We visited Bristol’s Southmead Hospital today for a pre-biopsy meeting with Dr. Maskell, who was to perform the procedure tomorrow. Dr. Maskell first checked the fluid situation in my lung. I was pretty sure it had not increased significantly since my weight has not increased. However, he spoke of the risk of “loculation” which is where the fluid, instead of sloshing around reasonably freely, gets trapped in little fixed pockets around the lung. You know what’s coming. After using an ultrasound scanner for a few minutes he was sure that I was indeed loculated.
This is not particularly good news as it means that he can’t carry out the camera-guided biopsy scheduled for tomorrow. There is not a single large enough mass of fluid in the right place for him to get in to hoick out a sample. He said a biopsy under general anaesthetic (at another Bristol hospital) is an option, but that he felt a CT-guided biopsy at Bath, as originally planned, would be better.
My understanding is that this a) because it can probably be done more quickly and b) he is pretty sure that my lung lumps are secondaries from the kidney tumour. Dr. Maskell explained that “some patients like you have had quite good outcomes” after the kidney has been removed. This has stopped the development of secondaries in these cases. I pointed out that Dr. Evans (urologist) had said, yesterday, that he did not think my lungs were in a good enough state for the kidney op. Dr. Maskell appears to differ and said that he’d known people with worse lung conditions have major operations, though it would be up to the anaesthetist to make the call.
So, the outcome is that he will now phone Dr. Walters (Bath) to see if he can fit me in for a CT-guided biopsy which should be sufficient to confirm the diagnosis. This is the biopsy I was scheduled to have last week but which then was switched for the proposed camera-guided one that now can’t be done. This has about 80% success rate compared to 90+% for the originally planned biopsy (but since that can’t be done it is immaterial). I would expect that Dr. Walters will fit me with a permanent drain after his biopsy (if he agrees to do it) since they won’t be able to shove the fluid-stopping talc in using this technique and there remains the risk of the lung going into fluid-production mode again. But we’ll see.
I asked Dr. Maskell about the persistent low energy, slight headaches and ‘flu like symptoms I am experiencing and he said this was to be expected and could be due the lungs, kidney or combination of both. And the catchy cough will, of course, continue which makes me hoarse and impairs speech. I also asked about the comment in my discharge note that I had tiny nodules in my right lung too. He said these could be insignificant but only a scan after an interval would provide any indication (i.e. if they get bigger, or not).
Although we didn’t like what Dr. Maskell had to say he seems very experienced and gave us very good clear information, so we were very happy with the quality of the advice we received. Now we wait to hear from Dr. Walters.
The good news is we can probably revert to Bath. We did not like Bristol Southmead much. It is modelled on an airport terminal and of similar size. You are told to go to “Gate 12” and it seems designed to move large quantities of people about from place to place. The big difference with an airport is that it appears that only after they built it did someone say “Crikey, we forgot a car park!” So they whacked up a nasty looking multi-storey which is notoriously inadequate for the purpose. It reminded me of the Escher stairs drawings with endless queues of cars going up and down hunting for a space (we were lucky, a kind couple flagged us in to the space they were about to leave). And it’s still pay and display, which only a criminal or insane (or both) mind could ever think suitable for a hospital car park. And you have to wait for a shuttle bus to the hospital, just like in an airport, or walk for about 10 minutes. This, of course, itself increases the “dwell time” in the car park by about 30 minutes, exacerbating the congestion problem. It’s bad for the staff too – Dr. Maskell said he has to cycle in as he can’t park. A new car park is under construction next door, and I think HMG have said all hospital car parks should move to pay on exit, but with luck we won’t have to go back there.