CT Scan Feb 15, 2021 Who Has The Right?

CT  021521 error W CONTRAST - Details

Comments from the Doctor's Office

CT looks pretty clear.

Study Result

Impression

IMPRESSION:

1. No evidence of new metastatic disease within the chest, abdomen, or pelvis.

2. Unchanged nonenlarged para-aortic and portacaval lymph nodes which were mildly FDG avid by comparison PET/CT. No new or enlarging lymph nodes in the abdomen/pelvis.

CONTACT INFORMATION:

If you are a patient and have a question about your radiology report, please discuss it with the provider who ordered this imaging study.

If you are a health care provider and have any questions regarding this or any other Abdominal Radiology report please call: (720) 848-6007. The Abdominal Radiology reading area location is: B-325 AIP2. We are staffed 7 AM - 5 PM Monday through Friday. After hours or on weekends please call (720) 848-8666.

Report E-Signed By: Matt Markese at 2/16/2021 10:48 AM
WSN:PACSREM73205

Narrative

EXAMINATION: CT OF THE CHEST, ABDOMEN, AND PELVIS WITH IV CONTRAST

DATE: 02/15/2021, 1907.

INDICATION: 56 yo F with a PMHx of recurrent ovarian cancer s/p hysterectomy/oophorectomy on chemo, now with rising CA125; please eval disease/METs
Was there a contrast reaction? No
Was there a contrast or saline extravasation? No.

TECHNIQUE: Transaxial images of the chest, abdomen, and pelvis were obtained from the apex of the lungs to the ischial tuberosity according to according to routine chest, abdomen, and pelvis protocol.

CONTRAST: Isovue 370, 85 mL.
IMMEDIATE ADVERSE EVENT: None

COMPARISON: CT of the abdomen and pelvis dated 8/5/2019, PET/CT dated 8/20/2020

FINDINGS:

CHEST:

Thyroid: No thyroid lesions.

Thoracic inlet: No adenopathy.

Mediastinum and hila: The airways are normal. There is no significant mediastinal or hilar lymphadenopathy.

Heart and great vessels: The heart is normal in size. There are no significant coronary artery calcifications. No pericardial effusion. Great vessels are normal.

Lungs, airway, and pleura: No significant pulmonary nodule or infiltrate is noted.

No pleural effusion.

Breasts and axilla: Normal. No adenopathy.

ABDOMEN AND PELVIS:

Liver: The liver appears normal in size, shape, and attenuation with no detectable focal lesion on this exam.

Patent portal veins.

Bile ducts: Unchanged dilation of the common bile duct.

Gallbladder: Surgically absent.

Pancreas: Normal.

Spleen: No splenomegaly.

Adrenals: Normal adrenal glands.

Kidneys, ureters, urinary bladder: Kidneys and ureters appear normal. No hydronephrosis.

Urinary bladder is thin walled and distended.

Reproductive organs: The uterus is surgically absent.

Gastrointestinal tract: Appendix is surgically absent. No obstruction. Contrast is seen in the small bowel.

Mesentery: Normal.

Peritoneum: No free air. No free fluid.

Retroperitoneum: Surgical clips. No significant lymphadenopathy in the abdomen and pelvis. Unchanged 7 mm periaortic lymph node, previously 6 mm (5/121). Unchanged 8 mm precaval lymph node in the porta hepatis (5/100). No newly enlarged lymph nodes are identified.

Vasculature: Mild calcifications of the aortic arch.

Bones and soft tissue: There is mild degenerative change of the spine. No aggressive osseous lesions are identified. Small fat-containing umbilical hernia another fat-containing hernia is seen along the anterior abdominal wall (5/89). There is a 6 mm nodule fat density located along the anterior chest wall, most likely represent fat necrosis (5/31). Stable lytic lesion along the right ilium.

Images

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Component Results

There is no component information for this result.

General Information

Ordered by Kian Behbakht, MD

Collected on 02/16/2021 8:56

Resulted on 02/16/2021 10:48 AM

Result Status: Final result

This test result has been released by an automatic process.

Back to the Test Results page

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CT SCAN FEB 22, 2022 NOTES PREVIOUS BLADDER TUMOR

I was punished for complaining about this.  Steady and regular increases in my CA125 during 2021 noted but no additional scans were ordered.  I was having bladder pain.  No UTIs.  So here I am today again not being heard. My depression is over the top.  It's my record.  I recently was criticized for needing too much control.  Well I need control over scheduling so that I can work.  I have intense fear of medical mistakes...and there is just reason.  My psychologist was recently on Fox31 because the oncology team has launched a virtual psychotherapy service to help patients cope with cancer. What I would give if my only challenge was cancer.  My challenge is not just cancer.  It's doctors making mistakes and ignoring my input.

• CT 020122 reports tumor has GROWth W CONTRAST

• PRIOR STUDY 021521

About this test

Details

Addendum

Signed by Clark, Toshimasa James, MD on 2/22/2022 4:41 PM

ADDENDUM:

 

On the MR 21 days later a right pelvic sidewall node is evident (in addition to the nodule abutting the bladder). In retrospect on this CT from 2/1/22 there is an isoattenuating nodule along the right external iliac vessels in this location, 23 x 13 mm (7/151) and new since 2021. 

 

Report E-Signed By: TOSHIMASA CLARK, MD at 2/22/2022 4:41 PM

WSN:PACSREM73182

Signed by Clark, Toshimasa James, MD on 2/8/2022 3:23 PM

ADDENDUM:

 

Ms. Archuleta requests an addendum for a paraaortic node measurement as one was measured before. Representative left paraaortic node near a clip causing streak artifact is about 8 mm short axis (7/119) from 7 mm before. It may be slightly larger but is still not frankly enlarged, and again this region has artifact.

 

Report E-Signed By: TOSHIMASA CLARK, MD at 2/8/2022 3:23 PM

WSN:PACSREM73182

Study Result

Impression

IMPRESSION:

20 mm apparent nodule atop bladder dome, suspicious for a tumor deposit in this setting. Cystoscopy with EUS may be useful in this setting.

CONTACT INFORMATION:

________________________________________________
This exam was interpreted by a University of Colorado School of Medicine radiology physician. If there are any questions regarding this report or other radiology questions, please feel free to contact a radiologist directly at 720-848-RADS (7237) or if in the UCH hospital or clinics at 8-RADS.

Report E-Signed By: TOSHIMASA CLARK, MD at 2/1/2022 2:42 PM
WSN:PACSREM73182

Narrative

EXAMINATION: CT OF THE CHEST, ABDOMEN, AND PELVIS WITH IV CONTRAST

DATE: 02/01/2022, 1122.

INDICATION: eval for disease, increased ca 125

Was there a contrast reaction? No
Was there a contrast or saline extravasation? No.

TECHNIQUE: Transaxial images of the chest, abdomen, and pelvis were obtained from the apex of the lungs to the ischial tuberosity according to according to routine chest, abdomen, and pelvis protocol.

CONTRAST: Isovue 370, 100 mL.
IMMEDIATE ADVERSE EVENT: None

COMPARISON: 2/15/21

FINDINGS:

CHEST:

Right sided implanted port, tip at cavoatrial junction.

Thyroid: No thyroid lesions.

Thoracic inlet: No adenopathy.

Mediastinum and hila: There is no significant mediastinal or hilar lymphadenopathy.

Heart and great vessels: The heart is normal in size. There are no significant coronary artery calcifications. No pericardial effusion. Great vessels are normal.

Lungs, airway, and pleura: No significant pulmonary nodule or infiltrate is noted.

No pleural effusion.

Breasts and axilla: Bilateral mastectomies. No adenopathy. Stable low attenuation presumed fat necrosis in medial right breast resection bed (7/27).

ABDOMEN AND PELVIS:

Liver: Likely fatty liver, top normal size, but with no detectable focal lesion on this exam.

Patent portal veins.

Bile ducts: Mild common bile duct dilation is presumed due to post-cholecystectomy state given normal bilirubin.

Gallbladder: Surgically absent.

Pancreas: Normal.

Spleen: No splenomegaly

Adrenals: Normal adrenal glands.

Kidneys, ureters, urinary bladder: Kidneys and ureters appear normal. No hydronephrosis.

Urinary bladder is thin walled and distended. 20 x 16 mm nodule atop bladder (7/174) might be a loop of small bowel, but on the prior study oral contrast was given and this didn't enhance (5/172). It was 12 x 12 mm at that time.

Reproductive organs: Uterus is surgically absent. No adnexal masses.

Gastrointestinal tract: Appendix not identified. No pericecal inflammation. No obstruction.

Mesentery: Normal.

Peritoneum: No free air. No free fluid.

Retroperitoneum: No significant lymphadenopathy in the abdomen and pelvis. Stable top normal periportal nodes, nonspecific (e.g. 7/94).

Vasculature: Aorta and IVC appear normal. Retroperitoneal surgical clips noted adjacent to vasculature.

Bones and soft tissue: There is mild degenerative change of the spine.

Images

Component Results

There is no component information for this result.

General Information

Ordered by Kian Behbakht, MD

Collected on 02/01/2022 2:08 PM

Resulted on 02/22/2022 4:41 PM

Result Status: Edited Result - FINAL

This test result has been released by an automatic process.

Back to the Test Results page

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Not Heard Again Counts Too Low For Gemzar Today

​I literally have no voice.  The pharmacist had agreed to lower my Gemzar, but they actually didn’t. Somehow I am supposed to be calculating doses “per meter squared” which is why somehow it is my wrror?!!! No! I clearly stated I wanted less than what the oncologist was intending … 25% of standard dose was my original request.  

She talked me into “650”.  I was given “750”.   

My intention was, because I needed a platelet transfusion in the past, to start LOW and work my way up. Sounds reasonable to me. 

I had my Gemzar last Tuesday, I was sick over the weekend but fended off ongoing fevers with Tylenol.  I literally cannot have the “plan” to be ER visits every week. I was avoiding the ER for many reasons but would have gone in if the Tylenol didn’t help.  It is Extremely difficult to isolate the differences between sickness from neutropenia versus side effects of Gemzar.  

My oncologist was patient and counselled me in a more specific way so that I make the righr choices but I literally am not going to agree to live in the ER.  We can do better and I thought that my request to lower my Gemzar even further was a safe alternative.  Appearently my opinion and voice are muted. I am extremely depressed.  

I think people in the oncology field assume patients expect ER visits. They don’t want to think about how to better plan avoiding ER visits, especially for patients like me. I am SINGLE!  I HAVE TO WORK! It is NOT MY FAULT that I have had such crappy medical care!

I have a few good friends but literally no family who can be with me during this time for regular ER visits. 

Why is my voice not heard? 

My burden for just having a place to live is overwhelming me. My rent was raised by $111.00 per month. If I have no apartment I have nowhere to live. Can you imagine me couch surfing or living in my car or transitional housing during chemo?

Does the medical community want me to die?  I love my NEW oncologist.  I really do.  I love the care team, but why??????? How many more little mistakes though? My bone marrow order said I have lung cancer.  I was restaged to grade IVB without Any conversation.  I hate the medical system.  I guarantee you if I were married or had money this would not be happening.  

I don’t want to do hospice in a nursing home, when it comes to that.  In order to reveive HOME hospice I need a HOME.  Can you imagine me finding a “roommate” at this point?  

No Gemzar today, onviously, because all my coumts are low. I have antibiotics now if fever returns.  My previous gynonc should be paying my rent.  He’s the one that let my cancer spread for a year.  My CA125 steadily rose every month for a year and there was a scan showing tumor growth. Then he punished me for complaining about that. I am going to publish my records.  An attorney may not value my life, but at this point I have no choice.  Letting recurrences go untreated while receiving REGULAR gynonc appointments is completely unacceptable.  I need to not have to work right now.

Why aren’t doctors asked to atone for their sins.

I am starting to think that there is literally a demon attacking me.  Nobody listens to me.

I wanted a lower dose of Gemzar last week, was told it was lower, but it wasn’t.  My request was clear, whether I calculated based on body weight or not.I am not a pharmacist, how would I know the difference?  

Very depressed, not feeling like Servivorgirl. 

Over The Years With My Baby Girl

​

Trying Gemzar

​Hello friends,

Peace. It’s been a nerve-wracking two weeks. My oncologist will allow me to try Gemzar at a reduced dose. I’ll be receiving bevacizumab during some of the treatment cycles. I pray I get through just one and see a big drop in my CA125.

I’m disappointed that my voice regarding PARP inhibitors was ignored.  My bone marrow is very weak, but praise God there is no sign of MDS or chemo-induced leukemia. If they would have listened and tried Gemzar last February I would have had a stronger bone marrow. If they wouldn’t have MISSED my recurrence we could have attacked my recurrence in 2021. Getting unstuck from the traumas has been hard, but progress is being made.....just in small doses. I need to keep my eyes on God (this last sentence added after confession Sunday before Mass.)

I had a melt-down yesterday because I’m already overwhelmed with too many appointments, a surprise appointment yesterday and realizing I can’t work and do these treatments.  I don’t know how this will work.

I’m receiving EMDR treatments, just getting started. Yesterday I was receiving EMDR while processing the trauma of my mom’s death in 2013.  There was not only trauma from her sudden loss but of course family stuff. It’s common, I think, for families to have differences when a central figure dies. All these things together are overwhelming. I wish healthcare providers better understood PTSD. The entire healthcare system is in a state of trauma.  It’s very sad.  

There are rays of sunshine that peak through the clouds but it’s not looking good right now.

The elephant in the room is my life and I’m trying to sustain myself as I attempt Gemzar.  The only other time I received Gemzar I ended up very sick in the hospital, and required a platelet transfusion.

I will be so happy if it works. But if I end up in the hospital without a significant drop in my CA125 we may need to stop. I don’t know.

I start Gemzar next week.  

Peace,

Denise