J: A flurry of activity – another biopsy and going for the kidney

I now have a repeat biopsy scheduled and an agreement to be scheduled for a kidney operation.

On Tuesday I called the lung nurses to ask about the outcome of the lung team meeting last Thursday following the inconclusive biopsy. Since then I have had calls from them and another from Simon Evans, the urologist. A way forward seems to have been agreed.

The chin-scratcher for the medicos has been that my lung tumours are “not typical of metastasis” which means they don’t look like secondaries from the kidney, even though that is what most people thought/think is most probable.

One solution to eliminate doubt would be to send me for a VATS – Video Assisted Thorascopy – at the Bristol Royal Infirmary. However that has a 4 week delay and requires a general anaesthetic.

Simon Evans has, therefore, agreed with Dr. Walters (lung specialist) that it would be best to list me for the kidney operation as the delays are mounting up and the kidney does need dealing with.

They have also agreed that it is worth having another go with the CT-guided lung biopsy. The radiologist thinks they really ought to be able to snag some decent samples. This is the same biopsy I had before on the 24th and just requires a day visit.

Dates have now been agreed as follows:
Wednesday 8th – lung biopsy
Thursday 9th – pre-op assessment
Monday 13th – meeting with Simon Evans (kidney)
Tuesday 14th – follow up with Dr. Walters (lungs)

The pre-op assessment is to decide if my lungs are up to the kidney operation. Simon Evans has ruled out keyhole surgery as, counter-intuitively, it is harder on the lungs than open-surgery. This is because they have to blow up the stomach with carbon dioxide to create working room and that stresses the lungs more. Although the operation will be more invasive it also has the advantage that they can poke about a bit more freely looking for and, presumably, removing secondary growths around the kidney, so that seems a big plus to me.

Simon Evans wants to do the operation in conjunction with another surgeon who specialises in this and he is hopeful it can be done in May but, of course, they can’t commit to dates – and it does depend on my “passing” the pre-op assessment. The operation will require a stay in Bath hospital of about four days.

Simon Evans agrees that my symptoms of fuzzy-headedness and permanent slight headache could be kidney/blood related. Paraneoplastic syndrome they like to call it – side effects to you and me. He reports that some patients show significant improvement in general well-being after kidney removal. He has also suggested I might have enhanced calcium levels which could be screened for when I have my bloods done for the biopsy.

I asked the lung nurses what would happen to the fluid in my lungs in the meantime, which probably remains in pockets (“loculated”) and is the cause of a catchy cough and hoarseness. Not much is the answer. They can drain a pocket but as I have several it does not sound practical and there is no drug treatment suitable. I have an appointment with Dr. Walters for the 14th to follow up on the biopsy so I can explore that further with him then. Unless the fluid becomes de-loculated I think I will have to live with it until lung-specific treatment is begun, which I assume will be after the kidney operation.

I’m pretty happy with this plan as we have a sporting chance of finding out whether the lung tumours are primaries/secondaries/something else before the kidney operation. So if there is a need to change the kidney extraction plan that can be done, but in the meantime I’m getting on the list for it to minimise delays.

2nd April 2015