Gallium and PET Scans

Bill asked me to do some research on Gallium scans and PET scans for the purpose of determining the levels of infection and cancer in Dad's body.  Here are some of my early thoughts:

• Gallium citrate appears to be no more dangerous to the kidneys than the antibiotics Dad is currently taking.  It is often used to diagnose kidney function and nephritis.
• After the Gallium is administered images are taken at regular intervals the first day than once a day for three days.  Each set of images takes about 30-60 minutes to produce.
• Sometimes Gallium scans are also used to determine the level of lymphoma and there may be some value to Dr. Nguyen which may preclude the necessity of a PET scan.  However, Gallium is mostly used to diagnose the level of non lymphocytic lymphomas and may not be acceptable to Dr. Nguyen. (my understanding is Mantle Cell is a lymphocytic lymphoma).  
• There are two other types of scans that may also be used, indium leukocyte imaging and technetium granulocyte.  The indium scan is NOT appropriate, but I would be curious to hear what Dr. Hedari and Trang feel about the technetium scan.
• IF the Gallium scan does take place, please let the testing institution know he has diarrhea and NOT to administer laxatives (this is sometimes, not always, but sometimes done to clear the Gallium from the body)

Some questions for Dr. Hedari at today's appointment:

1. Does he agree with the timing and purpose of the Gallium scan currently scheduled for October 1st?
2. Is the Gallium scan the most accurate in identifying the clearance of the SBO?  What about  technetium granulocyte scan?
3. Is this test going to significantly impact Dad's remaining kidney function?
4. What if the test still shows positive signs of SBO?  Do we just continue the same antibiotic regimen?  Will we need a future Gallium scan?
5. Can we concurrently scan for the level of lymphoma to eliminate the need for the upcoming PET scan?
6. Are there any suggestions he could make about this procedure to give Dad's ENT and Oncologist more and better information?

These might be better for Dr. Saike, but I think Dr. Hedari's opinion is valuable too.

1. Is the PET scan hard on Dad's kidney?
2. Is there a safe time period between the Gallium scan and the PET scan that should be observed?

That's it for now.  I may add some things as I ruminate about this.  I did find a scientific article that recommend the use of N-Aceytl-Cystiene (NAC) as a protector of kidney function for both Gallium and PET scans.  NAC is a nutritional supplement I can provide if you choose.

And this may be completely irrelevant (audacity of hope, and all that) but I did run across this article on the curability of Mantle Cell Lymphoma.  Granted it was a small study of subjects younger than 89 (they averaged 66), but it did talk about 5 year survival rates.
http://www.docguide.com/mantle-cell-lymphoma-curable-intensive-immunochemotherapy-presented-ash

March 9, 2011 Update

Hi all,

Dad had his consultation with the blood specialist yesterday afternoon. I digitally recorded about 8 minutes of the Dr.’s discussion. I missed about the first 10 seconds. You can download the discussion, if you wish, using this link:

http://www.mediafire.com/?daeucil3c1n5isl

The Dr. suspects lymphoma but needs to confirm the diagnosis, type, and style of the lymphoma and has recommended a surgeon take one of Dad’s lymph nodes for biopsy. Tom is taking Dad to the surgeon today for an initial consultation. It should be an outpatient procedure. We have a follow-up with the blood specialist in three weeks.

We also got a copy of the PET scan results. I would be happy to fax anyone a copy if you wish. There a couple of frustrating points from the visit, mainly the fact that we didn’t get a concrete diagnosis. Perhaps that’s good though. It could still be a non-malignant lymphoma. The pet scan was listed as “a comparison to the prior CT scans …of July7, 2009” which I interpret to mean that they saw something back then, but failed to adequately communicate their concerns to Dad. The PET scan report is fairly technical document, but I can see a few positive notes such as this statement, “Again, the overall changes suggest mild progression of lymphoma.” And, “Both lungs are clear without pulmonary nodules or pleural effusion.”

I am hopeful that this biopsy will give us a firm diagnosis and a list of treatment options to choose from. Saw Dad this morning. His tennis game is about the same. His eyesight seems to be pretty good. I think he has lost some muscle strength though.

That’s about it for now. Let me know if you need anything.

Love you all,

John