Double Update

Yesterday I, my brother and my sister saw my mother’s oncologist with her. She had the required tests and scans last week. The best news we could have hoped for was that they saw nothing they weren’t expecting and that treatment could be given as planned. That’s the news we got. So she is in a class for which CURE is the objective and statistically very achievable. Obviously we are very thankful. She will begin chemo next week.

As I said in my last post I learned a lot after seeing two specialists, a gastroenterologist and a kidney specialist. The gastroenterologist was suggested by Dr. George to determine whether or not I am a candidate for the semi-permanent catheter to allow me to remove the abdominal fluid myself. We don’t know the answer to that yet. There are basically two probable causes for the ascites. One is liver disease, the most likely cause in my case. The other possibility is a condition called portal hypertension which is usually found in people who drink. I never drank. If it is being caused by portal hypertension I would not be a candidate for the catheter for reasons I’ll explain later. To determine the cause, when I have the next paracentesis (draining) later this week a blood test will be done on the same day. The fluid removed will be sent out for testing and the protein level in it has to be compared with the protein level in the blood.

Assuming I am a candidate for the catheter, which is likely, I will have to make a decision as to whether or not I want it. As I’ve mentioned before there is a high risk of infection with paracentesis. The risk is even higher with the implanted catheter. The way the doctor explained it is that it is a foreign body in the abdomen. This foreign body has “communication” with the outside, constantly exposing it to germs if not handled properly. If it should become infected it is extremely painful, would likely require hospitalization, may have to be removed, and could be fatal. If the ascites is caused by portal hypertension the risk of infection is greater which is why that don’t use them for those patients. I would also have to consider the restrictions the implant would impose. I would no longer be able to mountain climb, sky dive or bungee jump.

This doctor gave me the prescription for the next paracentesis but also ordered that albumin be injected as the fluid is removed. The albumin should help to counteract the negative effects draining has on the kidney and my blood pressure. He was so helpful I figured I’d take a shot and ask him if he had a cure for me. He didn’t.

From his office I went to see the kidney specialist. He was very informative, most notably in explaining why I have so little urine. Because my fluid is escaping into the abdomen, it is not flowing through the blood stream to the kidneys. The kidneys, since they are not getting fluid, are tricked into think that I am dehydrating. They shut down urine production to conserve fluid. This forces more fluid into the abdomen. This is a self perpetuating condition which they can do nothing about. The longer it continues the more likely it is that the kidneys will shut down completely, That will be the end. By the way, dialysis has not been successful in this situation. The only hope of breaking this cycle is to treat the underlying cause of the ascites. Hence my quest to get more meaningful chemo and at least stabilize the liver tumors.

This doctor ordered another blood test, urinalysis and a kidney ultrasound to rule out any other cause and to assess the present condition of my kidneys. All of these tests have now been done and I’ll see him again next week hoping to get the go ahead for more chemo. He also agreed with the gastroenteritis’s use of albumin.

Today, weather permitting, I’ll have the MUGA scan to see if my heart is ready for more Herceptin.

So the plan is progressing; get every part of me ready for battle and then head for the front line.

Carry on.
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