We met with Dr. Chang and an outstanding, well spoken associate, Dr. Skylar who blew us away with all of the thoughtful consideration they had been putting into dad's situation. All good news to us. They still feel that Dad has plenty of skin in the game: the prognosis with colon cancer is pretty good (a "significant cure rate" was the term used). He just needs for the chemo/radiation to zap any rogue cancer cells. Dr. Skylar said they did an excellent job of removing the cancer cells during the surgery. As I'm writing this, I'm now realizing that Dr. Skylar was probably present during the 7-hour mega surgery too; after all, they told us two urologists performed that surgery.
Here are the options, all of which revolve around removing that shifting J stent and the addressing what to do with the weak kidney.
1) save the kidney
2) remove the kidney
3) get rid of the ureter and leave the kidney alone in the body (no harm done they tell us)
Benefit of keeping the kidney: the intensity of the chemotherapy is based upon the strength of the kidney since the chemotherapy is excreted through the kidneys. In layman's terms, your body gets rid of the unwanted/unused/unneeded chemo drugs through urinating. More kidney function means more chemo drug can get in and do it's job of killing the cancer.
At present, dad's good kidney operates @ 79%, the bad kidney operates @ 21%, which is pretty good by their account; at 15% function, they recommend removing the kidney.
Here's the game plan:
Dad reports for surgery on Tuesday. This is what they're going to do:
1) they're going to look at ways to remove the J stent. It's shifting and could cause blood clots or a puncture in a major vessel if left unattended or gets damaged during chemo/radiation. Dad is on blood thinners now to prevent blood clots. He's been instructed to walk to minimize the clots as well.
2) they're going to do some type of fluoroscopic test in the OR to test once again the viability of the weak kidney, and if they decide to keep it, they will insert a drain tube from that kidney. The drain tube will come out of his back, it will be thinner than a
coffee stirrer/straw, and it will collect urine in some type of
colostomy bag. The bag will be either attached to his hip or on his
upper thigh, and this will stay in place until after the chemo. Although the kidney is weak, it can still benefit dad through the chemo. They will perform reconstructive surgery after the chemo to fix that ureter tube.
At present, there are no blood clots, more good news, but they need to be very careful during the removal of the J stent at the top of the kidney, it comes close to major arteries. Five very skilled surgeons will work on Dad Tuesday. There are some risks with bleeding, infection, clotting, and creating a hernia, but they explained how they work carefully to minimize and control all of those risks.
Best case, dad will be in & out within 90 minutes with a small incision in the the groin and another in the lower belly. Worst case, they'll re-open about 4" of his upper abdominal incision to stop bleeding, if necessary, and he may possibly have another large incision on his side if they remove the kidney. We left the appointment feeling grateful for the many excellent doctors who are doing so much work to help dad through this "bullshit" (doctor's term) which by their accounts, has a good success rate. We are hopeful.
We went to breakfast after the consult and covered many topics of discussion: acceptance of what is, what will be, faith, salvation, boating, the military, and how impressed we were that the doctors are doing so much for Dad. Mom & I reassured him repeatedly he is worth it and the doctors obviously think so too. We are all tired from sleepless nights and vowed to spend the next few days catching up on much needed rest as we gear up for the Tuesday's surgery. They expect dad to stay overnight for observation.
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