I had no symptoms that really alerted me, but looking back, there were hints. The first was in June, when I experienced asthma like symptoms during a 128 mile ride. I wasn’t wheezing, but was short of breath, unable to breathe in my usual amount. This would have not been noticeable on my couch, but was VERY noticeable on a 128 mile bike ride. I had to stop and catch my breath on the one significant hill on the ride, became exhausted much sooner than usual, and was barely able to complete the ride. When I got home and told my wife, she thought I should go to the ER, but I couldn’t bring myself to tell a doctor, “Doc, I’m so terribly sick that I could barely complete a 128 mile bicycle ride.” I also had bronchitis for three weeks in August. I’ve always been bronchitis prone, but hadn’t had it this bad in years.
I probably should have posted some of this story about how it got diagnosed before, but here’s my story up to now. It starts with a thyroid nodule. It wasn’t cancerous, but ended up leading to the discovery of my lung cancer. It was the spring of 2006 when I noticed a lump on the lower right front of my neck. It was much lower than my Adam’s apple. I had a checkup with my regular doctor coming up, so I mentioned it to him, then. He said it was likely a harmless thyroid nodule, but referred me to a thyroid specialist. I traveled to the Dallas VA Medical Center to see this specialist. I had no idea then of how many times I would make this trip in the upcoming days.
The thyroid doctor ordered an ultrasound scan to measure the nodule, then an FNA (fine needle aspiration) for a biopsy to check it for cancer. None was found, and the doctor said the nodule should just be checked annually for growth. She did say, however, that an umbilical (belly button) hernia I’d had for a long time needed to be repaired, and I had surgery in January of this year for that. It was my first surgery in many years.
In the spring, another ultrasound scan was done on the thyroid nodule, and it was determined that there had been quite a bit of growth. Another FNA was done, and when it was inconclusive, another procedure was done, where the neck is numbed, and a much larger needle is used to extract biopsy samples. Just before he gave me a shot to numb my neck, the doctor said, “I don’t know if I should numb you or not. A long distance cyclist like you would probably like the pain.” I was NOT very reassured by this. There was still no cancer found.
I thought all this was to determine whether or not to do surgery on the nodule, but I was mistaken. The doctors had already decided to surgically remove it; they were trying to decide whether or not to take my left thyroid gland, as well. Thyroid nodules are common, and very low risk when they’re small and on young people, but when you are older and the nodule is bigger, and especially when it has a growth spurt, there is a very high risk of thyroid cancer. Thyroid cancer is among the least deadly of cancers, but it’s still cancer. If there is cancer on one thyroid gland, the risk of cancer on the other thyroid gland is so great, they remove them both. Since they didn’t find cancer in my thyroid nodule, they only wanted to do surgery on the right side.
I agreed to let them remove the thyroid nodule, and they scheduled surgery for September 29th. I was scheduled to race in The Texas Time Trials on that very day, so I asked them to reschedule for the next available date. They scheduled me for surgery on November 15th. Two weeks prior to that, I did all my pre-op appointments, which included a chest x-ray. They spotted a shadow on the x-ray, so faint they weren’t even sure if it was anything more than an x-ray glitch (properly called an artifact). When they went back and reviewed the pre-op chest x-ray from the umbilical hernia surgery, 10 months earlier, and saw the same shadow on it, they knew it wasn’t just an artifact, and ordered a CT scan.
When they called to tell me of my CT scan appointment, they only told me that my chest x-ray had something suspicious on it, and they wanted to take a closer look. It was 8:15 pm on Wednesday, November 14th, the evening before my scheduled surgery, when the surgeon called and told me my surgery had been canceled, and he was pretty sure I had lung cancer. It was a 2.8 centimeter SPN (single pulmonary nodule – anything less than 3 cm is a nodule, 3 cm or bigger is a mass). He called back the next day to tell me he wanted to admit me to the hospital on Sunday, November 18th.
Since the doctor was already supposed to operate on a thyroid nodule, and here I was with a cancerous nodule in my lung, he figured the thyroid nodule was probably cancerous, too, and that I might also have cancer in lots of other places, as well. With me as an in-patient, he knew he could get quicker test results and consultations with other doctors, to determine what, if anything, could be done for me. He didn’t share all that information with me at the time, but with the tone of his voice, he might as well have.
I was admitted, and violated with various tests. The first consultation the doctor wanted to do was, understandably, with the pulmonary (lung) doctors. It wasn’t until my second day in the hospital that he was able to do this consultation, and as soon as he did it, everything changed. The pulmonary doctor took one look at the CT scan, and told the thyroid surgeon that it was not a metastatic tumor from some other cancer, it was NSCLC (non-small cell lung cancer), and was the primary tumor, and as small as it was, it was probably the only cancer I had. He recommended that the thyroid doctor release me from the hospital, and turn my care over to the pulmonary doctors. I was released that evening.
My doctor care went from fast and furious to a snail’s pace. The pulmonary doctors seemed to be in no hurry. It was two weeks later when I had my appointment with a pulmonary doctor, who told me the SPN was well contained within the upper lobe of my left lung, that my lymph nodes showed no signs of cancer in the CT scans, making the cancer likely Stage 1, and that surgery to remove that lobe of my lung should be a slam dunk cure for the cancer, with a 90 percent chance of it not recurring. He told me with a straight face that I would notice no difference with that lobe of my lung missing. I’m no doctor, but I immediately knew better than that. Your right lung has three lobes; your left has two. A couch potato might not miss half of his lung being removed, but a serious cyclist was sure to notice his VO2 max being surgically reduced that much.
My research, though, had already told me that surgery was the best way to attack early stage cancer, so I agreed to the surgery. I asked about thorascopic surgery, which is much less invasive than open thoracic surgery, and he told me the VA only does open thoracic surgery for a lobectomy. I considered trying to get the less invasive thorascopic surgery. There were only a few doctors doing this type of surgery for lobectomies in the country, so I would have to travel, and even then, most would not guarantee not to change to open thorascopic surgery, once they got inside. Using a thorascope for a lobectomy is very difficult, apparently. The surgeon has to get all the way around the lung to remove lymph nodes to properly stage the cancer, and not many have the skill to do that with a thorascope. And if there are any complications, you get opened up anyway. So, I agreed to the open thoracic surgery at the Dallas VA Medical Center. If I had known then what I know now, I would have done whatever necessary to try and get the thorascopic surgery, instead.
I came in for a pulmonary function test the next week. A pulmonary function test checks your lung function to see if it’s good enough to give up a lobe of your lung, and still have enough lung function to get by. Not surprisingly, my pulmonary function was in the high-normal range, and the woman who administered the pulmonary function test said it was the first time she had seen a high-normal range on a lung cancer patient. I was to end up being a freak to many of the medical people I saw.
I waited for my surgery to be scheduled, and called when mid-December rolled around and it still hadn’t been scheduled. After my call, they called back to let me know my surgery had been scheduled for the day after tomorrow, December 20th. Wish me luck.