J: Am I too effusive?

Those who regard me as a model of taciturnity may now lower their raised eyebrows. It is a pleural effusion of a lung of which I write. The right one. Hmm… that has not figured in this blog to date.

Back when I had my first scan the analysis commented on very small nodules in the right lung, which I was told need not be cancer at all.

However the scan I had on the 22nd moves the plot along.

Earlier this week I noticed signs of breathlessness so went to our local surgery on Tuesday. They don’t have scanning equipment there, so other than tapping to establish some fluid in the lungs the doctor could not really comment. It’s much the same as when you tap on a wall – you know it’s solid or hollow, but you can’t tell how thick.

I pointed out I’d had a CT scan last week, so they agreed to chase up the results of that which would otherwise have been left until my meeting with the oncologist which had previously been postponed until the 3rd.

Yesterday one of the surgery doctors called me with the report but I found it quite hard to understand him. I did however learn that there was fluid in my right lung. That indicates a pleural effusion – where something has irritated the lung lining (pleura) causing excess water/blood to build up between that and the ribs. There has always been a bit of fluid remaining in my left lung from my February fun. I don’t think that’s changed.

Last night I found I was getting a bit breathless – for the first time when at rest. I figured this was probably because fluid at the bottom of the lung was flooding back. It’s much the same as when you have a cold on the chest and you can breathe better if propped up in bed. Strangely I had no idea that I had fluid in the right lung – you can’t seem to tell which lung’s underperformance is making you breathless. I’d just assumed it was the left. I also have the slight nausea and ‘flu-like feeling I had back in February, but not the tenderness in my sternum which seemed to puzzle people.

Today I took myself to surgery again to try to get some action. I was lucky to get an appointment with Dr. Munnelly who was the doctor who admitted me to A&E back in February. She’s lovely to deal with anyway, and was of course familiar with the plot to date.

She called the Medical Assessment Unit at Bath to see if they would take me in for a quick drain, but they asked her to call Oncology since I am now ‘under’ them. She thought they may well want to wait until Monday but said she would call later. While I was thinking “let’s get it drained before I get really breathless” she pointed out that to drain a pleural effusion you need a decent quantity. That’s because the liquid is between the lung lining and the ribs. So if the gap is too small when you whack in the drain needle you may puncture the lung, with complications arising… This is always a risk but clearly much greater with a narrower gap. So a delay may make sense when you think about it. Though I’d have thought a prompt X ray or ultrasound scan to check the state would be a reasonable idea…

This afternoon the surgery called back and confirmed that I should attend my Monday appointment with oncology as planned, and advised that they knew I might need draining.

Dr. Munnelly also took me through the CT scan analysis which makes a bit more sense now and is described as a “mixed picture”. I think this is the summary:

  1. The tumours in my left lung do show signs of being smaller. So that is a win and was the hoped-for outcome of removing the primary kidney tumour in May.
  2. There is evidence of a possible new ‘node’ in the right lung towards the top. As I understand it this is a bit different from a ‘deposit’ on the pleura (lining) itself – as I have on the left lung.
  3. There is evidence of a ‘deposit’ on the right pleura.
  4. There is possible evidence of some kind of hanky panky going on with a main aorta  – but this could be a consequence of the operation to remove my kidney.

The analyst also comments that I appear to have had a kidney removed, so full marks there! To be fair I have to say, having seen these scans in the past, that I am amazed they can figure anything out. Dr. Munnelly said she felt just the same when studying them during training. The problem with these tools is that once you have them you expect high levels of precision and that is not necessarily realistic.

The bottom line is that if my right lung is effusing, it’s caused by something; so there probably is a tumour kicking off in there. I just hope that this episode won’t delay the start of my chemo.

In the meantime I feel absolutely fine as long as I don’t get up to much. A good excuse to pick up a book rather than a paint brush!

We expect to update next week after the oncology appointment. Thanks for reading!

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