CT scan obtained for attenuation correction and localization purposes. images generated from the base of the skull to the proximal thighs.

The patient is S/P gastric pull-up surgery for esophageal carcinoma.

There is an intensely hypermetabolic 1.7 cm focus with an SUV of 11.7 nestled between the pancreas and the clips anterior to the abdominal aorta, inferior to the origin of the celiac axis, indicating a new metastatic lesion. There is also a more poorly defined focus superior to the origin of the celiac axis at the surgical clips at frame 110 with a maximal SUV of 4.4. It is uncertain whether this latter focus represents neoplastic disease or possibly only inflammatory changes.

Within the mediastinum however, there is also a new 1.6 cm intense lesion with a maximal SUV of 9.7. This node, in the right prevascular space anterior to the SVC at frame 73, would also represent distal neoplastic spread.

Elsewhere, there are no other FDG avid lesions to indicate additional potential sites of hypermetabolic neoplasm. Specifically, the lungs, liver and bones are free of FDG avid lesions.

IMPRESSION:

Mediastinal hypermetabolic metastasis. Additional metastatic lesion inferior to the origin of the celiac axis. Inflammatory or neoplastic changes more superiorly as detailed above.

I have my PET scan on January 31 at 1:30. MGH, D5129.

I really hope that there is a positive result.

I feel something strange where the tumour was. I shouldn't feel anything there. It could be reflux or something, but I dunno. I need January 31 to come quickly.

This was what I received in the mail today, along with my second to last payment from insurance. If I understand correctly, I don't get any long-term disability (and I only wanted a partial amount until the middle of January) because I started treatment during my first three months on the job. This also means that I will have to start back full time two weeks earlier, because I need the money. Luckily for me, my company gives us a paid (I think) shut down from December 24 to January 1.

The obvious lessons: insurance companies are sneaky, and don't get sick during your probation period. This means you.

I forgot to mention: three months ago today my life changed. At this time, I was waking up in my hospital room from surgery. The three month mark is where you can expect to start eating normally, and I am happy to report that I have been doing so for more than three weeks now.

The weekend before last I was up north in the beautiful autumn Laurentides at Camp Kinkora, with the Young Adults Cancer Group, a division of CanSupport. As luck (good? bad?) would have it, I was the only man there. There were two coordinators, one "MC" and five other participants.

So I took a cab downtown last Saturday to meet with these people who I had never met before save one, by chance. I was feeling, as usual lately, pretty crappy, but I was determined to make it there. My motivation was that I really, really needed to talk to some people that are in a similar struggle for health and mental/emotional well-being.

I am depressed, you see. I am not the same person you met in June, full of hope and great expectations. Sure, I still expect to be better, but the feeling isn't quite as strong. But in June I could not have imagined how difficult this recovery would be, and now the reality is brutal. This depression is affecting how I function in my relationship in a major way, but that's a whole other discussion. This is supposed to be a positive entry.