Category Archives: biopsy

Morning Musings

The nurse taking Debbi’s vital signs woke me up. Debbi’s numbers looked reasonable for her and oxygenation reported at 95% must imply that her lungs are still operational, infusing the hemoglobin and removing the carbon dioxide from the heme proteins as well. Sitting alone in the hallway, I was curious to compare Debbi’s latest blood test with that from the early days of this terrifying journey. Remembering that I had posted a table with such statistics, I went back in Debbi’s Journey to April of 2008 and found what I was looking for in the entry for Thursday the 24th.

Debbi had just finished the second application of the chemotherapy drugs and we had landed in Sloan Kettering’s Urgent Care center for the first time. I was comparing Debbi’s current counts to the trending counts almost one year ago. From April 3rd to April 24th, we watched the hemoglobin drop from 12.4 to 9.9 and as I wrote yesterday, it now stands at about 9.0. Then my eye caught a category that has not been followed in quite some time. That same day I posted the results of the Noodge Index and commented that Debbi had been noodging me about a fold-out sleeping chair.

In this department, counts have stayed quite constant. Last night I made sure Debbi was tucked in with two pillows under her feet to aid in fluid removal, her top sheet and blankets arrayed properly, an extra blanket folded just so (maximizing its weight over a smaller area) placed from her knees upward with an extra 2 inches tucked under her chin, and of course kisses good night. I then began to arrange sheets, a blanket, and a pillow to make up my own sleeping chair. I knew what was about to happen. True to form, once I began, Debbi began noodging. The noodge meter started rising. Do it like this or move the chair like that. Once I was finally settled in, Debbi wanted to get up and tuck me in and provided a bit more noodging when I politely asked her to just stay where she was with all her bedding arrayed just so!! Now, just as then, it remains true… as long as it stays within the normal range, Debbi’s noodging is quite welcome!!

So, once I had clicked into an earlier section of the blog, I continued down memory lane by perusing more of the entries. We were filled with trepidation but also with much hope at the beginning of the journey. And now? Now we are often talking about hospice, and being comfortable, and final affairs. We look back and wonder about what might have been or what we could have done differently. What is advised one day is ill advised the next. My good friend Schenker Jack has a whole litany, which I love hearing over and over, about things that we were told were good for us years ago, which then became bad for us, and then became good for us again. Debbi was meticulous in getting periodic mamograms, pap smears, and colonoscopys. Who ever heard of getting scans for early detection of cancer in the renal pelvis?

Well, a quick google search shows that there are companies that now feature wellness scans. One such firm in New Jersey, Able Imaging and Wellness, http//www.ableimaging.com does offer such a scan. Reading their web site, it can be seen that this is a non-invasive scan that covers all the body’s major organs. Certainly this technology was not available years ago but now it is becoming more commonplace. Might such a scan have discovered Debbi’s Transitional Cell Cancer earlier? Seems likely but who knew?

Speaking of scans, one good piece of news. When comparing the chest X-ray taken yesterday with the chest X-ray taken this past Monday, no differences were reported. So thank goodness we are not seeing rapidly changing nodules multiplying out of sight.

We will hopefully hear of discharge plans after morning rounds because Debbi anxiously wants to get back to the Cape House, back to the comfort and security of her mahogany rice bed, and certainly she wants to see and interact with her grandson Yonah.

What the biopsy said…

In addition to supplying family and friends with important information such as Debbi’s feelings, hopes, fears, and dreams, we are using the blog to record many of the test results for our own records. If you are not interested in this info, please simply scroll forward/backward as necessary.

As you know, biopsies were taken of the right kidney and the left scapula. The diagnosis was:

    1) Kidney Mass, Right Kidney, Biopsy

        Compatible with high grade urothelial carcinoma. The pattern of tumor invasion is unusual in that it appears to have a tubular architecture surrounded by basement membrane-like material in a background of myxoid stroma. This likely represents intratubular spread of the urothelial carcinoma into renal tubules. Immunohistochemical stains are consistent with urothelial carcinoma (CK7, 34BE12, 4A4 Positive; CK20, CD20, CD31 Negative).

    2)  Scapula, Left, Biopsy

         Blood and hematopoietic elements. No carcinoma seen. Multiple levels examined.

 

Reading between the lines, we are very happy that the scapula is not involved even though there was some evidence of cancer in the PET scan. When the biopsy was done on Debbi’s right kidney, the interventional radiologist, Dr. Constantinos T. Sofocleous, was able to place the probe and use the CT scan to verify that the location of the probe was consistent with the location of the mass. However, this verification process was not available for the biopsy of the scapula. Bone is solid and dense. Therefore, the radiologist did his best to use existing scans and multiple screens to try to triangulate the area for the biopsy. Considering that the involved area was approximately the size of the head of a thumbtack, it was difficult to be 100% certain that the biopsy was taken from the exact area. Four sample bone scrapings were taken with the largest one measuring approximately 0.25″. 

Where does this leave us??? Since we are not absolutely sure that there is no involvement outside of the kidney, we must do chemo in an effort to shrink the tumor in the kidney as well as to treat any possible cancer cells that may be traveling through the blood stream (as well as any possible cancer cells in the left scapula). If the chemo is successful in shrinking the tumor, surgery to remove the right kidney (or part of it) becomes possible. 

In the next post, I will try to explain the choices for chemo and how we move forward.

 

     

The Biopsy

I reported to Sloan at 11:15 but the biopsy did not even begin until 2:30.  What a busy place.  It is almost more frightening seeing the numbers and ages of people with cancer than dealing with your own illness.  And the attitudes of the people were amazing.  The staff is very upbeat, gentle, and caring.  Many patients are cooperative and as with me, hoping for the best.  And then you have those who complained the entire time about the wait or wanted to share the gory details of their story.  My Secret: I took my knitting with me and most people either commented on its beauty or just left me alone.  I liked the solitude of knitting and listening.

The biopsy itself was very uncomfortable since the radiologist informed me that the second MRI was inconclusive on the scapula so they are going in.  This saddened me because they have not ruled out the possibility or the spreading but he said the spread is so small that it would even be difficult for him to achieve.

 

I was fortunate enough to be highly sedated and although I sometimes felt the pain  and could hear what they were doing, overall I was very out of it.  The payback was that at 8:00PM I was still heavily sedated and very nauseated.  Finally we arrived home and once I hit my own bed, I was gone for about 4 hours. A little more pain meds and I slept the rest of the night like a baby.  

It is 6:30 am and I am uncomfortable but glad the first step has been taken.  Jan and I had the grandiose idea that I could make it to the Cape for the weekend but the reality is…..More meds and back to bed for awhile.  I would so love to see the beach but even I, who would try anything to get there, know that is not the smartest thing to do.  So I will close my eyes and imagine.

 

Thank you for all of your prayers and strength.  The blog comments are not working properly at this point so if you would like to contact me: jan@buckler.com or at home.

 

DAY BEFORE BIOPSY

What a crazy day.  I decided to go to work to make sure I was distracted all day.  Jan called at 8:00am asking for my PET scan discs that he needed to drop off at the doctor’s office across town by 9:00.  That wonderful man took his motorcycle and raced the results across town.  The doctor’s were meeting about the plan for tomorrow’s biopsy.  At 10:00, my cell phone rings again and the hospital wants me to report in at 1:00 for another MRI!.  I arrange to leave work, get to the hospital and have the MRI.  I then ask why? I just did this scan last week.  The doctor tells us that the last tests are inconclusive that the cancer really spread to the shoulder and they just want to make sure before they biopsy the area.  This gave us a little hope since the scapula is the only place it seems the cancer has spread from the kidney and would make things less complicated if it were true.

 

And so tomorrow morning, I will spend the day again at Sloan for the biopsy and pray for the best.  Results will probably be a week later.  So many people around the world are pulling and praying for us and I truly believe that that is what will help me get well and the doctors will assist!!!  Who would have thought from a person who hardly believed there was such a thing as a God 7 years ago!