Kidney cancer

It’s been a long week. Last Friday morning I was admitted to Greenslopes Hospital to have my left kidney and some associated tissue removed. Laparoscopic (keyhole) surgery was not possible so I had a long incision from just below my ribs down to some way below my navel. We arrived home yesterday afternoon but it will be some months before I approach full recovery.

Until the surgery last Friday I was feeling generally as well as usual considering I tested positive for COVID just after New Year. There had been just one incident that signalled a problem with my kidney.

That was on Saturday, 12 November last year. Sometime through the morning I noticed that my urine was discoloured, a dark brown with possibly a touch of red suggesting blood. Next time it was clear but I searched on Google for possible reasons. One possibility was the result of eating beetroot which Majella had served the previous evening. Others included kidney stones. As we watched television that evening I had intense pain in the kidney region. It was bad enough that I vomited more than once and Majella suggested going to emergency. Whatever we were watching was entertaining enough that I didn’t want to miss it so we waited. Within an hour or so the pain had subsided and there seemed little point in seeking urgent medical attention for a non-problem.

I was about due to have blood taken for the regular six monthly screens I have had since I was diagnosed as diabetic in November 2007. I am no longer diabetic, diet and exercise fixed that by dropping 20 kg and increasing fitness, but my GP still likes to see the results. I had the blood taken on Tuesday of that next week and booked the first available appointment with my GP for Wednesday of the following week. In the meantime I noticed occasional signs of blood in my urine but experienced no more pain.

Once I described what had happened to my GP he had me produce a urine sample on the spot. It tested positive for blood though there was no visible sign. He immediately referred me for a CAT scan to see what was happening with my kidney. Because the physiotherapist who had been working on my sore left shoulder had suggested an ultrasound to see what was happening there I got that added to the referral.

Luckily I was able to get an appointment for both scans the following morning, Thursday. I booked the first available appointment with my GP for Thursday of the following week to get the results.

That Friday we were driving to Sydney to visit Nick and the kids, timed to catch performances by Sophie and Ben. Somewhere along Thunderbolt’s Way, in one of the few areas with reception, my phone rang. It was the GP receptionist wanting to bring my appointment forward. Ben’s performance was on Sunday night so we were not driving back until Monday. The appointment was set for Tuesday, 29 November.

My GP was so focused on the scans showing a bulging growth on my left kidney that the shoulder was almost forgotten. Once we had settled on referral to a urologist, Dr Devang Desai, working on our side of town I did manage to get a referral for the recommended aspiration of the calcification in my left shoulder. He also referred me for another CAT scan, this time of my lungs where secondaries might be most likely to appear first.

I booked the first available appointment for the scan on the morning of Friday, 2 December. The first available appointment for aspiration of my shoulder was 6 January so I booked that too.

The urologist’s office called that afternoon and asked if I had booked a lung scan. Once I confirmed that was set for Friday morning she booked me to see him on the Friday afternoon.

Majella came with me to the appointment with Dr Desai. His office was set up with a screen on which he could show the scans and explain what was going on. He confirmed what my GP had said, that the kidney would need to be removed. However, there were some lymph nodes shown in the scan that should also go and that made laparoscopic (keyhole) surgery inappropriate. He was confident that he could do the operation but thought it warranted the better facilities at a Brisbane hospital. He contacted his colleague, Dr Malcolm Lawson, at Greenslopes and persuaded him to squeeze me into his already full schedule for an appointment before Christmas. He also ordered some more urine tests. Although it would have been more convenient to have the operation in Toowoomba there was some comfort in having a specialist straight enough to send us on to what he considered a better option.

The following week I somehow aggravated my shoulder to the point where it was sore to the merest touch. If I needed to reposition my left hand the only way was to pick it up and move it with my right hand. I made an appointment to see the physiotherapist as soon as possible but that was week on. By the time I saw him a course of Voltaren tablets had reduced the inflammation and the exercises he prescribed helped to improve and maintain range of movement while I awaited the aspiration.

We saw Dr Lawson at Greenslopes on the afternoon of Wednesday, 21 December. He came to the same conclusion about the scans and what needed to be done, explained the risks, and added me to his surgery list for Tuesday, 10 January. We drove home, sobered by the news, but confident in the surgeon and his proposed plan.

In the week after Christmas I had some congestion on my chest and a cough that I began to suspect might be COVID. On the morning of Saturday, 31 December I had a slight fever and decided I should use one of the RATs we had acquired on our trip to New Zealand in September. It tested negative. On Monday, 2 January I felt no better and was becoming concerned about the implications of respiratory problems for my upcoming general anaesthesia. A second RAT tested negative but I resolved to see a doctor on Tuesday after the holiday weekend.

The GP I saw that Tuesday swabbed my nose and throat and prescribed a course of antibiotics to knock any bacterial infection. Late Wednesday afternoon I had an SMS advising that my PCR had been positive for COVID. On Thursday morning there was no option but to advise Dr Lawson that I had tested positive for COVID. My surgery had to be postponed as did the aspiration of the calcification in my shoulder that was due that Friday.

At one point it looked like the major surgery might be on Tuesday, 24 January but it eventually settled on the morning of Friday, 3 February. I was able to get my shoulder aspirated on Wednesday, 18 January. By that time the pain was mostly gone and movement was restored but it was a relief to get that procedure completed ahead of surgery.

Majella and I stayed at a motel near Greenslopes for the evening of Thursday, 2 February. That way we had just a few minutes drive to be at the hospital for an ECG followed by admission around 7:00 am. Beyond that there was a short wait in the admissions area, time to strip and don a hospital gown and groin-high compression stockings followed by more waiting. Just after I was changed, Virginia arrived to sit with Majella until my operation was complete. Then it was off toward the operating theatres where I met the anaesthetist who inserted cannulas in both arms, explained what he would be doing and got my signature for consent. The surgeon came by, explained again what he would be doing, making sure that I understood it would require a large cut rather than keyhole, and obtained my signature for consent.

I was wheeled into the operating theatre. Beyond that I remember nothing until I woke briefly in recovery where the surgeon told me things had gone well. By the time I woke again it was well into the afternoon and I was in my hospital room where Majella was waiting and watching. Virginia waited with Majella for about six hours, departing only after making sure I was OK before she left Majella to sit by my bedside waiting for me to wake.

The remainder of Friday is a blur. I was plugged into a saline drip that had a button attached for rapid pain relief. A small pump was attached to my right side to push local anaesthetic into the wound. There was a drain on the other side to remove fluid from the wound area and a catheter. My stockinged legs were being pumped by a machine to reduce clotting risk and nurses visited every couple of hours to check blood pressure and other vitals. Majella sat through the afternoon and then went back to Virginia & Stephen’s for the night.

On Saturday I woke feeling not too bad and managed to eat a little breakfast. Dr Lawson visited in the morning and talked about the operation. It had gone well and the cancer appeared to be contained raising hope that it was all gone but pathology results would likely be available on Tuesday. Majella spent the day with me, working on a patchwork project and ensuring I did the hourly breathing exercises prescribed by the hospital physiotherapist who visited in the morning. She was determined I recover as quickly and as well as possible and for the rest of my stay in hospital ensured I was doing breathing exercises and short walks whenever she was there. After she went home I felt well enough to watch TV until about 10 pm and then slept fairly well despite the machine that massaged my stocking legs through the night.

Sunday morning I did not feel like eating. Another urologist visited and after talking with me concluded I had an ileus (inhibition of gastrointestinal propulsion). That is not uncommon after such surgery but can be painful as gas and other matter builds up and the abdomen becomes distended. I was receiving enough fluid for hydration from the drip so the advice was to eat and drink little and only clear fluids. I dozed through the day accepting whatever pain relief was offered. Majella spent the day working on her patchwork project but had some company when Hannah visited in the afternoon. I was not up to watching television that evening and slept little.

Monday was not much better than Sunday and I spent it much the same way. Majella had some company with visits from Helen and John and Jane in the early afternoon. Joel visited later in the afternoon. I was barely awake for any of their visits but appreciated their care for us. Came the evening and I tried to get to sleep early but woke later with nausea and vomited. That required a change of bedding before I settled back with more painkillers and medication for the nausea.

Tuesday saw some improvement and Majella stepped up her insistence on hourly breathing exercises and two-hourly gentle walks up the corridor outside. I was disconnected from the drip, the drain and anaesthesia pump were removed, and my catheter was connected to a leg bag. I was responsible for getting up to empty that every couple of hours except at night when another bag was attached. The surgeon visited in the morning and shared some details of the pathology report. The tumour had taken over most of my kidney but was enclosed within the outer boundary of the kidney and had not gone beyond. The inflamed lymph nodes had been reactive rather than cancerous. That news was as good as might be hoped for. Emily phoned late in the afternoon and I was well enough to speak with her.

On Wednesday I was well enough to finally eat more than broth and jelly. The cannulas and catheter were removed and all my other extra exit and entry points closed. I actually enjoyed food again. Majella took the morning off to visit the art gallery with Virginia and came in after lunch. She had completed one patchwork project and started another. I managed to watch some television and sleep reasonably at night.

When the surgeon visited on Thursday morning he gave me a copy of the histology report and a photograph of my removed kidney – after checking that I was up for seeing that. I’ve posted it here but it is not for the faint hearted. I will need blood tests and a visit with him in a month and ongoing surveillance of my bladder but otherwise should recover. By that time I was looking well enough that he declared me ready to go home. I called Majella who was on her way in but had anticipated my release and packed in preparation. It took a few hours for the hospital to complete its processes but we were on our way home soon after lunch of sandwiches provided by Virginia.

Now, a week post-surgery I am on the road to recovery. I have a 25 cm cut that will take some time to heal. While it does I’ll be restricted in activity but I managed a short walk this afternoon and will extend that as time goes on.

Thanks to all who have expressed their care for both of us over recent days, weeks, and months. Special thanks to Virginia and Stephen for hosting and caring for Majella while she has been caring for me in hospital.

It has been a long tough week preceded by a couple of months of anticipation. Given the advanced state of my kidney tumour despite my apparent good health and fitness over recent months an important lesson seems to be not to ignore any symptoms. That one November day with discoloured urine and an hour of intense pain was all that prompted the scan that found the tumour. Had it not been found when it was the outcome might have been very different.