renal cancer treatment

Mom and I met with Dr. Ronald Arellano (617-726-8396) and his team on Monday, 9/13 at MGH to review the radio-wave ablation for her renal cancer. This visit was to get more info on the procedure so that Mom could decide whether to have it now or wait.  Immediately after this visit, I took mom to the walk-in clinic and then straight to Emergency where, as you know, she eventually got admitted for a cardioversion.

The renal ablation is a day procedure. It uses extreme heat to kill the cancer cells in her kidney.  It is similar to the biopsy she had in that the position and meds are the same. It takes longer — 2-3 hours. And there are more risks.

Risks involve:

Bleeding

Scar tissue that would interfere with her urination. Her urologist, Dr. Feldman, would place a tube in her ureter to send cool fluid to the site to keep the ureter cold to minimize the risk of scar tissue during the heat of the procedure.

Bowel injury. They will try to move the bowel out of the way during the procedure with a needle.

Allergic reaction to the sedation, but she already did well with same med during biopsy.

Temporary nerve dysfunction. She might feel pins and needles at the site for about 10 days, but this is rare.

7-10 days after the ablation, she will feel fluish, run a low temp and have aches.

Dr. said renal cancer is slow growing, generally, and that the tumor is small. He also said the tumor may not impact her longevity at all or her quality of life. The risk is that the cancer does grow quickly and then tumor is too large for the procedure, then must have risker surgery.

Mom and I talked on Thursdays and both feel comfortable with her waiting, having another CT-scan in 4 months. I will let Dr. Feldman, her urologist, know.

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update re: mom’s renal cancer

Mom & I saw Dr. Feldman, her urologist, today at Mass General. She has clear cell renal cell carcinoma, the most common type of kidney cancer. It is small, a little under 2.5cm. In 10/08 it was about the same size, but then it was a cyst. Now a larger portion of the cyst is tumor. This is her left kidney. This cancer tends to grow slowly. In terms of treatment, he recommends treating the tumor and not the whole kidney. There are two basic options: watch the tumor actively for 4-6 months. But if she waits, the tumor may grow so large that it will be impossible to treat just the tumor and then you are taking about more invasive surgery to treat the entire kidney. The other option that he leans toward is called radio frequency ablation. You pass a needle through the kidney, similar to biopsy and kill the tumor with heat. It is a fairly effective treatment with a low recurrence rate. It is a good option for mom. The question now is what the radiologist, who did mom’s biopsy, thinks. Her name is Dr. Gervais. Dr. Feldman will consult with Dr. Gervais and then Mom will meet with Dr. Gervais. Appt. is not yet scheduled. There is no reason to rush this along. Dr. F. believes it is reasonable to wait and watch the tumor. It’s also reasonable to do the ablation in case the tumor gets too big for this procedure. Also, he said that Mom’s heart and kidneys and other vital organs are strong and functioning well at this point. There are risks with the ablation, including injury to the bowel and injury to some other areas of the kidney. But there are things Dr. Feldman can do just before the procedure begins to mitigate these risks. The ablation is a same day surgery with a radiologist using the same light anasthesia used for the biopsy. There is more risk than the biopsy, but recuperation is similar. So there will be more info coming once mom meets with the radiologist, Dr. Gervais once that appt. gets scheduled. That’s all for now.

Mom’s meds updated

As of 6/11/10

Lamictal starter (4 weeks) — anti seizure

Keppra (2x/day while taking lamictal starter) — anti seizure

Coumadin (bedtime)

Lisinopril (10mg. 2x/day)

Prilosec (20 mg daily)

Sotalol (80mg 2x/day)

Prevastatin (bedtime)

mom’s current condition

Hi all, I spent a very good weekend with Mom. She ended up feeling nearly normal by the time I left Sunday late afternoon. We got her on a strict 4 glasses of gatorade and snacks between meals regimen and it seemed to work. I encourage all of you to make sure Mom is keeping with this regimen:

1. Be sure she is drinking at least 4 glasses of gatorade per day; she has not been doing this consistently.

2. If she is walking the beach or more active, she needs to carry water or gatorade with her and increase her fluid intake beyond the 4 glasses.

3. Be sure she is having 2 high-protein snacks per day: between breakfast and lunch and between lunch and dinner. I have suggested nuts and dairy combos such as peanut butter crackers and cheese or nuts and yogurt.

The improvement in how she felt physically and mentally was dramatic. I reminded her gently that she needs to do her part so we and the doctors can do ours to get her back to feeling well.

I was really glad to have the time alone with Mom this weekend. We had fun and it was great to see her feeling better and less tense.

update dad’s meds, dr. appts.

As of 5/3/10

Dad’s meds

Lisinoprol    20 mg /d       Dr. Lefkowitz (a cardiologist he does not see now)

HCTZ          12.5mg/d            Lefko

Tricor       145 mg/d             Lefko

Prilosec      20mg/d     Sheckman

Thyroxine    .075mg     Lefko

Crestor    20mg      Sheckman

Prosac     20mg     Sheckman

Proair        90mcg. INHaler    Gabriel

Advair  60’s     500/50   Gabriel

Toprol     50mg                 Heist

Mom’s MRI reading in Cinn

Mike had a good radiologist who is also a neurosurgeon read mom’s mri.  He confirmed that there is nothing on the mri indicating a stroke – good news, and didn’t see anything else alarming.  (Mom asked that he comment on the large size of her brain.  A good sense of humor is the key to health!)

I was still hoping for a low read on the sodium level from the hospital in Maine after the stroke but the test results were normal.  It’s impossible to say if her sodium went back to normal after the fluids were given in the ambulance. He said that it’s possible that they would have drawn blood out of the same line as the IV which would have had glucose in it.  Either way, maintaing a normal sodium level does seem to be a problem for mom. The anti-seizure medicine will keep her from having a seizure if it does get low.  I don’t like her on any extra meds, particularly if they make her feel bad but I’m afraid of more seizures.  I’m not sure how many more an 83 yr old (even with a great sense of humor and a large brain) can tolerate.

The doc here suggested talking to her cardiologist about discontinuing the Provocal for the cholesterol altogether.  Chris, I know you got it cut in half this week as Mom thinks it’s what’s making her stomach upset.  Her cholesterol has always been low and at 83 it’s probably not going to kill her.  Chris, do you want to address this with Dr. Heidt?

He also suggested having her sodium level checked at the same time her cumidin level is checked (monthly?)  Don, do you want to run that by Dr Steckman? I’ll see if there’s an at-home sodium test we could get for daily use.

Let me know what you all think.  Aside from her not feeling great, it’s good news that she didn’t have a stroke and that she is not in danger of having another seizure now that she is on the meds.

Carol

update mom’s meds

As of 5/3/10, here is a list of mom’s meds:

toprol, 50 mg daily, Dr. Heist

Lisinaprol, 20 mg daily( 1/2tab twice per day), Dr. Heist

Sotalol, 160 mg. daily (80mg. twice per day) Dr. Heist

Warfarin, 7.5 daily, Dr. Heist

Pravachol, 20mg. daily, Dr. Heist

Phenytoin, 100 mg. 2x/ day, Dr. Levy (anti seizure)

Omeprazole (prilosec)      20mg.   Sheckman (nausea)

Dad’s Rx

Below is Dad’s med schedule as of  3/21/10, Mike

Crestor:  20 mg;   1 tab/day – PM

Tricor:  145 mg;  1 tab/day – AM

Prilosec: 20 mg;  1 tab/day – AM

Metroprol; 50 mg; 1 tab/day – AM

Prozac: 20 mg; 1 tab/day – AM

Lesinopril: 20 mg; 1 tab/day – AM

L-Thyroxine: 0.075mg; 1 tab/day – AM

mom’s new med dosages

As of today, 3/30, Mom’s anti seizure med is down to one pill per day. Suggested to her she take this at night.

Mom’s cholesterol med is down to once per day now as well, to be taken at  night.

talking with mom

This story is not about why I would have made a good doctor, but how we need to talk with Mom, especially about her health these days. For example, she tells some of us she is nauseous and some of is she is “sick to her stomach.” When I probed with specific questions, these are the details that emerged.

She has been nauseous for about a  month. When she gets up in the morning she is not nauseous (wish I knew how to spell that word,) eats breakfast, takes sodalol and about 1-2 hours later gets nauseous.  When I spoke with Dr. Heist’s office, that kind of detail is more helpful to them than a general “feeling nauseous” complaint. Because of the details, they were able to determine that the new cholesterol med she went on about a month ago could be causing the nausea and that those symptoms are consistent with side effects from the cholesterol med. To be determined if that is the cause, but nonetheless important to get as many details as possible from Mom.

Okay, okay, I probably would have made a great doctor — if only I were as smart as Scottie!