, and on Monday, Jan 24, 2011 Carl had a surgery to de-bulk the tumor in his neck and to stabilize his neck. Monday was a long day and a long procedure, and the Doctors felt it went well. Carl stayed in the hospital a few more days and came home from the hospital late Wednesday, January 26, 2010.
Carl has been mostly staying at home and trying to recover from the surgery. He has been in a lot of pain at times, and takes a lot of pain medication. Carl takes 60mg of Oxicontin, (a long acting pain pill) twice a day, and he takes 10 mg of Oxicodone between these doses for break through pain. He takes a version of Valium to relax the muscles, up to four times a day.
Carl didn't have to return to the Medical complex until Monday February 7, 2011, when he had three appointments: 9:00AM with the Oncologist, 10:20AM with the Radiation Doctor, and 11:30AM with the wound check people. The wound check lady removed the stitches in the back of Carl's neck. The meetings with the Doctors were surprisingly unenlightening. (A friend once told me that with cancer you have to remember that every Dr. meeting is not going to answer all your questions, or even tell you a whole lot. There is no great answer at the next appointment.)
On Tuesday, February 8, 2011, Carl went to work for about four hours. He felt good about getting out of the house and going to work. (I drove him both ways. Carl won't be able to drive for weeks)
On Wednesday, February 9, 2011, Carl went to work in the morning, and then I drove him to a 1:10PM CT simulation appointment in radiation oncology.
On Thursday, February 10, 2011, Carl had a 9:00 AM MRI appointment in radiation oncology. Carl's pain, usually bad, was even worse today. It was wincingly bad, and so while Carl got his MRI I tried to get appointments to address the pain. The Oncologist could see him at 12:30 that day, but recommended we contact the surgeon. At around 10:00 AM I call the surgeon, and they made an appointment for Carl to see them at 12:00 noon the same day. We were in the surgeon's office at noon, and the surgeon reviewed the mornings MRI (which were taken from angles appropriate for Radiation planning, not the angle the surgeon was used to). The Surgeon then ordered an X-ray which Carl had 20 minutes later. At 12:40 we were back in the Surgeon's office. He studied the X-ray and indicated that the mechanical parts placed in Carl's neck were not in the right position, a plate had slipped and a screw was out of position. He said we should have that fixed in surgery on Monday, was that OK? Carl just kind of stared at the guy numbly. The surgeon was good. He said let's schedule the surgery time to hold the time slot and you can decide later whether or not to do the surgery. I said, Carl, your going to go along with this, right? (and probably some more things...) and Carl agreed he had no real choice. (We could edit that to "Carl agreed"... but I am not sure either edit defines the real moment)
So... Carl will once again undergo neck surgery, this time on Monday, February 14, 2011, Valentines Day. Sigh....
The rest of Thursday afternoon included a pre-op appointment and expediting a CAT scan through both insurance and the hospital, and we were home by 4:00PM. Carl went home in pain, (not really numb, was he?) and so both Carl and I will just keep going.
Carl is like a exotic sports car - He's finicky. He needs a custom tune-up.
Monday, January 31, 2011. The weekend was Long. I was looking forward to Monday, don't know why, but Monday seemed like it would be simpler then the weekend. Less noise, activity, etc.
Insurance lady called Monday. [I am reviewing this post on 4-22-2011. I called her a lady. Now I am changing that word to machine. She is not a lady, and I don't even think she is a human.] Now that is stress. She wants permission to be the case manger for Carl. Her husband died of cancer, so she knows what I am going through. Really? I don't know what I am going through, but talking to her, God my stomach gets in such a knot, I feel like I really want to barf. Her questions, comments, insinuations of 'help', they made me feel like I was talking to Satan. I DO NOT TRUST ANY INSURANCE COMPANY. I THINK THEY WOULD PREFER MY HUSBAND DEAD SO THE CASH OUTLAY WOULD STOP. If an insurance company could get away with it, I think that there are people in the top echelons of insurance that would like to send a hit man to finish the capital outlay so they can 'make more money'. [I am reviewing this post on 4-22-2011. Today, I calmly and skeptically wonder if the insurance's machines' husband really existed, or had cancer, or if it was all a line to establish 'report'.]
The principles of good honest business are that you make a contract, initially believed to be good for both parties, and you honor it. If your business involves you taking a risk, you accept it. Trying to renege on a contract for profit is Evil perverting business.
Any F-ing individuals who think that what is good for business is good for the country, who think Fraud will self regulate, who think greed is good, who think consumer rights are anti-business, who think tangled contracts with loop holes are a good thing - they are EVIL, and sure sign that Satan is winning. How the HELL does the conservative party in any way equate with Christianity - caring for ones fellows man, that has to be the LIE OF THE CENTURY. And Satan is the prince of lies.
So now you might think I am a religious freak. (But then I'd be a very conservative Republican?) I am not, really, at least I don't think I am.
Carl took his first shower / bath today post chemo. It makes me want to cry. I think they put his head back on wrong. I think a first year resident stitched him up. And yet this totally conflicts with my also Genuine feelings - I am so damn glad he had the surgery and much of the tumor was gutted.
[4-22-2011 addition: I added the photos above on 4-22-2011. These photos were taken Jan 23, 2011, the night before the neck surgery; Jan 25, 2011, the day after surgery; on Jan 31, 2011 right after his shower; and Jan 31, 2011 with the Aspen collar neck brace Carl wears 24 hours a day except when in the shower.
Carl is not holding his neck that way to be funny. That is the only position his neck can be in.]
You might think I am in a crisis . Yes, I think I probably am. It's weird that a crisis can be helped by punching keys.
I don't know why, but I feel better after writing this. I am not sure I should ever publish this, but writing from the heart is supposed to make your writing powerful. Raw, yet real. I want to let this rip out there - maybe it will touch someone for a good purpose. Waiting, rewriting, would make this more objective, but is all writing supposed to be objective? Perhaps we should not be afraid of raw emotion now and then.
I pray that this post will go out and do God's will - that this writing will touch someone in some way for Good. I pray that God only allows those people that should see this see this. I am not against any political party, of any person employed in any job anywhere. Many businesses do good, some do evil (drug dealers, for example). Many people are employed to do good, some to do evil, many work just to have a paycheck to take home to their family and don't think about their job in terms of good OR evil. I hope you always try to do what is right, which to me is what is Christian. But the 10 commandments span more religions then just Christianity, and include the basis for many business rules - contracts are formed from thou shall not lie, thou shall not steal, thou shall not bear false witness, thou shall not covet... Thou shall not put false Gods (profit, money, gain) before the real God.
God Bless.
[NOTE: I could try to edit this into something better, but I don't want to spend the time and effort. Here are some real feelings, raw and unedited. If they make no sense, then let it be. I'll be honest, my notes above are, shall we say... conflicted...; to me now as I read them, they just remind me of a frustration I tried to bury on Monday, the last day of January.
I do feel the need to say this though: There is good and evil. It is mixed into our lives. The internet can be used for good or evil. Books can contain good or evil. People can do good or evil. Policies can be good or evil. Businesses can do good or evil. Politics can be good or evil.
I in no way feel that any political party is good or evil. I think all political parties have a little good and evil. Anything a reader reads into the rant above about politics should know that I consider myself fortunate to have friends who want good for this country in both political parties, and I have voted for people in both political parties.
[I finally posted this Saturday Feb 12, 2011.]
Carl came home from the hospital yesterday, Wednesday, January 26, 2010 at around 8:30 PM at night. My son Anthony and I went to pick him up and then I drove Carl home over the bumpy roads which caused pain at each bump. After Carl was tucked into bed at home, I went to fill prescriptions for him - the total bill for the prescriptions before insurance exceeded $1000. (It's a good thing I had the new prescription card with me. Insurance plans changed on January 1, and... lets just say I still had to pay WAY over $100.)
Carl was released about 48 hours after his neck surgery, and I personally think that was too early. He had barely eaten anything solid since the surgery, and the nurses had been giving him lots of drugs in the hospital. It throws a lot of responsibility on me be able to recognize problems.
Here is an example. On January 1, 2010 (one year ago) Carl went in to get chemotherapy. The night before he had been sick, it was the 4th day of a 5 day chemotherapy string, and I didn't know what to expect. All that I remember thinking was he was like a walking zombie. Carl never got chemotherapy that day, because pre-chemo blood work revealed his potassium level had crashed and so the nurses gave him IV fluids and potassium, etc., and sent him home. I now know (from this sample of 1) that "walking zombie" possibly means potassium is low. I have no idea what hi or low blood sugar, sodium, any of the other 30 things they check in a blood test would result in, so I happily only worry about potassium.
So yesterday I had the nurse check his blood test results before we left the hospital. Carl had his blood tested on Wednesday morning, Jan 26, 2011, and his potassium levels were only 'a little low'. How will I recognize (much less fix) a problem like this at home? Problems like this can only get worse then it probably would in the hospital, and then we would have to run back to the hospital to get it fixed.
That being said, if it were me in the hospital, I'd want to get out ASAP. (And Carl is the same way). In the hospital, people are always monitoring the patient, morning, noon, and night. Blood pressure, temperature, heart rate, blood oxygenation are checked often, 4x a day. They wake you up to check these things - day and night, they take blood tests, and more. You don't go to a hospital to get rest. And you don't get it either.
The fear of infection, usually highest at a hospital, is one of the main reasons medical personnel send post surgery patients like Carl home so quickly after a surgery. That, and Carl moaning "I just want to go home".
So, home he is. And since things seem to be going well, I am very glad. Today I don't have to race over to the hospital, and that is a really nice relief. WHAT A TREAT. Carl slept well, he has had some food, and is getting lots of rest. I will keep you posted.
Thank you for your prayers. Keep them coming. What I am praying for now is that the neck tumor does not grow back, a very real possibility.
