Let’s review. The pelvis of the kidney and the inside of both the ureter and the bladder are the same tissue. The diseased kidney, the ureter and a small part of the bladder have been removed. The bladder is downstream from the kidney. For that reason, any chemo treatment would essentially be for bladder cancer.
Dr. “O” (for oncologist) explained that it is very difficult to effectively get the drugs into a patient’s urine. That fact, if my weak understanding is correct, is the source of the Catch-22, which I mentioned at the end of the last post. The chemo drugs have to get past the kidney to be effective. The kidney basically wants to filter everything out. In order to get the drugs past the kidney, if the dosages are strong, the kidney takes a beating. That is a problem if you only have one kidney left.
Or if they protect the kidney with a lower dosage, the chemo isn’t very effective, and it doesn’t really make sense to take the chance of damaging the kidney.
The end of the short story is that for the last nine mornings, I’ve been walking again. I believe this morning’s average speed, over my two-mile route, was above 3 miles per hour. I think I was just at 2 miles per hour when I started my one-mile walks last week.
This was my saline and pain killer IV rack when I was in the hospital. I was actually disconnected from both at this point.I’ve been thinking about the long story since Monday’s appointment. It is not really well formed in my mind, so I guess I’d better just try to write it down. It’s actually three stories. The first was Dr. “O’s” attention to making sure I understood his perspective on the issue. The second is a curious tale that occurred when he answered my wife’s question about diet. Finally after meeting Dr. “O,” I was really taken by the different personalities of my doctors through this process. So I’ll write for a while and see if this begins to make sense.
Dr. “O’s” native language was not English. That said, of all the doctors I have encountered in this process, I believe that he offered the clearest explanation of his medical point of view. Maybe his clarity was due to his language challenges.
My wife teaches primary art and music to many students for whom English is a second language. Driving home from the appointment, she pointed out that Dr. “O” was very careful to explain things in multiple ways. He started with an explanation of what his concerns about the pathology report was; he drew a picture of my kidney, with detail of its renal pelvis, a cyst that had been there all along, the carcinoma, and the ureter; he pointed to the picture as he described the pathology concerns in at least two different ways; and then he summarized clearly before he asked gently, “This is not the information that you were expecting. Do you have any questions?”
In some ways it was exactly the explanation I had hoped for. The probabilities were made clear – chemotherapy only improves the survival rate marginally. Damage to the kidney is a real risk. He even explained that what we would be treating is actually bladder cancer, because my bladder is the only thing downstream from where my kidney used to be. And one of the problems with chemotherapy treatment of bladder cancer is the fact that bladders fill, empty and refill with urine.
I guess what I didn’t expect was the sudden clarity about the uncertainty of not knowing what lay ahead. If the cancer does come back, will I be facing chemotherapy’s ineffectiveness with the bladder or the loss of my bladder or some other unknown treatment (which is to say, a frightening one).
That clarity is frightening.
I’m walking, however. And I am doing the things I’m supposed to do to take care of myself. I believe I’m going to be in the lucky 80% to 90% who have no recurrence of this cancer.
And this leads us to part two of my long-story – the curiosity that occurred when Dr. “O” answered my wife’s question about diet. But that shall have to wait until tomorrow. It’s been written, so I promise it will be there.
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