In the hospital again, but some good news too

[Joan M]

I've been in the hospital from July 2-11 for coughing up blood again, and had a wedge resection via a thoracotomy on Tuesday, July 7, to remove the part of the lung that was bleeding.

I was admitted through the ER and put on NPO for about 48 hours over July 3-4 in the event emergency surgery would have to be performed if the bleeding didn't stop. But it finallly stopped.

But there is some good news. The bleeding appears related to the RFA last summer rather than to cancer. And to add to the good news, a brain MRI from about three weeks ago showed all is well in the head.

As some of you know the bleeding seemed to be the result of the lung RFA I had last August after which I developed a suspected fungal infection in the lung (aspergillous) that was noted on a January PET/CT. In February and after starting to cough up blood I was treated with voriconazole (VFend), an antifungal agent, and then most recently in mid May with an ambulatory pulmonary catheterzation embolization (with stainless steel coils) to stop the bleeding after it started up mildly.

The current PET/CT, the results of which I received the day before going to the ER, showed that the majority of the area of inflammation in the January scan was gone (and there was a lot of it), and the only hot spot left was the site of the RFA (or original area of the recurrence after the wedge resection in 2007 that prompted the RFA). And there were no other hot spots.

I had just seen the pulmonologist earlier in the week about whether to continue VFend, and he was waiting for PET/CT results to help him make that decision. A lung CT showed I still have bronchiectasis, or damage to the airways.

A thoracotomy is no picnic, but the surgeon needed to painstakingly determine which area of the lung to remove. Thankfully, he decided on a wedge, which is smaller than a segmentectomy, which is smaller than a lobectomy. He was aiming for a segmentectomy.

He said he could see the fungal ball that had grown in the cavity caused by the RFA, and a culture grew aspergillous so I'll be on VFend for another month just as a precaution,

I'm still waiting for the path report on cancer, but according to the surgeon, there were no visible nodules, and he doesn't think there's any unless it turns up microscopically.

A note about lung RFA: Please don't let my experience deter you from this procedure if you think it's right for you. Even the surgeon said that it could have gone the other way, or turned out perfectly. But I got the lousy fungal infection which was basically eroding my blood vessals in that area of the lung and causing them to bleed. Also, I already had a wedge resection in that area of the lung, so there was scar tissue and damage, just the environments that bacteria and fungi like to colonize. And I also researched RFA of the lung and never read that infection is a major issue. Then I had a craniotomy two months after the RFA and was given four weeks of Decadron, and the steroid could have added to my susceptabilty. But the take away message would be to ask the interventional radiologist about possible infection if you're thinking about such a procedure.

I'm not sorry I did the RFA. I would rather have tried the less invasive treatment first and to avoid chemo too since I had only one nodule.

I'm fading ... my back hurts ...

Love you all,

Joan