Updated January 20, 2010; links to research articles added.
I’ve just been giving myself a crash course in how to read CT scans. Not for the faint of heart, trust me on that, although you get to say mysterious things on your reports, like “there is some minimal linear subpleural opacity…which may be related to…radiation related changes.” Yee gods, as my mother used to say. Guess they don’t do English grammar in med school.
Thus, Grasshopper, do I direct you to the above image, which I have embellished for purposes of clarification. It is a transverse image, which means it’s like a horizontal slice of my thorax, from my CT scan last Friday. The pink ellipse indicates the putative “minimal linear subpleural opacity,” which, in English, means those little white grainy things there, that look like gravel along the outside edge of the lungs, which are those black bean-shaped things. That white outline around the lungs, by the by, is the pleural sac. The faint, squiggly lines in the lungs are, I think, the branches of the lower bronchial system that go into the alveoli. This image is at a level that’s just above the nipples, so it’s about at the level of my radiation tattoos. The purple dots are where the tattoos are, and the green line between them represents the inner margin of the external beam radiation with which they zapped my breast.
So, the good news is, I don’t have any scar tissue actually in my lungs. The bad news is that my asthma is worse than it has ever been in my life. But the good news is that I have normal lung capacity, according to the pulmonary function test I took this morning. But the bad news is that there is scar tissue along the front of the pleural sac around my right lung. I dunno, you do the math. Does this mean that I break even? The pulmonologist called and said that the asthma has likely worsened and continues to pester me because of some infectious or inflammatory process, although she wouldn’t come right out and pin it on radiation. They must have a class in med school called, “Hedging Your Bets 101.”
Well, here’s the thing. Before I had radiation to my right breast, I hadn’t had a cold in years. I’d had bronchitis maybe fifteen years ago. I hadn’t had any asthma reactions to anything in three or four years, and maybe I’d had only one or two teeny attacks that lasted all of ten minutes each. On the other hand, within two weeks of starting radiation, I came down with a raging, rip-roaring sinus infection requiring antibiotics. Three months after radiation, I had another sinus infection, also requiring antibiotics. Ten months after radiation, I started having what I have since been told was a protracted period of asthma, with increasingly worsening shortness of breath and a constant dry cough. This lasted from August through the end of December, and included another sinus infection requiring antibiotics, plus treatment with prednisone, plus a steroidal inhaler, before it subsided enough so that I could take a deep breath without coughing up a lung. It’s still with me, but now when I cough, my lung stays where it belongs.
So…I think we have one of those duck situations here. To wit, both the pulmonologist and the radiologist were willing to admit that radiation might have and even probably did have something to do with the pleural scarring, but wouldn’t commit themselves to blaming it for my breathing problems. However, as I have said before, if it looks like a duck, and it quacks like a duck, and it coughs like a duck, then it’s a damn duck.
Ya ain’t gonna snow me with all yer fancy lingo.
And here’s some research to back me up; these are downloadable PDF’s.
- Radiologic Findings of Pulmonary Changes After Breast Cancer Radiation
- Clinical Relevance of Pulmonary Late Effects After Breast Cancer Radiation
The title is a quote from the song, “The Air That I Breathe,” by the Hollies.
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