140 keV Gamma “Ray” Bone Scans…

July 5, 2025July 5, 2025 ~ quantumdreamer ~ Leave a comment

My rate of emission of 140 keV photons is now down to lower levels, five radioactive half lives after injection. The concentration has been reduced by biological elution and the radioactivity by decay. It was interesting to read how few suppliers there were for ^99mTc. Yesterday, she only injected a few millilitres of tracer.

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I have been reading up and watching videos on the interpretation of bone scans, I can probably note metastatic lesions, depletion in tracer localisation due to prothesis, fractures (old and new), areas of bone formation and depletion. It might be interesting to see what my damaged cervical spine looks like and if my “broken” ribs from rugby can be seen. Osteophytes are evident on my thoracic spine and near my Titanium pin. The Diffuse Idiopathic Skeletal hyperostosis (DISH) is probably still growing and could localise tracer. {I had a full body scan.} This, if seen, can be cross referenced with an upcoming CT scan.

There could be plenty in my scans for a nuclear medicine professional to discuss with her younger colleagues.

I meet some of the diagnostic criteria for polycythaemia (probably secondary). If it is the malignant form this may interfere with bone cycling in the marrow and could appear in the scintigraphy. There are a few suggestions in the literature to use nuclear medicine to detect this. But it is not common practice.

I guess the single-photon emission computed tomographic (SPECT) images might show something like this below. My hip arthritis is much worse than in the X-ray or CT images below. It does not look like a whole lot of extra knowledge comes from the SPECT data for the hip.

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Dunn’s view of (A) right and (B) left hips of a 48-year-old male patient presenting with left hip pain only. Single-photon emission computed tomographic images shown in (C) anterior and (D) posterior coronal views display more uptake (black arrow) along the superolateral aspect of the acetabular roof on the symptomatic left hip compared with the asymptomatic right hip (white arrow).

Clin Orthop Relat Res. 2008 Dec 17;467(3):676–681

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What might however be interesting is what tips up in the rest of the body scan. The pain in my lower and mid lumbar spine has been explained in different ways by different doctors. There might be clues as to what is going on.

I guess what I do not want to see is evidence for primary bone cancer or metastatic disease. The main diagnostic differentiation of the latter is a disordered or “random” appearance of tracer localisation. Metastatic disease is incurable and often terminal.

I have joked that I could re-train as a radiographer or a nuclear medicine operator. But you know what they say about old dogs.

It is weird, I feel very up in the air, with little or no idea if/when I will get to see the data. Something which could change the direction of life is hanging ill-defined in the aether. I am in a kind of limbo.

I wonder if people who prescribe scans have ever had to wait and hang like this…

Maybe it should be a compulsory part of training…

Low Parathyroid Hormone – Hypoparathyroidism?

June 26, 2025June 26, 2025 ~ quantumdreamer ~ Leave a comment

The results for the three different mutations of HFE gene are in. I don’t have any of these. Which excludes the vast majority of the diagnoses for hereditary haemochromatosis. The footnote from the lab suggests contacting the centre for rare iron related disease in the big university hospital 150 km away. They may just talk with me as an ex-boffin.

I do feel a tad rusty these days, like the tin man my joints could use some oiling.

That means the polycythaemia primary or secondary question is in focus. Is there a malignancy or did my blood just adapt to smoking tabs?

My parathyroid hormone (PTH) is low, it is 26 pg / mL.

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“The iPTH reference interval of a healthy blood donor population was measured as 25.2–109.1 pg/mL (2.7–11.6 pmol/L) at 2.5 and 97.5 distribution percentile. The iPTH reference interval from data stored in the laboratory database was 19.3–112.5 pg/mL (2.0–11.9 pmol/L). Furthermore, 60% of the whole population had prevalently insufficient vitamin D concentration (<30 ng/dL; <75 nmol/L).

Mineri et al., Clinica Chimica Acta Volume 521, October 2021, Pages 1-8.”

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So it is at the rare end of a distribution yet just within the 2.5-97.5 percentile range. It is probably within experimental error out of the range. The error bars on 26 picograms must be big in a small sample!!

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“PTH is secreted primarily by the chief cells of the parathyroid glands. The gene for PTH is located on chromosome 11. It is a polypeptide containing 84 amino acids, which is a prohormone. It has a molecular mass around 9500 Da”

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My results for Calcium and Phosphorus were very normal, this latter statement is a bit weird. Low PTH levels are very rare and usually come with low Calcium levels. That pathway is messed up. Low parathyroid hormone screws with the Calcium concentration and bone turnover.

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Symptoms of hypoparathyroidism

Hypoparathyroidism often starts if glands in your neck are damaged during surgery.

Symptoms include:

a tingling or burning sensation in your fingers, toes and face
muscle pain, stiffness and spasms

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I have these two but these are caused when Calcium is too low!! So I do not have hypoparathyroidism.

We have another “contradiction” of sorts so the GP has asked advice from an endocrinologist. My guess would be re-test and if the value is still low maybe do something.

I am going to have an Alpha 1 Antitrypsin assay tomorrow which may add a piece to the jigsaw puzzle, concerning my lungs.

I’ll wait to hear from the GP as to what the endocrinologist suggests. It could be more tests, or not.

On the GP front we are probably good until September now…fingers crossed…

The working notion is that whatever it is that may be going on, it is just not manifesting in a sufficiently serious way, yet…

It could just go away or it could develop.

I am a bit of an anomaly, so it is no surprise that my blood results are a tad skewed from the normal.

Dream Follow Up – Myeloproliferative Neoplasms

June 22, 2025June 22, 2025 ~ quantumdreamer ~ Leave a comment

“In oncology, polycythaemia vera (PV) is an uncommon myeloproliferative neoplasm in which the bone marrow makes too many red blood cells. Approximately 98% of PV patients have a JAK2 gene mutation in their blood-forming cells (compared with 0.1-0.2% of the general population)”

Before this afternoon I had no idea that a standard way of taking a bone marrow biopsy is as illustrated below. Careful what you dream…

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The main diagnostic criteria for polycythaemia are:

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My haemoglobin level is 17.4 g/dL and my haematocrit is 49%. This meets the criteria {just}. The next steps in diagnoses are bone marrow biopsy and a genetic search for JAK 2 mutation.

The treatment for actual disease, secondary polycythaemia and haemochromatosis is phlebotomy and aspirin. One of the markers for secondary polycythaemia is hypoxia. This measured from the arterial blood. These consistent with the bloodletting part of the dream. Mid-week I will find out if I have HFE gene mediated haemochromatosis. This may exclude PV.

PV is associated with a reduced life expectancy and can change into to some seriously nasty stuff. Thick gloopy blood has an increased tendency to clot. Hence PV has implications for hip surgery if that goes ahead.

I have mild hypothyroidism according to the blood work but I am asymptomatic. There is no smoking gun for osteoporosis. A problem with bone marrow Myeloid tissue could be a factor in the osteoporosis diagnosed recently. If the marrow is making too many red blood cells it could be neglecting its other duties {naively}. The bone may not be thick enough.

If there is no JAK2 problem things get scientifically very complex very quickly. Most likely they will diagnose secondary polycythaemia. It is a moot point if we will go down the JAK2 route. Fat, fags and beer being the holy trinity, plus COPD. This looks the most probable. Maybe we do need to rule it , JAK 2, out, though.

PV if diagnosed is rare with an estimated occurrence of 22 per 100,000, which means that most GPs may never see it. It is hereditary to an extent which could suggest some geographical clustering. I may have a follow up on the HFE genetic results due.

In a sense the dream is preparing me for more medical merry-go-round.

I need to get my head clear because we are meeting the orthopaedic surgeon about “bionic” hips tomorrow. What happens next is fairly pivotal for my/our thinking…

As an aside of late I have been dreading opening up a news web site like “The Guardian” of a morning. This morning the thought was “what unpleasantness has Trump unleashed on the world overnight?” He got to ejaculate his big bombs over Iran.

The United Nations has rarely looked so helpless. A dream of unity peace and togetherness after the brutality of World War has been shat upon time after a time. People forget…

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