Incidental findings

By | Tue September 20, 2016

Thursday, September 8th

My eyes quickly scan over the MRI results. The summary diagnosis states “Neural foraminal stenosis”, I flip through the page reading further. “Broad disc bulges” stands out. I flip through to the second set of MRI findings. My eyes fixate on the word “T2-hyperintense area … lesion” In addition “there is a 7x5x7 mm rounded T2-hyperintense structure”. These words are meaningless and yet they are not. The word lesion sounds an awful lot like cancer, and yet the MRI report does not say as much. The report guesses that the T2-hyperintense structure “likely represents a nerve root sleeve/perineural cyst. If clinically warranted, additional contrast-enhanced imaging could be obtained to more definitively exclude a solid lesion”

I decide to see if Dr. Google can help me make some sense of the report. The word that is stuck in my mind is “lesion”. The main diagnosis of neural foraminal stenosis is not what worries me. What worries me is that T2-hyperintense area. The radiologist reports the exact size of one of the lesions. There is more than one. They explain the onset of upper back pain. They explain some of my odd symptoms. They may even explain the popping sensation in my ears – that is if they are actually perineurial cysts – at least that is what Dr. Google is telling me. But my mind cannot move past the idea that this could indeed be cancer.

After reading the report, I know that I will need an additional scan – this time with contrast. There is also mention of cervical stenosis so those areas will need to be included in the next scan. The logical person in me says to wait for an appointment with a specialist before getting any more scans. I convince myself that I don’t want to go through the scan multiple times. But the emotional part of me does not want to wait. The waiting feels like forever.

Hours after getting the results I have an appointment with my primary care doctor. I had the forethought to book the appointment with her the moment I had the MRI booked, so that I would not be stuck waiting for results. When I go to see her, she doesn’t say much. I think I asked about arthritis but I don’t recall her answer. I asked about the lesions. She suggests that she could order the scan with contrast but would rather wait and let the specialist determine what additional scans are needed. If I need to, I will push the specialist for a scan with contrast. I need to know whether or not those lesions could be cancer. The waiting is killing me.

While I’m still in my primary care doctors office my phone rings. It is the office of the physiatrist calling to setup an appointment. I’m amazed at how quickly I can get in. I could see the doctor on Wednesday, however, I have plans all day that day. I push the appointment to Thursday. What matters is that I have the referral for the specialist. That is the next step. Until then, I will need to wait.

Thursday, September 15

The doctor walks in the room. I notice immediately his mannerism are different. I cannot place them. He is almost like a character out of a cartoon, animated in everything that he says.

“How can I help you?”

“I have back pain” I say, clutching the printout of the MRI

“Does the pain radiate to your feet? Your arms? Do you have numbness or pins and needles?”

The doctor, a physiatrist, isn’t particularly concerned about the cysts showing on the MRI. He doesn’t seem to be particularly concerned about anything. He does, however, order more tests. An MRI of the thoracic spine with contrast and an MRI of the cervical spine. Once we have all the information we can figure out what to do.

What strikes me most about these encounters is that my mood and my emotions seem to be tied to the ways in which the doctors tell me about the issue. My family doctor refers – she avoids telling me. When I had cancer I could see it in her eyes. This time I could see some form of concern. I think that is what lead to the high levels of stress leading up to the physiatrist appointment.

The physiatrist seemed to be not worried at all. When I explicitly asked about the cysts, he said, they were just fluid filled pockets – an incidental finding on the MRI. We will do a contrast MRI just to be sure, but his mannerisms seem to be not ones of worry or concern. Maybe it is just his normal mannerism. I don’t know. This is the first time I’ve seen that doctor. Does it matter? I have been much less stressed about the whole thing since that visit. Perhaps that is part of his treatment?

He pretty much said, we treat it (the stenosis) with anti-inflammatories and pain meds. We leave surgery as a last option. Until my pain is radiating or causing numbness or other issues (e.g. incontinence) they stay very conservative with treatment. No need to see the neurosurgeon, yet. He mentions the possibility of an anti-inflammatory injection and lists off the side effects like a commercial on TV, including DEATH. Ya, nice. Maybe I’ll wait on that one.

And so, I wait another week. I’m busy – really busy – teaching, research, closet install, storage locker emptying, conferences, doctors appointments, grocery shopping, preparation for surgery next week (minor arthritis in the toe issue), and throwing in daily exercise … so much happening that I don’t have time to worry. Perhaps this is what it means to get back into life post-cancer – busy, busy, busy.

Feature image: By Blausen Medical Communications, Inc. (Donated via OTRS, see ticket for details) [CC BY 3.0], via Wikimedia Commons

Leave a Reply