Clarity and Healing
We arrived in Tijuana at the Oasis of Hope the day before Thanksgiving, a day also celebrated by many Mexicans in Tijuana and other border towns and cities across Mexico. For the second year in a row we shared in a day of thanks and gratitude. New friends were met while old friends were embraced and remembered. We have come to view the staff of Oasis as friends and family and we always celebrate our return.
On Each visit to Oasis we have a meeting with Dr. Contreras and his senior staff to review Phyllis’ latest PET scan, review her treatment plan and adjust it as needed. When we left Union we left with a somewhat bothersome radiologist’s report that described three new tumors — some with a disturbing level of activity. For those of you unfamiliar with a PET scan (positron emission tomography) is an imaging test that is typically used to assess the presence and extent of a disease such as cancer OR hyperactive metabolic process such as inflammation.
The PET scan requires that the patient be injected with a small amount of a radioactive tracer which accumulates in areas of high metabolic activity such as cancer tumors. The degree of brightness of the areas that appear on the image is used to estimate the degree of activity. For PET scans used to explore the extent of cancer in a cancer patient the tracer is a substance called [18F]Fluorodeoxyglucose which is a molecule of glucose with an atom of radioactive Fluorine attached to it. This works well because glucose is the primary fuel of cancer cells. The rate of uptake of 6-Flurodeoxyglucose is called the Standard Uptake Value (SUV). In order, to calculate the SUV the amount of tracer that is injected into each patient is based on that patient’s body weight — at least it is supposed to be.
This is what happened. We left Union with a PET scan indicating three new tumors, two on my wife’s spine and on in her shoulder. All three showed a disturbing level of activity ( an SUV of around 8.5). When we met with Dr. Contreras and his staff and saw the PET scan for the first time ourselves we discovered that there was only one new tumor on her spine and that it was small and while it was of concern it was not alarming nor a surprise.
As it turns out the “tumor” in her shoulder was an area of inflammation that was due to the healing of a fractured shoulder that she had incurred over the summer (a longer and different story). The second “tumor” in her spine simply wasn’t present. We have no idea what the radiologist in Ohio was looking at.
And about that SUV — on the the radiologist report it was noted that the dose was prepared based on a body weight of 70 Kg or about 150 lbs. But my wife only weighs
58 Kg (about 128 lbs). Because the uptake of 6Fdeoxyglucose is linear (the more you present the more the tumor takes in) her SUV was overestimated by about 20%.
In short the radiologist provided us with a flawed report which greatly overstates the extent of the cancer present at the time of the PET scan.
Why was a dose for a 150 lb. person used for a 128 lb. person? Because it is more convenient than preparing a dose that actually reflects a patients true body weight. But wait; there’s more (isn’t there always?). Here is a concluding statement in the paper: PET/CT Standardized Uptake Values (SUVs) in Clinical Practice and Assessing Response to Therapy by Paul E. Kinahan, PhD* and James W. Fletcher, MD
“Thus one can expect the actual variability of SUVmax in practice to be greater than 15% to 20%.”
In other words take the PET scan SUV with a grain of salt. And maybe get a second opinion.
This is not the first that I have complained about the administration of dose of 6Fluorodeoxyglucose that is inappropriate for arriving at accurate interpretations of my wife’s scans and I am sure that it won’t be the last.
Here’s the bottom line, everything is under control and hope abounds. There will be more about this particular trip to The Oasis of Hope Hospital and an exciting new addition to their arsenal of treatments in about three months or so when a new PET scan will be performed.
Abiding Gratitude
On the first leg of our return from San Diego to Denver a young Marine Staff Sargent in full dress uniform was seated preferentially in the first row. This Marine was the escort of the remains of a fallen comrade in what is known as the Dignified Transfer of Remains from the location where the Marine died to where he or she will be interred. It is a solemn event and one that I was honored to observe with gratitude for the men and women who serve and for this young Marine who’s duty and privilege it was to escort his fellow Marine to his final resting place.
3 December 2023
Union, Kentucky
Thank You Jesus
For Oasis of Hope n for you, Larry, being so in tune n on top of Phyllis's health care treatments n reports.
May HolySpirit continue to lead, guide, n direct all care, meds, treatments, protocol for Phyllis.
Safe travels... wisdom n God favor🙏🙏