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| Steak Pie. Like me - with no kidney. Tasteless? |
For those expecting a sea-going theme, you may be disappointed; this article is not to be confused with feedback on where caviar-egg laying fish are breeding; that would be a Sturgeon Report.
If you read the educational (and musical) “Taking the P!ss”, you will probably be aware that not all is rosy within the temple you know as Fat Al (although the urine certainly has been; or rather rosé.)
I recently returned from a non-fish related surgeon although, this too, should not be confused with Acanthuridae which is in fact a surgeon fish. Frankly, this is even more confusing than Portuguese.
Very nice chap; Mr W, in no rush, sympathetic, empathetic, happy to answer all my questions even though I was there for an hour and a quarter; all very non-NHS. Thank heavens for private medicine. Even his secretary gave me her mobile number so I could contact her after hours! Imagine that?
In case you were wondering why the surgeon is called ‘Mr’ rather than ‘Doctor’, this is a tradition that appeared in the middle ages and lasted until the mid 1800s. Doctors had to study for a degree, ‘Doctor of Medicine’, whereas surgeons learned their ‘trade’ as apprentices to Alan Sugar… sorry, popular culture interfering in the facts… as apprentices to other surgeons. On passing the Royal College of Surgeons examinations, they were awarded diplomas rather than degrees so they could not call themselves doctors. My surgeon learned his trade as an apprentice to Honest Harry, the Locksmith. This can be the only explanation for how he was able to get his tools through such a small opening to reach my inner bits.
(Note to self: Keep tangents to a minimum.)
After urine tests, blood tests, cytology tests, CT scan, etc, there is no evidence whatsoever of Karl the Kidney Stone who was introduced in a previous blog. That was, for a brief period, some consolation as I could wee almost without fear. A short-lived consolation! Unfortunately, during this screening process, doctors did find an odd-shaped Thing in my right kidney which caused some concern and did ring one or two alarm bells.
Cytology (not to be confused with Scientology, which by virtue of being tax exempt is considered to be a legitimate religion in the USA; a country where the tax office holds more sway than God) did not produce any evidence of malignant cells. However, polymorphs (people who can speak lots of languages) were found to be present which are indicators of an infection.
A subsequent urine test (pop quiz this time – I did not study for it) was done to check for infection but this too came up negative. Odd!
It turns out that The Thing in my kidney – roughly three to four cm in size – is, to put it bluntly, a tumour. It is not in the tissue bit of the kidney (if it was, they could excise it and cut away the surrounding tissues to make sure it is all clear and leave me with at least some functioning organ). Rather, it is in the renal pelvis, which is the sac part of the kidney filled with fluid leading to the ureter which is the pipe that takes fluid to the bladder. It therefore does not have defined borders so cannot be removed on its own as it is sort of everywhere floating in the sac, blocking the tubes and preventing the kidney from draining.
According to the apprentice, The Thing could be one of three things:
If you read the educational (and musical) “Taking the P!ss”, you will probably be aware that not all is rosy within the temple you know as Fat Al (although the urine certainly has been; or rather rosé.)
I recently returned from a non-fish related surgeon although, this too, should not be confused with Acanthuridae which is in fact a surgeon fish. Frankly, this is even more confusing than Portuguese.
Very nice chap; Mr W, in no rush, sympathetic, empathetic, happy to answer all my questions even though I was there for an hour and a quarter; all very non-NHS. Thank heavens for private medicine. Even his secretary gave me her mobile number so I could contact her after hours! Imagine that?
In case you were wondering why the surgeon is called ‘Mr’ rather than ‘Doctor’, this is a tradition that appeared in the middle ages and lasted until the mid 1800s. Doctors had to study for a degree, ‘Doctor of Medicine’, whereas surgeons learned their ‘trade’ as apprentices to Alan Sugar… sorry, popular culture interfering in the facts… as apprentices to other surgeons. On passing the Royal College of Surgeons examinations, they were awarded diplomas rather than degrees so they could not call themselves doctors. My surgeon learned his trade as an apprentice to Honest Harry, the Locksmith. This can be the only explanation for how he was able to get his tools through such a small opening to reach my inner bits.
(Note to self: Keep tangents to a minimum.)
After urine tests, blood tests, cytology tests, CT scan, etc, there is no evidence whatsoever of Karl the Kidney Stone who was introduced in a previous blog. That was, for a brief period, some consolation as I could wee almost without fear. A short-lived consolation! Unfortunately, during this screening process, doctors did find an odd-shaped Thing in my right kidney which caused some concern and did ring one or two alarm bells.
Cytology (not to be confused with Scientology, which by virtue of being tax exempt is considered to be a legitimate religion in the USA; a country where the tax office holds more sway than God) did not produce any evidence of malignant cells. However, polymorphs (people who can speak lots of languages) were found to be present which are indicators of an infection.
A subsequent urine test (pop quiz this time – I did not study for it) was done to check for infection but this too came up negative. Odd!
It turns out that The Thing in my kidney – roughly three to four cm in size – is, to put it bluntly, a tumour. It is not in the tissue bit of the kidney (if it was, they could excise it and cut away the surrounding tissues to make sure it is all clear and leave me with at least some functioning organ). Rather, it is in the renal pelvis, which is the sac part of the kidney filled with fluid leading to the ureter which is the pipe that takes fluid to the bladder. It therefore does not have defined borders so cannot be removed on its own as it is sort of everywhere floating in the sac, blocking the tubes and preventing the kidney from draining.
According to the apprentice, The Thing could be one of three things:
- A non-biological, non-organic kidney stone. Scans and tests thus far rule this out.
- A fungal infection (fungus growth) which, if it is, could be removed by inserting a tube through the ribs into the sac and vacuuming it out. Sibling G, a vacuum cleaner is… never mind. Mr W said that both this option and option 1 above are so small that they are hardly worth considering. If it was a fungus, it would involve two or three days in hospital and four weeks recuperation.
- A tissue abnormality. Perhaps this is or could become malignant or equally, maybe it will stay as it is for years to come. No way to tell without further examination.
Irregardless, they have to investigate as man cannot wee cranberry juice on an indefinite basis.
Further CT and MRI scans were conducted, but thus far have not identified any other abnormalities at all and a more recent CT of my lungs showed that they were also all clear of anything nasty which is good news as this would probably have meant chemotherapy before considering organ removal.
The process for further checks generally goes something like this (after the lungs are given the all clear):
Pyelogram
Like a pentagram but for a Jewish Satan. “Ooh, is that a pie?”
Injection of black dye into the kidney; you do not want to know where they put the pipe to inject this dye!
They then flush the dye and then do real time X-rays. As opposed to play time X-rays.
Cytoscopy
This is a pipe with a camera at one end and a large eyepiece at the other. My mind immediately went to the large 35 mm SLR camera I got for my 21st birthday. Fortunately, the camera used in this procedure is just a little bit smaller. A cytoscopy is used to examine the inside of the bladder and (shudder) urethra.
Ureteroscopy
This involves a general anaesthetic and putting a tube up the urethra, through the bladder, up the ureter and into the kidneys for a worm’s eye view of the situation. A number of possibilities then exist…
If they are unable to complete the ureteroscopy (the tubes are very narrow and it is not always possible), they will put in a stent and leave it there. One then goes back for a second ureteroscopy making use of the stent, which will have held the tubes open.
Once they have the scope inside the kidney sac, they will check it out. If there is any doubt as to what it is (say a ‘67 as opposed to a ‘68 Chevy), they will take a biopsy, down periscope and then wake me up. They will then examine the biopsy bits to see exactly what it is before deciding on how to proceed. This is a story for another day.
However, yet another option is; they stick the periscope up and find that whatever is there should not be there; i.e. a sea weedy type thing that is floating about and is definitely, without doubt, bad news, wrong, nasty, giving them the beady eye, out of place, potentially malignant, etc, etc. They then do NOT wake you up but simply roll you over and proceed with the removal of the kidney. (Although the normal practise in one as young as me is to split these procedures)
Basically, the remainification or removalfication of the kidney (in the words of George Bush) is often decided once the patient is already in theatre and asleep.
If a kidney removal is required, the options are as follows:
Option One - An Open Surgery: This is quite old-fashioned and involves opening you up in a large and unpleasant way, sometimes opening the chest and, from what I have read, can involve the removal of a rib to gain access. It is quite painful and has a very long recovery time (approximately 3 months). This is rarely done nowadays unless there is a specific reason for it or they need a specific type of access.
See further down for option two.
Option Three - A New Way: This is a new surgery and is relatively non-invasive and is less painful and has a much quicker recovery time than the other two. It involves going in from the bottom up and I don’t mean rectally, I mean starting just above the bladder and cutting off the ureter and then moving up to the kidney and detaching it from everything else before removing it from a very small incision higher up in the body. The problem with this option is that it is new and no one knows what the effects will be in 15 or 20 years time; Mr W is reluctant to do this as I am still young. And handsome. He did not actually say ‘handsome’ but I am sure he meant to.
Which leaves Option Two: This involves keyhole surgery; three little holes made around the Midlands and the kidney and ureter detached from everything else via these holes. The bits are then put into a little baggie (NatWest, silver coins only) and pulled down to the stomach. The bag is then either removed via one of the keyholes (I told you he was an apprentice locksmith; you think it is coincidence they call it ‘keyhole surgery’?) or a larger incision (laparotomy) is made in the stomach and the bag taken out this way.
This option involves a five to seven day stay in hospital whilst having a catheter in for 10 days. In a very non-sibling like way, I rapidly did some (correct) mental arithmetic and determined that this would mean that I would have to spend three to five days at home with a ca…, ca…, catheter inside of me. (Owing to a morbid fear of this implement, it shall henceforth be known as a C as I don’t like to talk about it.)
The surgeon fish said “yes”.
Apparently they give you a bigger bag so you can sleep through the night before you need to tap it. Does this man even know that I am Jewish?! Can I not have people in to do this for me? It took all my courage just to leave a urine sample in a small glass jar; imagine a whole bag of it?!
The recovery time for this procedure is four to six weeks with an absolute minimum of three weeks before being able to go back to work. (Whether my car insurance will cover me for driving so soon is another story)
I told him that as worried as I was about malignant cells floating around my body and even the thought of organ removal, my biggest fear was the C-word. (Not that one, I have already explained this!) I asked if I could have the catheter removed under anaesthetic.
He pretended to think about it and then said “No”.
He said it was very quick and while it may hurt briefly, it was not a big deal. He also said there would be some burning when urinating because the skin (?) inside the tube is quite sensitive. By this stage I was sweating profusely, my hairs were standing on end and my testicles immediately packed their bags (bag?) and made their way to my throat; I coughed awkwardly, nearly dislodging one of them.
Before ending this episode, I thought I would leave you with some FAQ.
Is it possible to puncture The Thing whilst taking the biopsy and risk spreading the possibly malignant cells?
Mr W said this was not possible as they were not sending a spike in from outside, i.e. through chest or side; they were sending the scope and pincer thing in internally so no breaking of skin or pulling it out through open skin.
I asked what risks were associated with the procedure, apart from the usual risks of surgery and general anaesthetics.
He said internal bleeding was one possibility, as was damaging other organs. However, he has done loads of these as his speciality and removals are a daily occurrence now. They are considered quite straightforward.
I asked if there were any life changes that would need to be made, viz. diet, alcohol, exercise, etc.
He said none whatsoever. Exercise could be continued when my body felt sufficiently recovered. This is rather good news as I still have half a bottle of whisky on the shelf which would be a shame to waste.
I asked if I could continue TKD.
He said he had never been asked this question before but in all his surgeries, he had never treated anyone for a martial arts-type injury. He says he has had some young rugby players see him for kidney problems, but that, I would assume, is because a 120 kg battering ram ploughed into them full tilt with a shoulder to the kidneys. In TKD we don’t get points for kicking the back so he said it should not be a problem at all.
I asked what follow up medication/procedures would be required.
He said that as I would probably only have one kidney left, (not right), I would need to go for a cytoscopy after six months and then annually. This would be either a local or general anaesthetic where they stick a C up the urethra and examine the remaining bits for evidence of problems. This is a precaution and he said I should get used to being a frequent flyer on Air Urology. He did not say it quite like that although my testicles immediately made for my throat at the mere use of the C word.
As things stand now, it looks like I will be spending my 43rd birthday in Hospital. Expensive gifts are considered de rigueur.
Further CT and MRI scans were conducted, but thus far have not identified any other abnormalities at all and a more recent CT of my lungs showed that they were also all clear of anything nasty which is good news as this would probably have meant chemotherapy before considering organ removal.
The process for further checks generally goes something like this (after the lungs are given the all clear):
Pyelogram
Like a pentagram but for a Jewish Satan. “Ooh, is that a pie?”
Injection of black dye into the kidney; you do not want to know where they put the pipe to inject this dye!
They then flush the dye and then do real time X-rays. As opposed to play time X-rays.
Cytoscopy
This is a pipe with a camera at one end and a large eyepiece at the other. My mind immediately went to the large 35 mm SLR camera I got for my 21st birthday. Fortunately, the camera used in this procedure is just a little bit smaller. A cytoscopy is used to examine the inside of the bladder and (shudder) urethra.
Ureteroscopy
This involves a general anaesthetic and putting a tube up the urethra, through the bladder, up the ureter and into the kidneys for a worm’s eye view of the situation. A number of possibilities then exist…
If they are unable to complete the ureteroscopy (the tubes are very narrow and it is not always possible), they will put in a stent and leave it there. One then goes back for a second ureteroscopy making use of the stent, which will have held the tubes open.
Once they have the scope inside the kidney sac, they will check it out. If there is any doubt as to what it is (say a ‘67 as opposed to a ‘68 Chevy), they will take a biopsy, down periscope and then wake me up. They will then examine the biopsy bits to see exactly what it is before deciding on how to proceed. This is a story for another day.
However, yet another option is; they stick the periscope up and find that whatever is there should not be there; i.e. a sea weedy type thing that is floating about and is definitely, without doubt, bad news, wrong, nasty, giving them the beady eye, out of place, potentially malignant, etc, etc. They then do NOT wake you up but simply roll you over and proceed with the removal of the kidney. (Although the normal practise in one as young as me is to split these procedures)
Basically, the remainification or removalfication of the kidney (in the words of George Bush) is often decided once the patient is already in theatre and asleep.
If a kidney removal is required, the options are as follows:
Option One - An Open Surgery: This is quite old-fashioned and involves opening you up in a large and unpleasant way, sometimes opening the chest and, from what I have read, can involve the removal of a rib to gain access. It is quite painful and has a very long recovery time (approximately 3 months). This is rarely done nowadays unless there is a specific reason for it or they need a specific type of access.
See further down for option two.
Option Three - A New Way: This is a new surgery and is relatively non-invasive and is less painful and has a much quicker recovery time than the other two. It involves going in from the bottom up and I don’t mean rectally, I mean starting just above the bladder and cutting off the ureter and then moving up to the kidney and detaching it from everything else before removing it from a very small incision higher up in the body. The problem with this option is that it is new and no one knows what the effects will be in 15 or 20 years time; Mr W is reluctant to do this as I am still young. And handsome. He did not actually say ‘handsome’ but I am sure he meant to.
Which leaves Option Two: This involves keyhole surgery; three little holes made around the Midlands and the kidney and ureter detached from everything else via these holes. The bits are then put into a little baggie (NatWest, silver coins only) and pulled down to the stomach. The bag is then either removed via one of the keyholes (I told you he was an apprentice locksmith; you think it is coincidence they call it ‘keyhole surgery’?) or a larger incision (laparotomy) is made in the stomach and the bag taken out this way.
This option involves a five to seven day stay in hospital whilst having a catheter in for 10 days. In a very non-sibling like way, I rapidly did some (correct) mental arithmetic and determined that this would mean that I would have to spend three to five days at home with a ca…, ca…, catheter inside of me. (Owing to a morbid fear of this implement, it shall henceforth be known as a C as I don’t like to talk about it.)
The surgeon fish said “yes”.
Apparently they give you a bigger bag so you can sleep through the night before you need to tap it. Does this man even know that I am Jewish?! Can I not have people in to do this for me? It took all my courage just to leave a urine sample in a small glass jar; imagine a whole bag of it?!
The recovery time for this procedure is four to six weeks with an absolute minimum of three weeks before being able to go back to work. (Whether my car insurance will cover me for driving so soon is another story)
I told him that as worried as I was about malignant cells floating around my body and even the thought of organ removal, my biggest fear was the C-word. (Not that one, I have already explained this!) I asked if I could have the catheter removed under anaesthetic.
He pretended to think about it and then said “No”.
He said it was very quick and while it may hurt briefly, it was not a big deal. He also said there would be some burning when urinating because the skin (?) inside the tube is quite sensitive. By this stage I was sweating profusely, my hairs were standing on end and my testicles immediately packed their bags (bag?) and made their way to my throat; I coughed awkwardly, nearly dislodging one of them.
Before ending this episode, I thought I would leave you with some FAQ.
Is it possible to puncture The Thing whilst taking the biopsy and risk spreading the possibly malignant cells?
Mr W said this was not possible as they were not sending a spike in from outside, i.e. through chest or side; they were sending the scope and pincer thing in internally so no breaking of skin or pulling it out through open skin.
I asked what risks were associated with the procedure, apart from the usual risks of surgery and general anaesthetics.
He said internal bleeding was one possibility, as was damaging other organs. However, he has done loads of these as his speciality and removals are a daily occurrence now. They are considered quite straightforward.
I asked if there were any life changes that would need to be made, viz. diet, alcohol, exercise, etc.
He said none whatsoever. Exercise could be continued when my body felt sufficiently recovered. This is rather good news as I still have half a bottle of whisky on the shelf which would be a shame to waste.
I asked if I could continue TKD.
He said he had never been asked this question before but in all his surgeries, he had never treated anyone for a martial arts-type injury. He says he has had some young rugby players see him for kidney problems, but that, I would assume, is because a 120 kg battering ram ploughed into them full tilt with a shoulder to the kidneys. In TKD we don’t get points for kicking the back so he said it should not be a problem at all.
I asked what follow up medication/procedures would be required.
He said that as I would probably only have one kidney left, (not right), I would need to go for a cytoscopy after six months and then annually. This would be either a local or general anaesthetic where they stick a C up the urethra and examine the remaining bits for evidence of problems. This is a precaution and he said I should get used to being a frequent flyer on Air Urology. He did not say it quite like that although my testicles immediately made for my throat at the mere use of the C word.
As things stand now, it looks like I will be spending my 43rd birthday in Hospital. Expensive gifts are considered de rigueur.
