Go to see gallstones and suddenly turn into lung cancer?
I've had gallstones since I was a student. When I went to the emergency room for my first seizure seven or eight years ago, the doctor recommended removal of the gallbladder. The pain is terrible, but after all, this pain can be found: as long as you don't touch a diet that is too greasy, you usually have no symptoms. Coupled with the fact that I was a little afraid of surgery, I have been holding on to the luck mentality and have not dealt with it for a long time.
Later, I became a teacher, socialized less, and paid attention to myself. I don't smoke, drink less, don't touch dangerous goods, cook a handful of people, have a BMI of 25, and generally feel good. As long as the gallstones don't strike, the 39-year-old can even climb the mountain with my daughter in my arms.
Unexpectedly, it was the temptation of a piece of braised meat that sent me to the hospital... At the New Year's Eve party from 2019 to 2020, I let my guard down and secretly ate a piece of braised pork. Before the party was over, the pain spread from the waist to the abdomen. At this time, it was actually too late to take painkillers and antispasmodics, I was very conscious to go to the hospital emergency department, but after hanging up the bottle, it did not ease quickly, and after returning home, I was stuffy for a long time, which made me make up my mind to remove the gallbladder during the winter vacation.
On January 14, I went to a special hepatobiliary hospital to check and found that one of the 3 stones that were originally stuck in the mouth of the bile neck fell to the common bile duct. The doctor said that compared with simple gallbladder removal, the common bile duct stones would be more troublesome to deal with, and suggested that I first reduce inflammation, go home to recuperate, and then operate after the Spring Festival. At that time, the epidemic began, and people were panicked. On February 17, I was successfully admitted to the comprehensive tertiary hospital, and the doctor reopened the relevant examinations, not only to check the abdominal ultrasound of the gallbladder, but also to add a chest and abdomen CT scan. I felt good about myself and all the checks went on my own. When I returned to the hospital bed after doing the color ultrasound on the 19th, I saw my lover waiting for me with pale faces and trembling hands.
She nervously told me that the doctor had seen ct and thought there might be a problem with the lungs and that the doctor outside the chest needed to judge. I feel a little inexplicable, the results of this preoperative blood draw show that there is no abnormality in the tumor markers, I also did a chest X-ray in 2018, there is no abnormality, how after more than a year it is serious enough to notify the family? We clasped hands and went together to get the CT report, which concluded that there was an irregular nodular shadow in the upper lobe of the right lung, which could be seen with lobe-splitting, burrs, pleural depression and cavitation, and bronchial truncation, clear realm, about 2.4 ×2.1 cm in size. Multiple nodular density increased shadows were seen in the left lung, with clear boundaries and a diameter of about 0.6; no obvious substantial lesions were seen in the remaining lung. The final conclusion is that the upper lobe of the right lung is a mass lesion, and malignancy may occur. The attending doctor in charge of the liver and gallbladder said very kindly that the gallbladder operation should not be slow, and the thoracic doctor should be consulted first.
My heart was suddenly empty, looking at the bright and dangling sun outside, and my thinking stagnated for a long time. My lover later told me that the hepatobiliary doctor was talking very seriously, and she cried in the car for a long time before she dared to come to see me. In fact, my psychological endurance is OK, telling me that the condition is not a bad thing, I have a bottom in my heart but steadfast.
The chest doctor basically concluded that it might be malignant, but still comforted me that the hospital deals with many such cases every year, so I don't have to worry too much. I still felt incredible in my heart, and privately found another top three chest doctor to watch the film, he asked about my occupation, age, family history, suggested that I should not hang the bottle for ten days to see the situation.
The upper lobe of the right lung is removed, ending an operation
Gallbladder surgery is no longer a consideration. I was lucky and wanted to see the anti-inflammatory for ten days. The hepatobiliary doctor agreed to transfer me to the respiratory department on the 20th, because the bed was tight, and the doctor immediately arranged a preoperative examination. Electrocardiogram, cardiac ultrasound, ct lung scan again, showing no changes in the lungs... Doctors have also asked whether to do PET-CT, after all, this test is self-funded, about 8,000. But because PET-CT is more comprehensive, the lover did not hesitate to choose to do it. After the thoracic doctors have seen all the test results, they basically confirm that the upper lobe nodule of the right lung is lung cancer, and the good news is that it has not spread to the brain, nor has it metastasized to the bones and other parts, and the lymphatic system is very stable. The diagnosis was confirmed, and the surgery was confirmed.
Unexpectedly, in the preoperative family conversation, a doctor explained to the seven family members that I was the only one among the patients who participated. Other people's tumors are obviously much smaller than mine, and three or four people only need to do wedge resection (removal of a small part of the lungs).
When I arrived, the doctor said, your more serious, you may need to remove the upper lobe of the right lung, the lung function is damaged more, the breathing will be more rapid after the future, but the daily life will not be too affected, but also do lymphatic dissection, see if there is a tumor in the lymph, these will decide how to treat the follow-up, but wait for the pathological report and staging situation. At this point, my lover and I didn't really think about it that much, and even unanimously decided not to search for relevant information on the Internet. We think we can find the best hospital in the provincial capital city, the best doctor, and we have done enough. If learning more will increase fear, don't go and find information yourself, give it all to the doctor, and follow the doctor's arrangement.
I don't have any fear in my heart, fear stems from ignorance, and once I know the object and name of my fear, I don't need to think about it so much. I calmly comforted my parents, arranged a post-operative leave, and asked my friends to come over and help move the bed. My composure also comes from my lover. The two of us fell in love from our student days to start a family, and tolerated and supported each other. She handled the hospital-related chores crisply and neatly, and always firmly believed that there was no problem in front of me, and when I wanted to explain something, she would always interrupt me and say, after the operation, you do it yourself, sometimes people need a little blind confidence.
On 11 March, general anesthesia thoracoscopic (VATS) of the right upper lobe was removed. When I was waiting in the operating room, I looked at the ceiling- it was actually a painting of blue sky and white clouds, and I was really relieved. There is really humanistic care, I thought about it, and suddenly all my thoughts and feelings disappeared...
The operation lasts about three or four hours. When I woke up, my first reaction was thirst and weakness. There was no pain, only thirst, a breathing tube in my mouth, and a strong urge to urinate, and I wanted to hold back— in fact, I had already inserted a urinary catheter. The whole person was muddy and could not make a sound.
When I woke up the next day, I felt very tired, and with three tubes inserted in my body that made it very inconvenient for me to move, two tubes were connected to the chest drainage bottle, the largest tube was inserted into the top of the lungs to play a role in venting, the other small tube was drainage effusion, and one was a urinary catheter. Another thing that makes me feel bad is patting my back. In order to expand the lungs as soon as possible, to prevent infection, you need to pat the back cough, the nurse will come over for about two hours to help pat the back once, especially to stimulate the laryngeal junction to better cough up the phlegm from the depths, this series of operations is very painful, I cough on the chest tube, just began to grasp the strength is not good, cough can not come out, driving the deep tube, tramadol two pieces a day can not stop that pain.
The chief surgeon would come to the room every day and comfort me that he had helped me remove a time bomb and reassured me to wait for the pathological results. Two days later, the urinary catheter was removed and the nurse encouraged me to get out of bed, and it felt so nice to be able to go to the toilet by myself. Near dusk, the nurse saw that I was in good shape and let me walk down the corridor with a shelf that could hang bottles and drain bottles in the chest cavity. What a common thing it used to be to walk and eat, but now it takes a lot of effort and courage to complete it.
On the 14th, the inspection results were good, and the large tube was pulled. People are much more relaxed. The nurse also informed that it was possible to be discharged tomorrow, so soon! After being discharged from the hospital at noon on the 15th, I took off my hospital gown, changed into my own clothes, and suddenly became happy. Everything is moving in a good direction! When I got home, I suddenly fainted, and in the confusion, a small hand was gently caressing me, it was my 6-year-old daughter. She hadn't seen me for many days, and although her family had advised her not to argue with me, she couldn't help sneaking in and holding her hand, and I seemed to have a lot of strength again.
The pathology report made me cry
Discharge from the hospital is an important step, but it is only a step, and the disease is far from over.
The attending doctor told my lover, said in the lymph nodes, the mediastinum found tumor plugs, pathological reports: invasive adenocarcinoma, lung-derived ... Sending lymph nodes to see cancer metastasis..., he said that the staging is set at 3A, and chemoradiation is needed in the later stage. 3A is actually in the late stages, with a five-year survival rate of only 24%, and I was depressed for a long time. The next day I got up early, looked around, the house was silent, my lover got up early to work, my father was cooking, it was dark, and I broke down and cried for the first time since I was sick. The lover actually has no sleep all night, holding me and saying be strong, strong, you are still the head of the family, the pillar of the family.
Because there is no cough symptoms, the tumor marker range has been normal, the lymphatic system during the examination has been very stable, plus 2.3× 2.1cm said that it is not big, which is the reason why I have been optimistic in the early stage, but the conclusion of 3A, especially the detection of high tumor plugs, makes me really difficult to accept. The doctor also confessed to me that the chance of spreading to the brain is not small.
I searched for a lot of research articles backed by empirical data on CNKI, and I had a basic bottom in mind:
The degree of malignancy of 1.3A is indeed not optimistic, not to mention the 5-year survival rate, that is, the survival rate within 2 years is relatively low;
2. With the emergence of new technologies and means, especially the emergence of targeted drugs, the weapons of resistance are constantly developed, and the means that can be used are constantly updated. It reminds me that I didn't do genetic testing when I was discharged — doctors hadn't previously suggested I did — and now I need to apply for testing as soon as possible. Genetic testing is also fully self-funded, probably costing more than 8,000;
3. The current treatment is very standardized, the process is generally the same, chemotherapy is the first use of pemetrexe plus carboplatin, four courses of treatment, the data shows that too many courses of treatment can not benefit. Combined with radiation therapy, the survival rate can be significantly increased.
The conclusion is still very frustrating, the proportion of survivors or 5 years of complete cure is much lower than the 1A, 2A period, sometimes I can't help but wonder, will I be the majority? It felt like falling into a huge whirlpool, life kept going down in the darkness, struggling to exert a little strength, sticking out to shine a little sunlight, but quickly being sucked into the boundless darkness, but the bottom that I thought was still halfway up the mountain.
Disappearing stones and zigzag chemoradiotherapy
Life goes on. Considering the familiarity of the bed and process, we were finally transferred to the cancer hospital for radiotherapy and chemotherapy.
Treatment with pemetrexe plus carboplatin begins on 10 April. Pemetrexed is a relatively new and medical insurance drug, so it is basically the first choice, but my appetite was suddenly very bad that day, sleep was not good, and the body reacted very strongly. On the 13th, I was discharged from the hospital and felt that I had finally survived a hurdle.
However, on the 18th, the whole body began to be very itchy. As soon as I got home from the blood draw in the morning, the doctor called me, because the bone marrow suppression was so severe, that I was asked to get a white injection immediately—the white blood cells in the blood were as low as level four (the most dangerous level). As soon as the afternoon was over, after eating a little dinner, I began to feel sore, and the pain of gallstones came again.
It was a leak in the house that rained overnight. Only then did part of the lungs be removed, and the gall began to stir again. It took two days to stop eating tramadol, but on the 23rd, it didn't work. I thought the pain was a reaction to chemotherapy, but the next day's blood draw showed that although the white blood cells rose up, liver function was severely impaired, especially the liver enzyme index data rose to a high level. The doctor recommends immediate hospitalization and first stabilizing the liver function. Some drugs for the treatment of liver function in the cancer hospital could not be prescribed, and I needed to be transferred to the hepatobiliary hospital.
So on the 25th, I was transferred from the cancer hospital to the hepatobiliary hospital. Doctors say that liver enzyme indicators exceed so many, it may be caused by common bile duct stones, or it may be the cause of pemetrexed. If the liver function is impaired by common bile duct stones, then the common bile duct stones are removed with minimal trauma, and subsequent chemotherapy does not affect. On the 26th, an MRCT examination was done, and the results showed that the common bile duct stones had disappeared on their own, and only the bile neck mouth had two small ones. That is to say, the severe pain on the 23rd may be caused by the fall of the common bile duct stone, and the human body is really unpredictable.
Liver protection was hospitalized until May 6, and the indicators slowly became normal. Because the indicators are too slow, the doctor of the liver and gallbladder may judge that it may not only be caused by the discharge of common bile duct stones, but also because of the chemotherapy drugs, and it is recommended that the cancer hospital adjust the chemotherapy drugs.
So on May 12th, I was admitted to the cancer hospital. These months are like clocking in at various hospitals. This time, the doctor suggested that pemetrexed be replaced with albumin paclitaxel, because albumin paclitaxel is self-funded, plus it has the side effects of hair loss, so the first chemotherapy is useless. People have reached middle age, their lives are at stake, can they still worry about such things as hair loss?
After restarting chemotherapy, the body obviously adapted a little better. Also in accordance with the doctor's advice, long-acting whitening injections were given. Long-acting needles are self-funded, but the effect is good, and the white blood cells have been kept in a stable state. On the 15th, I returned home, feeling good in health, and took time to apply for a driver's license that was about to expire and participate in an online thesis defense, but my memory seemed to have declined sharply, and many questions had to be written down in advance. On the 26th, he began to lose a lot of hair, and then simply shaved his head. Unexpectedly, while touching my bald head, my daughter said that it felt good and that she could call me an egg in the future.
In the middle was a brine egg, and later the hair grew out again
Eating and sleeping are finally getting normal. You can get up in the morning for a walk, and the long-awaited dawn has finally arrived.
The third and fourth chemotherapy sessions were started in June. The next three chemotherapy treatments followed the normal time and procedure, and as for the effect - the doctor never said that there may be no recurrence is a good effect.
In addition, I was impressed because the blood vessels on my hands were particularly thin, and every time I hit the nurses, it was a challenge, and once I even changed three nurses... So at the beginning of chemotherapy, I did a central venous catheterization (chemotherapy has a lot of damage to blood vessels, so it is generally intubated from the neck, it is very painful, and it must be re-inserted every time; the other is to insert a needle from the hand, called peripheral venous puncture central venous catheter, which is what I chose), and the treatment saves a lot of trouble. This one is maintained until the end of chemotherapy before it can be pulled.
The process of radiation therapy is relatively smooth. Although there are still many ups and downs, in short, if it does not hurt, it will be dealt with, and then go back and deal with the gallbladder stones that often hurt to death.
Resume your life and continue your classes
On September 5, all treatments were completed. I did my first enhanced CT review and it showed that everything was smooth. On October 13, I returned to the podium for the first time, and I felt a lot of emotions. The students also thought I was lamenting the epidemic, but in fact, it was the happiness of the rest of my life. And, of course, the joy and excitement of standing on the podium. After three classes, I obviously felt that I was short of breath, and although I was tired when I returned to class, I touched the usual appearance of life, relieved my depression and depression during my illness, and especially began to feel that I could finally completely overcome the disease.
After recuperating for about half a year, on March 16, 2021, I finally had gallbladder removal surgery. Pushed to the operating table again, I didn't have the blind optimism of the first time, nor the fear of the first time, but just calmly accepted the inconvenience and said, "Come on, I can carry it." After the gallbladder is removed, you can eat with more confidence, which is also a way to get rid of the hidden danger of long-term pain.
Now every three months or go to the re-examination, the results are not bad, the brain two magnetic resonance is also no problem, the 0.5cm nodule of the left lung, asked many doctors, all said follow-up. Then use the daily routine to resist anxiety and continue to the podium. Instead of worrying about recurrence all day, get back to your routine and keep working.
expenses
Located in the capital city of East China, the economy seems to be developed, but the treatment of teachers is not only a lot worse than other sister cities, but fortunately, the medical insurance for employees is still very good. From hospitalization to the end of treatment, the total cost is about 240,000, of which medical insurance pays more than 110,000. When the cancer hospital does chemotherapy, if you use the drugs in the medical insurance catalog, a course of treatment is more than 20,000, but you only need to pay more than 2,000 out of pocket, and then use self-funded drugs, all of a sudden to 6,000 yuan. Radiotherapy also chose to be able to be medicated, paying about 1/4 out of pocket.
In fact, when people are sick, they simply do not have the energy to calculate the proportion of medical insurance reimbursement. Doctors actually choose Medicare first to help patients save money, but some money can be saved, and some money is still try not to save.
Another thing that makes me feel confident is that the long-term self-purchased major illness insurance quickly settles the claim after falling ill, so that I don't have to worry too much about the cost.
Genetic testing
Genetic test results show EGFR gene mutation 21 exon point mutation (L858R).
However, doctors in both the top three hospitals where the surgery is performed or the doctors in the cancer hospital recommend traditional chemotherapy and radiation therapy. The doctor at the cancer hospital explained that the weapons were used one by one, and the traditional treatment methods did not have any effect, and then used targeted drugs, and did not directly go to the strongest osimerinib. And at that time, osimtinib was not a medical insurance, and it cost about 15,000 yuan per month at self-expense, and the doctor said that if you take targeted drugs directly, there is no need to do radiotherapy and chemotherapy.
Last year's NCCN guidelines (clinical practice guidelines for various malignancies published annually by the National Comprehensive Cancer Network) recommended osimertinib for postoperative adjuvant first-line therapy, and the report showed a benefit from DFS (i.e., progression-free survival, usually an 83% non-recurrence rate). I consulted the doctor again during the review, he for my situation, or think that if you eat oscitinib now may change the genetic mutation factors, and then the NCCN guidelines because of the time relationship, did not say whether the 5-year survival rate works, now take medicine will reduce the quality of life, even if you enter the medical insurance every month, you still have to pay about 5,000, comprehensive consideration, he still recommends that I do not use. Although he was worried in his heart, out of trust in the doctor, he never took osimtinib.
2020 has passed, the nightmare epidemic and treatment have passed, as a patient, I would like to say that the companionship and understanding of family members is crucial. The patient will have a bad temper, that's because it takes a lot of strength to control himself, the discomfort and tiredness of the body, so that the mood that may have been controlled before becomes extremely poor, coupled with depression and fear will make the mentality worse, the family in addition to comfort, can only try to understand. For patients, in addition to actively adjusting their mentality, they should also understand more knowledge, learn and understand knowledge from formal and authoritative channels. Knowledge is the best means of dispelling fear.
Doctor reviews
Wang Xing | Attending physician of thoracic surgery at Shanghai First People's Hospital
In fact, it is not uncommon for a teacher to find lung cancer from the problem of gallstones, of course, the most common is because the respiratory department has been treated as pneumonia for a period of time to find lung cancer, as well as some trauma emergency accidentally found. Now during the epidemic, there are also many accidental discoveries during the investigation of the new crown. In any case, we have to thank those diseases in the beginning that allowed us to meet the disease as soon as possible, rather than waiting until the time of irreparability.
Malignant tumors are not uncommon among young and middle-aged people, as oncologists. According to the latest research published by Academician He, the incidence of lung cancer in China is 36 per 100,000, which is lower than 57.13 per 100,000 of the incidence of lung cancer in China in 2014, so the incidence of lung cancer itself has not increased, but the diseases we previously discovered through symptoms at the age of sixty or seventy are likely to be discovered at a young age.
I think the author has done a particularly good job: he has a strong ability to retrieve literature and obtain information, but when it comes to treatment, he thinks that he has done his best to find the best hospitals and doctors within his ability, and the rest trusts the doctors, which is actually an important point, which is the basis for the best treatment for both doctors and patients. The author will also discuss with doctors whether to assist with targeted therapy after surgery, but several doctors have given similar advice, so he still chooses to follow the doctor's advice rather than blindly follow his own opinion. If ordinary readers want to learn about cancer-related information through some popular science resources, I personally feel that they can refer to Pineapple's two books "Cancer • Truth" and "Deep Breathing".
In addition, for lung cancer, the most common gene mutation points are EGFR, ALK, other mutation sites are relatively few, detection methods Are currently more and more people will choose the way of second-generation sequencing. This is already a routine diagnosis and treatment of lung cancer, so it is not exclusive to first- and second-tier cities. Even if you have surgery in a fifth-tier city, you can go to the pathology department to cut 15 white tablets and send them to a genetic testing company for testing. Among Asians, female adenocarcinoma patients who do not smoke have a high probability of mutations in the EGFR gene, while men smoke relatively few. Genetic testing is not only the basis for postoperative adjuvant therapy, but also an opportunity left for oneself in the future.
Theoretically, the author's situation is actually two coexisting diseases, gallstones have little impact on lung cancer surgery, then go to the general hospital and the cancer hospital for treatment. In some cases, such as combined kidney failure, myocardial infarction, etc., general hospitals will have more advantages. Medical records between different hospitals cannot be shared, but you can copy the full set of medical records from the previous hospital to the second hospital, and it will be more convenient for doctors to read them, and generally avoid repeating the examinations that have been done. Of course, this is only an ideal situation, and indeed many friends will encounter the experience of several hospitals walking in a broken head. In short, choosing a doctor who can communicate with himself and is willing to communicate with himself may indeed be more important.
The author is also fortunate to have family members who are equally willing to consult information and rationally face the disease. In fact, the most critical point of being a family member is to treat the patient as a normal person and strive to maintain a normal heart. Otherwise, the more you care, the more deformed the movement. (If you're interested, you can refer to my book, Patient Families, Please Come Along.) ）
Sharing personal experience does not constitute a diagnosis and treatment recommendation, can not replace the doctor's individual judgment of a specific patient, if you need to go to a regular hospital.
Author: Middle-aged in literature and art
Edit: Silver Gusang
Fruit shell patients have now set up lung nodules and cancer, thyroid nodules and cancer, breast nodules and cancer, psoriasis, infertility and other disease groups, in the group you can consult with the patient god to consult medical experience, and optimistic and positive patients to exchange rehabilitation treatment experience, we will also regularly invite experts from well-known domestic hospitals to come to the fruit shell patient live broadcast room, live interaction. Questions from the patient group will be answered first. At the same time, the group also provides a series of exclusive services such as patient recruitment and insurance knowledge. If you are a patient or family member of the above diseases, please scan the code to join the group.