I haven’t had an MRI/CT scan since December when the last one picked up the recurrence in my pesky liver.  There is a “lifetime max” to how much radiation you can be exposed to and for long-term cancer patients, it is definitely something that needs to be considered.  Each organ has a different limit and there are various factors contributing to what constitutes a lifetime max such as total dose of radiation and whether the entire organ was irradiated or just in part.  It is very possible that you cannot have radiation therapy on one organ, but you can with another given that there is enough distance in between.  Targeted radiation via SRS (Stereotactic Radiosurgery) can limit the amount of radiation in comparison to chemorad (low dose chemo + radiation).  Thanks to the radiation therapy and scans that I have had, the Wizard (my oncologist) has to balance out a limit on how much radiation I am exposed to vs. being scanned frequently enough for early detection of any recurrences.

One of the few things that I have found to be consistently missed in discussions between patients and their oncologists is the dental impact of treatment.  Last year I went to see the dentist to find that I had 8 cavities.  I was shocked to hear this and wondered if I just had bad teeth.  Around the same time I found that others who had undergone similar treatments had similar problems with their teeth.  My guess would be that it’s not the chemo that affects the teeth directly but the dry mouth that it sometimes causes contributing to the expedited degradation of the enamel.  I switched dentists after having those pesky cavities filled and the new dentist wanted to have a set of x-rays done to have a benchmark in my dental records.  The look of surprise I got when I promptly refused the x-rays was priceless.  I guess that dentists aren’t used to people being so matter of fact in their refusal of a painless procedure.  I explained about all the radiation I have had and why I will not have any further exposure unless I first clear it with my oncologist.  They tried to convince me that it would be okay because I would have the apron around my throat and on my chest, but still I refused.  I rely on my oncologist to oversee my medical care and that means that anything which may impact it will first have to be cleared.  The point of this is to be proactive in your own care people.  Don’t be afraid to say no and refuse anything that you are not comfortable with until it is explained and discussed.  Yes you have to trust your doctors, but that does not mean that you should be passive in your care.

CT scans are not the only way to detect the presence of cancer.  Fortunately for me, my CEA (Carcinoembryonic antigen) levels have always been a really good indicator of when the cancer is active.  That is not the case for everyone, but it can be an even more reliable indicator than CT scans for patients where the test is reliable.  Before the tumors appeared on the MRI last December, we saw a slow but consistent rise in my CEAs over the course of 3 blood panels, each several months apart.  With that in mind, I saw the Wizard in July to get the results of the most recent blood tests.  Everything was right as rain.  Anything up to 5.0 is within a “normal” range and my CEAs were <0.5 which means that it was “undectable.”  If my numbers came in hot (3+ for me), I would get a PET scan.  Anything in the mid-range (1-3) would warrant further discussion on whether to schedule an MRI/CT scan in the near future, and anything less than would give me a 3 month reprieve.  I was very happy to get the prize behind door #3.

Fast forward to my most recent blood tests…I saw the Wizard last Monday and I knew it was good news when he smiled and turned the screen so that I could see the results for myself.  My CEAs remain at <0.5 which begged the question – now what?  Options were to go back to scanning or to go with the wait and see approach.  Rather than regular CT scans for detection coupled with PET scans for confirmation (basically doubling up on radiation exposure), we’re going to stick with blood panels every few months and I will only have a PET scan if my numbers start to go up again.  It is not uncommon for patients to stop scanning once they have cleared a certain period (determined with their oncologist), but that can be a frightening time.  After all, how do you really know that cancer isn’t there unless you’re checking?  Have I kicked the beast to the curb forever?  Perhaps.  We don’t know for certain, but what we do know is that I’m one of the lucky ones for whom this is a great way to keep checking sans radiation.  It certainly offers peace of mind so that I can enjoy doing things like making asparagus soup with crab on a Sunday afternoon with football games running on the tube.

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