If it wasn’t for an appendicitis -- and a relatively new Bryan Health program double-checking suspicious spots -- Mary Jo Oie could be dying of lung cancer.
Instead, the 63-year-old Lincoln woman is relishing a cancer-free retirement and an extended lease on life.
"I went in for a stomach ache and they found lung cancer,” she said with a grin.
It all started April 14.
Oie thought she had food poisoning. But after a fitful, painful night, in which she felt her insides "were on the verge of exploding," Oie called her doctor, who sent her straight to the Bryan East emergency department.
There, doctors ordered a CT scan of her abdomen. The problem was obvious: an acute appendicitis.
Oie had emergency surgery and went home the next morning. She put it all behind her.
Little did she know that back at Bryan East, Oncology Nurse Navigator Ruth Van Gerpen and her assistant Jen Knox were re-reviewing all CT scans that included at least a portion of the lungs. The review is part of a new program aimed at detecting lung cancer well before any symptoms appeared.
Radiologists reading Oie’s CT scan had documented a small spot on her right lung.
But since the spot had nothing to do with the issue at hand -- an inflamed appendix -- the radiologist’s notation went unnoticed in the finer details of the report.
That is until Knox did her review and saw the word “nodule.”
That started a chain of events. Van Gerpen pulled up the scan. The spot measuring two-thirds of an inch, was big enough to require follow-up.
Van Gerpen contacted Oie’s primary care physician, Dr. Holly McMillan, and mailed Oie a letter telling her to see her doctor.
Oie was unfazed.
“I never get sick,” she said. And so she assured herself the spot was nothing more than a blip on the scan or an innocuous shadow. She had never smoked, she exercised regularly, and no one in her family had ever had cancer.
Just to be sure, McMillan suggested a PET scan, in which a radioactive glucose solution is injected into the body. McMillan told her if there were any cancer cells they would “light up.”
“The spot lit up like fireworks,” Oie said.
A needle biopsy followed. Oie was assigned a pulmonologist.
“And that is when I started collecting ‘ologists,’” she quipped.
Weeks later Oie was back at Bryan Medical Center East. This time to have the lower lobe of her right lung removed.
She had her last chemo treatment on Halloween.
Her prognosis for remaining cancer-free is excellent.
A grateful Oie said she shares her story to teach others to pay attention, read their own medical records and educate themselves.
“I’m totally non-medical,” Oie said.
She had only been hospitalized once before, a handful of years earlier when doctors replaced a heart valve due to a congenital birth defect.
Ironically, that scan was the first to show a teeny tiny spot in her lung. Since the spot had nothing to do with the heart -- the reason for the CT scan -- its detection was simply documented in the lengthy list of notations. It was not included in the summary, which physicians often turn to.
If it had not been for an appendicitis attack this past spring, Oie’s blissful ignorance could have continued for years -- until the cancer had grown and spread to other organs and her health had taken a noticeable downturn, Van Gerpen said.
The Lung Nodule Program -- for lack of a better name -- started in April 2014. It was the brainstorm answer to a common lament among medical providers: Too bad we can’t find lung cancer earlier.
In its early stages, lung cancer is symptom-free. By the time symptoms appear, the cancer often has spread, Van Gerpen said. Treatment options are limited. Survival rates are poor.
Then came a patient with advanced lung cancer. Long before cancer symptoms were present, the patient had a CT scan for another ailment. That scan, which included the lungs, revealed the much smaller lesion had been present for years, but it had gone unaddressed because it had nothing with the medical issue leading to the CT scan.
That led to Dr. Richard Thompson asking a roomful of specialists what would happen if they followed up on these incidental nodules earlier. Would it improve patients' odds with lung cancer?
The Lung Nodule Program was built around “the need to do everything we can to keep this from happening again,” Van Gerpen said, referring to the unnamed patient.
Thompson put Van Gerpen in charge, checking every Bryan CT scan showing part of the lungs. Van Gerpen’s assistant Knox, reviews roughly 324 scans a week (about 40,000 scans since spring 2014) looking for keywords in the radiologist reports: nodule, lesion, tumor and mass.
Every scan that contains one of the keywords is forwarded to Van Gerpen -- about 45 scans a week.
“I individually review each one,” Van Gerpen said.
If the patient's doctor is aware of the lesion and is treating it, she goes further.
“I want to find the ones with no notation or any documentation that it is being followed up on,” Van Gerpen said.
On average, that’s about 20 scans a week.
Using national guidelines -- based on size of the nodule and the patient’s risk of lung cancer -- she determines whether the patient should come in for additional testing, or whether primary care physicians should simply be on alert.
Because Oie had never smoked, she was at very minimal risk of lung cancer, Van Gerpen said. But the spot on Oie’s lung fell within the parameters recommending a biopsy.
Van Gerpen mailed a letter and copy of the CT scan to Oie’s primary care doctor, Holly McMillan.
“Dr. McMillan called me and thanked me for the report," Van Gerpen said. "She had never seen the report before."
The letter also prompted McMillan to pull an older CT scan of Oie's chest. And there it was, a teeny tiny spot in the lower right lung lobe. A spot that was noted in the complete report, but far too small to attract attention.
Van Gerpen also mailed a letter and a copy of the report to Oie, encouraging her to call her doctor.
"My letter causes anxiety,” Van Gerpen said. “But if it is cancer we want to find it early.”
To date, she has mailed about 1,750 letters to patients. About 10 percent of them do not have primary care physicians, so Van Gerpen tells them to call her.
More often than not, the suspicious spots are not cancer. Often they are granulomas, inflammation caused by bacteria or an infection, which over time has calcified into a nodule, Van Gerpen said.
“We find a lot of infections like histoplasmosis (a fungal infection) and sarcoidosis, an inflammatory disease,” she said. “Most of the time these are nothing to worry about. We just watch them.”
But then comes a patient like Oie. A healthy woman no one would have predicted would get lung cancer -- until it might have been too late.
“Mary Jo is our proof … that after two years of doing this, it really works,” Van Gerpen said. “And it did what we intended it to.”