Hello there,Please be patient, as I may be in the operating room, with a patient, or driving but will get back to you ASAP.
yes, I have responded to that
I was posing a lengthy question to you and I lost it. I will start over continuing from last answers.
After getting unit of blood on 9/22 Mrs was released to home from hospital with a follow up appt for CBC on 9/26, Urology followup on 9/27 and appt with her Oncologist on 9/30.
Mrs. released weak, blood in urine still present.
Blood Work results were pleasant for a change.
Dramatic change from pre unit in hospital draw.
On 9/27 appt with Urologist Mrs basically had two ?s. When is bleeding going to stop or Do we have to do something else?
Urologist indicated at this point he does not know when bleeding will stop however he is not jumping at other solutions. " Less aggresive is better and at present he would not actively pursue embolization or removal of left kidney"
He indicated several symptoms could force more aggresive action such as plumetting BP's, severe kidney or back pain, increased blood flow and loss, fatique "
But he has a sense this will resolve itself.
Stated there are no active clots and they were not able to to find or isolate clot, diagnosis of Renal Vein Thrombosis is now a Patent diagnosis.
Set follow up in a month.
Urine is cranberry colored.
Oncology appt on 9/30.
Mrs weight down to 112 at home. She is weak. Appetite so/so BP's 115/90 temp normal, still bleeding, horseness in voice, a bit short of breath, fatiqued.
She is just "OK".
Ordered a chest x-ray which was done that day. results unknown.
BP's...Doc told her to eat six times a day, increase fluid intake, salt her food and in effect make her own saline solution.
Blood draws once a week. No evidence of RVT on renal arteriogram(?)
Doctor prescribed a biggie however in order to stop bleeding. A drug call Amicar. Clotting med.
She actually started this today 10/6. 1000 milligrams, 3X a day.
This drug is scary both to Mrs. and the family. Her mother died of pulmonary embolism, and is very mindfull of clot dangers.
Given all factors, including no sign of metastatic cancer, Lungs good, heart good, all of the tests in hospital pointing to a non specific bleed from kidney and now the addition of Amicar, what are the options of that have not been medically pursued?
If Amicar does not work can that drug just be stopped?
Can Amicar cause a life threatening clot?
Despite no signs of metastatic cancer are there other tests which could be done to possibly point to a source of blood loss?
Are we just facing a yet undiagnosed progression of post Whipple Pancreatic Cancer? and that bleed is a first sign other cancer issue in lining of kidney, ureter lungs etc.?
What about a PET scan?
What about a blood test MD 70? ( I think this is correct) Should we request another CA19-9 at next blood draw?
Or should we just manage the blood loss until other symptoms present?
I just received partial results of CBC done on 10/4/11
RBC Not in
Chest X-Ray Impression: "No accute Abnormalities"
Doc I have further questions.
Furthur cancer marker tests? What kind? PET Scan?
What is Mrs. cannot eat leafy vegetables because of Whipple? Is pill form of K acceptable.
Embolism and kidney removal off the table for now. Next urology appt. not for 3 weeks.
Next blood work next Tuesday, the 11th.
If Amicar and or veggies are effective will results be noticible by then.
Side effects of Amicar, if any, will they be immediate or will it be cumulative.
If Mrs. decides to stop Amicar does it need to be gradual?
Thanks Doc! Good information. One more question.
Mrs. was placed on Warfarin after a serious clot issue in August 2010 while undergoing chemotherapy and just after palative radiation treatments.
At this point vascular physician placed IVC filter just above outlet from left kidney. It is now tilted in the Vena. The physicians think it is still effective, however the tilt is very evident on CT scans.
When Mrs. went in hospital last month, they took her off Warfarin of course, because of the bleeding.
Is Vitamin K, which is available by prescription only, an antidote to Warfarin?
If yes, is it preferable to Amicar because of side effects (potential clotting) of Amicar?
Mrs. is weak, nausea and vomiting are not happy options either. Especially as she has been told to eat 6 times a day to put on weight.
Does Vitamin K in pill form have side effects.?
My understanding is that Mrs. was told not to eat leafy veggies because of contraindications while using Warfarin. That ban has now been lifted.
Thanks for your help. I will await your reply.
One more Doc.
I have questioned the IVC being a source of the bleed. It is possible.
I have asked if another filter can be placed above the present one, as an insurance filter, as they are reluctant to take the current one out.
Is this posible?
Is it advisable.
Can Kidney bleed be a long term management issue with no Amicar and no Vitamin K.?
None of us in the family, nor does Mrs. have good feelings about Amicar or any clotting
agent at this point.
If bleed is from Vena and not Left Kidney how is that resolved? It would be terrible to embolize the Kidney if that did not stop bleed.
Thanks for help Doc. I am leaving you to other problems tonight. Lots of good information today and clarification of issues.
I am sure we will have more.