It’s over. The photos for my holiday cards are taken and ready to be processed. Look for a Christmas card with a cross section of my pelvis coming to you soon!
I had my 68Ga PSMA-11 PET and CT scans yesterday. In short, all went well but the technician couldn’t (or wouldn’t) tell me if the scan lit up like the Rockefeller Center Christmas tree. She said that images had to be processed first, and that she wasn’t trained to interpret them anyway. The doctors would have to do that in 1-2 business days.
The whole process took just under four hours—from the time I left my car in the parking garage to the time I got back in it.
I checked into the Department of Nuclear Medicine about 40 minutes before my scheduled appointment (I was told 7 a.m. by the booking representative), and was told that my appointment was actually at 7:45 a.m. Oh well. It gave us a little time to complete the necessary paperwork and payment.
You’ll have several forms to complete, mostly asking about your current health status and history. Pretty easy. Just check the boxes and sign. You’ll also get one of those plastic wristbands with all of your information on it placed on your wrist. Mine initial band had my wrong birthday on it, so we had to have that corrected and a new wristband printed.
If you’re like me and your paying for it out of pocket, this is also where they’ll ask for your credit card (no cash or check) and charge the $3,300 fee.
After you’re checked in, they’ll let the staff know that you’re there ready to begin the preparation process.
In the preparation room, the technician will insert an IV catheter into your arm that will be used to inject the 68Ga tracer and iodine contrast. As he does this, he’ll go through a very thorough explanation of what to expect once the scans begin.
He will also prepare another contrast that you take orally. It’s about 1 to 1.25 liters of a slightly yucky-tasting solution that you have to consume over the course of 45 minutes. They’ll also want you to reserve about 6 to 8 ounces of the fluid to gulp down just before you go in the scan. They want to have it in your stomach and not your intestinal tract. But you can’t start ingesting any of this until the 68Ga tracer is injected into your arm.
I believe that they actually manufacture the tracer on the spot for each patient. This is because, with its relatively short half-life, they can’t have it sitting around on a shelf waiting to be used.
When he returned with the 68Ga tracer, it was in this cute little container that I’m guessing was lead-lined to contain the radiation. He connected it to the IV catheter, juiced me up, and instructed me to start drinking the solution.
The last thing that he did was give me a little, “This guy is radioactive,” card to show to the authorities should I happen to set off sensors at airport or border security check points. Thankfully, I drove, so it wasn’t a concern for me.
That whole process took a little over an hour.
Once you’re primed and ready to go, they’ll take you to the scanning room but they’ll ask you to stop by the toilet to empty your bladder first.
Interestingly the only articles of clothing that I had to remove were my shoes and jeans. Actually, they gave me the option of just pulling my jeans down below my knees or wearing a pair of hospital-provided pajama bottoms. I opted for comfort and the pajama bottoms.
They’ll place you on your back on the scanner bed and place a little cushion under your knees to make you feel a little more comfortable and, I suppose, to help better position you for the scan. You’ll raise both arms over your head and you’ll have to keep them there throughout the scan.
They’ll use your IV catheter to inject some iodine as a contrast. For me, the last time I had a CT scan and they injected the iodine, I became rather nauseated and told this technician about that incident.
She told me that they inject the contrast at a much slower rate than what’s used for a normal CT, and that should lessen the effects of the nausea. Even so, for insurance purposes, we put a little bib around my neck and a towel on my left shoulder just in case. “Try not to move your body if you do vomit.” Yeah, right. Good luck with that. Fortunately, she was right about the slower injection rate. The feeling was there briefly, but much less intense that before.
They’ll start with the PET scan first while the 68Ga tracer is still pretty strong, and it probably took about 25-35 minutes (I couldn’t see a clock for reference). Your only task is to stay completely still throughout. At the very beginning, you’ll be asked twice to inhale and hold your breath for about 10 seconds. After that, you just lay there, close your eyes, and enjoy the ride. (The scanning machine is nearly silent.)
Once the PET scan is done, they’ll send you off to the toilet once again to empty your bladder before the CT scan.
You’ll get back in position onto the scanner bed just as before—knees propped up and arms above the head—and they’ll begin the CT scan. The technician said it would take 8 minutes, but it seemed closer to 15 minutes to me.
When you’re done with the CT scan, you’re done. You get dressed and head home—I didn’t have to stop at the reception desk afterwards. They will tell you, however, to drink lots of fluids (preferably water) to flush the contrasts from your system.
They will forward the results to the physician who ordered the scan.
Aside from a slight metallic taste in my mouth and being really hungry after fasting in advance of the scans, I felt fine leaving the hospital. My shoulders were a little sore from holding my arms above my head for an hour or so, and that was about it.
When I arrived home, though, it all caught up with me. I was spent.
During the whole process, I felt very calm and relaxed, so I didn’t think it was stress-related fatigue, but I guess our subconscious can play games with us. It may have had something to do with waking up at 4 a.m. and not being able to fall back asleep, too. Or a combination of all of the above. Regardless, I just crashed on the sofa and took a nap.
One other thing that happened yesterday afternoon was that I had a bunch of gremlins doing a jig in my stomach that caused me to run to the toilet half a dozen or so times. (TMI, I know.) Whether it was related to the contrasts or the hot giardiniera peppers I had on my Italian beef sandwich at lunch, I don’t know. Needless to say, it wasn’t anticipated either way. I’m better this morning, with a few lingering grumbles going on down there.
Regular readers already know the hassle I went through trying to get San Diego VA Medical Center to talk with UCLA Department of Nuclear Medicine, so I won’t rehash that here. Needless to say, be persistent if you encounter similar issues.
I did find it interesting that the scheduler told me my appointment was at 7 a.m. when it was actually at 7:45 a.m. I’m not sure how or where that disconnect came into play.
Because my appointment was so early in the morning, I opted to drive from San Diego to Los Angeles the afternoon before and stay in a nearby hotel to the tune of $216. Apparently, UCLA has its own hotel at the convention center, but the price would be about the same, if not more.
Obviously, UCLA is a huge campus and I wished that the scheduling office provided more information about where the building was, where to park, and where the Nuclear Medicine department was located when they set the appointment. They provided nothing until I asked.
They are located at 200 Medical Plaza Driveway Suite B114, Los Angeles, CA 90095.
When you pull in from Westwood Blvd. to Medical Plaza Driveway, you’ll turn right but will want to be in the left lane to enter the parking garage (red arrows below).
Once you’re in the parking garage, you can take the elevators on the west side of the building up to the lobby. You’ll walk all the way across the lobby and follow the signs for the North Elevators (blue line above). Take the North Elevators down to Level B1 and the Nuclear Medicine department is right off the elevators in Suite B114.
Parking is $14 per day and, no, they won’t validate your parking ticket even after spending $3,300.
First, the staff in the Nuclear Medicine department were amazingly friendly and caring. It made the whole experience all that much better.
Second, I’ll have to admit that I second-guessed myself in wanting to have to get this done after the insurance company denied the payment. Not because of the cost (although it’s not insignificant), but because I knew from my own research that the 68Ga PSMA-11 PET scans are better at picking up the location of the cancer when the PSA level is 1.0 ng/ml (the insurance company threshold), than at my 0.22 ng/ml PSA level. Am I wasting $3,300 on a crap shoot? We’ll soon find out.
Finally, there’s the, “If you can’t stand the answer, don’t ask the question,” factor in play here. If the scan wasn’t a crap shoot and does, in fact, reveal the location of the cancer, the pressure to act (i.e., salvage radiation) goes up by an order of magnitude. As you already know, I’ve been trying to dodge the short and long-term toxicities of salvage radiation for quite some time now, and my preference would be to continue to do that for as long as I can. There will be more research and decisions in the days and weeks ahead, that’s for certain.
Let’s just hope that getting the results from UCLA to VA San Diego won’t be as difficult as getting them to talk to each other in the first place.
Happy December! Be well!
Cover photo from Google Maps