On PET scans and nuclear sugars

One of the first things I want to tell you about is the bizarre experience of having a PET scan. The PET scan -- or, Positron Emission Technology --was explained to me in this rather simple way: "cancer cells consume glucose much more rapidly than normal cells. We inject you with nuclear sugars, wait an hour for the sugars to be absorbed, and then do a full body scan to look for 'hot spots.' " It is a standard technology for understanding how far/if the cancer has spread.

A quick note about radioactivity: I grew up less than 30 miles from Three Mile Island, and in 1979 when the almost-meltdown happened, my family drove to Long Island for about a week. I remember being scared and confused, and the word "nuclear" was frequently uttered. I was twelve when Chernnobyl happened, and recall the horrors of multi-headed goats and other agrarian deformities reported in the pages of Time magazine in the following years. I am also a fan of The Simpsons, and cannot think of radioactivity with imagining the opening sequence in which Homer obliviously releases radioactive material into Springfield. All of this is to say that I am a child of the nuclear age, and in my normal, pre-cancer world, could not have imagined willingly putting myself anywhere near radioactive materials, let alone putting them into my body.

So, last Thursday at 10am I showed up to the Bellin Cancer Center for my very first appointment: the PET (which, a friend teasingly explained to her children, meant they would be scanning Buddy). The kind but rather brusque technician came to retrieve me from the calm environs of the lobby. She did a quick overview of what was going to happen as we walked down the hall to the staging room, a tiny little room (perhaps 5x5 feet) with only a small stand and a recliner. She then began to explain that, although the building was generally very very nice, the PET rooms were poorly designed and "all us technicians are pretty mad about it." No shit!, I thought as I attempted to sooth the slightly claustrophobic tendencies beginning to encroach.

She then explained that the first step was to test my blood sugar "If you are over 180, we can't do the scan today." And another small round of panic surged as I thought about the big chocolate chip cookies and blackberry pie consumed the night before as a group of friends converged on our house for a small distract-the-girls-from-cancer party. Why didn't anyone tell me this ahead of time? I had known to fast after midnight, but no one mentioned a thing about blood sugars. "Okay" I muttered "but, uh, I ate a lot of sugar last night." The technician looked at me with vague disapproval and pity , issued a slight tisk-tisk and in her best Wisconsin accent said "Oh! You did some carb-overloading last night, did ya?"

We quickly got past the sugar scolding as my blood levels were fine. We moved on to the most important -- and strange -- part of this story: the injection of nuclear sugars. The technician left the room to obtain the sugars (they have a half life of 13 minutes, so everything must be ready to go) and returned with a nifty-looking little lead box. It really looked like a Japanese-design modernist lunchbox with cute handle and all. Shen then took out a vial which was also wrapped in a lead jacket, and then quickly shot me up with the sugars.

She the left the room, returned with warm blankets, propped my legs up and said in a most perfunctory way: "Okay. I'll be back in an hour. You are not allowed to have any stimulation at all, so no reading or music or anything." What!? Did you just tell me I am not allowed to have any brain stimulation? Of course, being who I am, my immediate response is to have a rapid-fire inner-dialogue about the sheer impossibility of this request. Are you telling me not to think? Really? 'Cause you just shot me up with radioactivity and enclosed me in a room smaller than my bathroom. Never mind the fact that she had just conveyed this request to a slightly neurotic academic trained by a vast army of theoretical geeks to always think, always analyze. I'm pretty sure not thinking is not possible. But, whatever.

The results of the PET are discussed elsewhere, and the actual process of being scanned was far less exciting than the setup. I essentially laid on a gurney while being shuttled through an enormous CT donut. It felt kind of reminiscent of going through a car wash, minus the water, of course.

As I retell this story, I can't help but think of Mary Poppins who cheerfully assured her wards that "a spoonful of sugar helps the medicine go down." And this, my friends, was my introduction to Cancerland.