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From: t2k on 3 Sep 2008 23:24
I know this is a long post but I think it's necessary to include
all details of what has occurred from the very beginning.

Around December 13 2007, my dad fell down and bruised what
appeared to be his ribs. He tripped over the curb of a sidewalk. He
refused to have himself checked out until the 23rd when the pain at
the
rib area continued. At hospital they tell us x-rays show only two to
three ribs broken and nothing else. They tell us it's the eight and
ninth ribs that are broken and that "the ends are still together"...
it's more like a crack". Doctors tell us the ribs should heal by
themselves.

My dad, at the time, also told the doctors that a few days after he
fell, one of his ankles became very swollen. This was the ankle of
the
same foot he had tripped over the sidewalk. They don't know what
caused this.

On January 28 2008, Dad informs me he's been constipated since he
fell
and now feels pain because he can't get rid of his stools. We went to
the hospital where he was given several enemas that weren't helping.
They did some tests on him but found nothing. They eventually manage
to get the stools out and gave him something to help. He increases
the
amount of water he drinks. He's give Apo Lactulose USP 667mg/ml.
He also mentions that he can still feel his broken ribs moving and
that
this bothers him.

After taking Apo Lactulose USP 667mg/ml. his bowel movements return
normal.
But sometimes he's constipated throughout February.

On March 1st, Dad says he saw blood in his urine! A doctor gave him
Co Trimoxazole DS 800/160. Since then he's urinated a few times with
no blood. On March 2Th he says his urine is now clear like water.
Specialists do some test on him but find nothing to indicate what's
wrong. And dad, feeling better, refuses to have anymore tests.

On May 30Th at 3am, dad says he saw "deep red blood" in his urine.
He decides to resume the tests he had been scheduled for such as a
blood test. But the blood test didn't show anything wrong other than
that he is low iron. So dad is scheduled for a more complete
examination and a CT Scan.

By this time he's been given Palafer GSK 300mg, Macrobid 100mg and
Synthroid 100mcg (Levothyroxine) for the blood in the urine.
Most days his urine is clear but other days, some blood.

On June 3rd, a doctor tells us there are more tests to take and this
will take some time to organize all this. Dad informs the doctor he
once saw blood clots coming out with his urine along with blood.
The Doctor tells us these things tend to be benign in nature and that
my dad and I are thinking 'worst case scenario' that it's not right
[for us to think this way]. The doctor says the most likely cause is
a bladder problem. And talks about putting a scope up in, to look at
his bladder. Dad is then asked to see another doctor in a few days.

On June 5Th, dad is given: Nitrofurantoin 100 MG.

On June 15: Blood in urine again. At the hospital they gave him more
Nitrofurantoin. Slight blood in urine on the morning of June 16Th.
More tests to take in the next several days.
They put a scope and looked at his bladder and found it normal.

First week of July: my dad tells me that both legs are now swollen!
I was unaware of the swollen legs thinking that the one swollen ankle
he had had. Instead, it had now spread to the other leg.
Doctor says he doesn't know what's causing his leg condition and that
it's risky to have veins burst if it continues. Dad is told to sleep
with his legs elevated. He begins taking Furosemide 20mg for his
ankles and is
given special socks to wear.

By now he's now also taking Furosemide 20mg. And a doctor gave him
Centrum Select for 50+ .

Around this time dad tells me that he previously had blood in his
urine once 10
years ago. And the cause then had not been investigated. He remembers
it wasn't
as bad it was now and they had given him some pills and it had cleared
up.

On July 16, A nurse phones us and says a recent blood test indicates
his D-dimer is
on the high side and could be an indication of a blood clot. And to go
to hospital right
away to have an ultra-sound. We do that but the result of ultrasound
doesn't show
what's wrong.

On August 7: Dad restarts urinating "deep red blood". He contacts his
doctor who
warns him to go to immediately go to emergency if it doesn't stop. The
doctor then
informs my dad that the CT scan showed polyp on his kidney. Not known
if it's malignant.

My dad continues bleeding like this until Saturday Aug 9Th
evening. Just before 1am Sunday morning, he says his urine
is now black! The next three urine was very black with a bit
of red. But I was not aware of this because I was sleeping.

At around that time (1am) he also began having pain at his right side
kidney area. At 3am the blood stopped and then the pain spread all
over and intensified "like a cramp". Very intense pain. It prevented
him from breathing. The pain got so great that he became short of
breath. When he wakes me, I call 911 at 5:30am. We tell the two the
only ambulance persons that arrived about the polyp on the kidney
that
we were told was causing the problem. They told us it's not serious.

In the hospital room, they do an ultrasound of the bladder and have a
urine sample.

About half an hour later the pain grew much worst. A few times I tried
getting a nurse
to help him but some of them didn't know why we were there for. One
nurse walked in
the room and ask us why we were there and why he was in pain.

At 7am a doctor talked to us. We tell them about the polyp on his
kidney. Doctor says will get something for the pain. At 7:30am the
pain began to get
much worst. The gave him pills to dull the pain. But he vomited them
5 minutes later.
The pain came and went.

At 8:30am a doctor finally tells us dad will be put on an iv.
Dad's pain became so great at times he'd vomit and almost passed out!

At 8:35am a nurse finally tries to put in an iv. He was then given
large amounts of morphine to dull the pain. She tells us that she
doesn't know what happened to dad's urine sample he gave earlier.

At 9am dad has a ct scan. A doctor tell us the ct scan shows dad has
"a couple of
cysts: one on each kidney". "but no kidney stones". It also showed "an
area on the
right kidney they couldn't really tell what exactly what it was".
Doctor said the pain
could be caused by blood clot(s) and is coming from the kidney pipe
and not the
kidney itself and should go away. He called it renal colic. It might
be something worst
then a cysts like a small cancer.

They told us they don't know why dad is still in pain after several
hours in the hospital.
To know more detail they'll have to go in
and look inside. And to do that, dad's doctor will be contacted to
first come and see him. They reassured me that his doctor had been
contacted and is
coming. They said they could not do anything more for him until his
doctor arrives to see him. The bleeding, they said, is coming from
"the kidney pipe" and not the kidney itself. It's
possible it's a tumour. It's called it renal colic. When the pain
subsided I returned home.

I returned to the hospital the next day to to find him arguing with
nurses that he was unable to call anyone with his call bell. He had
been calling them because was in pain from his arm that had swollen
twice it's size. The nurse says his needle slip or had not been
inserted properly. The intravenous fluid from the plastic bag above
his bed had filled up in his arm instead of his body. Should return to
normal they said. Although he was still urinating lots of blood, his
blood count was good.

I asked again about his doctor and they again told us that his doctor
is coming. A nurse tells my dad the doctor didn't forget him. And she
reminds both of us that doctors see patients in priority sequence
and that he will eventually come to see dad. And that besides pain
control medication and good food, nothing more could be done until his
doctor comes. When things settled down, I left.

Later that evening a nurse calls me and tells me dad has been
discharged. Dad says he was told that he could go because and was
feeling better even though he was still urinating blood. I arrive at
hospital to pick him up.

After we were out of the hospital, I turned around and walked back in
to ask why his doctor still hadn't come. Dad followed me in. It's only
then did they tell us that the person responsible for telling my dad's
doctor to come hadn't told him at all. All this time we had been
waiting for a doctor who was never coming! They apologized but I
wasn't happy by the fact that it was only after I had asked did they
apologized!
We called his doctor the next day and made an appointment.

A few days later, my dad took a cab to the hospital because he had
problem passing stool again. But he says that while he was there
waiting,he began having pain on his right side. The pain increased
until he could no longer stand it. He says he then told the nurse who
he says was not sympathetic towards his new problem and just told him
to sit
down. When the pain became too great and unbearable, he says he
complained again. At some point, security was called and a security
guard took him into a room where a nurse acted angry towards him and
tore up some papers she had with her or papers that were already
there.
He says he wasn't allowed to use a phone until after they finished
seeing him.

On August 14, we finally saw a doctor who told us what's going on.
The doctor told us "it's not polyps and it's not cyst; it's cancer".
And that it showed up on the first Ct scan; the same CT scan we were
once told didn't show any thing's wrong. He tells us he has a
tumour in/on his right kidney. And that it's called, Transitional
Cell Carcinoma.

Unfortunately, he says, the treatment is to remove take out his
kidney
and his utterer. He says the tumour extends about 1.5cm to 2cm.
And doesn't think only tumour can be removed.He doesn't know if the
tumour is actually cancer but the majority of the time, it is.
In fact, he says there's not much else that gives you this picture.
However, after saying all that he adds that he and other doctors will
look at it more closely (more Ct Scans and scope).

Dad says that he found that he could reduce the blood in his urine by
drinking less large amounts of water. In other words he could drink
the same amount of water by taking small drinks small sips of water
(every
few minutes or half hour) rather than a full glass of water.
The doctor doesn't know why my dad's legs are swollen and says there
may not be any connection. But I wonder.

A few days later we see another doctor. Two option: remove the kidney
and the ureter and a little bit of the bladder out as well.
The other option is put a scope all the way up, take a look at it and
try to take the tissue out to see if it truly is a cancer or not. It
could be a benign tumour, this doctor says.

The doctor adds that the more he looks and read the reports and
listen
to what happen that he thinks it probably wouldn't be unwise to
actually just take the whole kidney out. It's most likely cancer and
there was bleeding on the right side.

At the end, the doctor decided to go take a look first and try to
diagnose it by putting a scope up and take a look. And also try to
grab a bit of the tissue for diagnose. And if possible, actually
laser
the area to stop the bleeding.

A few days later, my dad writes to his doctors refusing to have them
look and touch the tumour. He fears that doing a biopsy on it (if it
is a tumour) will cause any cancer that might be there to escape.

So, one of the doctors calls us in to talk with my dad. I arrived
there with him.

And this is what the doctor tells us: With this situation, there's no
definite right or wrong answer as to what we do. There are two
options. Because there is something in the right kidney, it's probably
a tumour. Most likely it's cancer because of the amount of blood that
came out.
The standard treatment is to remove the whole kidney. But because of
dad's age, the doctor would instead like to take a look to see if they
could treat it. The doctor says that looking at a tumour and taking
pieces of it for diagnosis is less serious then removing a whole
kidney, utterer and parts of the bladder. Because removing an organ is
hard
on an 81 yr old body and may be unnecessary if the tumour is benign.
And even unnecessary if the cancer is treatable.

Dad's other kidney function is good, the doctor said.
The doctor tells us that the last thing a urologist wants to do is
take
a normal kidney out of somebody and subject them to major surgery for
no reason. He feel that there's probably a greater than 90% chance
that dad has a tumour in there, based on the first CT scan and because
of
the amounth of blood.

I then asked the doctor if it's possible a biopsy on a cancerous
tumour can cause the cancer to escape. The doctor answered by saying
he thinks it's a theoretical risks and is very low. And that if he
thought it was
a major risk he wouldn't do a biopsy. He said that if there is cancer
he doesn't think the cancer will spread by doing a biopsy.

The doctor also added that if you ask 100 urologist what they would
do,
a good number of them would say to just remove the whole kidney. But
the other half might biopsy it, to see if they can treat it instead.

The doctor tells us it's not his normal sequence of doing things; he'd
prefer to go in and look at it to see what it is and if it's
treatable. But can't, because my dad refuses. He said he has to listen
to my dad's concern as he doesn't want him to be unhappy. And
therefore can't do the biopsy.

So my dad signed a consent form for the removal of a small part of the
bladder along with his kidney.

So as it stands now, my dad is to have his kidney utterer and parts
of his bladder removed. I disagree with my dad's decision to not have
a biopsy first. It may not be cancer at all. And if it's cancer it
could be treatable. But I can't seem to change his mind.
From: J on 4 Sep 2008 08:32
"t2k(a)vcn.bc.ca" wrote:

> I know this is a long post but I think it's necessary to include
> all details of what has occurred from the very beginning.
>
> Around December 13 2007, my dad fell down and bruised what
> appeared to be his ribs. He tripped over the curb of a sidewalk. He
> refused to have himself checked out until the 23rd when the pain at
> [...]On August 14, we finally saw a doctor who told us what's going on.
> The doctor told us "it's not polyps and it's not cyst; it's cancer".
> And that it showed up on the first Ct scan; the same CT scan we were
> once told didn't show any thing's wrong. He tells us he has a
> tumour in/on his right kidney. And that it's called, Transitional
> Cell Carcinoma.
>
> Unfortunately, he says, the treatment is to remove take out his
> kidney
> and his utterer. He says the tumour extends about 1.5cm to 2cm.
> And doesn't think only tumour can be removed.He doesn't know if the
> tumour is actually cancer but the majority of the time, it is.
> In fact, he says there's not much else that gives you this picture.
> However, after saying all that he adds that he and other doctors will
> look at it more closely (more Ct Scans and scope).
>
> Dad says that he found that he could reduce the blood in his urine by
> drinking less large amounts of water. In other words he could drink
> the same amount of water by taking small drinks small sips of water
> (every
> few minutes or half hour) rather than a full glass of water.
> The doctor doesn't know why my dad's legs are swollen and says there
> may not be any connection. But I wonder.
>
> A few days later we see another doctor. Two option: remove the kidney
> and the ureter and a little bit of the bladder out as well.
> The other option is put a scope all the way up, take a look at it and
> try to take the tissue out to see if it truly is a cancer or not. It
> could be a benign tumour, this doctor says.
>
> The doctor adds that the more he looks and read the reports and
> listen
> to what happen that he thinks it probably wouldn't be unwise to
> actually just take the whole kidney out. It's most likely cancer and
> there was bleeding on the right side.
>
> At the end, the doctor decided to go take a look first and try to
> diagnose it by putting a scope up and take a look. And also try to
> grab a bit of the tissue for diagnose. And if possible, actually
> laser
> the area to stop the bleeding.
>
> A few days later, my dad writes to his doctors refusing to have them
> look and touch the tumour. He fears that doing a biopsy on it (if it
> is a tumour) will cause any cancer that might be there to escape.
>
> So, one of the doctors calls us in to talk with my dad. I arrived
> there with him.
>
> And this is what the doctor tells us: With this situation, there's no
> definite right or wrong answer as to what we do. There are two
> options. Because there is something in the right kidney, it's probably
> a tumour. Most likely it's cancer because of the amount of blood that
> came out.
> The standard treatment is to remove the whole kidney. But because of
> dad's age, the doctor would instead like to take a look to see if they
> could treat it. The doctor says that looking at a tumour and taking
> pieces of it for diagnosis is less serious then removing a whole
> kidney, utterer and parts of the bladder. Because removing an organ is
> hard
> on an 81 yr old body and may be unnecessary if the tumour is benign.
> And even unnecessary if the cancer is treatable.
>
> Dad's other kidney function is good, the doctor said.
> The doctor tells us that the last thing a urologist wants to do is
> take
> a normal kidney out of somebody and subject them to major surgery for
> no reason. He feel that there's probably a greater than 90% chance
> that dad has a tumour in there, based on the first CT scan and because
> of
> the amounth of blood.
>
> I then asked the doctor if it's possible a biopsy on a cancerous
> tumour can cause the cancer to escape. The doctor answered by saying
> he thinks it's a theoretical risks and is very low. And that if he
> thought it was
> a major risk he wouldn't do a biopsy. He said that if there is cancer
> he doesn't think the cancer will spread by doing a biopsy.
>
> The doctor also added that if you ask 100 urologist what they would
> do,
> a good number of them would say to just remove the whole kidney. But
> the other half might biopsy it, to see if they can treat it instead.
>
> The doctor tells us it's not his normal sequence of doing things; he'd
> prefer to go in and look at it to see what it is and if it's
> treatable. But can't, because my dad refuses. He said he has to listen
> to my dad's concern as he doesn't want him to be unhappy. And
> therefore can't do the biopsy.
>
> So my dad signed a consent form for the removal of a small part of the
> bladder along with his kidney.
>
> So as it stands now, my dad is to have his kidney utterer and parts
> of his bladder removed. I disagree with my dad's decision to not have
> a biopsy first. It may not be cancer at all. And if it's cancer it
> could be treatable. But I can't seem to change his mind.

Hello Tony,
Thank you for the summary.

Since the others (here) don't know, I'm mentioning that your father had
liver surgery 40 years ago.

Just for the record, there's also transitional cell bladder cancer.

I'm not a doctor, but I don't see the point of another biopsy.

I don't usually say this about older patients, but I think this situation
calls for surgery; so that hopefully the bleeds and episodes of pain (and
possibly the leg swelling) can be stopped. It's hard to know what he'll
gain or lose. I suspect the surgeon won't know until in there. Sometimes
we have to trust the doctors, especially surgeons.

If it is kidney cancer, the size you mentioned shows a good prognosis here

< http://www.bccancer.bc.ca/PPI/TypesofCancer/Kidney/default.htm >
The only chance at cure is surgery.

If it works, a number of his medicines could be stopped.
When's the surgery?

He's made his decision. All we can do, is hope for the best now and I
believe in Canadian surgeons.
I wish I were there to support and reassure you, but I'm not there.

Feel free to share your concerns and feelings. We'll understand.
J


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